Case Study #1 Rash After Showering

Onset  Family of 5 who have been living on a farm since 1980’s  Parents and three children ages 11, 14, 18  Mother reports that sometimes when some of the family members takes showers, they notice their skin gets red and itchy

History  Use well water since moved into this home  Two wells drilled in the last 8 months  One fracked and producing  One drilled only  Noticed oily residue after the second gas well was drilled

History (continued)  Also developed GI symptoms and stopped drinking water  continue to shower and wash dishes in well water  Middle child has mild anemia on CBC and mild thrombocytosis  Mother has Lyme disease What other pieces of information do you want to know?

Exam  All five family members have normal abdominal exams  Middle child has white comedons on chest and back  What are the health effects of water contaminants?

Health Effects of Exposure to Water Contaminants  Type of contaminant  Bacterial contamination- Gastrointestinal  Inorganic  Organic  Radioactive  proprietary  Acute vs Chronic  Dizziness vs kidney damage  Organ system  Neurological, respiratory, dermal

Water Test Results for the Family  What are key components of a water test?  What does this water result tell us?

About Water Tests  EPA’s website defines MCL and secondary MCL  If have basic changes such as TDS, further testing is recommended

Water Testing  Professional testing and citizen monitoring (Total dissolved solids)  Location of samples taken (water well, creek, spigot)  Sample contamination from metal containers used to collect the samples

Potential contaminants of Well Water  Volatile Organic Chemicals-Benzene, Ethyl Benzene, Toluene, Xylene  Semi-volatile Organic Chemicals-Phenol and Pyridine  Heavy Metals-Arsenic, Barium, Cadmium, Chromium, Lead, Mercury and Vanadium  Sulfur containing compounds  NORM-Radioactive Radium 226, Radium 228 and Uranium 238  Salt Water Minerals  Additives

Endocrine disruptors  Don’t follow typical dose response  Vulnerable populations women and children  Reproductive organ systems  47% of contaminants in flow back considered EDC’s

Determining Biomonitoring from Environmental Monitoring

Recommendations for Patients  Pre-drilling testing  Routinely monitor TDS, PH, coliform bacteria and nitrates, conductivity  Avoid cooking and drinking until there is a better understanding  Methane alarm  Shorter showers  Ventilation

Recommendations for Health Care Professionals  Urine testing for salts and heavy metals are generally more appropriate  Use the correct test  At the right time  within hours of ingestion if possible for blood tests  within days for urine testing  hair analysis does not have validated reference ranges and is controversial  In the right tube- whole blood vs serum, preservative free urine vials, …  With the right recommendations

Answer Key  See Handout