The Newsletter of the Hanford Health Information Network
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| Vol.3, No.1 | Winter 1997 |
Inside this Coping: |
by Jim Thomas, HHIN Research Director
A new assessment requested by the Agency for Toxic Substances and Disease Registry has identified several weaknesses in the work of the Hanford Environmental Dose Reconstruction Project (HEDR) on the Columbia River pathway. A "pathway" is the way people might have been exposed to radioactive materials. HEDR considered the Columbia River pathway to include consuming contaminated river water, fish or shellfish, and spending time along, on or in the river downstream from Hanford. (See also, Hanford-Related Studies.)
According to the new assessment, a key weakness in HEDR's Columbia River work is failing to consider another pathway: eating whole fish (including the bones) rather than fillets. This would apply to Native Americans and possibly to other groups of people. The HEDR reports reviewed in this assessment were not intended to apply to Native Americans, however. HEDR's reconstruction of dose estimates for Native Americans is continuing.
The assessment of HEDR was done by Owen Hoffman, Ph.D., and his colleagues at SENES Oak Ridge, Inc. Hoffman presented their conclusions to the December 1996 meeting of the Hanford Health Effects Subcommittee (HHES). (
Additional Radionuclides
Early in HEDR's work, some initial calculations (called scoping calculations) were done to help focus the work on the pathways and radionuclides that contributed the most to people's exposures. Based on these calculations, HEDR chose five radionuclides (phosphorus-32, sodium-24, zinc-65, arsenic-76 and neptunium-239) and used them in estimating the Columbia River doses to representative individuals. HEDR reported these estimates in 1994.
Hoffman reviewed the HEDR scoping calculations and found another key weakness. The calculations were done only for adults at the time of exposure and not for children. Generally, children are more sensitive to radiation exposure than are adults.
Hoffman's own scoping calculations identified three radionuclides that he believes need to be reconsidered for future Hanford dose estimates.
Iodine-131 has an eight-day half-life and was released to the Columbia River during fuel element failures at Hanford's plutonium production reactors. HEDR estimated that there were approximately 2,000 failures, mostly from 1955 to 1965. The main route of exposure from iodine-131 in the river would have been internal: from drinking river water, especially in the Tri-Cities.
Cobalt-60 was released with the reactors' regular effluent and settled in the river's sediments. It has a five-year half-life and is a very strong emitter of radiation. The main route of exposure would have been external: from getting near the sediments, by walking along the shoreline or by swimming.
Strontium-90 concentrates in the bone when it enters the body and has a half-life of about 30 years. Hoffman recommended further consideration of strontium-90 for people who ate whole fish (including the bones).
Radiation Risk Estimates
Hoffman also estimated risk to people exposed to the Columbia River pathway and compared it with his estimate of risk for those exposed to the air releases of iodine-131. He concluded that some people exposed to the radioactivity in the river were at a similar level of risk as those exposed to airborne iodine-131.
Based on HEDR's 1994 reports, most scientists and government officials had considered the risks from the river pathway to be much lower than the risks from the air. Last year, the HHES recommended developing a medical monitoring program for those most heavily exposed to the iodine-131 releases to the air.
COPING |
Rebecca Leonard lived in The Dalles, Ore., from 1953 to 1957. Her family ate fruit and vegetables from their garden and fish from the Columbia River. She has hypothyroidism and scleroderma. We asked about her experiences in choosing health care.
Responding are two naturopathic physicians, Debra Clapp, N.D., and Ralph Wood Wilson, N.D., M.S. Acupuncture; and a primary care physician, Suzanne Staudinger, M.D.
Rebecca: It's difficult to find a doctor that truly knows about scleroderma and how to treat it. When you mention "Hanford downwinder," doctors look at you like you are nuts or want to sue someone. Where would you find a doctor that knows about this condition? How would I find others with this condition?
Drs. Clapp and Wilson: You deserve respect and attention from your caregiver. Scleroderma is one of many connective tissue diseases, possibly with an autoimmune component. These are not well understood.
Different types of health care providers take significantly different approaches to health and disease. You might like a team approach. Holistic practitioners (naturopathic doctors, acupuncturists, Chinese herbalists, homeopaths, etc.) do not see all scleroderma patients as the same, and will tailor the therapy to your experience. Interview several about their training, diagnostic methods, therapies and time spent with patients. Would they cooperate with a diverse team? Ask about their experience with your diseases and how they would approach your situation.
Naturopaths (N.D.) use nutritional, herbal and other therapies to support connective tissue integrity and the immune system. N.D.s strive to maximize health as well as relieve symptoms, in part by correcting imbalances that may have contributed to your disorder. A computer search of natural medicine databases shows therapy combinations that can be tailored to a scleroderma patient.
The main radionuclide released from Hanford was radioactive iodine. Because the thyroid concentrates iodine, it is thought to be most at risk, although other sites may be at risk. Health history, physical exam and lab/diagnostic tests help detect abnormalities at early, treatable stages. Many N.D.s treat hypothyroidism and can provide care for cancer patients to decrease side effects of chemo- and radiation therapy and to maintain viable immune function.
Dr. Staudinger: I can imagine that you had trouble finding a doctor to answer all your questions. Because scleroderma is uncommon, not all doctors are familiar with it.
Scleroderma is a disorder in which the body's connective tissue becomes very thickened. It can affect the skin, blood vessels, lungs and kidneys. Patients who just have involvement of the skin usually consult with a dermatologist. If internal organs are affected, you would want to see a rheumatologist (specialist in the musculoskeletal system and joints) in addition to your primary care doctor.
In some areas, your county or state medical society or a community hospital may be able to refer you to a specialist in your area. Or try contacting a national group. For example, there are national organizations for scleroderma patients (see selected resources below). HHIN may be able to help you locate a support group or connect you with other downwinders in your area.
Another option is to ask your primary care doctor if he/she is interested in becoming your "expert" about the health effects of living downwind of Hanford. You could help by sharing information you have found (such as HHIN's health care provider packet) and letting your doctor know how to stay updated. If your doctor doesn't feel comfortable doing this, respect that decision and keep looking until you find a doctor who is interested. They do exist!
National Organization of Rare Disorders, Inc. (NORD)
Networking Program connects families having the same diagnosis.
Reports (at a nominal charge) and Web site offer disease information, list support organizations and other services.
NORD, P.O. Box 8923, New Fairfield, CT 06812-8923, 1-800-999-6673;
Web site: http://www.pcnet.com/~orphan/
Specific disease organizations
Search on the Internet. For example, the Scleroderma Federation, Inc. (1-800-422-1113) makes referrals to doctors and has support groups.