Healthy Environments, Healthy Environments, Homes, and ChildrenHomes, and Children

History of History of Josiah Hill III ClinicJosiah Hill III Clinic

The Clinic was formed in 1997 The Clinic was formed in 1997

by the community activist by the community activist

and physician assistant, and physician assistant,

Josiah Hill III.Josiah Hill III.

Working together to Working together to identify the “invisible identify the “invisible threat”threat” Josiah and his colleague Rick Bayer, Josiah and his colleague Rick Bayer,

M.D. were concerned lead poisoning M.D. were concerned lead poisoning was going unnoticed and untreated.was going unnoticed and untreated.

Collaboration between PSR, COBM, Collaboration between PSR, COBM, and volunteers who began a free blood and volunteers who began a free blood

lead testing clinic.lead testing clinic.* After Josiah passed in 2000, the clinic * After Josiah passed in 2000, the clinic

was established as a non-profit and was established as a non-profit and named after our founder.named after our founder.

What Is Lead Poisoning?What Is Lead Poisoning? The presence The presence

of lead in the of lead in the body.body.

Lead can Lead can enter any cell enter any cell so toxicity so toxicity may occur in may occur in any tissue or any tissue or organ.organ.

Lead Levels and Threshold Lead Levels and Threshold DoseDose Even small amounts of lead can Even small amounts of lead can

cause severe and lasting harm, cause severe and lasting harm, especially to children. especially to children. No level of No level of lead exposure is safe.lead exposure is safe.

The Center for Disease Controls The Center for Disease Controls level of concern is 10 µg/dL for level of concern is 10 µg/dL for children and 25 µg/dL for adults. children and 25 µg/dL for adults.

Josiah Hill Clinic provides Josiah Hill Clinic provides consultation and resources for consultation and resources for levels over 5 µg/dL to help families levels over 5 µg/dL to help families reduce exposure sources and reduce exposure sources and monitor levels. monitor levels.

Lead Levels of ConcernLead Levels of Concern

Exposure PathwaysExposure Pathways

Inhaling lead Inhaling lead

dustdust

Ingesting lead Ingesting lead dust from dust from hands, toys hands, toys and other and other objectsobjects

Exposure SourcesExposure Sources

Remodeling Remodeling Lead based paint (pre-1978) Lead based paint (pre-1978)

chipping or flakingchipping or flaking SoilSoil Charms and jewelry Charms and jewelry ToysToys GlazesGlazes Cultural home remediesCultural home remedies

Metabolism of LeadMetabolism of Lead

BoneBone

TeethTeeth

Renal Excretion

IngestionInhalation

Blood

RBC

Soft Tissue

Central Nervous System

Bone Marrow

Kidney

30-50 % 5-50%

1/2 life- 20 years1/2 life-40 days

½ life-28-36 days

What Happens When Lead What Happens When Lead Enters the Body?Enters the Body?

Enters the blood stream and Enters the blood stream and circulates throughout bodycirculates throughout body

Body tries to excrete the leadBody tries to excrete the lead

Some deposits in soft tissues Some deposits in soft tissues such as kidneys, lungs, brain, such as kidneys, lungs, brain, spleen, muscles and heartspleen, muscles and heart

Remainder (majority) moves into Remainder (majority) moves into bones and teeth (and some into bones and teeth (and some into hair)hair)

Lead In The BloodstreamLead In The Bloodstream

Primarily distributed 3 Primarily distributed 3 compartments:compartments:

Blood-carries only small Blood-carries only small fraction, but distributes lead fraction, but distributes lead through bodythrough body

Soft tissue-liver, lungs, kidneys Soft tissue-liver, lungs, kidneys highest lead concentrationhighest lead concentration

Mineralizing tissue-Most lead Mineralizing tissue-Most lead body burden in bones & teethbody burden in bones & teeth

Biochemical EffectsBiochemical Effects

Lead inhibits or mimics the Lead inhibits or mimics the actions of calcium.actions of calcium.

This can affect calcium-This can affect calcium-dependent or related dependent or related processes.processes.

Enzyme function decreases as Enzyme function decreases as lead binds with protein lead binds with protein components of enzymes.components of enzymes.

