Environmental Issue & Sick Building Syndrome Blog

Lawsuits Filed In Cases of Death in Mold Outbreak at UPMC Hospitals

Paris Healthcare Linen Services has been discovered to be the original source of the mold.

A deadly mold outbreak at University of Pittsburgh Medical Center hospital campuses Montefiore, Presbyterian and Shadyside in Western Pennsylvania has been linked to contaminated bed linens from Paris Healthcare Linen Services. The contaminated sheets and linens were distributed by Paris Linen’s DuBois facility in Clearfield County; the same location which provides linens to all UPMC hospital campuses.

The attorneys of Meyers Evans Lupetin & Unatin are currently (as of October 31, 2017) representing four families in cases against the UPMC hospital system and Paris Companies in which multiple transplant patients have died as a result of a fungal infection. More such lawsuits are expected to be filed in the coming weeks.

About The Mold Outbreak

This mold outbreak started with sheets that were contaminated with the fungi including Rhizopus, Rhizomucor, Mucor, Lichtheimia, and Zygomycetes.

These common fungi are considered harmless for most people – but for immune compromised patients or those suffering from auto-immune diseases they can result in a deadly infection such as Mucormycosis or Zygomycosis.

The sheets delivered by Paris Companies to the UPMC hospital system were found to be damp and contaminated with the mold spores. Upon delivery they were distributed throughout the hospitals, including to the transplant wards, where immune suppressed transplant patients were exposed to the fungi both through skin contact and more dangerously, through respiratory contact.

As of February 2017, the UPMC hospital system continues to use Paris Companies as their hospital linen distributor, and Paris Companies continues to use the same laundry service.

Any patient suffering from an auto-immune disorder or a compromised immune system needs to be aware that UPMC hospitals may not taking proper precautions to protect patients from exposure do potentially deadly mold and fungal infections.

Contact our experienced medical malpractice lawyers if you have questions about any patient treated at UPMC hospitals that experienced a fungal infection during hospitalization.

Additional Articles About The UPMC Mold Outbreak From Other Sources:

Trib Live: Family disturbed by UPMC statements on mold death
CNN: Lawsuit alleges sixth death linked to Pittsburgh hospital mold outbreak
Post Gazette: Lawsuit says mold killed patient at third UPMC hospital
CBS: Attorneys: 6th Patient Died Due To UPMC Mold Outbreak
WPXI: Lawsuit blames death of 6th patient on UPMC mold
WTAE : New lawsuit alleges wrongful death of UPMC Shadyside patient due to mold infection
CNN: Mold at two Pittsburgh hospitals linked to 5 deaths

Posted by Dan Howard on May 14th, 2018 9:26 PM

Did you ever think that exposure to the environmental problems that make us sick is like hitting your thumb with a hammer……..but nobody can tell you what the hammer is?

We go and do so many different things and go so many places each day that it is often difficult to pinpoint what “is” or just as importantly what “is not” making us ill.

       Making all of this figuring out whether something in our environment is making us ill more of a puzzle is the fact that we react to environmental stresses in “time delay”. The difficulty is “time delay” is not how our brain usually works.

       Please let me explain: If we touch a burner on the stove, we feel pain. If we hit our thumb with hammer, we immediately feel the consequences of that action. Based upon that reaction, we each learn not to do those things. We learn in real time that for those actions there is a predictable, consistent and unpleasant reaction. We also figure out to not do those things again. However, I must admit that when I worked as a carpenter to get through college, that hitting fingers with a hammer happened a couple of times past the first. Before you judge that fact, I assure you that IT WAS NOT ON PURPOSE. Ouch.

        Environmental exposures are more complicated because they not only happen in time delay, but they also often occur in combinations of events. Our minds do not do well at processing the complex conditions and events that trigger environmental reactions.

       Keeping a diary of how you feel, where you are what you are doing and what you eat is probably the best tool for establishing health patterns that may predict sources of environmental reaction.

