Blog #4

Toxicology v. Pharmacology: Dose effects that are harmful v therapeutic effects. We spend so much time memorizing drugs and pharmacokinetic effects in nursing school..but why not toxicology? Even MD's only study one course in toxicology unless they take on an ED specialty. More education for clinicians is necessary to convey knowledge surrounding the many exposures in our environment. I would like to see this become part of all clinical education.

My current confidence in the evidence provided by the EPA is not high. However, they do provide a great resource called "ECOTOX" where a database of nearly 12,000 chemicals exists. You can look up studies and who and what they were tested on. It is very comprehensive, but difficult to apply unless you have your Phd in chemistry..I tried looking up ingredients in most deodorants (since I am on a quest to reduce harm in my daily living) and was not able to find the actual compounds. 

Fracking: We do not have any fracking in SD proper, but do rely on deep wells to supplement drinking water and irrigation. I lived for 10 years in and near Santa Barbara where there are several, and grew up on the north central coast where we experienced groundwater contamination. The more I learn about fracking, the more I hate it. The destruction it causes should be enough reason to stop this practice. The negative health risks related to ground water contamination, asthma, silica exposure and wastewater used to irrigate our food supply.

 I liken the fracking industry to a drug cartel- it is not just the end product that dirty energy- it is the entire cycle from business, to production, to transport to bribery & corruption that make it criminal. The EarthJustice group is a law group that works on large environmental law cases. Their website has a map of CA fracking sites and incidents related to this destructive industry.

"Perc" can and should be avoided. The risks of cancer, lung disease and neurological symptoms have been linked to these chemicals. Many dry cleaners now use alternative processing to clean clothes. C02 and wet-cleaning methods can achieve similar results. More restrictions on maintenance and emission from PERC cleaners need to also be addressed. We should consider how much industry workers who are exposed in carpet cleaning, dry cleaning, laundry services, tailoring and printing/graphics. 

Using a simple screening questionnaire is a good way to summarize patient risks. 

IPREPARE:

• Investigate potential exposures
• Present work
• Residence
• Environmental concerns
• Past work
• Activities
• Referrals and Resources
• Educate 

 Perchloroethylene is a colorless liquid that is also called tetrachloroethylene, PERC, or PCE. It is primarily used for dry cleaning fabrics and degreasing metals.

Lead: We often forget in modern medicine that lead toxicity is alive and well! In San Diego about 5% off children demonstrate toxic lead levels. Our cultural diversity, old homes and old municipal plumbing provide increased risks. I have a lead prevention specialist come to my nursing courses each semester and share knowledge about this problem and how to screen & educate patients. Below is a list of common sources. My favorite slogan is "Well fed=Less lead". Feeding kids a healthy diet of calcium, iron and vitamin C can help prevent lead from being absorbed by the body. Also teaching parents to wash toys, have homes inspected by the county and check local water supplies. 

Common Sources of Lead Poisoning

• Lead-based paint on older homes, buildings, furniture, and fixtures built before1978

• Home Remedies also known as Traditional/Folk/Ayurvedic Medicine and cosmetics can contain lead. Some examples include: Surma, Kohl, Alkohl, Azarcon, Greta, Ghasard, Kandu, Lozeena, Pay-loo-ah, Sindoor, and Daw-Tway.

• Handmade or imported pottery and tableware with leaded paint or glaze.  Terra cotta pots, highly decorative, imported low cost dishware, and antique tableware have been found to contain lead.

• Take-home exposure. Some jobs such as auto repair, construction, metal work, soldering, battery manufacturing, or working at a shooting range may expose people to lead that they bring home on their clothes, shoes, equipment, or car.

• Soil contaminated from when leaded gasoline was used and from factory pollution, especially in areas that are near busy roadways, freeways, or factories.

• Spices, such as chili, tamarind, and turmeric have been found to contain lead.

• Imported candy or food, especially candies containing chili and/or tamarind as well as chapulines (toasted grasshoppers).  Lead can be in the candy, spices, wrapper, or container.

• Imported food in cans that are sealed with lead solder.  Food cans with lead solder often have wide seams.

• Metal jewelry and accessories. Lead has been found in inexpensive children’s jewelry sold in vending machines as well as costume jewelry designed for adults.

*Source SDCHHSA: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/child_lead_poisoning_prevention_program.html#whatisleadpoisoning