Work related?

[kdish]

Hello...I am concerned about my 25 yo son..he works for a professional baseball team as a goundskeeper and is frequently exposed to products such as Diamond Dry (clay like mateial to soak up wet spots). They do not wear masks when applying to the infield. He has worked full time at this job for 3 years plus...Recenly he has developed symptoms he describes as:
Intemittent chest pain in varying locations, but mainly on the left side.
"It feels like the is a weight on my chest".
Slightly distend superficial veins on the chest and thoracic cavity...on the front only....
Has had several small capillary breaks around the diaphragm and right upper chest...they come and go.
Has had episodes of syncope...never has lost consciousness. Usually when knelling then standing or pulling the tarp.
Finds it difficult to get comfortable...lifting and physical exhertion increase symptoms.
A recent EKG was normal, Blood Pressure/Pulse normal...SGT elevated to 75...this was the only abnormal lab value from Thyroid, Liver enzymes and CBC. Chest X-Ray results pending. Sees his internist again June 2nd..but should we wait?
He has had most of these symptoms for a few months....but lack of insurance has provided a challenge to say the least. We do have Parrots...but have had them for a few years and their cages are very clean.
He is a smoker...though has drastically cut back almost ceasing his smoking (yeah)..No one else in the house smokes. He is @ 6"1-180 lbs and overall has been in good health until now.
Please advise if you can if we should see cardiologist, seek more urget care..or wait it out until chest x-ray is back and we have completed the June 2nd visit.
He is currently off work but symptoms still persist.
Thanks!
KAthy

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Kathy,

Related to the possibility of histoplasmosis, here is an article that might be interesting for you and your son.

Radiographics. 2001 May-Jun;21(3):737-57. Fibrosing mediastinitis. Rossi SE, McAdams HP, Rosado-de-Christenson ML, Franks TJ, Galvin JR. Department of Radiology, Buenos Aires, Argentina.

Article Abstract:

"Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases in the United States are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young and present with signs and symptoms of obstruction or compression of the superior vena cava, pulmonary veins or arteries, central airways, or esophagus. There may be two types of fibrosing mediastinitis: focal and diffuse. The focal type usually manifests on computed tomographic (CT) or magnetic resonance (MR) images as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests on CT or MR images as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. CT and MRI imaging play a vital role in the diagnosis and management of fibrosing mediastinitis."



~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Kathy,

From your description, the diagnostic plans and next steps sound appropriate to determine the diagnosis. As your internist has likely discussed, there are several possibilities which include but are not limited to histoplasmosis, sarcoidosis, lymphoma, thymoma, mediastinal thyroid mass. Also, the CT scan + labs + and possibly a biopsy will assist with narrowing down the diagnosis.

Please feel free to keep your questions and thoughts coming.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hi Kathy -

The chest x-ray is an important part of the diagnostic/medical evaluation based on the symptoms that you describe. The chest x-ray results should be available within 24-48 hours from the exam and you might consider requesting the results or making a follow-up appointment sooner than June 2nd.

My understanding is that Diamond Dry is composed of processed corn cobs. Do you know what other substances or chemicals are used in the Diamond Dry? What other products are used by your son while performing his job? Do any of your son's co-workers have similar symptoms?

Does your son complain of wheezing or is shortness of breath while physically exerting himself his predominant symptom? Does your son have a history of asthma or lung problems (besides the history of smoking)? Does you son feel better or worse when he lies down flat on his back?

With regard to the "syncope" that you describe, has he lost consciousness or only felt "lightheaded and dizzy"? In general, syncope implies a loss of consciousness.

With regard to seeing a cardiologist, I would recommend that you discuss a referral with the internist.

Please feel free to keep this line of communication open.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[kdish]

Thanks so much for the article and your input/ feedback. The cardic symptoms seem to develope when he would bend or pull on the tarp, he would experience chest pain and lightheadedness, as well as distention of superficial blood vessels.When he would change position, the syptoms would gradually subside.
Whatever the diagnosis, we are happy to be moving forward so quickly to determine the corse of treatment in getting this young man feeling better and back to work.
Will definately continue to post so that others may be helped when faced with similar challenges.
Kind regards,
Kathy

[kdish]

Chest X-Ray noted Pulmonary nodules and a mediastinal mass...Son has been seen by an internist today at Washington University School of Medicine.....CT/with dye scan tomorrow and they drew labs for Histoplasmosis Antigen today.
Pending CT results the referral to the appropriate scpecialist will be made.
As my  son has worked the last four years as a grounds crew person, and two years before that in the nursery business...Histoplasmosis looks like a posibilty as he has been "in the dirt" for 6 plus years.
He just looks "too healthy" overall to have CA...
We will see...thanks again for your input Dr. Parks.  If it is Histoplasmosis...the ballteam may want to institute masks for their grounds crew at the appropriate time....
Thanks again,
Kathy

[kdish]

Thank you so much for the quick response....my son had the chest x-ray today and hopefully we will have heard from the Dr. by tomorrow..or more likely on Monday.
With regards to chemical exposure and other products used......other than the chemicals used to treat the grass (fertilizer and fungacide) and the chalk to line the bases, Diamond Dry is the main substance they use....I will pull an MSDS sheet and check the components and get back to you. He does state when they moved from the old stadium to the new two years ago they had to clean out a storeroom that contained chemicals of some sort. He complained about it for a few days, but then was ok. I'll quiz further to see if he can find out what it was.
There is no history of asthma but he does suffer from seasonal allergies. He has has to quit a seasonal job in a nursery do to the chemicals they sprayed on the trees/shrubs. However the syptoms were nothing like the ones he exhibits now. He does feel better sleeping proped up on a couple pillows. He has the chronic dry cough...no sputum. Anti-inflammatories provide little relief.
He is someone who likes to work, and I know he really must be feeling poorly to have missed a couple weeks of work. This is not a workman's comp claim....he just want's to find out what is wrong and it is hard due to not having insurance.
Thanks so much and I'll be back with more info later.
Kathy