Heat Bakes the Nation, Here Are Some Safety Tips

By Robert Preidt
HealthDay Reporter

THURSDAY, July 18, 2019 (HealthDay News) — The heat is on.

Across two-thirds of the United States, over 115 million Americans live where some level of heat alert is already in effect, and 290 million will see temperatures soar past 90 degrees at some point in the next week, USA Today reported Wednesday.

As a dome of high pressure settles over much of the eastern and mid-Atlantic states, the heat indexes (the real-feel temperatures) in many places will top 100 and approach 110 degrees or higher, according to the U.S. National Weather Service.

What to do when the temperatures soar so high that heat-related illnesses start to take their toll? One expert offers some sage advice.

"Weekend athletes exercising in the heat need to remember to keep ahead of their fluids. It's vital to stay ahead of your thirst during these heat extremes, not just to drink when you are thirsty," said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

"Taking breaks is essential when intensely exercising in the heat for more than one hour. This includes rest, finding shade from the sun, and drinking water mixed with sugar and electrolytes. Salty pretzels, fruit and nuts are always a good option if you don't have access to a drink with sugar and electrolytes," Glatter noted.

If you exercise in the heat, try to do so early in the morning when humidity and heat from direct sunlight is low.

During heat waves, seniors are at greatly increased risk for heat stroke due to their reduced ability to sweat and therefore cool their bodies. They also may be taking medications to treat blood pressure, which can reduce their ability to sweat, Glatter said.

Heat stroke is a medical emergency that requires immediate treatment. Call 911 in such cases.

Medications such as acetaminophen (Tylenol) and ibuprofen (Motrin) do not reduce high core body temperatures, and could even be harmful. Patients need rapid cooling to reduce high core temperatures.

Along with blood pressure medications, antihistamines and medications to treat anxiety and depression may also increase the risk for heat stroke by reducing a person's ability to sweat, Glatter noted.

Continued

"Hypertension, coronary artery disease and kidney disease — common in the senior population — all elevate the risk for developing heat stroke, due to reduced cardiac reserve and plasticity of blood vessels. These are major risk factors for heat stroke," he explained.

During heat waves, check on seniors to see how they're feeling. Make sure they have access to air conditioning, plenty of cool fluids, and create a heat response plan to help reduce the risk of heat stroke, Glatter advised.

Children are also at increased risk for heat stroke because they can't regulate their body temperature as well as adults, and they may not drink enough in hot weather.

Everyone should drink plenty of cool fluids in the heat. Water is the best choice, but low-sugar sports drinks are recommended if you're working in the heat or exercising for more than one hour. Don't drink alcohol or sugary drinks, such as soda, in the heat because they can cause dehydration due to excessive water loss, Glatter said.

"Never leave a child or a senior in a parked car in the hot sun. In temperatures as low as 70 degrees Fahrenheit outside, the interior of the car can reach 90 to 100 degrees in as little as 20 to 30 minutes. When it's 90 degrees outside, the interior can heat up to 110 to 120 degrees in 30 minutes and be lethal in that short time frame," Glatter said.

Residents Unaware of Cancer-Causing Toxin in Air

This story is jointly reported by Brenda Goodman of WebMD and Andy Miller of Georgia Health News.

July 19, 2019 — Ann Singley was trying to muscle her lawnmower out of a ditch in front of her home in Covington, GA., when she felt a tug in her breast. It was a hard lump, and in the days after she discovered it, it didn’t go away.

It was stage III breast cancer. Singley, who was 33, was just beginning what would be a long and desperate fight to survive. Her youngest child, Gene, was only 3.

“She told me, all he’s going to remember about her is her being sick,” said Singley’s mother, Velma Slaton.

The year Singley was diagnosed with breast cancer, 2007, a company now called BD Bard, which sterilizes medical devices, reported releasing more than 9,000 pounds of a gas called ethylene oxide into the air about a half-mile from her home.

Ethylene oxide is used on about half the medical products in the U.S. that need sterilizing, according to industry estimates. It’s also used to make other chemicals, like antifreeze.

As Singley began her treatment, scientists at the U.S. Environmental Protection Agency (EPA) had just begun a 10-year study to better understand the risks of ethylene oxide to human health.

By 2016, the agency had made its decision: Ethylene oxide was far more dangerous than the scientists had understood before. The agency moved it from a list of chemicals that probably could cause cancer to a list of those that definitely caused cancer. The EPA also updated a key risk number for the chemical to reflect that it was 30 times more likely to cause certain cancers than scientists had once known.

Two years later, in 2018, the agency used that new risk value for a periodic report that assesses health risks from releases of airborne toxins in the U.S. That report, called the National Air Toxics Assessment, or NATA, flagged 109 census tracts across the country where cancer risks were higher because of exposure to airborne toxins. Most of the risks were driven by just one chemical: ethylene oxide.

The highest risks were in 12 census tracts in “cancer alley,” in Louisiana, near facilities that make ethylene oxide or use it to make other chemicals. Other states with affected areas included Pennsylvania, Colorado, Texas, New Mexico, Delaware, New Jersey, and Illinois, according to an analysis of the NATA data by The Intercept, an investigative reporting site.

Georgia has three affected census tracts, all in metro Atlanta — two in the Smyrna area, and one in Covington where Ann Singley lived. The report estimated that around Smyrna, ethylene oxide causes 114 extra cases of cancer for every million people exposed over their lifetimes. In Covington, it estimated the gas causes 214 cases for every million people exposed. The EPA considers the cancer risk from pollution to be unacceptable when it tops 100 cases for every million people who are exposed to a chemical over the course of their lifetime.

In the neighborhoods that have been impacted in Georgia, people are just hearing about the hazard –from Georgia Health News and WebMD nearly a year after the federal government released its official list of the hot spots. The EPA decided not to put out a news release, and state regulators did not issue one either.

