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Voices from the front lines: How nurses feel about Ebola

Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged after receiving treatment for Ebola.

Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged in August after receiving treatment for Ebola. Photo credit: Samaritan’s Purse

When the first Ebola patient to be treated in the United States was headed for Emory University Hospital this past summer, two of the hospital’s nurses canceled their vacations to be there.

That’s how registered nurse Barbara Ribner described the dedication of the Emory nurses who deal with Ebola. Her husband, Dr. Bruce Ribner, is the medical director of the Serious Communicable Diseases Unit, which has successfully cared for four patients with Ebola.

Nurses are on the front lines of treating such deadly diseases, and have been in the forefront of the news surrounding Ebola in the U.S. Two nurses in Texas contracted the disease from a Liberian man who eventually died, and an American nurse returning from West Africa was subject to a controversial quarantine in New Jersey and Maine.

GHN talked to several Georgia nurses — some who work at Emory and some who work elsewhere — about caring for Ebola patients. The viral disease, originally identified in West Africa in the 1970s, has killed more than 5,000 people there this year, and for the first time has turned up in a few places outside Africa.

Emory nurses who cared for the Ebola patients discussed the complexity of the medical procedures at a recent conference. And at the same time, they said it was rewarding beyond their expectations.

“It’s a different feeling, because there’s this barrier between you [the nurse] and the patient,” said one nurse who preferred not to be identified. “You cannot touch your patient” to support them or help them understand that the staff is doing everything possible, the nurse said.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

People with Ebola symptoms are contagious, and the sicker they are, the more risk of contagion they pose to others.

There is no “one size fits all,” explained another infectious disease trained Emory nurse who preferred to remain anonymous. Putting on the personal protective gear took 38 steps, while removing it took 50. These highly specialized nurses counted each step while another trained nurse watched every move.

Day after day and week after week, they could not make a misstep even once during this demanding process.

“Not everyone who went through our rigorous training passed,” said one of the nurses. Each nurse working with Ebola patients had to be 100 percent detail-oriented by following the highly complex procedures every time one of them entered or left the patient’s room.

The fear came not from getting the infectious disease, explained one Emory nurse, but “we were more afraid of giving the virus to someone else.” And for that reason, each nurse was fastidious about every procedure.

The nursing education coordinator for Emory Healthcare, Kelly Shelby, said that depending on when they started nursing, “nurses were probably frightened by other types of infectious diseases as well.” For some it might have been polio, while others feared SARS and AIDS.

 

Taking the danger seriously

 

“I think there is fear [of Ebola] because it’s a scary disease,” said Lorine Spencer, a nurse and a  CDC public health adviser. Fear of the unknown is a problem.

CDC workers and prepare to enter an Ebola treatment unit in West Africa.

CDC workers and Doctors Without Borders personnel  prepare to enter an Ebola treatment unit in West Africa.

“We are getting evidence-based, accurate information out there,” Spencer said. “We continue to learn from those that have been to West Africa to treat patients and returned safely.”

Rebecca Wheeler, an RN and past president of the Georgia Nurses Association, told GHN that “we [nurses] must seek out the latest information and evidence-based practices to respond to any emergency or infectious disease outbreak.”

Communication, training and equipment are critical. The U.S. is not accustomed to managing Ebola, so information and strategies will evolve as more experience with the disease is gained, said Wheeler.

Valdosta nurse Jody Leonard added, “The public has a much greater risk of dying from influenza [than from Ebola], so please, just get your flu shot.” When discussing the Ebola problem with family members, Leonard reminded them that the risk of contracting Ebola in the U.S. is extremely low. Not so for the flu.

 

Fear and uncertainty

 

 

The scientific information about Ebola has not changed. Experts have long known that infected people are not contagious until they have developed symptoms. That means the disease, though it poses a serious risk to people who care for ill patients, is not easily spread in casual settings.

But public fears about the disease have waxed and waned, reaching a peak last month after several Ebola diagnoses in the United States in quick succession.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Americans are both divided and uncertain about the threat posed by the illness, according to a recent Washington Post article. A Washington Post-ABC poll showed that just 24 percent of Republicans believed the federal government was doing all it could reasonably do to stop the disease. In contrast, 50 percent of Democrats believed the government was doing enough. But even 50 percent is not a ringing vote of confidence.

“The key is for the front line [health care providers] to have accurate information from reliable sources like the CDC. But they also need training and appropriate equipment,” said Wheeler.

Nurses and other members of health care teams need to speak up when they feel they are getting the things they need, and they must be listened to, Wheeler said.

In early October, National Nurses United stepped up the call for U.S. hospitals to immediately upgrade emergency preparations for Ebola. NNU is calling for all hospitals to immediately implement a full emergency preparedness plan for Ebola or other disease outbreaks.

