A number of U.S. troops with unexplained symptoms such as impaired concentration, anger, irritability and impulsivity, as well as physical problems such as high blood pressure, peripheral neuropathy and low sex drive, have chronic lead poisoning, according to a report Wednesday in The New York Times Magazine's At War Blog.
Thirty-eight troops -- mostly from Special Forces units -- have gone to Mount Sinai Medical Center in New York for a special test that measures the level of lead in one's tibia bone. Of those, a dozen registered bone lead levels higher than normal, with four having roughly twice the expected amount.
Dozens of other service members sought treatment at the Cleveland Clinic's Center for Functional Medicine for lead and other metal poisoning, including those tested at Mount Sinai.
While the numbers are small compared with the 1.3 million active-duty personnel currently serving, the diagnosis is significant for these troops, who have wrestled for years with symptoms that mimic traumatic brain injury or post-traumatic stress disorder (PTSD) but who also have physical manifestations.
One of those diagnosed, Steve Hopkins, a former Special Forces major who is now retired, called receiving the test results "a big deal." After bouncing from doctor to doctor and being told by Army physicians that he likely had depression or PTSD -- or was malingering -- Hopkins was grateful to put a name to his debilitating illness.
"It was a big weight off my shoulders and off my family," he said. "I mean, we were in crisis."
Hopkins was diagnosed in 2012 after falling severely ill and traveling to Walter Reed National Naval Medical Center, Maryland, where he was seen by Navy Capt. Kevin Dorrance, also now retired. Like Hopkins' physicians at Fort Bragg, North Carolina, Dorrance originally thought Hopkins' issues were mental health-related. But he noticed that one medical test, an erythrocyte porphyrin test, consistently came back as elevated.
He consulted with a colleague at the Uniformed Services University for the Health Sciences who, according to Dorrance, immediately suspected lead exposure. Dorrance then sent Hopkins to Mount Sinai for the K X-ray fluorescence, or KXRF, test to measure his bone lead levels.
Hopkins, then 42, had levels two-and-a-half times what is typical in a man his age.
Other service members followed Hopkins to Mount Sinai, including Master Sgt. Geoff Dardia, a Special Forces training instructor who has deployed to combat zones seven times. Dardia's results were 30 percent higher than normal.
Lead exposure in the U.S. military can occur on firing ranges, during military operations and while working and living in environments where lead is common -- on military bases in cases of lead abatement and repair work and in countries such as Afghanistan and Iraq, which continue to use leaded gasoline.
Troops can inhale lead or ingest it by firing weapons or eating, drinking, smoking or chewing tobacco on ranges. If lead is absorbed, it is present in the bloodstream for up to a month, where it can be detected by a blood test, and it remains in soft tissue for up to 90 days.
It is then absorbed into the bones, where levels can increase with additional exposure. But the medical community and government agencies that study environmental exposures say once it is in the bone, it leaches back into the bloodstream only under certain medical conditions, such as a broken bone, pregnancy, osteoporosis or kidney disease.
Affected veterans, along with Dorrance and Dr. Mark Hyman, director of the Center for Functional Medicine at the Cleveland Clinic, say this isn't correct -- and they'd like to see more physicians considering the possibility of chronic lead exposure in cases of unexplained symptoms in troops, rather than dismissing their patients as mental health cases.
"Here you are dealing with a group of men, highly trained, highly skilled, emotionally stable individuals who want to work. These are not wackadoodles," Hyman said.
Dorrance, Hopkins and others want to call attention to the issue of lead poisoning in the U.S. military and have pressed the Defense Department for broader testing and treatment -- for acute and long-term exposure. They want the Pentagon to purchase a KXRF machine and conduct mandatory baseline screening and ongoing testing for troops who work in environments where they face chronic exposure.
They also would like to see more acceptance in the medical community for diagnosing and treating lead in bones. Chelation is an FDA-approved outpatient treatment for acute lead exposure, but both Hopkins, who took an oral chelation medication, and Dardia, who used both oral and intravenous chelation agents, say it worked in their cases.
They say troops deserve to have the general medical community understand what a handful of physicians -- those who treat civilian workers often exposed to lead in jobs such as smelting, soldering, bridge repair, and foundry work -- understand. That chronic lead exposure can make a person sick.
"The fact that we have a lack of intellectual curiosity about a condition that likely is pervasive in the U.S. military is criminal," Hopkins said.
"The reason it's being sidelined is it's not understood," added Dorrance. "There's this discomfort with not knowing that's the problem with doctors."