Neuron GrowthNeuron Growth

Neurologic EffectsNeurologic Effects

Encephalopathy-RARE. BLL’s > 70-Encephalopathy-RARE. BLL’s > 70-80 80 μg/dL μg/dL

S/S: Hyperirritability, ataxia, S/S: Hyperirritability, ataxia, convulsions, stupor, coma, death.convulsions, stupor, coma, death.

Disruption of balanceDisruption of balance

Impaired peripheral nerve functionImpaired peripheral nerve function

Hearing impairmentHearing impairment

Neuropsychological/Neuropsychological/behavioralbehavioral

IQ loss:average 4-7 point drop IQ loss:average 4-7 point drop for every 10 for every 10 μg/dL BLL μg/dL BLL increase.increase.

ADHDADHD

Deficits in vocabulary, fine Deficits in vocabulary, fine motor skills, reaction time, motor skills, reaction time, hand-eye coordinationhand-eye coordination

Delinquent and aggressive Delinquent and aggressive behaviorbehavior

Blood/hematologic EffectsBlood/hematologic Effects

Lead inhibits hemoglobin Lead inhibits hemoglobin synthesissynthesis

This interferes with other This interferes with other heme-dependent processesheme-dependent processes

Lead shortens the average lifespan of RBC’s

Cardiovascular EffectsCardiovascular Effects

Several epidemiological Several epidemiological studies have linked lead to studies have linked lead to hypertension, including low hypertension, including low lead level exposure and lead level exposure and absence of classic symptoms.absence of classic symptoms.

ECG abnormalities, ECG abnormalities,

degenerative changes degenerative changes

in cardiac muscle.in cardiac muscle.

Renal EffectsRenal Effects

Proximal tubules of Proximal tubules of kidney are sensitive kidney are sensitive to lead levels > 25 to lead levels > 25 µµg/dl.g/dl.

Lead forms protein Lead forms protein complexes that lead complexes that lead to fibrous connective to fibrous connective tissue and gout.tissue and gout.

Gastrointestinal EffectsGastrointestinal Effects

Colic is aColic is aconsistent earlyconsistent earlysymptom ofsymptom ofexposure:exposure:

abdominal painabdominal pain constipationconstipation crampscramps nauseanausea vomitingvomiting anorexiaanorexia weight lossweight loss

Other EffectsOther Effects

Auditory: negative impact on Auditory: negative impact on auditory function.auditory function.

Endocrine: decreases in human Endocrine: decreases in human growth hormone.growth hormone.

Vitamin D metabolism: interferes Vitamin D metabolism: interferes with the conversion of vitamin D to with the conversion of vitamin D to its hormonal form.its hormonal form.

Growth: growth retardation in Growth: growth retardation in height, weight and chest height, weight and chest circumference.circumference.

Reproductive EffectsReproductive Effects

Decreased sperm count Decreased sperm count

Increase of abnormal Increase of abnormal spermsperm

Increased miscarriages, Increased miscarriages, stillbirths and premature stillbirths and premature birth.birth.

Impotency Impotency

Developmental EffectsDevelopmental Effects

Reduced birth weight Reduced birth weight and growth.and growth.

Negative impact on Negative impact on neurologic neurologic development.development.

Minor congenital Minor congenital anomalies, including: anomalies, including: skin anomalies and skin anomalies and undescended undescended testicles.testicles.

Why Are Children At Why Are Children At Greatest Risk?Greatest Risk?

Greater exposureGreater exposure– High “hand-to-mouth” activityHigh “hand-to-mouth” activity– Crawling, chewing and suckingCrawling, chewing and sucking– Play in dirt and/or on floorPlay in dirt and/or on floor

Higher lead absorption rate Higher lead absorption rate

Negative impact on nervous Negative impact on nervous system development system development

Critical Period of Critical Period of DevelopmentDevelopment

End of critical period

Most sensitive phase

Blood Lead Patterns by AgeBlood Lead Patterns by Age

The Warning Signs of The Warning Signs of Lead PoisoningLead Poisoning

Lead poisoning is an invisible Lead poisoning is an invisible dangerdanger

Children with lead poisoning Children with lead poisoning do not always look or act sickdo not always look or act sick

Signs & SymptomsSigns & Symptoms

General fatigue and lethargyGeneral fatigue and lethargy Hyperactivity and ADHDHyperactivity and ADHD IrritabilityIrritability Colic Colic Trouble sleepingTrouble sleeping Myalgia or paresthesiaMyalgia or paresthesia HeadachesHeadaches TremorTremor

Receiving a Test is the Receiving a Test is the Only Way to Know…Only Way to Know…

Lead Poisoning IS a Lead Poisoning IS a Problem in OregonProblem in Oregon

Estimated 1,000-2,000 children Estimated 1,000-2,000 children with elevated levels. In Portland, with elevated levels. In Portland, nearly 1 in every 50 children are nearly 1 in every 50 children are poisoned each year and 1 in every poisoned each year and 1 in every 30 have dangerous levels.30 have dangerous levels.