“EPA is not issuing a press release,” wrote Larry Lincoln, director of the EPA’s office of external affairs for Region 4, which covers the Southeastern U.S., in an email message to state officials.

As a result, few people who live in the impacted census tracts in Georgia and elsewhere are aware of the threat, which goes back decades.

Companies that release ethylene oxide have largely continued to do business as usual. Many are legally allowed to release thousands of pounds of ethylene oxide each year because they received state permits before the EPA lowered the risk threshold for the chemical.

“No one wants to believe something irresponsible is going on,” said Tony Adams, a former board member of the homeowners association at the Chadsworth at Vinings Townhomes in Smyrna.

News that ethylene oxide might be a problem touched off heated debate on the neighborhood’s Facebook page. Maps made in June by the Georgia Environmental Protection Division (EPD) — which did its own modeling to examine risks from the toxin — show that releases in both the Covington and Smyrna areas exceed the state’s level of a chemical where health risks begin to rise. That level is known as the acceptable area concentration, or AAC.

The AAC for ethylene oxide represents one additional case of cancer for every 1 million people exposed.

In Smyrna, the state estimates ethylene oxide emissions are 27 to 61 times higher than the AAC. In Covington, concentrations of ethylene oxide in neighborhoods around the plant range from 17 to 97 times the AAC.

“Oh my,” said Stephanie Cargile, as she looked at the state’s maps.

“So what do I need to do? Move? I’m not going to jeopardize my children,” said Cargile, 59, who lives in Covington with her two grandsons.

The state maps offer only educated guesses about the pollution in the affected areas. That’s because they are based on estimated emissions that are self-reported by the companies. No air testing for ethylene oxide has been done in the neighborhoods around the plants. In an interview, Georgia EPD said it has no plans to do air testing. It also said it has no immediate plans to require the companies to cut their emissions.

“It’s far too early for that,” Karen Hays, chief of Georgia EPD’s Air Protection Branch, said in an interview with Georgia Health News and WebMD. “We’re trying to figure out what is actually going on, on the ground. This is modeling. We’re looking at this. This is what we have come up with so far.”

When asked whether the EPD had any plans to talk to people about the pollution near their homes, Hays said, “We have not so far.”

Cancer Risks Around Georgia Plants

Proving that cancers have been caused by environmental pollution is difficult, and there has been no specific health investigation of the Georgia census tracts that are at risk.

But data compiled by the Georgia Comprehensive Cancer Registry show at least one of the cancers tied to ethylene oxide , non-Hodgkin’s lymphoma, has risen significantly over the last decade, especially among men, in the 30014 ZIP code around the sterilizing plant in Covington. That’s the same pattern seen in studies of exposed workers. The EPA’s risk review noted that men who worked with ethylene oxide in sterilizing plants were more vulnerable to “lymphoid” cancers — including non-Hodgkin’s lymphoma — than their female co-workers.

A lawmaker says he is troubled by the state’s response.

“I’d like to see independent air quality testing in the area around Covington that the EPD study says is impacted,” said U.S. Rep. Hank Johnson, a Democrat who represents Georgia’s 4th District, which includes Covington and the BD Bard Plant. “The fact that state and federal agencies have known the dangers of ethylene oxide and have not informed residents is unacceptable. Federal, state, and local officials should work together to assess the dangers these emissions pose to our communities and determine next steps to protect the health and well-being of our citizens.”

State Sen. Brian Strickland, a Republican who represents the Covington area, declined to comment.

An Airborne Menace

Ethylene oxide is a stealthy poison. It’s an invisible gas with no noticeable odor in outdoor air.

It’s used to sterilize medical equipment because it penetrates cardboard, paper, and plastic, laying waste to microbes like bacteria and fungi that can cause infections or spoil foods.

The chemical can snip and scramble DNA, the instructions for how living cells work. Errors in DNA can cause cells to grow out of control, leading to cancer.

Workers exposed to the gas on the job got breast, leukemia, and lymphoma cancers at higher-than-expected rates, according to a 2004 study of more than 18,000 employees at sterilization plants.

Besides breast and blood cancers, rats and mice that were dosed with ethylene oxide to study its toxic effects got lung and brain tumors, uterine cancers, and cancers of their connective tissue. They also had more miscarriages and breathing problems than unexposed mice.

Ethylene oxide molecules disperse in outdoor air, but they don’t disappear for a long time. The chemical has a half-life of about 200 days in air, or almost 7 months. That means it takes that long for just half of the chemical to break down.

“It’s enough time that an ethylene oxide molecule that’s released will probably go around the world two or three times before it’s destroyed,” says Richard Peltier, PhD, an associate professor of environmental health sciences at the University of Massachusetts Amherst.

In communities where ethylene oxide is steadily released “you’re being exposed to this continuously 24 hours a day,” he says.

Documents obtained through lawsuits against chemical companies show the industry had heard about the cancer risks related to ethylene oxide as early as the 1980s.

At a toxicology conference in Galveston, TX, in 1981, Marvin Legator, PhD, briefed the audience on emerging cancer risks from chemicals. “The biggest problem chemical we have right now is ethylene oxide,” he said.

It would be 35 more years before EPA policy caught up to Legator’s warning.

Outrage in Illinois

There was one place where news about ethylene oxide exploded: the Village of Willowbrook, IL, an affluent suburb of Chicago.

The EPA has a regional office in Willowbrook. There, EPA staff had been working for months behind the scenes, before the air toxics report’s public release, to learn whether the cancer risks predicted by that upcoming assessment existed in the real world.

The EPA’s air toxics assessment is a cancer risk screening tool. Its conclusions are based on data modeling, not a measurement of chemicals in the air. The regional EPA staff wanted to know how much ethylene oxide they were actually breathing. For them, the threat was personal.