Georgia health officials have not yet revealed the hospitals that are being prepared to treat Ebola patients. But infectious disease training remains ongoing for nurses and other medical professionals, as it has for years.

 

Quarantining nurses: Is it realistic?

 

October was a scary month of Ebola headlines. Thomas Eric Duncan, recently arrived from Liberia, died of the disease in a Dallas hospital. Then two nurses who had treated him were found to be infected with the virus. Then a New York doctor who had recently treated Ebola patients in Africa was diagnosed with the disease, amid media reports that he had roamed all over the Big Apple just before falling ill.

All three of those health care professionals were successfully treated — one at Emory — and all fully recovered. But officials around the country began to talk about not just isolating Ebola patients, but quarantining people who might have the disease.

When nurse Kaci Hickox returned to the United States in October after treating Ebola patients in Sierra Leone, she was placed in quarantine by New Jersey and then by Maine.

Hickox, insisting she did not have Ebola, objected to the quarantines. In Maine, she took the matter to court. A judged ruled there were insufficient grounds for quarantine, saying Hickox should simply submit to direct active monitoring. She did, and eventually was confirmed as not infected with the virus.

An Ebola isolation tent in Newark, N.J., for Kaci Hickox

An Ebola isolation tent in Newark, N.J., set up for Kaci Hickox

After the court fight, Hickox said, “We’ll only win this battle as we continue this discussion, as we gain a better collective understanding about Ebola and public health, and as we overcome fear . . .”

The American Nurses Association opposes the mandatory quarantine of health care professionals who return to the United States from the Ebola-ravaged areas of West Africa.

On Oct. 27, Gov. Nathan Deal announced that Georgia plans to increase Ebola monitoring for all people arriving from affected countries. His directive also included the possibility of quarantines, but none have been implemented.

An open letter to Georgia’s nurses (co-authored by Public Health chief Dr. Brenda Fitzgerald and Carole Jakeway, a Public Health Department official), called for vigilance in recognizing early symptoms of Ebola. “As nurses, this is the type of situation we have been trained for,” the letter reads, while discussing the potential for anxiety and stress among Georgia’s nursing personnel.

Nurses are a good source of information about this potentially deadly disease, said Texas Nurses Association Executive Director Cindy Zolnierek.

“Also, I have advice for a concerned public: Talk to a nurse. Very likely, you have nurses in your own family or as friends,’’ she said in a statement.

“Nurses are a great resource for information and a calm voice of reason. We hope you care for nurses as much they work to care for you.”

 

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

 

Chickens do their part in school program on healthy eating

The chickens at Clarke Middle School serve as a basic introduction to agricultural animals.

The chickens at Clarke Middle serve as a basic introduction to agricultural animals.

Two Thursdays each month, the family and consumer sciences classroom at Clarke Middle School in Athens buzzes with conversations about gardening, recycling, mindful eating, and how families can reduce their carbon footprints.

Each student has an idea about what can or should be done. The sound of their excited young voices mingling together leads a visitor to the room.

Just outside the classroom there’s a chicken coop, which houses two roosters and three hens.

The classroom group, coordinated by family and consumer sciences teacher Hope Zimmerman and agricultural sciences teacher Debra Mitchell, calls itself the Sustainability Corps.

It’s an offshoot of the school garden program, which has grown rapidly since Mitchell started it in 2012.

Mitchell originally came to the school as an AmeriCorps VISTA volunteer. She registered the Clarke Middle School garden with the Edible Schoolyard project, which was started by chef Alice Waters and fosters healthy relationships between children and the food they eat by teaching in a school garden.

Edible Schoolyard currently has 3,797 registered garden classrooms and 476 kitchen classrooms worldwide.

It fits into the nationwide movement to encourage healthier eating, especially among children.

Farm to School, for example, is an initiative that emphasizes not only buying food from local growers, but also teaching children to raise their own vegetables in school gardens. The Georgia effort is led by Georgia Organics, a nonprofit group that promotes Georgia farms and locally grown food.

 

Cooking on wheels

 

Americans eat a varied diet, and crops are seasonal, so schools can’t rely solely on locally produced food. But in a major agricultural state such as Georgia, such food is often available. And Farm to School helps teach urban and suburban kids how important farming continues to be to our state.

The garden fits into Edible Schoolyard’s “kitchen garden” category because it grows produce that is cooked by Zimmerman’s students and is occasionally served at the cafeteria salad bar.

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Debra Mitchell tends to the garden at Clarke Middle School.

Mitchell and her students sell extra produce to shoppers at the West Broad Farmers’ Market, right down the street from the middle school. Mitchell and Zimmerman also hope to launch a student-run restaurant. This summer they brought in local chefs to work with students.

“It’s kind of funny,’’ said Mitchell. “It’s just serendipitous that all these people, all at once and all of these organizations, everybody’s pulling together and saying, ‘hey, well let’s just do it then.’”