Each year less than 10,000 (<5%) Each year less than 10,000 (<5%) of all children under age 6 are of all children under age 6 are actually tested.actually tested.

Each year less than 5,000 adults Each year less than 5,000 adults are tested.are tested.

Screening GuidelinesScreening Guidelines– Eight questions Eight questions

to determine need to determine need for blood lead for blood lead test.test.

– Children should Children should be assessed at 1 be assessed at 1 and 2 years of and 2 years of age.age.

– Questionnaires Questionnaires available in available in different formats different formats and languages.and languages.

Diagnostic Lead TestingDiagnostic Lead Testing– Behavioral problems:Behavioral problems: aggression, aggression,

hyperactivity, ADD, school and hyperactivity, ADD, school and learning problems, pica behavior.learning problems, pica behavior.

– Developmental:Developmental: growth, speech and growth, speech and language delays and/or hearing loss.language delays and/or hearing loss.

– S/S consistent with lead poisoning:S/S consistent with lead poisoning: irritability, headaches, vomiting, irritability, headaches, vomiting, seizures or other neurological seizures or other neurological symptoms, anemia, loss of appetite, symptoms, anemia, loss of appetite, colic.colic.

– Ingestion of foreign bodyIngestion of foreign body..

Blood Lead TestingBlood Lead Testing

Blood lead testing is the only Blood lead testing is the only acceptable laboratory test.acceptable laboratory test.

Capillary-finger or heel stick.Capillary-finger or heel stick.

Venous test-more accurate.Venous test-more accurate.

All capillary BLLs of 10 All capillary BLLs of 10 μg/dL μg/dL or higher or higher must have follow-up must have follow-up venous test.venous test.

JHC’s mobile clinicsJHC’s mobile clinics

Provides convenient and Provides convenient and accessible screening for familiesaccessible screening for families

Within Portland Area Within Portland Area neighborhoodsneighborhoods

Community centers, parenting Community centers, parenting classes, head starts, fairs classes, head starts, fairs

and events, churchesand events, churches

What happens with an What happens with an elevated level?elevated level? Results are reported to Results are reported to

Department of Human Services Department of Human Services who work with local County who work with local County Health DepartmentsHealth Departments

Referrals to community resources Referrals to community resources to identify exposure sourceto identify exposure source

Re-test in upcoming months to Re-test in upcoming months to monitor levelmonitor level

Identifying Environmental Hazards

ChelationChelation

– Chelating agents are drugs Chelating agents are drugs that bind with heavy metals in that bind with heavy metals in the blood.the blood.

– Does not improve neurological Does not improve neurological outcomes.outcomes.

– Side effects: Increased GI Side effects: Increased GI problems, bone-marrow & liver problems, bone-marrow & liver problems, strips necessary problems, strips necessary minerals-calcium,iron, zincminerals-calcium,iron, zinc

Reducing lead Reducing lead poisoningpoisoning Working together, especially through Working together, especially through

**cultural comptencycultural comptency

* * healthhealth (eduation and testing) (eduation and testing)

* * housinghousing (controlling and (controlling and

reducing the sources)reducing the sources)

* * policypolicy (regulations and (regulations and

enforcement) enforcement)

Ways to become Ways to become involvedinvolved VolunteerVolunteer DonateDonate Host an Host an

eventevent Spread Spread

the wordthe word

Josiah Hill III ClinicJosiah Hill III Clinic

Erin McNally, Executive DirectorErin McNally, Executive Director

www.jhillclinic.orgwww.jhillclinic.org

*Thanks to Barbara Zeal and the *Thanks to Barbara Zeal and the Department of Human Services for Department of Human Services for providing slides and information* providing slides and information*