They ordered air testing in 39 locations in the neighborhood that surrounds a medical sterilizing plant run by a company called Sterigenics, which had reported releases of hundreds of thousands of pounds of ethylene oxide to the outside air there over more than 2 decades. The results of that sampling confirmed higher levels of ethylene oxide in the air around Willowbrook.

The regional EPA staff then asked the Agency for Toxic Substances and Disease Registry (ATSDR), a specialized division of the CDC, for help. ATSDR reviews the latest science and likely exposures to understand specific health risks to communities from toxic pollution.

Based on the levels of ethylene oxide found in the air around Willowbrook, ATSDR’s calculations showed the extra cancer risk for residents was roughly 6,400 cases of cancer for every million people. The EPA considers the cancer risk in a community to be too high when it tops 100 cases for every 1 million people exposed to a pollutant.

The ATSDR report came out August 21, 2018. The EPA released its National Air Toxics Assessment the next day.

News of the cancer risks spread rapidly.

“We found out about the ATSDR report the day after it was published,” said Margie Donnell, a real estate attorney who lives in Willowbrook. “We were told it was never supposed to be made public,” she says. “The village freaked out.”

Residents in Willowbrook quickly mobilized, forming a nonprofit called Citizens 4 Clean Air. They raised money and started a Facebook group called Stop Sterigenics to spread the word about the pollution.

Three days after the report came out, the group was protesting in front of the Sterigenics plant. They enlisted the help of Illinois legislators, including Democratic U.S. Sens. Dick Durbin and Tammy Duckworth.

By October, the Illinois attorney general had sued Sterigenics in state court. In February 2019, after more air testing, the Illinois Department of Environmental Protection issued an order that shut the plant down.

Sterigenics says that the amounts of ethylene oxide it released were tightly controlled and always within legal limits.

Just this week, though, state and company officials announced that Sterigenics will resume its operations at its Willowbrook facility after installing new equipment intended to cut its ethylene oxide emissions. The company will face no fines from the state but will set aside $300,000 during the next year for “environmental improvements, or educational scholarships or programs,” in the Willowbrook area, according to reporting by the Chicago Tribune.

“Sterigenics has a proven track record of complying with and going above and beyond what the regulations require in the safe use of EO [ethylene oxide] to sterilize critical medical products and devices,” said the company in a statement posted on the Sterigenics Willowbrook website.

Donnell says the EPA’s air testing suggests that the emissions the company was reporting to the EPA were wrong.

“Self-reporting [by a company] is a guess. It’s abundantly clear that the numbers are just a guesstimate or whatever the company wants to submit,” she says.

In other public responses, Sterigenics has questioned whether its operations were the sole source of emissions measured near the plant. It says the EPA failed to account for ethylene oxide from background sources like traffic and construction around the canisters that took air samples.

Scientists don’t dispute that ethylene oxide can come from sources other than sterilization plants. But they note that EPA air testing showed that levels of ethylene oxide fell by an average of 50% after the company ceased operations, according to the Chicago Tribune. The emissions plunged by more than 90% in air monitors that were closest to the plant.

Sterigenics and other medical sterilizers also take issue with the EPA’s new risk value for ethylene oxide, which finds that the chemical can cause cancer in minuscule amounts. They say the threshold set by the EPA is unreasonable, because it’s a level of ethylene oxide that is lower than the amount found in healthy human bodies.

Independent experts don’t doubt that our bodies make some ethylene oxide. But they say even if it comes from normal body processes, that doesn’t mean it is without harm.

Peltier says ethylene oxide from industrial pollution adds to what we already have in our bodies. And he says airborne ethylene oxide is a cancer source we should be able to protect people from.

“We can control the outside environment exposures. We can’t control the ones on the inside,” he says.

Sterigenics in Georgia

In Smyrna, GA, another Sterigenics plant sits tucked into a low-slung industrial area next to The Light Bulb Depot and a doggie daycare. The Garden, a shelter for homeless women and children, is across the street.

Smyrna is one of Atlanta’s closest suburbs. New townhomes in the area, which has become a hot location because it’s close to Atlanta highways, are selling for $500,000 and up.

There, residents are just learning from reporters that a toxic gas is drifting through their neighborhood.

Cassandra Saffold started shaking when a reporter from WebMD showed her a map made by the Georgia Environmental Protection Division. The map estimates concentrations of ethylene oxide near the Chadsworth at Vinings Townhomes, where she lives, at 27 times the annual safe level determined by the state.

“This is my major investment,” she said, speaking of her home’s resale value. “What if we can’t get it shut down?”

Saffold alerted her homeowners association, and within 3 days, members were posting on the Stop Sterigenics Facebook page, looking for more information.

Adams, a massage therapist who also lives in the townhomes, said he, too, was worried about his home’s value, but “I’m more concerned about my health than money. And I like money.” He says he and his neighbors “want to have peace of mind that the air we’re breathing is not toxic.”

To come up with its maps, the state worked for months with BD Bard and Sterigenics, using numbers reported by the companies for the modeling. Unlike in Willowbrook, no follow-up air testing has been done.

Emails obtained through the Georgia Open Records Act show that as the companies worked with state regulators, they dramatically lowered their own emissions estimates, dropping them from thousands to hundreds of pounds.

Sterigenics says it was able to lower its emissions, in part, by better controlling “back vent” emissions that escaped when plant workers opened the door of the sterilizing chamber after a cleaning cycle.

Bard says its numbers dropped because testing showed its pollution control equipment removes more ethylene oxide than the company had first estimated.

Even using the companies’ lower figures, data modelers at the state EPD found that the estimated ethylene oxide emissions from the Sterigenics and BD Bard plants exceeded the state’s yearly acceptable levels.

Smyrna resident John Keller says he is troubled that the state has relied solely on the company for information about its releases.

“That’s a mistake,” says Keller, 83, a retired dentist. “They need to do their own testing. Depending on the company to admit to their own pollution is like depending on Philip Morris to tell you about cigarettes.”