       As an example, a diary could show that you become ill 6 to 10 hours after a visit to a particular building, riding in and automobile, eating a particular food or a host of other events occurs. This can be a life changing tool.

      Based on that information, an assessment by a environmental specialist and testing of the area that appears to be the source of illness is the next step on the path to a return to good health

       Mold is one of the most common triggers for health issues. Allergens are another very common trigger. Testing for these issues is a prudent first step in the process of narrowing sources of environmental stressors
Posted by Dan Howard on May 12th, 2018 4:40 PM

CEDAR PARK, TX (CBS Local) – A Texas mother is speaking out after an attempt to clean a fish tank nearly killed her and her entire family.

Chasity Ahman was cleaning the family fish tank when she noticed a strange substance growing on the decorative coral inside the aquarium. “I noticed these little, cute… button polyps that were new to me,” Ahman said, via KHOU.

After scrubbing off the odd algae, Ahman said she immediately started to feel sick. Unknown to her, the algae had released a dangerous neurotoxin into the air. By the next morning the Ahmans were completely incapacitated and their condition stumped local hospitals. “I thought we were coming down with the flu or something. We couldn’t get out of bed. I couldn’t answer the door. I couldn’t force myself out of bed.”

According to local saltwater livestock experts, colorful coral arrangements known as palythoa can be deadly for owners who don’t know how to properly take care of them. “When that stuff becomes airborne, it’s usually caused by somebody scraping,” said Austin Aqua-Dome manager Hunter Leber. “I would suggest, really, to leave them alone for the most part.”

Ahman and her family reportedly spent two days in the hospital. The palythoa toxin also killed five of the family’s fish.

In late March, 10 people in Great Britain were hospitalized after being exposed to “palytoxins” that were released by a man cleaning his fish tank. 27-year-old Chris Matthews reportedly removed his decorative aquarium rocks from the tank and unknowingly exposed his family and firefighters to “incredibly lethal” fumes produced by the coral. Those patients were all treated and released after suffering flu-like symptoms and eye irritation.

Posted in:toxns and tagged: fish tanktoxinmedicine. coral
Posted by Dan Howard on May 6th, 2018 10:09 PM

Prevent Lyme Disease

Family of four outdoors

Before gardening, camping, hiking, or just playing outdoors, make preventing tick bites part of your plans.

Lyme disease is spread by the bite of an infected tick. In the United States, an estimated 300,000 infections occur each year. If you camp, hike, work, or play in wooded or grassy places, you could be bitten by an infected tick.

People living in or visiting New England, the mid-Atlantic states, and the upper Midwest are at greatest risk. Infected ticks can also be found in neighboring states and in some areas of Northern California, Oregon and Washington. But you and your family can prevent tick bites and reduce your risk of Lyme disease.

Protect Yourself from Tick Bites

Know where to expect ticks. Blacklegged ticks (the ticks that cause Lyme disease) live in moist and humid environments, particularly in and near wooded or grassy areas. You may get a tick on you during outdoor activities around your home or when walking through leaves and bushes. To avoid ticks, walk in the center of trails and avoid walking through tall bushes or other vegetation.

Map: Report cases of Lyme Diseasae, United States 2009

Though Lyme disease cases have been reported in nearly every state, cases are reported from the infected person’s county of residence, not the place where they were infected. More Lyme disease data >

Repel ticks on skin and clothing. Use Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone. EPA’s helpful search tool can help you find the product that best suits your needs. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth. Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.

Perform Daily Tick Checks

Check your body for ticks after being outdoors, even in your own yard. Search your entire body for ticks when you return from an area that may have ticks. Use a hand-held or full-length mirror to view all parts of your body and remove any tick you find. Take special care to check these parts of your body and your child’s body for ticks:

Graphic: Tick sizes
  • Under the arms
  • In and around the ears
  • Inside the belly button
  • Back of the knees
  • In and around all head and body hair
  • Between the legs
  • Around the waist

Check your clothing and pets for ticks because they may carry ticks into the house. Check clothes and pets carefully and remove any ticks that are found. Place clothes into a dryer on high heat to kill ticks.

