Agricultural Medicine

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Agricultural Medicine

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James E. Lessenger, MD, FAAFP, FACOEM

Morinda Medical Group, Inc., Porterville, California Editor

Agricultural Medicine

A Practical Guide

With 15 Illustrations

Foreword by Stan Schuman, MD, DrPH, LLD

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James E. Lessenger, MD, FAAFP, FACOEM Morinda Medical Group, Inc.

Porterville, CA 93257 USA

Library of Congress Control Number: 2005928355

ISBN 10: 0-387-25425-0 ISBN 13: 978-0387-25425-8 Printed on acid-free paper.

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.

While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

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Foreword

The reader of this volume will experience a voyage of discovery with one of the finest guides available. James E. Lessenger has combined experience in private practice, preventive medicine, and public service in California’s San Joaquin Valley, one of the most productive agricultural regions in the world.

His experience and selection of chapter authors is, in every sense, a contribu- tion to illuminating the art and science of agromedicine. As one examines the table of contents, one is impressed by the range of topics and the importance of each concern. Covering both injury prevention and environmental hazards, this innovative work is a practical guide for the family physician working in a rural area. The contents demonstrate the vitality of agromedicine and the vision and insight of the authors.

The chapters on farm chemicals provide thorough information about the many types of chemicals commonly used in the farm environment, how they are applied, and the principles of diagnosis and management for family physicians treating patients for toxic chemical exposure. These chapters underscore the fact that the use of farm chemicals is one of the things respon- sible for the increase in worldwide agricultural production and that risks can be managed through preventive measures.

The Agricultural Medicine represents a benchmark in the evolution of a concept begun in South Carolina over two decades ago called agromedicine.

Several faculty members at two state-supported universities in South Car- olina needed a shortened name for our closer partnership between the land grant campus of Clemson University and the Medical University of South Carolina at Charleston. In 1983 the agromedicine program was only an idea:

how to provide an innovative public service program to benefit farmers and farm families with the most useful information on health, safety, nutrition, and preventive medicine. The new term agromedicine connotes an update of the traditional terms agricultural health and safety and agricultural medicine.

The need for the agromedicine partnerships is just as real now as it was in its inception. The target population of farmers, farm families, and consumers of food and fiber are underserved by direct and effective forms of preventive medicine. These forms include health education, patient motivation, and food safety. Dr. Lessenger’s book addresses these issues as well as preventable disorders such as noise-induced hearing loss, ultraviolet light–induced skin can- cers, heat and humidity syndromes, allergic anaphylaxis, zoonoses, injuries, and pulmonary disorders.

Complex agromedicine questions keep arising: How should we focus on the most practical health measures for the average hard-working rural farm

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family and consumer? How should we react to illnesses resulting from hazards such as infectious rodents and ticks, noxious hog-farm odors, botanical toxins and dermatitis, pesticide residues measured in food at parts per billion or trillion, self-medication with herbal preparations, and excessive stress pre- disposing farmers to depression and suicide? How should we define the prob- lem, select countermeasures, and communicate to farmers and farm families at risk?

The average farm family today differs from that of the 1980s. Rural patients and extension clients in the past were less oriented to the media and untouched by cyberspace. Today’s farm family can be deluged with health information and misinformation. One constant issue is that health insurance is still an unmet need for many farm families. Chapters 1 and 2 of this book address the context of agricultural medicine and traditions that affect treatment. Health issues of migrant farm workers are also covered.

Our experience in South Carolina helped other southeastern states initiate similar interuniversity partnerships for their farmers and farm families. Nat- urally, priorities and methods of outreach vary with the types of agriculture.

Grain farmers endure different hazards than orchard sprayers; the ergonomics of dairy farmers differ from those of vineyard workers; heat stress and cold injury vary with climate. Client-based research will lead to a broadened range of preventable health problems, whether they involve food bioterror- ism, the Norwalk virus in oyster beds, immunodeficiency in poultry workers, asthma in hog-confinement operations, or anaphylaxis from fire ant stings.

In South Carolina, in the 1980s, client-based research led us into medical entomology and epidemiology: How many cases of Lyme-like illness are never reported? How can people protect themselves from unnecessary tick- borne disease? How can patients get specific antibiotic/antiinflammatory treatment early? How can primary care physicians offer earlier diagnosis and treatment? It is clear that agromedicine is not a subspecialty of occupational medicine seeking academic or grant recognition as it is a responsive pro- grammatic approach to emerging rural health problems in exposed segments of the population.

Stan Schuman, MD, DrPH, LLD vi Foreword

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Preface

This is the book I wish I had when I started practicing medicine in an agricultural community. During 22 years of researching, practicing, and teaching agricultural medicine, I have encountered bat bites, thorn punctures from cit- rus, grain harvester machine entrapments, and pesticide exposures. I have seen packing-house women who routinely got into fist fights, and a lawyer run over by a bull while visiting a dairy. I’ve treated farm laborers from Mex- ico who worked 12 hours a day, and millionaires dressed in mud-caked jeans and boots, looking not much different from the day laborers.

