Eve Glazier, Elizabeth Ko

DEAR DOCTOR,

My 5-year-old grandson craves lead paint and has used his toothbrush to get at old layers of lead paint in his family’s renovated 1880s home. His development has slowed, and people think he’s autistic. If it’s the lead, what can we do?

DEAR READER,

Your question covers several issues. We don’t make diagnoses in this column, so we would just note that the impulse to eat nonfood items — such soil, chalk, clay or lead paint — can be a disorder known as pica.

The cause of these persistent cravings isn’t known, but pica has been associated with certain nutritional deficiencies, and with certain mental health conditions. The disorder can lead to serious complications, including intestinal blockage, parasitic infection and lead poisoning.

The United States government banned lead-based paints for residential use in 1978, but it remains a hazard in millions of older homes. Lead is a heavy metal that our bodies can’t use. When ingested, it interferes with numerous metabolic processes, including the production of red blood cells, absorption of calcium for bone and tooth development, and the proper functioning of the liver, kidneys, blood vessels, immune system, nervous system and the brain.

Lead is harmful to the developing bodies and brains of babies, children and adolescents. In high amounts, it can be fatal. Even low levels of lead have been linked to impaired or delayed physical development, low IQ, learning disabilities, and emotional and behavioral problems.

Lead is a cumulative toxicant, which means it builds up in the body over time. As a result, symptoms of lead poisoning can take months or even years to appear. These include loss of appetite, abdominal pain, nausea and vomiting, chronic constipation, hearing loss, problems with vision, persistent fatigue, weight loss, tremors or seizures, irritability and developmental delays.

Since you know your grandson has been eating old paint, it’s important to learn his blood levels of lead. Your family doctor can do this with a simple blood test; have it done as soon as possible.

The body can fight a painful war on itself

DEAR DOCTOR,

My brother-in-law thought he had the flu, but it turned out to be Guillain-Barre syndrome. He’s now in his fifth month of an intense recovery. What can you tell me about the disease?

DEAR READER,

Guillain-Barre syndrome is a rare disorder that affects about 1 in 100,000 people each year. It’s an autoimmune disease, which means the immune system goes a bit haywire.

It mistakes cells within your body as threatening invaders and sets out to destroy them. In Guillain-Barre, the immune system attacks the peripheral nervous system, which encompasses all of the nerves in the body other than the brain and spinal cord. Infection with certain viruses and bacteria is a known trigger of Guillain-Barre, and is responsible for up to two-thirds of all cases.

Damage to the nerves results in weakness and exhaustion, often accompanied by tingling or pinprick sensations in the extremities. In the early stages of Guillain-Barre, people experience a loss of coordination that can impair balance, movement, speech, swallowing, vision and bladder control. These initial symptoms, along with possible abnormal blood pressure, both high and low, evolve over the course of the first few weeks.

Progressive muscle weakness affects both sides of the body and occurs rapidly, often within hours or days. Severe cases of Guillain-Barre syndrome affect the patient’s ability to breathe and result in near-complete paralysis.

Diagnosis relies largely on a person’s symptoms. However, blood tests to measure red blood cells, white blood cells, platelets and hemoglobin, and metabolic panels to determine levels of electrolytes, blood sugar, total proteins and metabolic waste products, may be used to rule out other conditions.

Guillain-Barre can cause certain changes to spinal fluid, so a lumbar puncture, also known as a spinal tap, may be ordered. Tests to measure nerve function can also be useful. There is no known cure, so treatment consists of addressing existing symptoms, which is known as supportive care. This includes blood therapies such as plasma exchange, or plasmapheresis, which “cleans” the blood, or immunoglobulin therapy, which uses antibodies to try to calm the immune system.

Patients often experience significant pain, which can be eased with medication. Since prolonged inactivity can lead to blood clots, compression garments and blood thinners are prescribed often. In serious cases, when swallowing or breathing are compromised, a feeding tube or a ventilator may be needed.

Most patients recover completely. However, as in the case of your brother-in-law, it’s often a gradual process. A lucky few are up and about in just a few months, but the majority of patients take about a year to fully recuperate. It’s also possible for recovery to take several years, and for patients to experience ongoing neurological issues.

Rehabilitative care includes physical, speech and occupational therapy. It can be a tough road back to good health, and many patients and their caregivers find a support group to be helpful. You can find more information at the Guillain-Barre Syndrome Foundation’s web site at gbs-cidp.org.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.

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