Remove Attached Ticks Quickly and Correctly

Photo of Sign: Prevent lyme disease tips

Remove an attached tick with fine-tipped tweezers as soon as you notice it. If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small; however, other diseases may be transmitted more quickly.

Over the next few weeks, watch for signs or symptoms of Lyme disease such as rash or fever. See a healthcare provider if you have signs or symptoms. For more information, see tick removal.

Be Alert for Fever or Rash

Even if you don’t remember being bitten by a tick, an unexpected summer fever or odd rash may be the first signs of Lyme disease, particularly if you’ve been in tick habitat. See your healthcare provider if you have symptoms.

Prevent Ticks on Animals

Prevent family pets from bringing ticks into the home by limiting their access to tick-infested areas and by using veterinarian-prescribed tick prevention products on your dog.

Create Tick-safe Zones in Your Yard

Modify your landscaping to create “Tick-Safe Zones.” It’s pretty simple. Keep patios, play areas, and playground equipment away from shrubs, bushes, and other vegetation. Regularly remove leaves, clear tall grasses and brush around your home, and place wood chips or gravel between lawns and wooded areas to keep ticks away from recreational areas (and away from you).

  • Use a chemical control agent. Use acaricides (tick pesticides) to reduce the number of ticks in treated areas of your yard.  However, you should not rely on spraying to reduce your risk of infection.
  • Discourage deer. Deer are the main food source of adult ticks. Keep deer away from your home by removing plants that attract deer and by constructing barriers (like a fence) to discourage deer from entering your yard and bringing ticks with them. ?
Posted in:mold, lyme, and tagged: MolddiseaseLymeCIRS
Posted by Dan Howard on May 4th, 2018 9:35 PM

NIH statement on World Asthma Day


NIH video: patients and scientists work together to advance asthma research.

On World Asthma Day 2018, the National Institutes of Health stands with people worldwide to renew our commitment to advance understanding of asthma and develop effective strategies to manage, treat and ultimately prevent the disease. A new three-minute NIH video provides a glimpse into the stories of patients and doctors who are working to advance research. Patients discuss the impact asthma has had on their lives, and investigators highlight promising areas of research and the critical role that clinical trial volunteers play in combatting the disease. 

Asthma is a chronic lung disease characterized by episodes of airway narrowing and obstruction, causing wheezing, coughing, chest tightness and shortness of breath. An estimated 235 million people worldwide, including 24.6 million in the United States, have asthma. The disease can reduce one’s quality of life, and it is a major cause of missed time from school and work. Severe asthma attacks may require emergency room visits and hospitalizations, and they can be fatal. NIH is committed to reducing the burden of this disease, which disproportionately affects minorities and families living at or below the poverty line.

NIH conducts and supports all stages of asthma research, from basic studies in the laboratory to human clinical trials. Clinical research volunteers are essential to developing new interventions and treatments, and NIH expresses our gratitude to all the individuals and families who have participated in these clinical studies.

Three NIH institutes support and conduct studies on asthma—the National Institute of Allergy and Infectious Diseases (NIAID); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute of Environmental Health Sciences (NIEHS). Each institute focuses on a specific area of asthma research, with the common goal of developing improved strategies for management, treatment and prevention of this chronic disease.

NIAID supports asthma research focused on understanding the immune responses that lead to asthma, as well as developing asthma prevention strategies and treatments to improve life for those with the disease. As part of its broad asthma portfolio, NIAID sponsors two major programs — the Inner-City Asthma Consortium (ICAC), which studies the causes of asthma in urban children and works to develop treatments to improve asthma; and the Asthma and Allergic Diseases Cooperative Research Centers (AADCRC) program. With nine centers around the country conducting state-of-the-art human, basic and applied animal model research, the AADCRC program aims to understand the origins of asthma and the reasons underlying development of severe asthma. ICAC supports nine clinical research sites located across the United States, including the Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) asthma clinic at Children’s National Health System, led by Stephen J. Teach, M.D., M.P.H., chair of the Department of Pediatrics at Children’s National. 