People in agriculture are a hearty and bull-headed group. You can tell a cowboy to wear a cast; the next day he will be riding a bull with the cast miss- ing. He will tell you he “lost” it. Or the farmer will insist on working even though his finger was just cut off by a machine: “It’s just bleeding a little, Doc. Can’t you put a butterfly on it?”

This book cuts across several different medical disciplines to include those subjects of importance to a physician practicing in an agricultural area. As such, it is a reference and overview of those subjects that form the core of primary care in farming communities. Important topics include the broad field of farm chemicals, the nexus of food safety and employee health, com- mon injuries seen in agriculture, and special topics including mental health, diseases and injuries of veterinarians, and zoonoses.

This book is intended for students, researchers, academicians, and, most important, physicians on the front lines of illness and disease among agricultural workers. It is designed to be as useful as a text to students new to the field and as a reference for those of us who have been in the field for decades.

The authors of this book are as diverse as the field of agriculture is broad.

Professionals from around the world and representing multiple scientific disciplines have contributed. They come from academia, clinical practice, scientific institutions, and industry to present a broad-based introduction to the care of individuals in a diverse field.

I am indebted to Dr. Stan Schuman, editor emeritus of the Journal of Agromedicine, and Dr. Robert Taylor, editor of Family Medicine: Principles and Practice, for their guidance and help over the last decade.

I am grateful to Robert Albano for the opportunity to write this book.

Developmental editor Merry Post was instrumental in bringing it to fruition.

My son Ernest, now an MBA student at Rice University, helped me with all the computer setups. My wife, Leslie, who has a Ph.D. in psychology and

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keeps me sane, helped with research, reviewed manuscripts, and gave encour- agement. My deepest thanks to all those involved in this project.

James E. Lessenger, MD, FAAFP, FACOEM Porterville, California viii Preface

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Contributors

Karl Auerbach, MD

Assistant Professor, Department of Occupational and Environmental Medi- cine, University of Rochester, Rochester, NY 14642, USA

A. Nelson Avery, MD

Associate Professor and Director, Department of Occupational and Envi- ronmental Health Services, University of Texas Medical Branch, Galveston, TX 77555, USA

James B. Becker, MD

Associate Professor, Department of Family and Community Health, Joan C.

Edwards School of Medicine, Marshall University; Chief of Industrial, Department of Occupational and Environmental Health at Marshall University; Director, Office of Medical Management, West Virginia Office of Workers’ Compensation, Marshall University, Huntington, WV 25701, USA

James M. Daniels, MD, MPH, FACOEM, FAAFP, FACPM

Director, Primary Care Sports Medicine Fellowship, Associate Professor, Department of Family and Community Medicine, Southern Illinois Univer- sity School of Medicine, Quincy, IL 62301, USA

Victor Duraj, BS

Associate Development Engineer, Department of Biological and Agricultural Engineering, University of California, Davis, Davis, CA 95616, USA

Antonio Durazo, MD

Chair, Department of Family Practice, Sierra View District Hospital, Porter- ville, CA 93257, USA

Guilia Earle-Richardson, MPH

Research Supervisor, New York Center for Agricultural Medicine and Health, Cooperstown, NY 13326, USA

Louise Ferguson, PhD

Horticulture Specialist, Department of Plant Sciences, Kearney Agricultural Center, University of California, Davis, Parlier, CA 93648, USA

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William E. Field, EdD

Professor, Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, IN 47907, USA

Capri-Mara Fillmore, MD, MPH, MSc

Associate Medical Director, Department of Health of Milwaukee; Assistant Professor, Epidemiology, Health Policy Institute, Preventive Medicine and Family and Community Medicine; Associate Director, Preventive Medicine Residency, Medical College of Wisconsin, Milwaukee, WI 53226, USA

John E. Furman, PhD, MSN, CIC, COHN-S

Occupational Nurse Consultant, Department of Labor and Industries of Washington, WISHA Services Division, Policy and Technical Services, Olympia, WA 98504, USA

Robert L. Goldberg, MD, FACOEM

Associate Professor, Department of Medicine, Division of Occupational and Environmental Medicine, University of California, San Francisco; Univer- sity of California Ergonomics Program, Richmond, CA 94804, USA

Joseph D. Hovey, PhD

Chair, Department of Psychology; Director, Program for the Study of Immi- gration and Mental Health; Co-director, Center for the Study of Anxiety Disorders and Depression, University of Toledo, Toledo, OH 43606, USA

Sarah Janssen, MD, PhD

Occupational Medicine Fellow, Division of Occupational and Environmen- tal Medicine, University of California, San Francisco, San Francisco, CA 94143, USA

Royce H. Johnson, MD, FACP

Vice Chair, Professor of Medicine, University of California, Los Angeles;

Chair Department of Medicine and Chief Infectious Diseases, Kern Medical Canter, Bakersfield, CA 93305, USA

Paul Jones, BA

Manager, Breaking New Ground Resource Center, Purdue University, West Lafayette, IN 47907, USA