State Goes Easy on Business

The state of Georgia consistently ranks high on lists of the best states for businesses. One reason, according to surveys, is a friendly regulatory environment.

According to state guidelines, a company seeking a permit to operate in Georgia has to demonstrate that its releases will not exceed acceptable concentrations of certain toxins. And even though the models the EPD made followed the same process the state uses to set limits on releases of toxic air pollutants, the EPD said these models won’t be used for that purpose.

Emails obtained under the Georgia Open Records Act suggest how the state has been reluctant to provide information to assist federal investigations into Georgia’s ethylene oxide pollution. EPD Air Protection Branch chief Karen Hays pushed back at EPA staff who requested more information on medical sterilizers in Georgia, including how companies were making their estimates for ethylene oxide emissions. Hays said the work was unnecessary and burdensome, emails show. The EPA backed off the request.

In April, ATSDR, a division of the CDC, reached out to see if the state had modeled any health impacts from ethylene oxide sterilizers. Emails show that Hays suggested that ATSDR file an open records request to get more data, though her staff had, in fact, been working on those models for months.

An EPD manager who works on finding out health risks to people from environmental pollution questioned that federal agency’s report on Willowbrook. “My concern with ATSDR’s recommendations is the assumption that a causal relationship can be easily drawn between chronic exposure to [ethylene oxide] air emissions and elevated cancers in the population surrounding a facility under routine monitoring,” the manager wrote.

It’s unclear if the state of Georgia will require either company to take any corrective measures.

Sterigenics says it is installing new pollution control equipment in its Smyrna plant, which will make its operations even safer.

Hays says she has asked a different department of the EPD to study what its maps mean for the health of residents around the plants. She has given it a deadline of August 1 to report back.

State regulators say they are waiting before they take further action, because the EPA may roll back the new, stricter risk value for ethylene oxide at the request of the American Chemistry Council.

When Hays read the news that the EPA might be reconsidering its new risk value for ethylene oxide, she responded to a colleague with just one word: “Yeah!”

Though the state doesn’t plan to test air in the impacted neighborhoods, the EPD is testing a single sample of air for ethylene oxide at its monitoring site in south DeKalb County. The site is not near any plants that release ethylene oxide. Instead, Georgia wants to see if ethylene oxide may be present in the air from sources like traffic.

Georgia state Sen. Jen Jordan, who represents part of the impacted Smyrna area, questions whether enough is being done.

“This is bad,” says Jordan, a Democrat for the 6th District. “I’m incredibly troubled that it sounds like they were trying to manage the situation instead of being transparent,” she says.

“When we have modeling and a memo that shows elevated cancer risk, why that would not somehow have some kind of regulatory or legal impact on a company, especially when we know what they’re doing is hurting the people that live around them,” Jordan says.

Cancer Risks Around Medical Sterilizers

At the request of WebMD and Georgia Health News, the Georgia Department of Public Health looked up cancer rates in the ZIP codes around the plants in Smyrna and Covington.

The 30339 ZIP code sits next to the Sterigenics plant in Smyrna. The ZIP code covers a slightly different area from the one the pollution was projected to impact, so there’s no way to make a direct comparison.

Cancer rates in this ZIP code appeared to be on par with those in the rest of the state. In 30339, the latest data show 474 cases of cancer were diagnosed for every 100,000 people, the same as the statewide rate.

While rates of breast cancer were slightly higher in 30339 than in the rest of the state, the difference is not statistically significant, meaning it could be due to chance alone.

While higher levels of cancer haven’t shown up in state data in the Smyrna area, the numbers tell a different story in Covington.

People who live in the 30014 ZIP code are diagnosed with more cancers than residents in Newton County overall and in the state as a whole. In 30014, there were 527 cases of cancer diagnosed for every 100,000 people, compared with an average of 474 cases of cancer diagnosed for every 100,000 people statewide. The difference between the cancer rate in 30014 and the state is statistically significant, meaning that the increase is not likely due to chance alone.

Rates of non-Hodgkin’s lymphoma, a type of cancer linked to ethylene oxide exposure, have recently been higher in the 30014 ZIP code, compared with the Georgia average.

Non-Hodgkin’s lymphoma rates have been rising an average of nearly 7% each year from 2007 to 2016 in this ZIP code. The increases are statistically significant, according to public health officials.

Rates of breast cancer, another type of cancer linked to the toxin, have varied. The latest data show rates in the ZIP code are close to the state average of 127 cases diagnosed for every 100,000 people. But historical data indicate that they peaked in this ZIP code between 2010 and 2014, when 139 cases were diagnosed for every 100,000 people. Over the same time frame, Georgia’s breast cancer rate was 127 cases per 100,000.

In a written statement, the Department of Public Health cautions that it is extremely difficult to find out if an environmental exposure has caused cancer. The department says its data shouldn’t be seen as a link between any particular environmental exposure and a specific type of cancer. That’s particularly true in some of the impacted neighborhoods in Covington, which have had documented exposures to other types of toxic chemicals in addition to ethylene oxide.

Longtime Company

Ann Singley had lived in the same neighborhood of neat wooden row houses for much of her life. The homes were built to house workers at the old Covington Mill.

Singley grew up, for a time, in a house on Wheat Street, where she lived with her mother and four brothers. She moved back in 1991 when she married her husband, Kelly, a deputy for the Newton County Sheriff’s Office.

Bard has a longstanding presence here, too. The company has been using ethylene oxide to sterilize medical equipment in the area for decades.

Federal records show the plant, which sits about half a mile as the crow flies from the yellow house where the Singleys lived, has been emitting ethylene oxide to the outdoor air since at least 1987, the first year companies were required to report releases of toxic chemicals to the federal government. That year, the plant reported releasing more than 76,000 pounds of ethylene oxide. By 1991, when the Singleys moved in, that number was down to 35,700 pounds.