School administrators and county nutrition officials actively support the program.

Zimmerman has a full kitchen set up in her classroom, but Mitchell works from a wheeled cart provided by the school. She has made pesto from herbs grown in the garden, cooked eggs laid by the school’s chickens and prepared fried green tomatoes and green beans, all on her mobile cooktop.

Mitchell and Zimmerman say that access to the garden and to fresh eggs have made students more willing to try new things.

Students who are more reserved in a traditional classroom setting gain confidence in the garden as well as the kitchen, get their hands dirty, and become more adventurous, said Zimmerman.

 

Poultry in action

 

The entire program continues to expand, with the chicken coop being one addition. All five of the chickens came to Clarke Middle by way of Hilsman Middle School in Athens.

Having the chicken coop right outside their classrooms allows Mitchell and Zimmerman to teach sustainability and mindful eating in a different way.

The chickens serve as a basic introduction to agricultural animals. Some students have never had any previous experience with livestock. Before they interacted with the little flock of egg producers, many of the children had rarely, if ever, asked questions about where their own food comes from.

Though their eggs are on the menu, the chickens themselves are not.

The students “always say, ‘You’re not gonna eat them, are you?’ and I’ll say ‘Nooooo.’ ’’ Mitchell said. “But then, it’ll be like, ‘but you do know that’s where your Chick-fil-A sandwich came from!’ ”

While the students are fond of the chickens, sometimes their excitement gets the better of them. They need regular reminders not to chase the skittish birds.

“I always tell them, ‘We’ve got to respect the chickens! They’re terrified of us!’ ” Zimmerman said.

Kids in Sustainability Corps gain knowledge and confidence from participating, and Mitchell and Zimmerman hope it continues to expand. People who would like to become involved can buy Clarke Middle School produce at the West Broad Farmers’ Market, volunteer in the garden, and — soon — eat at the student-run restaurant.

Visit Clarke Middle’s Edible Schoolyard page, Athens Farm to School on Facebook, or athensfarmtoschool.org for more information.

IMG_0622

 

Lauren Schumacker is pursuing her master’s in health and medical journalism at the University of Georgia. She also holds a certificate in culinary arts and enjoys writing about all things food-related.

Saving soldiers’ limbs: UGA researchers see promise in ‘bone putty’

U.S. Marines carry a wounded comrade for medical treatment in Iraq.

U.S. Marines carry a wounded comrade for treatment  during the  Iraq War.

War is hell on the bones of warriors. And when the long bones of the arms or legs are so badly broken that they can’t heal on their own, amputation is sometimes the only option.

But University of Georgia researchers and colleagues from other universities have developed a jelly-like substance that may help catastrophic breaks knit together. Stem cells are the key ingredient in what the scientists call “bone putty.”

Catastrophic arm or leg injuries are the No. 1 reason why U.S. troops have extended hospital stays, says Steven Stice, director of the Regenerative Bioscience Center at UGA.  And it’s all too common for a service member with a so-called “non-union” break to lose the limb.

In 2008, the Defense Advanced Research Projects Agency issued a call to duty for scientists: come up with a bone-healing substance for service members.

Responding to the call were Stice and John Peroni, associate professor of large animal surgery at the UGA College of Veterinary Medicine, in partnership with Baylor College of Medicine and the University of Kansas School of Medicine.

The UGA scientists and their collaborators have since created fracture putty, hoping that it could potentially save an injured limb, or at least allow less of it to be amputated.

They engineered stem cells using the gene for a special bone-growing protein called BMP2, bone morphogenetic protein 2.

Recovery from severely broken bones is notoriously slow, and the patient has to avoid using the injured leg or arm for weeks or even months. But there is early evidence that the fracture putty could reduce healing time by a third or even half, says Stice.

 

A recipe for healing

 

The fracture putty has three essential ingredients, and each does something different.

The stem cells calm inflammation and attract the body’s own stem cells to the site of the break.  The BMP2 gene accelerates protein production to make more bone faster.  These are incorporated into hydrogel, a jelly-like substance that glues everything together so surgeons can apply the mix to broken bones.

Steven Stice

Steven Stice

The Stice and Peroni teams are currently testing the putty on sheep.  Bones are healing faster in these experiments, but much work remains before the product can be tested in people. For one thing, a different carrier might replace hydrogel in future experiments. Other changes are possible as well.

“As a product, fracture putty must go through safety and efficacy trials before being approved as a therapeutic for use in humans,” said Robin Webb, a postdoctoral fellow in the Stice lab.

Looking ahead, if the Food and Drug Administration approves fracture putty for humans, it could be a boon to elderly people as well as to much younger military personnel.

As people age, their production of BMP2 decreases, drastically reducing bone-healing capacity.  Breaking one of the long bones in the thigh or leg is often a devastating injury for older folks, whose overall condition deteriorates when they can’t walk.  Fracture putty could potentially speed healing and get them back in the game.