Clinical research volunteers share their experiences of living with asthma and participating in NIH studies. To search for asthma studies in your area, please visit https://clinicaltrials.gov/.

Clinical research volunteers share their experiences of living with asthma and participating in NIH studies. To search for asthma studies in your area, please visit https://clinicaltrials.gov/.

NHLBI’s broad asthma research portfolio includes efforts to understand the biology of disease development, progression and severity and to optimize treatment for patients. Children’s National is a clinical site for the Oral Bacterial Extract (ORBEX) study, which is testing new ways to prevent or reduce wheezing in infants, a major risk factor for later development of asthma. Severe asthma, which disproportionately affects women and minorities, is an area of emphasis for NHLBI. Research in the laboratory of Stewart J. Levine, M.D., in NHLBI’s Division of Intramural Research revealed that apolipoproteins—proteins in blood that typically transport fats into and out of cells—play a role in asthma severity. Based on this research, NHLBI scientists have developed a potential new asthma treatment—a synthetic protein that mimics the function of an apolipoprotein associated with better lung function in people with asthma. In addition, the new NHLBI clinical trials network Precision Interventions for Severe and/or Exacerbation-Prone Asthma (PrecISE) will conduct early clinical trials with novel interventions in severe asthma patients to identify the best interventions for specific groups of patients. NHLBI also funds the Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities. This program supports clinical trials to evaluate Asthma Care Implementation Programs (ACIPs) that provide comprehensive care for children at high risk of poor asthma outcomes and will also include measures of the ability to implement and sustain the ACIPs in specific communities.

Asthma research conducted by NIEHS scientists focuses on the complex relationship between the environment, the immune system and asthma. Stavros Garantziotis, M.D., leads the Natural History of Asthma With Longitudinal Environmental Sampling (NHALES) study at the NIEHS Clinical Research Unit. The study examines how the environment affects asthma symptoms. In particular, Garantziotis and colleagues are investigating how the microbiome — the microbes naturally present in and on the body and in the home — may be associated with asthma activity. NIEHS also funds researchers studying the impact of environmental exposures on asthma. Some of these projects include pioneering the development of sensor systems that measure personal exposure to environmental triggers of asthma, clinical trials examining reductions in indoor air pollution exposures to improve asthma control, and innovative data science tools that integrate nationwide environmental data. These efforts promote better asthma prevention and management strategies. Several studies are specific to high-risk populations, including children and the elderly.

These examples represent only a small portion of NIH efforts to reduce the global burden of asthma. NIH is grateful to all those who help make advances in care possible—from scientists and health care professionals to clinical research volunteers, advocates and educators. Together, we can advance our shared mission to develop and implement effective strategies for the management, treatment and prevention of asthma. 

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at https://www.nhlbi.nih.gov.

NIEHS supports research to understand the effects of the environment on human health. For more information on NIEHS or environmental health topics, visit www.niehs.nih.gov or subscribe to a news list.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®


Posted in:Asthma and tagged: asthmaNIH
Posted by Dan Howard on May 1st, 2018 10:19 PM

The door in the picture is the entry door of a building having a mold assessment. SURPRISE! Termites inside the metal door. Yes, the door has metal on the outside, but these doors have wood between the metal faces to allow for installation of hinges and locks using carpenter tools for wood.

Termites and other wood destroying insects occupy the same place in the eco-system or "universal plan" as does mold. They recycle dead wood and turn it into top soil so that new plants and trees can grow.

It’s not that one causes the other. Think of it as they have the same needs to survive and thrive. As an example, we find both desert plants and animals in the same place.

In a damp location with wood fiber, we can find both mold and termites. Now I am not trying to be "Little Miss Mary Sunshine" here........there is a point to this observation.

