RECOGNIZING OCCUPATIONAL DISEASE--TAKING AN EFFECTIVE OCCUPATIONAL HISTORY

Recognizing Occupational Disease -- Taking an Effective Occupational History


MICHAEL B. LAX, M.D., M.P.H., and WILLIAM D. GRANT, ED.D.,
Central New York Occupational Health Clinical Center,
State University of New York Health Science Center at Syracuse, Syracuse, New York
FEDERICA A. MANETTI, M.D., M.S.,
Syracuse, New York
ROSEMARY KLEIN, M.S., C-ANP, COHN-S,
Central New York Occupational Health Clinical Center,
State University of New York Health Science Center at Syracuse, Syracuse, New York

Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.

The patient with a possibly work-related illness frequently seeks care initially from a family physician. The physician's recognition of a possible link between work and disease often determines the diagnostic tests that are performed and the treatment that is recommended. Early diagnosis of an occupational illness may prevent progressive morbidity and disability from conditions such as occupational asthma and may facilitate the reversal of adverse effects from exposures to substances such as lead.1 The identification of an occupational illness in one patient also provides the physician with an opportunity to protect other patients with similar exposures.2 Since much remains to be learned about the effects of toxins on health, the family physician is in a crucial position to contribute new information about occupational disease.

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OCCUPATIONAL DISEASE THOUGHT TO BE BIPOLAR DISORDER

CASE REPORT: 33 year old female experienced acute, full-blown manic episode, diagnosed as manic-depression with psychotic features. Subsequent treatment included various psychiatric medications from which she suffered numerous severe side effects including involuntary movements and a weight gain of 80lbs. Despite pharmaceutical management, she continued to have manic episodes and required recurrent psychiatric hospitalization.

Two years after the initial onset of mania the patient was seen by a physician trained in environmental health sciences and had various investigations confirming she had bioaccumulated high levels of lead. Patient had been employed for 15 years in an industry that uses chemical processes and was diagnosed with Substance Induced Neuropsychiatric and Cognitive Disorders (292.11, 292.12, 294.9). Substances included Toluent, Heavy Metals (lead, silver, mercury), Sulfuric Acid, Xylene, Propyl Alcohol, n-Hexane, and other organic solvents.

Patient sought treatment from complimentary medicine for detoxification. Chemical detoxification of lead was undertaken with a heavy metal chelator and values of lead progressively diminished. Chelation treatments were initially covered by the patients primary insurance company. Concomitant with the decline in accumulated lead, all of her psychiatric symptoms gradually subsided and all medication was discontinued.

Patient received supportive depositions in worker’s compensation proceeding of the diagnosis toxic encephalopathy and was awarded a worker’s compensation settlement in New York State.

Patient was unable to continue maintenance chelation treatments and over the course of 10 years has experienced two incidents exacerbating symptoms of mania. A detoxing protocol quickly relieved symptoms of the first incident. The second incident was a result of a bacterial infection from an abscessed tooth, patient reported both visual and auditory hallucinations, that of schizophrenic nature. Treatment with the anti-biotic Flagyl, and a root canal quickly abated all symptoms.

This case represents the importance of taking an effective work history and recognizing visual hallucinations as part of organic brain disease.