A Sickening Tale

Lindenmayer, Greta; Hoggett, Kerry; Burrow, Jim; Howard, Diane; Falhammar, Henrik

doi:10.1056/nejmcps1716775

Cited by 3 publications

(7 citation statements)

References 8 publications

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“…3 Anything greater than 12 µg/L is considered high; critically high values are those above 50 µg/L. 3,5 Our patient's blood arsenic level was 13 µg/L.…”

Section: Discussionmentioning

confidence: 98%

“…Today it is used as a treatment for leukemia and in several ayurvedic and homeopathic remedies. [3][4][5][6][7] It is a common earth element found in ground water and a waste product from mining and the manufacturing of glass, computer chips, wood preservatives, and various pesticides. 2,3,7,8 ❚ A great masquerader.…”

Section: Discussionmentioning

confidence: 99%

“…2 Arsenic can cause symmetrical peripheral neuropathy characterized by sensory nerves being more sensitive than motor nerves. 2,3,5,6 Clinically, it causes numbness and paresthesias of the distal extremities, with the lower extremities more severely affected. 3,6 Symptoms can de-velop within 2 hours to 2 years of exposure, with vomiting, diarrhea, or both preceding the onset of the neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 Symptoms can de-velop within 2 hours to 2 years of exposure, with vomiting, diarrhea, or both preceding the onset of the neuropathy. 2,3,5,6 Arsenic is linked to forgetfulness, confusion, visual distortion, sleep disturbances, decreased concentration, disorientation, severe agitation, paranoid ideation, emotional lability, and decreases in locomotor activity. 3,5,6 ❚ Testing and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5,6 Arsenic is linked to forgetfulness, confusion, visual distortion, sleep disturbances, decreased concentration, disorientation, severe agitation, paranoid ideation, emotional lability, and decreases in locomotor activity. 3,5,6 ❚ Testing and treatment. Arsenic levels in the body are measured by blood and urine testing.…”

Section: Discussionmentioning

confidence: 99%

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34-year-old man • chronic lower back pain • peripheral neuropathy • leg spasms with increasing weakness • Dx?

Webb¹

2022

The Journal of Family Practice

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Ch ro nic low er ba ck pa in -Pe rip he ra l ne ur op at hy -Le g sp as m s wi th inc re as ing we ak ne ss THE CASEA 34-year-old man was referred to the sports medicine clinic for evaluation of lumbar radiculopathy. He had a 2-year history of chronic lower back pain that started while he was working on power line towers in Puerto Rico. The back pain was achy, burning, shooting, and stabbing in nature. He had been treated with anti-inflammatories by a company health care provider while in Puerto Rico, but he did not have any imaging done. At that time, he had tingling and burning that radiated down his left leg to his ankle. The patient also had leg spasms-in his left leg more than his right-and needed a cane when walking. His symptoms did not worsen at any particular time of day or with activity. He had no history of eating exotic foods or sustaining any venomous bites/stings. Ultimately, the back pain and leg spasms forced him to leave his job and return home to Louisiana.Upon presentation to the sports medicine clinic, he explained that things had worsened since his return home. The pain and burning in his left leg had increased and were now present in his right leg, as well (bilateral paresthesias). In addition, he said he was feeling anxious (and described symptoms of forgetfulness, confusion, and agitation), was sleeping less, and was experiencing worsening fatigue.Work-ups over the course of the previous 2 years had shed little light on the cause of his symptoms. X-rays of his lumbar spine revealed moderate degenerative changes at L5-S1. A lab work-up was negative and included a complete blood count, testing for HIV and herpes, a hepatitis panel, an antinuclear antibody screen, a C-reactive protein test, and a comprehensive metabolic panel. Thyroid-stimulating hormone, creatine kinase, rapid plasma reagin, and human leukocyte antigen B27 tests were also normal.Magnetic resonance imaging (MRI) revealed a cystic lesion in the right ilium near the sacroiliac joint. A more recent follow-up MRI and computed tomography scan of the pelvis found the cyst to be stable and well marginalized, with no cortical erosion. Attempts at physical therapy had been unsuccessful because of the pain and decreasing muscle strength in his lower extremities. The patient's primary care provider was treating him with meloxicam 15 mg/d and duloxetine 60 mg/d, but that had not provided any relief.

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“…3 Anything greater than 12 µg/L is considered high; critically high values are those above 50 µg/L. 3,5 Our patient's blood arsenic level was 13 µg/L.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

34-year-old man • chronic lower back pain • peripheral neuropathy • leg spasms with increasing weakness • Dx?

Webb¹

2022

The Journal of Family Practice

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Antibacterial/succimer

2018

Reactions Weekly

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A New Model of Learning: Environmental Health in a Global World

Rom¹,

Rao²,

Hoepner

et al. 2023

IJERPH

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Introduction. Environmental Health in a Global World at New York University was re-designed as a class participatory effort, challenging undergraduate students to understand environmental hazards and the resultant adverse health outcomes by embracing the inherent complexity of environmental risks and proposing solutions. Methods. Following introductory lectures, students are placed into teams and assigned a specific perspective, or avatar, which includes learning to see the challenge from the perspective of a technical expert such as a biologist, an engineer, or an anthropologist. The teams then design specific systems maps to visualize the complex interactions that lead to adverse health outcomes after a given environmental exposure. The maps highlight potential leverage points where relatively minor interventions can provide a disproportionate benefit in health outcomes. The teams then explore potential interventions and identify the potential unintended consequences of those actions, develop and advocate for innovative new strategies to mitigate risk and improve outcomes. Results and Discussion. Over the past 5 years, we have taught this methodology to over 680 students with strong, student-oriented results. The teams created and presented more than 100 strategies, addressing a diverse set of environmental challenges that include water contamination, gun violence, air pollution, environmental justice, health security, and climate change. Developing the strategies helped the students understand environmental threats in a more holistic way, provided them with some agency in finding solutions, and offered an opportunity for them to improve their presentation skills. The responses in course evaluations have been enthusiastic, with many students reporting a deep impact on their college experience.

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A Sickening Tale

Cited by 3 publications

References 8 publications

34-year-old man • chronic lower back pain • peripheral neuropathy • leg spasms with increasing weakness • Dx?

34-year-old man • chronic lower back pain • peripheral neuropathy • leg spasms with increasing weakness • Dx?

Antibacterial/succimer

A New Model of Learning: Environmental Health in a Global World

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