Stice explains that the product may also be used in spinal fusion procedures for people with back problems, and in periodontal surgeries such as dental implants.

Pre-clinical tests are encouraging, Stice says. “The most rewarding thing so far is showing that we can get something to work that is faster, better, and could help a lot of different people in the future.  We’re excited about the potential of who could benefit from this.”

 

What’s next?

 

All technology related to the fracture putty is under the UGA research umbrella.  Scistem, a company co-founded by Stice, has licensed the patent application for the putty to be approved.  If that is granted, UGA will be able to block competitors from formulating an identical compound, and there are similar products in the research pipeline elsewhere.

For an experimental medical treatment, the journey from lab to hospital is a long one. “[A] typical therapeutic drug today takes 15 to 20 years to go through that whole process, from the time that a promising drug is discovered to the point where it’s cleared for clinical trials,” says Stice.

But he’s not discouraged.

“You know, we’re in science, and we always have great hope that things will work out.”

 

Ansley Stewart is pursuing her master’s degree in journalism at the University of Georgia.  She is a freelance writer, musician, and also works full time at UGA.  

 

Football concussions: Amid the fear, UGA research brings some hope

Concerns over football concussions have led to changes in sideline protocols to improve safety for players.

Concerns over concussions have led to changes in football protocols to improve safety.

Headlines about concussions and their effects on professional and college football players are inescapable. The issue is changing the way people talk about the game.

Recently, University of Texas quarterback David Ash quit playing because of continuing symptoms related to a 2013 concussion. And the family of ex-San Diego Chargers player Paul Oliver, a former University of Georgia defensive back, filed a wrongful death suit against the NFL, alleging that repeated concussions on the field drove him to suicide at his Marietta home.

Concussions have been associated with negative changes in memory and thinking ability, as well as movement disorders. There is also mounting evidence that repeated concussions lead to chronic traumatic encephalopathy (CTE), the degenerative disease that doctors found when they examined Oliver’s brain after his death.

From peer-reviewed research to playground hearsay, new awareness about the dangers is changing how some parents think about having their kids play football.

Felicia Harris is one such Georgia parent. The Athens mother pulled her son off the field at age 6.

One day, she watched a boy, about her son’s age, throw up on the sidelines after a hard hit. When she suggested the child might need medical attention, coaches and other parents brushed off her worries. The mentality was, ‘It’s just football, he’s OK,’” Harris says.

When Harris’ son was tackled, a much larger boy kept him pinned down before letting him up. She decided to enroll him in a new sport.

 

New research

 

While most concussion research focuses on college and professional players or young children, a team of neuroscientists at the University of Georgia is tackling an often overlooked cohort of athletes.

“A lot of thought is given to professional football players,” says researcher Doug Terry. “But what about the average Joes?”

The average Joes are middle-aged men who played football, but not in any kind of national spotlight. They suffered concussions during their glory days on the high school gridiron.

Doug Terry's research at UGA involved former high school football players in Athens.

Doug Terry’s research at UGA involved former high school football players.

Terry and his colleagues recruited 41 men ages 40-65, all former high school players from Athens. They all had roughly the same IQs and even had right-handedness in common. Of the group, 25 had suffered at least two concussions playing high school football. The other 16 had not.

Each participant underwent an fMRI scan, which measures brain activity by detecting changes in blood flow within the brain. An image of the brain appears on the computer screen, and as the volunteer performs various mental tasks, different regions light up to different degrees, representing activity in those areas.

On the monitor outside the testing room, changes in brain activity look like moving patterns of multicolored splotches.

Researchers expected to find signs of memory deficit in the players who had experienced concussions. But when put to the test, concussed players performed just as well on memory tests as their teammates who had not suffered concussions.

“Which is kind of great news,” Terry says.

Stephen Miller heads the MRI lab. “People are pretty resilient,” he says. And his research indicates that young brains can adapt to maintain normal function after some injuries.

When the two groups of former athletes performed cognitive tasks while being monitored, there were no significant differences in performance. There was no data to suggest cognitive decline in the men who had concussions in the past.

Researchers described seeing differences between the two groups, but not in the brain regions they predicted.

“We expected, if there were deficits, hyperactivation,” Miller explains. “It would mean that those areas of the brain were working harder to sustain the same level of performance.”

Instead, they saw decreased activity in the left hemisphere of the brain. Specifically, there was less activity in regions responsible for verbal understanding. This suggested that there were subtle brain organizational changes, but no overall changes to cognitive function. Essentially, concussed players could be using different parts of their brains to achieve the same results as non-concussed players when given the same memory task.

 

More to be learned

Terry says the next step is to find out what happens later in life. The teenager’s brain may continue to function normally after the injuries, but will there be some residual effect that’s not obvious until several decades later?