When you have had a termite or other wood destroying insect infestation that requires damp wood, you should have the building also checked for mold. That advice goes the other way too. If you have mold, be on the look-out for wood destroying insects. The earlier you find either a mold or wood destroying insect infestation the less damage and expense will occur.

By the way, the door in the picture is hanging and swinging on only the top hinge. When I opened the door, the termites were scurrying to get out of the exposed air and light. 

This was an Interesting observation of nature at work. .........and as a science experiment, This was not as delightful as a science experiment for the building owner.

Posted in:Mold, termites and tagged: Moldtermitesdoor
Posted by Dan Howard on April 28th, 2018 9:54 PM

It’s the time of year that termites, carpenter ants, carpenter bees and other wood destroying insects are on the prowl to devour or damage wood. Your home could be on their list of targets.  When it comes to hiding from homeowners, the destructive pests have two things going for them. They do their damage in places few people look and most homeowners don't recognize what an infestation looks like. 

Many of the homes that have mold have wood destroying insects. Many of the homes with wood destroying insects have mold. The lesson is that if you have one, check for the other.

           Just like with mold, most infestations start where there is wet wood. It can be from a wet basement, leak where a concrete patio meets the house wall. a poorly sealed door sill, or a plumbing leak. The wood destroying insects found in most areas need water and lots of it.  

            Wood destroying insect infestations start with a nearby 'successful" but crowded insect nest. The original nest could be in a dead tree, its roots or a woodpile. The initial nest can also be in your neighbor's house, or the nearby woods. This established nest will send out a reproductive queen and additional insects to help the "new town" get established.  

          This entourage of invading insects are swarmers. These are insects that temporarily have wings to carry them out to colonize. They lose the wings at their new home. Think of the wings as their Conestoga Wagons to the Wild West or Shuttle to the space station. If you see something that may be members of a new colony, capture some of the insects in a jar to show a pest control professional.

The biggest mistake people can make is believing that after seeing swarmers, the swarmers decided to go to someone else’s home. The reality is that swarmers usually don’t leave. They start their nest in a hidden area.

Posted by Dan Howard on April 28th, 2018 6:48 PM

If you hired a restoration firm and paid them to restore your structure and contents, would you expect them to clean strictly for appearance, or should the safety and health of workers and your family be the primary concern?

Given a choice, which would it be: appearance or safety and health?

“Well, the answer’s obvious.” you say, “Of course I’d choose safety and health over appearance any day!”

Exactly; but don’t you think your restoration customers feel the same way?

To actually remove particles, gases and biologicals that create a potentially unhealthy environment, restorers must slow down, use well-maintained equipment and be trained and certified in multiple restoration disciplines.

“But Indoor Environmental Quality (IEQ) issues are far too complicated for me to grasp,” you say. “I barely can keep up with technical restoration issues.”

I used to feel exactly the same way. That’s until I came to understand that IEQ issues aren’t all that complicated – especially on the prevention side. Let’s summarize the three major categories of contaminants and see if that doesn’t clarify things somewhat for the average restorer.

Environmental contaminants fall into three basic categories:

  1. Particles – The human lungs cilia can trap particles down to about 10 microns in size. Smoke particles (0.1-4 microns) can penetrate deeply into delicate lung tissues where they can have a cumulative adverse effect over time. In our industry, particle contaminant also can include: asbestos (from deteriorating insulation or building materials during demolition), lead (lead-based paint), fire contaminants, biologicals (fungi and bacteria associated with aerosolized Category 3 water or prolonged drying), or just plain old household pollen, dust and dirt.
  2. Volatile Organic Compounds (VOCs or gases) – Anything from exhaust emissions, to dry-solvent vapors, to radon – all fall in this category. Interestingly, many restoration chemicals used to be significant contributors here because of their VOC content. But responsible product formulators have largely solved this problem.
  3. Microbiologicals (micro = microscopic, bio = life) – Here we’re talking about all those smelly substances resulting from living things growing and decomposing soils, and even building materials themselves. It includes the dreaded “black, toxic, killer molds” that are such a hot topic in the media today despite the fact that color is irrelevant; molds are “toxigenic” rather than toxic, and no normal person dies from household mold exposure. It includes water borne bacteria that are found everywhere and, given proper growth conditions, are waiting to amplify and decompose organic soils and materials.

