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Case Study

Concerns of a young family exposed to TCE-contaminated drinking water

Your practice is in a suburban community with a number of high-technology industries. A couple for whom you have been the family physician asks for an appointment to discuss their daughter’s illnesses and a matter of concern to them.

During the initial consultation, the mother reports that they are living in an area supplied by municipal well water. They have recently received a notice from the municipal water district stating that their drinking water contains 100 parts per billion (ppb) trichloroethylene (TCE), and as a precaution, they are being supplied with bottled drinking water until an alternative well can be put into service. The notice indicates that the well water is suitable for bathing and laundering. The father interjects that he is familiar with TCE; it is used in the electronics plant where he works.

The daughter, aged 4, has had a number of ear infections during her first 2 years, culminating in a myringotomy at age 3. Follow-up by an ENT specialist has shown normal hearing. Although there have been no further infections, the mother stresses that her daughter seems to have a greater number of colds than her classmates and “has not seemed as healthy as she should be.” However, the daughter’s chart does not reflect an unusual number of office visits or calls. The mother also notes that the child’s day-care center is next to “some kind of machine shop” where a chemical odor has been noticed recently. Several of the children and one of the teachers have complained of eye and throat irritation in association with the odor.

The mother, who is 33 years old, then reveals that she may be pregnant and she has had mild nausea for 1 week. It has been 8 weeks since her last menstrual period. Both parents are concerned about the possibility that the TCE in the drinking water might have affected the fetus. Although this pregnancy was planned, they might consider terminating the pregnancy if the baby was likely to be “damaged.” They are also concerned that the entire family might suffer from cancer or other diseases in the future.

Before receiving bottled water, the family drank tap water when thirsty and made coffee with tap water. Tap water also was used for cooking and brushing their teeth, and is still used for bathing. They have never noticed discoloration or an off-taste to the tap water. They encourage their child to drink water instead of sodas during the summer and estimate the amount of water each of them consumes is 2 to 3 glasses a day.

You schedule each parent and the child for an individual office visit.

(a) What would you include in the mother’s and daughter’s problem list?

_________________________________________________________________

(b) What additional information would you seek before seeing the family again?

_________________________________________________________________

(c) What reassurances might you provide at the end of this initial visit?

_________________________________________________________________

Answers to the Pretest can be found on page 19.



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