“Two concussions, when you’re 16, could be fine, but what happens when you’re 65, when you’re 70?” Terry asks. “We don’t know.”

guardian-ghn-rising-senior

A soft padded covering for football helmets, the Guardian Cap, is designed by an Alpharetta company run by Georgia Tech grad Lee Hanson and his wife, Erin.

More research is needed to determine whether multiple concussions in high school athletes whose football careers end with graduation elevates the risk for Alzheimer’s or other forms of dementia, says Terry. But for now, findings suggest that high school players seem to be able to rebound from typical concussions.

These encouraging findings, though preliminary, are good news for parents like Harris. She says she is willing to reconsider the sport as her son grows older.

Meanwhile, the NFL, college football and high schools in Georgia are taking action to prevent concussions and to treat the injuries properly.

The NFL commissioner has pushed for increased safety in football, as the league has toughened its protocols for players who have suffered concussions.

Last August, the NFL agreed to a $760 million settlement with more than 4,000 former players who had sued the league over head injuries.

The Atlanta Falcons and the NFL have supported a program, Heads Up Football, for youth leagues that teaches concussion awareness and proper helmet fitting, and proper techniques for tackling.

And a new Georgia law has established protocols for school athletes who have suffered concussions.

 

Alyssa Stafford is pursuing her master’s at the University of Georgia, studying health media and communication. She is a freelance writer and her work has appeared in GHN, Piedmont Healthcare and the Association of Health Care Journalists blog. 

 

‘Water lady’ on front lines in campaign against arsenic in Georgia wells

McMahan preaches the use of water filters to eliminate contaminants in household water from wells.

Janet McMahan preaches the use of water filters to eliminate contaminants in household water from wells.

 

Janet McMahan figured it out five years ago — just before her son Ben was diagnosed with cancer.

Starting in 2008, she had skin cancers erupting all over her body, including parts “where the sun don’t shine.” Her two dogs had also developed cancer.

McMahan had just given a talk about world hunger at an Irwin County church, and had read about Bangladesh. In that impoverished South Asian country, millions of people were being exposed to arsenic in their drinking water from wells.

She says she woke up in the middle of the night in October 2009, contemplating pieces of a puzzle. “God put it together,” she says.

She told her husband, Dr. Howard McMahan, an Ocilla family physician, “I know what is wrong with me.”

The water.

The McMahans got their water from a private well on their Ocilla property.

They had the water from their tap tested, and it came back with negligible levels of arsenic.

At about the same time, their son Ben, a Valdosta State University student who had been a three-sport athlete in high school, grew sick.

Ben McMahan

Ben McMahan

The family thought at first that Ben’s problem was food poisoning. But he was diagnosed that November with gastro-esophageal junction adenocarcinoma. He was 24.

“It had to be the water,’’ Janet McMahan says now.

Seeing a pattern, the McMahans stopped drinking their well water.

Since that horrible diagnosis five years ago, Janet McMahan has been a crusader on environmental health in South Georgia, and especially on contaminated well water. During that time, health officials in Georgia came to recognize the potential danger of arsenic in well water.

Officials of the state’s Department of Public Health sent alerts last year to elected officials in 10 counties in South Georgia, as well as to UGA Cooperative Extension agents, health care providers, veterinarian facilities and local libraries, urging people to test their well water regularly to ensure what they were drinking was safe. A news release on the issue was sent to local media.

Public Health repeated the warnings this year.

But McMahan says many people across South Georgia haven’t yet gotten the word that the water coming out of their taps should be tested to make sure it isn’t endangering their health.

 

 

The unseen contaminant

 

McMahan says arsenic and other elements in unfiltered water from wells have led to many cancers and other illnesses in the southern part of the state.

She also believes that in agricultural areas, some of the arsenic contained in poultry litter fertilizer has seeped into the water that people drink. The drought of 2008 concentrated the arsenic at an abnormally high level, she says.

The family’s arsenic situation became clearer in early 2010, she says, when a woman who helped with Dr. McMahan’s medical billing said her husband had been hospitalized with arsenic poisoning.

Water contamination issuesAn extension agent had tested that couple’s tap water and found a negligible level of arsenic. Then he tested a sample drawn from their water heater, which showed much higher amounts of arsenic.

So the McMahans tested water that came from their own water heater. That sample had high levels of arsenic, iron and manganese, Janet McMahan says.

The state Department of Public Health estimates that one in five Georgians regularly drinks water from private wells — a figure that might surprise people in developed urban areas.

“We have a lot of rural areas that don’t have access to municipal water,’’ says the Department of Public Health’s Chris Rustin.

Most people in Irwin County drink well water, says Dr. McMahan, a past president of the Georgia Academy of Family Physicians. “There is no safe level of arsenic exposure,” he adds.

