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

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Onset Family of 5 who have been living on a farm since 1980s 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

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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

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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 724.260.5504 What other pieces of information do you want to know?

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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

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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 724.260.5504

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Water Test Results for the Family What are key components of a water test? What does this water result tell us? 724.260.5504

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About Water Tests EPAs website defines MCL and secondary MCL If have basic changes such as TDS, further testing is recommended 724.260.5504

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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

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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

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Endocrine disruptors Dont follow typical dose response Vulnerable populations women and children Reproductive organ systems 47% of contaminants in flow back considered EDCs 724.260.5504

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Determining Biomonitoring from Environmental Monitoring 724.260.5504

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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

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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

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Answer Key See Handout 724.260.5504