“Good grief! This is getting a bit complicated,” you say. “Where and when did all this stuff become such a problem?”

Answer: only a few millennia ago when man began living on the face of the earth. Contaminants – really soils –have always been there. It was when man began enclosing himself, and the air he breathes, in increasingly sophisticated shelters (caves to condos) that pollutants became a problem. In fact, the energy conservation movement of the 1970s made the problem worse by eliminating air leaks (drafts) from our homes and businesses. By trapping conditioned air in structures and not exchanging it with fresh air from outside, we also trap contaminants, recirculate them time and again, and eventually, allow them to accumulate in the air we breathe. The result? IEQ problems.

So what do we do about all this IEQ stuff? Well, that’s where restoration professionals come in.

The following are seven guidelines for healthy restoration offered by the U.S. EPA. Look them over and see if they don’t make sense to you.

  1. Provide for the safety of all human beings before, during and after cleaning. OSHA regulations lay out specific requirements for safety compliance. Problem is, too many cleaning firms ignore these requirements, and regulators seldom check.
  2. Clean for health first and for appearance second. Fortunately when you clean for health, you also get outstanding appearance. But it doesn’t necessarily follow that better appearance produces a healthy environment.
  3. Maximize the extraction of pollutants from the building. The World Health Organization’s definition of cleaning includes: “locating, identifying, containing, removing and properly disposing of soils and pollutants.” Professional restorers must concentrate on this important goal. Otherwise, dirt or contamination might be less visible, but still present, and have a potentially damaging effect on property and occupants.
  4. Minimize chemical, particle and moisture residue. Most agents used in restoration are safe, but some leave residues that cause resoiling and even potential health effects. Particles left behind can become airborne and result in respiratory irritation. Prolonged drying (moisture) can result in resoiling, and eventually, microbial growth that can trigger allergies or asthma attacks.
  5. Minimize human exposure to contaminants, cleaning chemicals and cleaning residues. Both during and after restoring, professionals should make sure that neither they, nor their customers are exposed to HAZMAT.
  6. Evaluate cleaning in relation to the total environmental system, not just part of the system. Fabric and surface cleaning is only part of the solution to unhealthy environments. Trained, certified restorers can advise property owners of other strategies to improve IEQ.
  7. Dispose of cleaning wastes properly. Finally, when soils are removed, or unsalvageable materials have been packaged during restoration, they must be disposed in an environmentally-responsible way.

OK. Specific to the restoration industry, what can restorers do to maintain IEQ?

1. Fire and smoke restorers should ensure that:

  • Fire damaged sites are adequately ventilated during initial inspection and restoration work;
  • Appropriate PPE is available for workers and occupants during inspection and evaluation, and inventorying and packing;
  • Engineering controls, along with managed airflow, are used to contain contaminated areas, or any area during deconstruction, to avoid aerosolizing contaminants, HAZMAT or debris;
  • HEPA-filtered vacuum cleaners are used for initial dry soot removal to avoid particle aerosolization and cross contamination;
  • HEPA-filtered air filtration devices (AFDs) are used to control particle aerosolization during structure and contents cleaning, particularly when occupants or workers are present in work areas, and all restoration products – cleaners, sealers, deodorants – are evaluated for the presence of VOCs, and products that have been evaluated and approved for use in indoor environments are substituted.

2. Water damage restorers, particularly on Category 3 losses, should ensure that:

  • Airmovers not only operate safely (properly grounded electrical cords, protective screens on inlets and outlets), but also that screens, fan blades, and squirrel cages are clean and free of dust, microbials and contaminants from previous jobs;
  • Dehumidifier filters, coils and drip pans are thoroughly cleaned and decontaminated after each job;
  • AFD components (fans, ducting) are clean and well maintained, with new filters before placing them on successive job sites;
  • Thorough cleaning takes precedence over antimicrobial application;
  • Low-VOC antimicrobials are selected and used properly, always following label directions, and recording dilution rates and the quantity of dilute product applied;
  • Recommendations are made for post-remediation evaluations, performed by qualified IEPs, and conducted after unsanitary water losses, and
  • Unsalvageable microbially contaminated materials are packaged and disposed properly.