Those numbers are much higher than current reported releases, but experts say that when the releases were made years ago, less was known about the risk, which means communities impacted by ethylene oxide may have been exposed for decades.

The state’s model shows the risks from the ethylene oxide emissions span a wide area in Covington — more than 15 miles from the facility. Data mapping company ESRI estimates more than 18,000 people are impacted there.

In the Covington Mill neighborhood, ethylene oxide emissions exceed the state’s annual safe level by an average of 23 to 34 times. In 2015, the average concentration of ethylene oxide in a neighborhood on the other side of Bard, called Settlers Grove, was 97 times higher than the state’s safe level. That means ethylene oxide in the air could be expected to cause 97 cases of cancer for every 1 million people exposed over the course of their lifetimes.

Cancer is common, to be sure. According to the American Cancer Society, one in three people will get cancer in their lifetime, and most will never know exactly what caused it. Some of the risk for cancer can be inherited, through genes. Cancer can also develop because of exposure to something in the environment.

Experts who have studied the issue believe that environmental cancer triggers have been overlooked.

In 2010, a federal report from the President’s Cancer Panel concluded that “the true burden of environmental induced cancer has been grossly underestimated” and that human exposure to cancer-causing chemicals is widespread in the U.S., where chemicals are untested and “largely unregulated.”

In response to questions from WebMD and Georgia Health News, BD Bard issued a written statement:

“BD cares deeply for our employees and the communities in which we operate. We are an important part of the Covington community and take our responsibility to be a good corporate citizen very seriously. We continue to take all steps necessary to ensure the safe operation of our facilities.”

The company further says that the EPD’s maps are based on computer modeling and not actual air testing.

“Neither Georgia EPD nor U.S. Environmental Protection Agency has asked BD to take any actions as a result of this report, as our ethylene oxide levels … are well below all required levels.”

Resident’s Asthma, Breast Cancer

On the other side of the BD plant, in apartments maintained by the Newton County Housing Authority, state regulators predict concentrations of ethylene oxide are 42 times higher than the acceptable limit. Resident Cynthia Newsome was not surprised to learn her air quality could be compromised.

“You just walk outside and your lungs say, ‘Nope!’” she says.

Newsome, who is 49, has gotten asthma since moving to the unit she rents there. Her daughter and her two grandsons, who live with her, have it too. They require an arsenal of pills and inhalers to manage their breathing problems. She runs an air purifier inside the house, and she has stopped sitting on her front porch because of her health problems.

“I stay sick all the time,” she says. In addition to her breathing problems, she says she has symptoms like skin rashes that she attributes to “weird allergies.”

She’d like to move, but three bouts of breast cancer have wiped her out financially. She was first diagnosed at age 29, when she lived 12 miles away from the BD Bard plant at the Salem Glen apartments. That neighborhood is just outside the state’s impact zone for ethylene oxide. She said she has no history of breast cancer in her family and no known risk genes for it. Many different things can contribute to having cancer and asthma. It would be almost impossible for doctors to pinpoint what led to Newsome’s health problems.

Still, it’s rare for a woman to be diagnosed with breast cancer in her 20s or 30s. According to the National Cancer Institute, the chances of a woman being diagnosed with breast cancer between the ages of 30 and 40 are just .4%. That translates to about 1 case for every 227 women. (Ann Singley was also diagnosed in her 30s).

Velma Slaton says her daughter always wondered how she got breast cancer. Tests failed to find any genes that would have increased her risk.

“I would have traded my life so she could be here with her family and her kids, because my kids were grown. Hers weren’t,” Slaton said.

The year after doctors found Ann’s breast cancer, Velma and her twin sister were diagnosed with it, too. They both live in Covington. They survived, but Ann was not so fortunate.

After surgery, chemotherapy, and radiation put the cancer into remission, it returned in 2010. Her bones were riddled with it. Her doctor hoped she would make it to Christmas of 2012, but she didn’t. She passed away on Dec. 10 at home. Her youngest son, Gene, was 8.

“It was a horrible experience. I’ve been alone ever since. I guess I’m afraid to start over because something like that could happen again,” says her husband, Kelly. Ann died the day before their 21st wedding anniversary.

When told by reporters about the ethylene oxide near his home, he said the information was concerning. He recalled his birth mother worked at the Bard plant in the 1970s. She died of a brain tumor when he was 3.

“If that’s something that’s going on, if something is causing a problem, they need to stop that particular part of the operation and move it out to unincorporated areas where people won’t be affected by it,” he said.

“If they knew about it, if they knew there was a possibility that it could cause cancer and they allowed it to continue anyway, those people should be punished.”

Pot Use During Early Pregnancy on the Rise

By Robert Preidt
HealthDay Reporter

FRIDAY, July 19, 2019 (HealthDay News) — Pot use and pregnancy hardly go hand-in-hand for health reasons, but more American women are using marijuana just before and right after they become pregnant, new research warns.

"These findings should alert women's health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients," said lead study author Kelly Young-Wolff. She is a research scientist at Kaiser Permanente, in Oakland, Calif.

In the study, the investigators analyzed data on self-reported marijuana use among nearly 277,000 pregnant women (about 367,000 total pregnancies) in Northern California over nine years, from 2009 to 2017. California legalized recreational marijuana in 2018.

During that time period, the use of marijuana in the year before pregnancy rose from close to 7% to 12.5%, and the use of marijuana in early pregnancy (up to 8 weeks' gestation) rose from nearly 2% to 3.4%, the findings showed.

Frequency of marijuana use also increased.

Among those who used marijuana in the year before pregnancy, daily users rose from 17% to 25%, weekly users increased from 20% to 22%, while monthly-or-less users fell from 63% to 53%, according to the report.

And among women who used marijuana early in pregnancy, daily users increased from 15% to 21%, weekly users rose from 25% to 27%, while monthly users decreased from 60% to 52%.

