Renovation and Other Environmental Risks in Our Homes

Last winter I wrote about home water contamination risks and how to avoid them. Several other home environmental risks, especially for young children, may be worsened when we re-do a room in our houses or bring out old furniture, like heirloom cribs and chairs. I’ll review several of the most important ones in this column.

Lead is not good for any of us, but infants in their first year or two are particularly susceptible to lead, which can cause permanent brain damage. Lead used to be in most paints, helping with gloss and durability. Amounts began to decline in the 1950s, as people began to appreciate the risks; and lead was fully banned from paints by 1978 (although not in some imported toys even now). So the primary risks are with paints older than that. Lead also is found in solder fumes and importantly, in many home pottery glazes, from which it can leach.

Infants and toddlers crawl around on dusty floors where paint chips and dust accumulate; and they put everything in their mouths. Babies’ risk of lead injury is further enhanced when they have low iron levels, because both lead and iron are competitively absorbed by similar mechanisms in the gut; iron deficiency induces enhanced absorption of either.  Iron stores are depleted, unless supplemented, as babies grow quickly and in-utero supplies of iron are used up, by age 9-12 months. Breast fed babies get less iron than do babies fed an iron enriched formula. So, if babies are crawling around in lead dust, they absorb more lead, which can do more damage. And, in higher doses, lead is not good for adults either; it can cause anemia, kidney damage, neuropathy, and psychiatric symptoms.

You can find out if your pottery, toys, heirloom furniture or home (the walls, baby-level window sills or stairs and railings) have lead paint, by doing home testing with kits you can buy on-line or from hardware stores. Swabs, made by several manufacturers (Home Alert, and others), to test 4 places cost $8 or so. If you find lead, then more extensive testing and clean up can be done by with the help of the Maine lead testing service (http://www.maine.gov/dhhs/mecdc/environmental-health/eohp/lead/parents.shtml#atrisk). And all babies should have blood tests for lead at least once by age 12 months.

Asbestos is a second common environmental hazard incorporated in many of our houses before 1980. Chronic exposure to asbestos dust causes lung scarring, and, over time, the irritation in the lungs, as well as elsewhere in the body, can induce cancers; lung and lung lining (mesothelioma) cancers are the most common but gut and other cancers are also increased. Asbestos is clearly not good for adults or babies. Shipyard workers and brake grinders used to be the most asbestos exposed patients I saw. And town water supplies have sometimes been contaminated near mining sites. In our homes, suspect asbestos-containing building materials include thermal system 
insulation like fire mats, ceiling tile, exterior siding, rigid panels, attic and wall insulation,
 vinyl floor tile and resilient floor covering (linoleum). Some specific building materials that do
 not require inspection, sampling, and analysis for asbestos include: wood, fiberglass,
glass, plastic, metal, laminates, exterior caulking and glazing, and gypsum board when joint compound was used only
 as a filler and not as a layered component. And some materials in good condition, like flooring and siding, can be left alone or covered, until they will be impacted by renovation or demolition activities. Be careful to document the locations of covered asbestos, because real estate laws require disclosure of all asbestos at the time of sale.

State regulations require you to have expert advice if you undertake any home renovation which might disturb asbestos-containing materials greater than 3 linear or square feet (http://www.asbestos-abatement.com/state-resources/maine.html). State certified contractors are available as well; most use “wet down” techniques to minimize aerosolization of the particles, and stipulated safe disposal of the materials.

Mercury used to be a much bigger problem. As children, we played with liquid mercury! And it was the cause of “mad hatters” disease in workers, who made hats with mercury-containing chemical in the 19th century, because it can cause mental illness as it progresses. Nowadays, industrial water supply, fluorescent light bulbs (enhanced by the recent push for electricity conservation by their use), and our local fish and other food source contaminations are the main risks. If you break an old thermometer or new fluorescent bulb, here are helpful suggestions on how to minimize home contamination (http://www.maine.gov/dep/mercury/mercurymedical.html).

Other home environmental contaminants are rarer or less lethal. Carbon monoxide can cause headaches and dizziness at low doses, coma at high doses. Most home owners are aware of carbon monoxide risk from incomplete ventilation of exhaust from furnaces, cars, generators, etc. Mold, which grows in damp areas, disperses spores and other allergenic dust.

Finally, second hand smoke presents a serious risk of lung cancer, emphysema and asthma for all of us. Not smoking is the best long term solution; but, if you do, don’t smoke in the house, for the sake of the others who live or visit there.

So, be aware of these risks as you re-do your home, heating systems, or get ready for a new young family member.