3. Deodorization and decontamination restorers should ensure that:

Environmentally-friendly and approved products (cleaners, EPA-registered disinfectants) are used;

  • Appropriate PPE is available to workers;
  • OSHA regulations regarding bloodborne pathogens are followed;
  • Contaminants are properly packaged and disposed, and
  • Equipment is decontaminated thoroughly before loading for transport, and a second time before being returned to storage in the restoration facility.

Cleaning for health must become a priority for true professionals. Indeed, today’s informed consumer should demand more of restorers who service their homes or businesses. Appearance only is no longer an acceptable criterion for evaluating results. When customers call a restoration firm, they should be assured that the safety and health of workers and occupants is the company’s first priority.

After all, it’s not just occupant or worker health, but also the restorer’s reputation that is at stake.


Posted by Dan Howard on April 24th, 2018 9:46 PM

National Primary Drinking Water Regulations

The National Primary Drinking Water Regulations (NPDWR) are legally enforceable primary standards and treatment techniques that apply to public water systems. Primary standards and treatment techniques protect public health by limiting the levels of contaminants in drinking water.

Printable version: Complete NPDWR Table

Posted by Dan Howard on April 20th, 2018 8:24 PM
Leonard Sigal, MD, clinical professor and former chief of the Division of Rheumatology at Robert Wood Johnson UMDNJ Medical School, explains his approach for treating Lyme disease patients with persistent symptoms.

“There are many potential explanations for why somebody has ongoing complaints after what should have been adequate antibiotic therapy. First of all, it’s possible that the patient didn’t take the antibiotics. You give them 2 weeks of doxycycline and they got 5 days [but now it’s] sitting in the medicine cabinet because they feel so much better. Why bother, right? [The thought is] so they’ll have the antibiotics for next time that they get bitten by a tick. This is not the way that we practice medicine. And so, it’s possible that they didn’t take the antibiotic.

It’s also possible that the antibiotic was not absorbed. There are some people for whom the diarrhea and abdominal pain from doxycycline are so great—and the same thing is true sometimes of amoxicillin—that they just flush it right through their system and it never really gets absorbed. There are other people for whom it’s not diarrhea, it’s just that they don’t absorb it; it’s possible.

There are people who had more advanced disease than you identified at the time you saw them. Let’s say that you see somebody with erythema migrans—the rash of Lyme disease—you give them oral antibiotics because it turns out that they already had meningitis; it was subclinical, you didn’t see it, you didn’t appreciate it. They come in 3 weeks later for a follow-up and they say, ‘My neck is so stiff and I’m feeling so weak.’ We can do a spinal tap if there are cells; you can also find antibodies against the organism, but if you find a lot of inflammatory cells, this is meningitis. This requires intravenous (IV) therapy, not oral therapy. And so, I didn’t give the appropriate therapy the first time through, not because of my incompetence, but because it was subclinical.

Assuming that you have given appropriate antibiotics and they were absorbed, some people will have persistence of organisms—presumably. That’s very ill-defined, as of now. But it is possible that there is a persistence of organisms. All of the organisms that have ever been identified, all the Borrelia burgdorferi, are sensitive to the antibiotics that we use; it’s not as though there’s a resistant strain out there. But it’s possible that it was in a cell someplace and the cell broke open and now, you’ve got the organism multiplying again. And so, in some sort of a privileged site, it’s possible—unproven, but possible.