"The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional," said Young-Wolff.

There is significant evidence that marijuana exposure during pregnancy is associated with having a low-birthweight baby, the researchers said.

And women who are pregnant or planning to get pregnant should not use marijuana because it may impair fetal neurodevelopment, according to the American College of Obstetricians and Gynecologists.

"There is still much that is unknown on the topic, including what type of cannabis products pregnant women are using, and whether the health consequences differ based on mode of cannabis administration and frequency of prenatal cannabis use," Young-Wolff said in a Kaiser news release.

The findings were published online July 19 in JAMA Network Open.

According to senior study author Dr. Nancy Goler, "There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used." Goler is associate executive director of The Permanente Medical Group.

"Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving, and certainly once a woman knows she is pregnant," she added.

EPA Won’t Ban Pesticide Linked to Harm in Children

July 19, 2019 — Even though the pesticide chlorpyrifos has been linked to brain harm in children, it will not be banned in the United States, the Environmental Protection Agency announced Thursday.The agency said data highlighting health concerns about the pesticide was "not sufficiently valid, complete or reliable," and added that it would continue to monitor the safety of chlorpyrifos through 2022, The New York Times reported.

In 2015, the Obama administration said it would ban chlorpyrifos after EPA studies showed that the pesticide could damage brain development in children. That ban was reversed by the Trump administration in 2017, which triggered legal challenges.

In April, a federal appeals court gave the EPA a July deadline to issue a final ruling on whether to ban chlorpyrifos, The Times reported.

One of the groups that challenged the 2017 Trump administration decision on chlorpyrifos was Earthjustice, which acted on behalf of farmworker organizations and others.

"By allowing chlorpyrifos to stay in our fruits and vegetables, Trump's EPA is breaking the law and neglecting the overwhelming scientific evidence that this pesticide harms children's brains," Patti Goldman, a lawyer for Earthjustice, said in a statement.

She said the groups would continue their legal challenge, The Times reported.

Hawaii banned chlorpyrifos in 2018, and California and New York are considering similar measures. Consumers and environmental groups are urging the European Commission to ban the pesticide.

In the United States, the chemical industry and farmers have lobbied to continue using chlorpyrifos, saying it's needed to protect crops, The Times reported.

Is Caffeine Fueling Your Anxieties?

By Robert Preidt
HealthDay Reporter

FRIDAY, July 19, 2019 (HealthDay News) — If you struggle with anxiety, you might want to skip that second cup of coffee, new research suggests.

For some people, caffeine may help with concentration and provide an energy boost, but it can cause problems for those with general anxiety disorder, said Dr. Julie Radico, a clinical psychologist with Penn State Health.

"Caffeine is not the enemy," she said in a university news release. "But I encourage people to know healthy limits and consume it strategically because it is activating and can mimic or exacerbate the symptoms of anxiety."

Low doses of caffeine are in the range of 50 to 200 milligrams (mg). Consuming more than 400 mg at once may lead to feeling overstimulated and anxious, and bring on symptoms such as racing heart, nausea or abdominal pain.

Anxiety is a common problem, but many patients and their doctors don't think about caffeine as a potential contributing factor, said Dr. Matthew Silvis, vice chair of clinical operations in the division of family medicine at Penn State Health.

"We want people to consider whether there may be a connection between their caffeine consumption and anxiety," he said.

As well as being a potential problem for people with anxiety, caffeine can interact negatively with medications for seizure disorders, liver disease, chronic kidney disease, certain heart conditions or thyroid disease, Silvis noted.

"Medical disorders that a patient may already have can become more difficult to control," he said.

In terms of amounts of caffeine, an average cup of home-brewed coffee has about 100 mg, compared with 250 mg in a tall Starbucks coffee and as much as 400 mg in energy drinks. A can of Mountain Dew has 55 mg while a can of Coca-Cola has 35 mg.

Many vitamin and sports or nutritional supplements also contain caffeine, but many people don't think to check the labels of those products, Silvis added.

Diabetes Raises Heart Failure Risk More in Women

By Serena Gordon
HealthDay Reporter

FRIDAY, July 19, 2019 (HealthDay News) — Diabetes brings with it a variety of long-term complications, but at least one of those — heart failure — is a bigger threat to women than men, new research suggests.

The risk difference was even more pronounced for women with type 1 diabetes.

"Our global review of 12 million people shows that having diabetes increases the risk of heart failure in both women and men. However, this increase is greater for women than men," said study author Toshiaki Ohkuma. He's an honorary senior fellow at The George Institute for Global Health at the University of New South Wales in Sydney, Australia.

One of Ohkuma's co-authors, Sanne Peters, quantified these differences. "Type 1 diabetes was associated with a 5.15 times higher risk of heart failure in women and a 3.47 times higher risk in men — meaning a 47% higher risk of heart failure for women compared to men," she explained.

Peters noted that women with type 2 diabetes — the more common form of diabetes — had nearly twice the risk of having heart failure. Men with type 2 diabetes had a 1.74 times higher risk. That means the risk of heart failure is 9% higher for women with type 2 diabetes compared to men.

Peters is a research fellow in epidemiology at The George Institute for Global Health at the University of Oxford in the United Kingdom.

Heart failure is different than a heart attack. During a heart attack, the heart is starved of blood and oxygen, leaving part of the heart damaged. In heart failure, the heart isn't able to pump blood efficiently, according to the American Heart Association. This means the body may not be getting enough blood and oxygen.

Although the new research wasn't designed to tease out a definitive cause of the increased risk, the researchers suspect that under-treatment of diabetes in women may play a role. The study authors also noted that other heart disease risk factors, such as high blood pressure, seem to be more common in women than in men.

Continued

Ohkuma also pointed out that women may have had prolonged exposure to high blood sugar levels, which can affect the heart's ability to function. It can take up to two years longer for women to be diagnosed with diabetes than men.

