www.environmentalhealthproject.org
Case Study
#1
Rash After
Showering
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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?
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
Health Effects of Exposure to
Water Contaminants

Type of contaminant






Acute vs Chronic


Bacterial contamination- Gastrointestinal
Inorganic
Organic
Radioactive
proprietary
Dizziness vs kidney damage
Organ system

Neurological, respiratory, dermal
724.260.5504
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
724.260.5504
Water Test Results for the
Family
 What
are key
components of a
water test?
 What does this
water result tell us?
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
724.260.5504
Determining Biomonitoring
from Environmental Monitoring
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
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
SOUTHWEST PENNSYLVANIA ENVIRONMENTAL HEALTH PROJECT
Answer Key
 See
Handout
724.260.5504