At least partly due to Janet McMahan’s advocacy, many people in Irwin County and surrounding counties have begun testing their well water for arsenic and other contaminants.

“Janet started it all,’’ says Wanda McLemore, a longtime UGA extension service employee in Fitzgerald before her retirement this year. “She’s brought a lot of awareness to it.”

“Everybody knows Janet,’’ says Betty Metts, 39, who has survived an extremely rare form of breast cancer.

Together, Metts and McMahan take reporters around an area near the Alapaha River in Berrien County where, they say, many residents have had cancers. All are from households that use well water.

 

Well-known but poorly understood

 

Arsenic, classed as a heavy metal, is an element that occurs naturally in certain rocks, ores and soils. The amount varies by region.

Ingested in large quantities, arsenic causes severe gastrointestinal illness and death relatively quickly. From ancient times until fairly recently (when advances in science made it more detectable), it was the favorite poison of murderers. Members of the Borgia clan of Renaissance Italy were infamous for using arsenic to dispatch their political enemies.

distagain

The South Health District has 10 counties.

Today at least, the greatest danger from arsenic is not homicidal, but environmental.

When the element is present in drinking water, people can ingest small amounts over a long period of time without realizing it. Though the effect is not as swift or dramatic as what happened to the Borgias’ victims, serious health problems can develop.

Arsenic enters drinking water supplies from natural deposits in the ground or from agricultural and industrial practices, according to the EPA. It does not affect the taste of the water.

According to a fact sheet prepared by the National Institute of Environmental Health Sciences (NIEHS), arsenic is a known human carcinogen associated with skin, lung and bladder cancer, and it has also been connected with kidney and liver cancer. The fact sheet adds that ingesting arsenic can also predispose children to other health problems later in life.

The U.S. government has put limits on how much of this toxic element is allowable in drinking water. The maximum level of inorganic arsenic permitted is 10 parts per billion (ppb). But while public water systems are routinely tested for it, there are no regulations that mandate testing of water from private wells.

Approximately 7 percent of wells in the nation are thought to have arsenic levels above 10 ppb, NIEHS says.

No Georgia or federal regulations govern wells that have fewer than 15 connections (water meters) serving fewer than 25 people. Owners of these wells are under no obligation to check the water for harmful bacteria or minerals.

Given that situation, most people who rely on these private wells “don’t know what they’re drinking,” the head of the University of Georgia’s water-testing laboratory, Uttam Saha, told GHN earlier this year.

A basic water test picks up most common problems affecting private wells. But homeowners can ask for broader testing to detect bacterial contamination or heavy metals. “You should ask for arsenic tests in South Georgia,’’ Rustin of Public Health says.

The arsenic in South Georgia’s water is linked to the Gulf Trough, a natural deposit of sediment underneath the Floridan aquifer that runs from the Florida Panhandle through South Georgia. It slashes straight through the health district that includes Irwin County.

Aside from a few outliers, most water samples that tested higher than the federal limit for arsenic came to the University of Georgia’s testing lab from wells along the Gulf Trough.

 

Thomas County water study

 

In 2011, a Thomas County resident told state officials that arsenic concentrations in private drinking water wells in that area exceeded federal standards. The Department of Public Health followed up with a study.

“The resident described health problems and reported that neighbors have health complaints they think may be a result of arsenic exposure, including cancer, weight loss, difficulty swallowing, night blindness, fatigue, hair loss, stomach, kidney and bladder problems, and sick pets,” said a 2012 report written by Jane Perry, director of Public Health’s chemical hazards program.

Thomas County

Thomas County

The University of Georgia Cooperative Extension analyzed 36 private water samples from Thomas County for arsenic. Twenty-five tested positive, and 18 exceeded the maximum level of 10 ppb. The report noted that the rates for several types of cancer were elevated in Thomas County.

As McMahan and others note, arsenic is sometimes used in agriculture, where it can seep into the water supply. (Agriculture is the main business in much of South Georgia.) The EPA says high arsenic levels can come from certain fertilizers and animal feeding operations.

U.S. poultry farmers were allowed for years to feed their chickens an antibiotic called roxarsone, which contains arsenic. The drug was pulled from the U.S. market in 2011. American companies can still use a different arsenic-containing drug, nitarsone, to protect turkeys and other poultry from deadly infections.

Litter is a mixture that includes manure, feathers and other materials from where poultry are kept. Farmers often choose it as a cheap and effective fertilizer. But litter from chickens that have ingested arsenic-containing drugs can retain arsenic, a UGA Extension Service report says.

Wells that have been tested in agricultural areas more often contain trace elements such as arsenic than did those in urban areas, the U.S. Geological Survey reported in 2011.

And in Southern states, including Georgia, farmers would dip their cattle in large vats containing arsenic to ward off pests, up till the 1960s.

When arsenic seeps into the ground, it doesn’t break down or decay over time.