Dr. John Osborne, an American Heart Association spokesperson and director of cardiology at State of the Heart Cardiology in Southlake, Texas, said, "There's still a problem with diagnosing women. In this study, they spent longer in the 'prediabetes' stage than men."

That delay, he said, may be a factor in the differences in heart failure risk.

"Diabetes is bad for everyone, but in women, it's really bad," Osborne said.

The new research included information from 14 studies. Those studies included 47 distinct groups comprised of more than 12 million people. (About 3.2 million had type 1 diabetes).

So, what can someone with diabetes, especially a woman with type 1 diabetes, do to lessen the risk of heart failure?

Peters said a healthy lifestyle and controlling high blood pressure, diabetes and coronary heart disease are all important for preventing heart failure. She added that preventing diabetes in the first place is also helpful.

Osborne said eating right, getting regular exercise and not smoking are all important in preventing heart failure. If you have diabetes, newer medications — known as SGLT2 inhibitors — have been shown to reduce the risk of heart failure, he said.

If you have a family history of heart failure, or you have high blood pressure, abnormal cholesterol and excess weight, it's important to talk with your doctor about your heart failure and diabetes risk.

The study was published July 18 in Diabetologia.

The ‘Bottom’ Blood Pressure Number Matters, Too

By Amy Norton
HealthDay Reporter

THURSDAY, July 18, 2019 (HealthDay News) — When it comes to blood pressure readings, the "top" number seems to grab all the attention.

But a large, new study confirms that both numbers are, in fact, critical in determining the risk of heart attack and stroke.

Blood pressure measurements are given as a "top" and "bottom" number. The first reflects systolic blood pressure, the amount of pressure in the arteries as the heart contracts. The second reflects diastolic blood pressure, the pressure in the arteries between heart muscle contractions.

For years, systolic blood pressure has been seen as the one that really matters. That's based on studies — including the famous Framingham Heart Study — showing that high systolic blood pressure is a stronger predictor of heart disease and stroke.

At the same time, though, doctors measure both systolic and diastolic blood pressure, and treatment guidelines are based on both. So just how important is that diastolic number?

"The idea behind this new study was to address the confusion," said lead researcher Dr. Alexander Flint, an investigator with Kaiser Permanente Northern California's division of research.

Using medical records from 1.3 million patients, his team confirmed that, yes, high systolic blood pressure was a stronger risk factor for heart attack and stroke. But those risks also climbed in tandem with diastolic pressure; and people with normal systolic readings were still at risk if their diastolic pressure was high.

"There's been a common belief that systolic blood pressure is the only one that matters," Flint said. "But diastolic definitely matters."

He and his colleagues reported the findings in the July 18 issue of the New England Journal of Medicine.

The definition of high blood pressure has gotten a revamp in recent years. Guidelines issued in 2017 by the American College of Cardiology (ACC) and other heart groups lowered the threshold for diagnosing the condition — from the traditional 140/90 mm Hg to 130/80.

The fact that treatment guidelines include a diastolic pressure threshold implies that it's important. And indeed it is, said Dr. Karol Watson, a member of the ACC's prevention section and leadership council.

Continued

In fact, she said, doctors once thought that diastolic blood pressure was the more important one — based on research at the time. Then came the studies showing that systolic pressure was generally a better predictor of people's risk of heart disease and stroke.

In addition, Watson said, high systolic blood pressure is more prevalent, because of natural changes in blood pressure as people age.

"As we get older, systolic blood pressure keeps marching up," she explained. Diastolic blood pressure, on the other hand, generally peaks when people are in their 40s to 60s — and then it declines.

But it's clear, Watson said, that while systolic and diastolic blood pressure are different, they both deserve attention.

In the latest study, cardiovascular risks rose with each "unit increase" in systolic pressure above 140, by about 18% on average. Meanwhile, each increase in diastolic blood pressure above 90 was tied to a 6% increase in heart disease and stroke risk.

The researchers saw a similar pattern when they looked at blood pressure increases above the 130/80 threshold. That, Flint said, supports the 2017 guideline shift.

The findings are based on over 1.3 million patients in the Kaiser Permanente health system who had roughly 36.8 million blood pressure readings taken from 2007 through 2016. Over eight years, more than 44,000 patients had a heart attack or stroke.

According to Flint, it's the largest study of its kind to date.

The bottom line for patients, Watson said, is that they should care about both blood pressure numbers. In her experience, she noted, patients often point to the number that's in the normal range and say, "But look how good this is."

Flint agreed, saying that no one should "ignore" the diastolic number. "It's important not only in blood pressure treatment, but on the side of diagnosis, too," he said.

Money Might Motivate Smokers to Quit Long Term

By Robert Preidt
HealthDay Reporter

THURSDAY, July 18, 2019 (HealthDay News) — Financial rewards for quitting smoking do help smokers — including pregnant women — kick the habit and remain smoke-free, a new study confirms.

"Rewards, such as money or vouchers, have been used to encourage smokers to quit, and to reward them if they stay stopped. Such schemes have been used in workplaces, in clinics and hospitals, and within community programs," said study lead author Dr. Caitlin Notley. She's with Norwich Medical School of the University of East Anglia in England.

"We wanted to know whether these schemes actually work long term, as previously it was thought that perhaps incentives only worked for the time that they were given. We found that they do help people stay smoke-free, even after the incentive scheme ends," Notley said in a university news release.

For the new study, the investigators analyzed 33 randomized controlled trials. The studies included more than 21,600 people in eight countries and looked at whether financial incentives — such as cash payments, vouchers or the return of money deposited by participants — helped people quit smoking. Ten trials focused on pregnant smokers.

There was significant variation in the amount of incentives used in the trials, ranging from zero (self-deposits) to between $45 and $1,185.

The researchers found that after six months or more, people who received financial rewards were about 50% more likely to have quit smoking than those in the "control groups."