The second potential explanation is debris, dead organisms lying there in a joint, as an example, and it’s a focus of ongoing inflammation because your macrophages are trying desperately to get rid of this residual stuff and it’s very indigestible. And so, there’s ongoing inflammation; that’s ongoing symptoms, despite. It’s possible that you might have debris elsewhere in the body and have inflammation and inflammation is causing your symptoms—global inflammation, systemic inflammation.

It’s possible that what’s going on in the patient is immune in mechanism, that somehow the infection has caused an immune response, not necessarily autoimmune, but an immune response, an ongoing inflammation, and so, it just can’t be tamped down. It could be autoimmune; I must tell you that Alan Steere looked at autoimmunity due to B. burgdorferi outer-surface protein (OspA), or centered on OspA. I think that has been demonstrated to not be of any clinical relevance.

My laboratory, when I was at Robert Wood Johnson, looked at neurologic disease. We found cross-reactivity between a Borrelia burgdorferi antigen and a human antigen. The possibility of autoimmunity was raised. We demonstrated it in the laboratory; I don’t know that we have ever seen that be of clinical relevance, but it’s possible. There’s no evidence to suggest that it happens, but it’s possible. Ongoing immunity, autoimmunity, maybe.

The final explanation is that the patient once had Lyme disease but something else is going on now. As I said before, Alan Steere has shown that there are people who have chronic inflammatory diseases that have nothing to do with Lyme disease, that follow Lyme disease. Life does not come to a screeching halt medically when you eradicate Borrelia burgdorferi; other things can happen. Are they causative? Is it that the B. burgdorferi caused rheumatoid arthritis? There’s no reason to believe that’s the case, but it happened.

And so, it’s very important that you not assume. Remember the old expression, ‘When you assume, you make an ass out of you and me?’ It’s very important that you not assume that something that happens after Lyme disease, is, therefore, due to the preceding Lyme disease. You have to have an open mind about this. What you need to do is approach the patient, with the Lyme disease in the background, but look for other potential explanations. Does this lady have Lupus? Does this lady have rheumatoid arthritis? Does this lady have amyotrophic lateral sclerosis? And then, there’s always the very real question: Was the initial diagnosis of Lyme disease correct? Very frequently, in a referral practice, you’ll see somebody come in with a diagnosis of Lyme disease that I can’t substantiate; I don’t know how that diagnosis was made. When I start digging through the records, there’s [nothing there to indicate it]. And so, it’s very important that you be sure that there’s really a Lyme disease diagnosis that is supportable in the first place. But even if there was, look for other things to make sure that you don’t miss something. Because the diagnosis of chronic Lyme disease is almost a diagnosis of exclusion, and a diagnosis of exclusion is a very difficult thing to do because it means that you’ve excluded everything else? Not the easiest of practicing medicine.”

What Is "Lyme Anxiety?"

“Lyme anxiety: the anxiety related to Lyme disease, usually related to the diagnosis of chronic Lyme disease. So, somebody walks into the office with erythema migrans, who’s done a little bit of research, and says, ‘That. That’s Lyme disease, isn’t it?’ And I say, ‘Yep. We’re going to give you some antibiotics and you’re going to get better.’ And the overwhelming majority of people in that setting do get better.

It’s the person who walks in with vague complaints, no physical findings, nothing that I can say, ‘That’s what it is.’ It’s a vague constellation of complaints. Those people, somebody has told that that it’s Lyme disease; it might have been at the grocery checkout; they might have been looking at something on the internet; they might have been going to a physician who claims that it’s chronic Lyme disease. And then they would wind up coming to me at the referral center that I used to run at Robert Wood Johnson.

And they’re scared out of their minds because they think ‘I’ve had this disease for who knows how long. Look what it’s doing to me. I’m not going to be around to watch my children grow up.’ People’s anxiety runs wild. Should you be concerned if you have Lyme disease? Sure. Is there reason to be afraid of it? A little bit, sure. But to approach hysteria is in nobody’s best interest and it’s really unnecessary. And it’s really one of the really toxic consequences of this ongoing debate about chronic Lyme disease.”

Posted by Dan Howard on April 20th, 2018 6:32 PM



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