Nikita B. Katz, MD, PhD

Senior Lecturer, Department of Neurology, INR/Biomed, Inc., Concord, CA 94520, USA

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Olga Katz, MD, PhD

Clinical Instructor, Department of Neurology, Jefferson Medical College;

Neurology and Neurophysiology Associates, Philadelphia, PA 19107, USA

Steven R. Kirkhorn, MD, MPH, FACOEM

Medical Director, National Farm Medicine Center and Occupational Health, Marshfield Clinic, Editor, Journal of Agromedicine, Marshfield, WI 54449, USA

Ricky Lee Langley, MD, MPH, FACP, FACOEM, FACPM

Department of Health and Human Services of North Carolina, Division of Public Health, Raleigh, NC 27699, USA

James E. Lankford, PhD

Professor, Emeritus and Former Dean of the College of Health and Human Sciences, Northern Illinois University, DeKalb, IL 60115, USA

Bruce J. Lanser, BS

Senior Clinical Research Assistant, Medical College of Wisconsin, Milwau- kee, WI 53226, USA

James E. Lessenger, MD, FAAFP, FACOEM

Morinda Medical Group, Inc., Porterville, CA 93257, USA

Gideon Letz, MD

Medical Director, State Compensation Insurance Fund, San Francisco, CA 94103, USA

Stephen A. McCurdy, MD, MPH

Professor, Department of Public Health Sciences, Division of Environmental and Occupational Health, University of California, Davis, Davis, CA 95616, USA

Steven Mandel, MD

Clinical Professor, Department of Neurology, Jefferson Medical College;

Neurology and Neurophysiology Associates, Philadelphia, PA 19107, USA

Deanna K. Meinke, MA

Assistant Professor, Department of Audiology and Speech-Language Sci- ences, University of Northern Colorado, Greeley, CO 80639, USA

Augustine D. Muñoz, MD

Associate Clinical Professor of Medicine, David Geffen School of Medicine at University of California, Los Angeles; Vice-Chair, Department of Medi- cine, Director, Pulmonary Medicine, Kern Medical Canter, Bakersfield, CA 93305, USA

Contributors xv

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Hitoshi Nakaishi, MD, DMSc

Chief Executive Officer of Y.N. Medical Company; Former Lecturer of Uni- versity of Tsukuba, Hon-amanuma 3-18-15, Suginami-ku, Tokyo, 167-0031, Japan

Michael Nasterlack, MD

Department of Occupational Medical and Health Protection, BASF Aktiengesellschaft, GOA/C, 67056 Ludwigshafen, Germany

Robert Bhavesh J. Pandya, MD, MPH

Los Angeles Medical Center, Los Angeles, California; Occupational Health Services, Kaiser Permanente, West Los Angeles, CA 90034, USA

Danny B. Pence, PhD

Professor, Department of Entomology, Texas Tech Medical Center, Lub- bock, TX 79430, USA

Scott Prince, MD, MSPH

Department of Preventive Medicine and Environmental Health, Southeast Center for Agricultural Safety, Lexington, KY 40504, USA

Mark A. Purschwitz, PhD

Research Engineer, Agricultural Safety, National Farm Medicine Center, Marshfield, WI 54449, USA

Alan Scott Ragland, DO, MS

Assistant Clinical Professor of Medicine, David Geffen School of Medicine at University of California, Los Angeles; Associate Program Director, Inter- nal Medicine; Director, Ambulatory Care, Internal Medicine; Director, Med- ical Student Program, Kern Medical Canter, Bakersfield, CA 93305, USA

Laura D. Seligman, PhD

Assistant Professor, Department of Psychology, Co-director, Center for the Study of Anxiety Disorders and Depression, University of Toledo, Toledo, OH 43606, USA

William M. Simpson, Jr., MD

Medical Director, South Carolina Agromedicine Program; Professor of Fam- ily Medicine, Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA

Lorann Stallones, MPH, PhD

Professor of Epidemiology and Director of the Colorado Injury Control Research Center, Department of Psychology, Colorado State University, Fort Collins, CO 80526, USA

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Roger L. Tormoehlen, PhD

Professor, Youth Development and Agricultural Engineering, Department of Agriculture and Biological Engineering, Purdue University, West Lafayette, IN 47907, USA

Mitchell S. Wachtel, MD

Associate Professor, Department of Pathology, School of Medicine, Texas Tech Medical Center, Lubbock, TX 79430, USA

Carl John Williams, DVM

Department of Health and Human Services of North Carolina, Division of Public Health, Raleigh, NC 27699, USA

Huiyun Xiang, MD, MPH, PhD

Assistant Professor, Center for Injury Research and Policy Columbus Chil- dren’s Research Institute and Columbus Children’s Hospital, College of Medicine and Public Health, Ohio State University, Columbus, OH 43205, USA

Andreas Zober, MD, PhD

Director, Department of Occupational Medical and Health Protection, BASF Aktiengesellschaft, GOA, 67056 Ludwigshafen, Germany UL

Contributors xvii

Agricultural Medicine

Agricultural Medicine

Agricultural Medicine

Foreword

Preface

Contents

Contributors