www environmentalhealthproject org Case Study 1 Rash After

www. environmentalhealthproject. org Case Study #1 Rash After Showering

724. 260. 5504 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

724. 260. 5504 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

724. 260. 5504 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?

724. 260. 5504 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?

724. 260. 5504 Health Effects of Exposure to Water Contaminants Type of contaminant Bacterial contamination- Gastrointestinal Inorganic Organic Radioactive proprietary Acute Dizziness vs kidney damage Organ vs Chronic system Neurological, respiratory, dermal

724. 260. 5504 Water Test Results for the Family What are key components of a water test? What does this water result tell us?

724. 260. 5504 About Water Tests EPA’s website defines MCL and secondary MCL If have basic changes such as TDS, further testing is recommended

724. 260. 5504 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

724. 260. 5504 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

724. 260. 5504 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

724. 260. 5504 Determining Biomonitoring from Environmental Monitoring

724. 260. 5504 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

724. 260. 5504 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

724. 260. 5504 Answer Key See Handout