Buying more time

 

Ben McMahan’s cancer was very unusual, his father says.

“Nobody in their 20s has this,’’ says Dr. McMahan. “He was very healthy — never had a health problem,’’ he adds.

(A decade earlier, Dr. McMahan says, he had noticed some strange esophageal cancers among his patients.)

Ben received treatment at Memorial Sloan Kettering Cancer Center in New York, where surgeons removed most of his esophagus, the top third of his stomach, and lymph nodes in his chest.

“He had a tremendous response,” and his health improved, Dr. McMahan says. The next year, Ben had 10 inches of his colon removed at Sloan Kettering.

Then, in 2012, Ben had a recurrence. He took chemo again. He had surgery on his colon, again at Sloan Kettering.

“They couldn’t find the tumor anywhere,’’ Janet McMahan says.

Again, Ben recovered.

 

Spreading the word

 

Public Health officials and extension agents in Georgia have sent out advisories about arsenic and well water since 2011. David Kissel, head of the Agricultural and Environmental Services Laboratories at UGA, sent county extension agents an email about high levels of arsenic (and uranium) in some well water samples. The arsenic samples “were widely distributed geographically in Camden, Irwin, Tift, Bibb and Lowndes counties,” he said in the email.

“It is not our intent to alarm the public,’’ Kissel said, but his message urged agents to “encourage more testing of private wells used for drinking water.”

When Ben McMahan was battling cancer in 2012, Perry of Public Health sent his mother an email that said, in part: “The drought concentrates the levels of arsenic in groundwater.

The two McMahan dogs that developed cancer.

The two McMahan dogs that developed cancer.

“The levels of arsenic are high enough to increase the risk of cancer in south Georgia and we are seeing statistically significant rates of some arsenic associated cancer types in some counties; e.g., lung. . . . But as you know, it is very difficult to prove a cancer cluster, and even harder [to prove] that it might be caused by this or any other environmental exposure. Arsenic is the most complex chemical, in that it causes several different cancers. Most chemicals are organ system specific. However, I am impatient to get the word out too so that people reduce, eliminate exposure, and that those who haven’t tested, do so.”

The agency last year sent out an advisory for people in 10 South Georgia counties to test their well water for arsenic. It sent out another advisory this year.

But Rustin of Public Health, in an email to Georgia Health News on Friday, said that at this time, his agency cannot attribute cancer cases in Georgia to arsenic exposure. “It is important to note while the study indicates elevated incidence of some forms of cancer, they are not cancers typically associated with arsenic exposure.’’

Yet the Thomas County study found elevated levels of lung cancer for males from 2005 to 2009. That’s a type of cancer associated with arsenic.

Arsenic is not easily absorbed by the skin, and does not “stick” easily to hard surfaces (such as dishes) or clothing, so cleaning, laundering, brushing teeth, and bathing are not considered routes of exposure, Rustin added.

 

Smoking gun is elusive

 

High cancer rates have been found in the 10-county district that includes Irwin County. The rate of bladder cancer, which can be associated with arsenic, is slightly higher than the state average in four of the 10 counties: Lowndes, Ben Hill, Tift and Turner, according to the National Cancer Institute.

For Georgia as a whole, 18.6 people per 100,000 will be diagnosed with bladder cancer each year.

In the four counties mentioned above, annual incidence rates ranged from 20.4 to 20.8. In the other six counties of the district, the likelihood of being diagnosed was either negligible or no different from the rest of the state.

Irwin County

Irwin County

People living in the 10-county area are also more likely to be diagnosed with lung cancer, another tumor associated with arsenic. Each year, 81.6 new cases of lung cancer will be diagnosed for every 100,000 people, which is significantly higher than the state average of 71 new cases per 100,000.

There’s a competing explanation for this, however: South Georgia generally has higher rates of smoking than other areas of the state, and smoking is the top cause of lung cancer.

Yet an Irwin County nurse who worked with an area hospice says she recalls four people who did not smoke but had lung cancer. “All of them were on well water,’’ says Crystal Brown of Irwinville, who gets water from a well herself. “I have children, and it definitely concerns me.”

The incidence of skin cancers, another common malignancy associated with arsenic, is statistically insignificant throughout most of the counties in the district, according to the National Cancer Institute.

Carcinogens can be identified in an area’s water, but it is very difficult, if not impossible, to determine whether a specific case of cancer is directly attributable to a water source.

Cancer clusters are also notoriously difficult to identify. In a true cluster, according to the CDC, a greater-than-expected number of cancer cases must hit within a specific period of time. Each case must either be the same type, or derived from the same cause.

One problem with establishing direct causation is that cancer is all too common. As the CDC points out, it is the second-leading cause of death in the United States. Nationwide, one out of four deaths are due to some type of cancer.