Dan Onion

Vienna Health Officer

293-2076, dkonion@gmail.com

Vienna Newsletter

Health Officer Column

August, 2012

Senior Driving

Nearly everybody over 45 has probably worried about a elderly parent or other loved one’s safety when driving. Crashes caused by older drivers are a significant public health issue, especially in Maine with its oldest median age of all the states, and its predominantly rural environment that lacks much public transportation. In those rural areas, like Vienna, nearly 20% of the population is already over 65, which the rest of the country is not predicted to achieve until 2030. So seniors who live here must have a car and be able to drive to get most things done they need to do, from shopping, to medical care, to entertainment, despite recent local improvements in those and other services. And we hear reports of crashes involving elderly drivers constantly in the news recently. So what are the issues and what can be done to diminish the risks without isolating our seniors?

Here are national fatality rates per mile driven by driver age group (graph #1) As you can see, at about age 70, these rates start to climb from younger adult rates but don’t exceed the teen rates until age 85. But not all this fatality increase is from increased crash rates; at least half is because older people are more fragile and break more easily in a crash. But older Mainers do have an increased rate of crashes with increasing age beyond about age 70 per mile driven (graph #2), though barely higher rates per driver, because most older drivers decrease and limit their driving more than younger adults.  

Not everybody ages at the same rate, so age group definitions are unfairly limiting. And not all medical limitations prevent driving, at least with limits (fewer miles, day time, no throughways, in local areas, etc.). Older drivers with intact cognition usually self-impose those restrictions; the most troublesome group are those with early dementia, who are likely to progress over 1-2 years and must rely sometimes (not always) on others to suggest or impose limitations for their own and others safety. But the reality is that the average person has to retire from driving 5-10 years before they die. So we all need to plan for how to recognize and decide when its time.

Drivers themselves and their families must be vigilant to recognize serious limitations as they develop, like hitting the gas instead of the brake, minor or major car damage/crashes, failing to stop for stop signs or stop lights, trouble making left turns, driving too fast or slowly for the traffic conditions, and family feeling it is not safe for others (like grandchildren) to ride with the senior driver (hartfordauto.thehartford.com/UI/Downloads/FamConHtd.pdf). Family members can check by riding with or following the senior driver, or, if there is doubt, encourage self-screening with a very helpful on-line series of tests from the American Automobile Association called Roadwise Review (http://seniordriving.aaa.com/evaluate-your-driving-ability/self-rating-tool). Sometimes a road test with an occupational therapy department driving tester or with the Bureau of Motor Vehicles (BMV) may be necessary and can be suggested by the driver’s doctor on the BMV form usually filled out when there are potential medical issues. In the rare case where a senior driver appears impaired but will not engage in evaluation, anybody can report their concerns to the BMV, neighbor, family member, doctor or police. This will precipitate a re-evaluation.

And finally, to make the transition easier, planning for how the retired senior driver can get along without driving is crucial to making it possible. The Independent Transportation Network, which originated in Portland, now has programs all over the country and in other cities in Maine whereby seniors can get transportation on-demand in exchange for having donated their car, or they or their family having volunteered time. But in rural areas, the local Area Agency on Aging, churches, friends, and the rare public transportation systems may be all that is available. Rarely leaving the old homestead and moving to where such services are more available may be necessary.

These are scary but important issues, best confronted directly when they appear, or someone can get hurt. Drivers, families and friends proactively need to evaluate and prepare for driver retirement when and if it is finally necessary.

Dan Onion: 293-2076, dkonion@gmail.com

Vienna Health Officer

Graph #1

Graph #2

And

Cell phone, cell towers and other Electromagnetic waves in our lives

What are the risks of living next to a new cell tower, or of using your cell phone a lot? Many in the area are asking these questions as new cell towers go up. In response to questions like these from Bob Weingarten, Marti Gross and others, let me give a mini lesson on what is and isn’t known about the interactions between electromagnetic waves and our body’s physiology, and how you might measure your exposure if you wish. And I’ll close with a bit about radon, the greatest radiation risk in our lives and homes.  But first I must review a little physics with you.