Among smokers not receiving incentives, about 7% had successfully quit smoking for six months or longer, compared to almost 11% of those receiving incentives, the findings showed.

"This is an important increase when we consider the enormous harms of smoking, and benefits of quitting, and suggests that incentives can be a useful part of a comprehensive approach to help people quit smoking. Another really important thing is that success rates continued beyond when the incentives had ended," Notley said.

Among mothers-to-be, women in the rewards groups were more likely to quit smoking than those in the control groups — "both at the end of the pregnancy and after the birth of the baby, suggesting incentives may be a useful part of a comprehensive approach to helping pregnant women quit smoking," Notley said.

Giving up smoking is one of the best things an expectant mother can do to boost the odds of having a healthy pregnancy, and it also provides benefits after the baby is born by preventing the child's exposure to secondhand smoke, she added.

The study was published July 17 in the Cochrane Library.

Study Casts Doubt on Safety of Herbal Drug Kratom

By Dennis Thompson
HealthDay Reporter

THURSDAY, July 18, 2019 (HealthDay News) — The herbal supplement kratom regularly causes serious side effects and doesn't appear safe for use, a new study argues.

Kratom, made from the leaves of a Southeast Asian plant, is usually used to treat pain and addiction. But poison control center data shows it has been tied to seizures, withdrawal, hallucinations, agitation and rapid heart rate, researchers report.

Kratom is "probably not something that's safe enough to be available as an herbal supplement," concluded lead researcher William Eggleston, a clinical assistant professor with the Binghamton University School of Pharmacy in New York.

Kratom contains compounds that act on the opioid receptors in the brain and the body, according to the U.S. National Institute on Drug Abuse.

And while it's a legal herbal supplement, the U.S. Food and Drug Administration has already issued a warning against using kratom. The FDA has called the drug "opioid-like" and cited concerns that it might pose an addiction risk.

In the new study, poison control centers received more than 2,300 calls related to kratom between 2011 and 2018.

Those calls increased from 18 in 2011 to 357 in the first seven months of 2018, according to stats drawn from the U.S. National Poison Data System.

The research team zeroed in on 935 cases where kratom was the only substance involved.

About 56% of cases involved kratom taken as a pill, capsule or powder, and in nearly 9 in 10 cases people ate the kratom that had affected them.

The most commonly reported adverse effects were agitation (in almost 20% of cases), rapid heart rate (17%), drowsiness (14%) and vomiting (11%), the data showed.

Severe side effects included seizures (6%), hallucinations (5%), respiratory depression (3%), and coma (2%). Cardiac or respiratory arrest was reported in 0.6% of cases.

The researchers also identified four cases of neonatal abstinence syndrome, where babies were born addicted to kratom after their mothers took the supplement during pregnancy. They said it caused two deaths.

The National Poison Data System statistics indicated that kratom has a lower risk for fatal overdose than opioids like heroin or fentanyl, Eggleston said.

Continued

"The risk for things like serious respiratory depression is probably less with kratom than it is with other opioids," Eggleston said. "We saw a very low incidence of this in our data."

However, other studies also have shown that users can experience withdrawal symptoms, Eggleston said.

"That suggests that patients could develop a dependence or a substance use disorder, as you would with other opioids," Eggleston said. "To me, that exceeds what I would consider a reasonable risk for an herbal supplement you can buy at a local convenience store or head shop."

Kratom proponents argue that the new study is flawed because it relies on poison control and medical examiner data, which tags kratom as the main suspect and could fail to consider other possible explanations.

"If a person dies and the tox screen identifies kratom in the bloodstream, that is labeled as a kratom-associated death," said Mac Haddow, a senior fellow on public policy at the American Kratom Association. "It is just as plausible you could identify caffeine in the bloodstream as a result of drinking a cup of coffee that morning."

Susruta Majumdar, an associate professor with the St. Louis College of Pharmacy in Missouri, said the new study adds a bit more evidence regarding kratom's safety, but agreed that its reliance on poison control center data makes for a flawed approach.

Based on available data, Majumdar said, kratom probably is safer that prescription and illicit opioids, but "I think we are getting to a point where we can say it's addictive."

Majumdar added that he believes kratom-related deaths are not caused by kratom alone, but kratom combined with other substances.

"People are on multiple drugs, and it's the synergy between those drugs that is causing the toxicity," Majumdar said.

Eggleston said he does not advocate a ban on kratom, since studies suggest it might have a role in treating chronic pain and addiction.

Instead, clinical trials are needed to assess kratom's usefulness and establish its safety at certain doses, Eggleston said.

"Our research is not coming from a place where we want to hinder access," Eggleston said. "We want the public to have all the information they need and be transparent, so they know what works and what's safe."

The study findings were published July 9 in the journal Pharmacotherapy.

Ground Bison Linked to E. Coli Outbreak: CDC

July 18, 2019 — An E. coli outbreak in the United States that's linked to ground bison produced by Northfork Bison Distributions, Inc. of Canada is being investigated by federal and state officials.

There have been 21 cases of Shiga toxin-producing E. coli O103 and O121 infections in seven states (CT, FL, MI, MO, NJ, NY, PA) and eight people have been hospitalized, according to the Centers for Disease Control and Prevention.

No deaths have been reported.

On July 16, 2019, Northfork Bison Distributions recalled ground bison produced between February 22, 2019, and April 30, 2019. It was sold to distributors as ground bison and bison patties, referred to as Bison Burgers and/or Buffalo Burgers. Recalled ground bison was also sold to retailers in 4-ounce burger patties, the CDC said.

People get sick from Shiga toxin-producing E. coli an average of 3 to 4 days after swallowing the germ. Most people get diarrhea (often bloody), severe stomach cramps, and vomiting.

While most people recover within a week, some illnesses can last longer and be more severe, the CDC said.