Since 1990, state and local health agencies around the nation receive about 1,000 inquiries each year from people wondering if deaths in a particular locality constitute a cancer cluster. Very few of these reports qualified as true clusters.

Still, McLemore, the longtime UGA extension service employee in Fitzgerald, says the area surrounding Irwin County has “an awful lot of cancers.”

“Clean and safe drinking water is essential to a healthy environment,’’ says Stephanie Stuckey Benfield, executive director of GreenLaw, nonprofit law firm that works to reduce pollution. “Many Georgians depend on private wells as their primary source for drinking water. Arsenic in well waters can be a health concern, as long-term exposure above the EPA limit increases the risk of some types of cancer.”

 

Water heater debate

 

Janet McMahan’s emphasis on water heater samples has raised skepticism among some water experts.

“You’re supposed to drink cool water and cook with cool water,” says Jake Mowrer of the Agricultural and Environmental Services Lab of UGA. “You don’t drink from the hot water heater.”

Sediment from the house’s water pipes builds up inside the tank over time – and since it’s not cleaned out regularly, trace amounts of minerals can accumulate into thick piles, he says.

“Given that drinking hot water heater water is not recommended and that no person would be expected to quaff back a huge Mason jar of orange water, common sense tells me that this water is not representative of what the well owners are actually drinking,” Mowrer adds.

The lab uses a special filtering process for water heater samples, he says.

McMahan argues that arsenic builds up in a water heater like it builds up in a human body.

She takes reporters to a rural area in Ben Hill County where four children were diagnosed with cancer within nine months back in 2008. Each was within a 6-mile radius of the others, and all drank well water, McMahan says. She believes that a severe drought during that period elevated arsenic levels in the water. Two of the children had acute lymphoblastic leukemia, while the other two had different forms of cancer, she says. All four are alive today.

Gage Kicklighter is one of the four. Nicole Kicklighter thinks her son’s cancer was caused at least partly by well water he drank. She admiringly calls Janet McMahan “the water lady.”

A survey conducted by UGA researchers found that Georgia had about 648,000 private wells in 2012. The Soil, Plant and Water Testing Lab receives samples from about 23,000 of those wells every year, or roughly 3.5 percent.

High levels of uranium — a naturally occurring element found at low concentrations in virtually all rock, soil, and water — were recently detected in Monroe County well water. This is a public health concern because drinking water with elevated uranium increases the risk for kidney malfunction.

(Thanks to a federal loan of close to $2 million, Monroe County will finally be able to provide water to the area where many home wells are polluted by uranium, the Macon Telegraph reported Saturday.)

At UGA's Soil, Plant and Water Lab (SPW),  tests determine how much coliform bacteria are in each sample. Each cell in this tray contains E. coli, the most dangerous type of coliform.

Well water can also contain dangerous bacteria. At UGA’s Soil, Plant and Water Lab (SPW), each cell in this tray contains E. coli, the most dangerous type of coliform bacteria.

 

Public Health officials urge Georgians to test their well water once a year for bacterial contaminants, and every three years for minerals such as arsenic.

Water tests are fairly cheap – $15 for the basic test, $30 for the bacteria test – and highly accurate.

McMahan preaches the use of water filters to eliminate contaminants in household water. She buys such filters “for little old ladies and for kids.”

 

Grief redoubles resolve

Since Ben’s illness began, Janet McMahan has been an evangelist for water testing.

She has a Facebook group that has topped out at 5,000 friends. “About 1,000 are moms of kids with cancer; about 1,000 have cancer; and about 1,000 have a family member with cancer.”

Janet McMahan with a photo of her son Ben.

Janet McMahan with a photo of her son Ben.

 

Ben McMahan’s cancer came back again in January 2013. This time it was inoperable. And by that point, his body couldn’t tolerate more chemo.

A third recovery was not possible. But though doctors gave him two to six months to live, Ben lived for 14 more months. He died in April at age 28.

His death has spurred Janet McMahan onward. She is a one-woman clearinghouse for people with possible water contamination or other environmental health problems in Georgia.

She has met Erin Brockovich, whose crusade against contaminated water in California was the basis for a hit movie.

On the importance of testing water and using filters, McMahan says, “I hammer, hammer, hammer it.”

“I have this bulldog tenacity,’’ she adds. “When I take on something like this, I can’t let it go.

“This is how I keep Ben’s story alive.”

 

Lee Adcock is a master’s degree health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets.

 

Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets.

– See more at: http://www.georgiahealthnews.com/2014/05/georgias-water-healthy-tastes/#sthash.dXkN6p1q.dpuf

Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets. – See more at: http://www.georgiahealthnews.com/2014/05/georgias-water-healthy-tastes/#sthash.dXkN6p1q.dpuf
Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets. – See more at: http://www.georgiahealthnews.com/2014/05/georgias-water-healthy-tastes/#sthash.dXkN6p1q.dpuf

 

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