Electromagnetic radiation (EMR) consists of waves of energy travelling at the speed of light emitted from a source like the sun, a magnet, or commonly from various machines (eg. flashlight, radio tower, xray machine, computers, TV sets, nuclear bombs). The waves have both a photon and a magnetic component, which oscillate in phase with each other perpendicular to their direction of travel. Both components contain roughly equal amounts of energy measured in Gauss units (more later) and can be transferred to a body, animate or inanimate, directly in their path (line of sight usually but those with long wave lengths like FM radio waves can bend over and around hills too). They can be blocked by some barriers, generally less well the higher frequency they are; generally the higher the frequency the more energy the waves contain, so gamma waves are very difficult to block at all. The energy transferred is primarily heat at frequencies less than ultraviolet light; but at higher frequencies more and more molecular and cellular ionization occurs, knocking molecules and atom parts out of kilter, like pool balls with a “break” shot. And one final important point: the power of the source, exposure time, and distance all make a huge difference to level of exposure.  The first two are obvious and the energy from EM radiation decreases logarithmically as you move away from the source; so, for instance, a 50 Gauss unit exposure next to the sources decreases to 7 Gs 100 ft, away and 1.8 Gs at 200 ft.

All this may seem too mysterious; but look at this table for some EM radiation forms you may recognize. The examples are listed by increasing potential risk.

mGs = milligauss, Gs = gauss, Hz = hertz, KHz=kilohertz, MHz= Megahertz, GHz=Gigahertz. Prefixes: milli= 1/1000, kilo = x1000, Mega =  x1 million, Giga= x1 billion. UHF = ultra high frequency; VHF = very high frequency

The magnetic energy component (measured in Gauss units) of these waves tends to predominate in lower frequency zones and the photon/particle radiation energy (measured as RADs) in higher ionizing frequency sources.  Rads are a measure of ionizing radiation at the source. The average person in the US gets about 400 milliRems of ionizing radiation per year. REMs (Roentgen-equivalent-man) are estimates of the effect of RAD doses in humans.  Low doses of ionizing radiation are something we are well adapted to; humans evolved in the presence of radiation and have well developed mechanisms for repairing cell damage from it.

Non-ionizing radiation is generally thought to be safe. However, as with most things in nature, it’s designation is arbitrary and all EMR carries some ionizing particles down the spectrum, hence the concerns with those designated non-ionizing.  Although most studies find no effect, there are some tantalizing epidemiologic studies that suggest cell phone use tight to one’s head and brain for extended periods (over 1 hr at a time) may be increasing brain glioma cancer rates in those users. Many research studies are pursuing this in rats and people. PET scans show changes in glucose metabolism in the brain just beneath a cell phone after 50 minutes of continuous use. This suggests the EMR may be re-orienting the atoms and molecules in the brain, much like an MRI machine does to generate a medical image. I’ve seen gliomas in 2 young women who were intense cell phone users, for what that’s worth. So, I urge everyone you know to avoid such use; this is especially important now that many people no longer have land lines. It is unclear if in-ear Blue Tooth devices help.

Beyond that, epidemiologic research over 30 year has failed to find cancers or leukemia/lymphomas increases in people living close to high voltage power lines. I couldn’t find a similar study about cell towers, but the risks should be similar since their EMR outputs are on the same order of magnitude.  There are also many anecdotal reports of EMR sensitive individuals, who suffer a variety of subjective discomforts when exposed to low energy radiation. Many companies try to sell ineffective devices with fraudulent protection claims. I doubt there’s much there to worry about. If you are concerned, I’d buy a $30 gaussmeter at Home Depot and measure EMR in milliGauss’s wherever you put your head/body for extended periods of time. If the total is in 100s of thousands, try to increase your distance from the sources; if the total is under a few thousand, you are probably better off worrying about Radon.

Ionizing sources of radiation are a much greater concern. Radon is a colorless, odorless, naturally occurring radionuclide that exists in soils and seeps into the air. Maine has a lot of radon in its rock and soil. It is a breakdown product of natural uranium and radium and emits ionizing radiation (alpha particles) into house basements and well water. The tighter the house is insulated, the more radon accumulates, especially in winter. The danger from radon in water is that it enters the air we breath by our showers and water boiling. Because the concentration of radium that generates radon is highly variable in soils, so is the concentration of radon—two houses side by side can have vastly different levels. You must test your house when you move in and every 5-10 years to protect yourself.  Levels under 2picocuries/L in air and over 4000picoCuries/L in water need attention. Prolonged exposure clearly increases lung cancer rates, even faster if you smoke. Don’t wait until someone gets cancer to test. It costs <$50 to do both air and water. Buildings can be made safe, and all should be tested and remediated if necessary.

General principles to diminish your exposure to any radiation: increase your distance from the source, decrease your exposure time, and block it with effective barriers if it is an ionizing radiation.

Relative Contribution Of Various Sources To The Average Annual Dose

Dan Onion, MD, MPH

Mt Vernon Health Officer

dkonion@gmail.com, 293-2076