Hexane and Gastroparesis?

[callum07]

I hope you can offer some insight for me. I'm a 33 year old female. Since June I have been suffering from dysphagia and gastrointestinal problems, prior to June, I had no history of stomach problems or reflux. There is pain in my thyroid area, in addition to pain in muscles/joints and intermittent numbness and tingling in arms, legs and the left side of my face. An endoscopy revealed bile in my stomach, and my gastroenterologist suspects gastroparesis and esophageal spasm, but a gastric emptying study will need to be done to confirm that. Also, a blood test indicated possible ulcerative colitis. A barium swallow was negative. A neurologist does not believe that I have any nerve damage in my limbs. My gastroenterologist suggested that my issues could be occupational, but also said that he had little experience in this field. I have been working at my current position for the past year, and for nine months of that time period, I was exposed to large amounts of 3M Super 77 spray adhesive, without ventilation. After looking up the material data safety information on-line, I found that this product has hexane in it, which I've read can cause autonomic nerve damage, like gastroparesis? An additional co-worker also has been suffering from health problems beginning in January of this year: weight loss, severe reflux, chest pain, and gastroparesis. I began the job in December 2006, began to have occasional stomach discomfort in February, once or twice a month. Acute symptoms to chemical exposure were headaches, throat irritation and difficulty breathing/coughing. I became very ill in early June of this year, with dysphagia and trouble breathing. My symptoms improved significantly by mid July. But then was exposed again to several days of chemical spraying at the end of July and became ill again, symptoms have not improved since. Is it possible that Hexane exposure could cause gastroparesis?  thank you.

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

Dear Callum07,

I praise you for your research on the web, for finding the material safety data sheet (MSDS), and for detailing your symptoms so well.

A couple questions that you may answer and I'll reply in a second answer/posting:
1. Were you wearing respiratory protection during the exposures? I am assuming that you were not because it does not sound like you thought you were working with chemicals that may cause health effects in some people, under certain conditions.
2. Do you have areas on your body that feel "numb", "tingly", or do you have any weakness in your extremities?
3. Do you know if your co-worker seen a medical provider that specializes in either occupational medicine or toxicology?
4. Has your primary care provider ruled out all possible medical causes for your symptoms (including thyroid problems)?
5. Is your (possible diagnosis) of ulcerative colitis the result of a blood test or a biopsy? The biopsy is the gold standard.

It is conceivably possible that if the concentration of hexane and cyclohexane (ingredients in the product you describe) were at a high enough level and there was poor or no ventilation (and you were without respiratory protection), that your acute symptoms could be explained by inhalation of the chemicals.

In general, if nerves are injured, inflammed, or aggravated (by trauma or a toxicant), the nerves heal very slowly and recovery from exposures) beyond acute effects, can take some time.

There is no blood test that will tell your physicians whether or whether not exposure to hexane is related to your symptoms. However, if your physicians are not able to find other medical explanations for your symptoms, occupational exposures should always be considered. I am biased on that last point.

It is quite suspicious that your co-worker seems to be having very similar symptoms. Does he or she have an exposure history similar to your history?

When we try to provide answers related to cause and effect of toxic chemicals, several factors are important. First, there must be an exposure to a dose (amount) that causes health effects; Second, the exposure and the timing of the symptoms or health effects is critically important; Third, the health effects must be consistent with what is known about the chemicals’ toxicity in humans (and/or animals. Occasionally, we do not know for sure what health effects are associated with substances (for example, with nanoparticles of various composition, shape, and size).

I hope this posting is helpful to you and I wish you well.

-Dr. Parks

* Respirator information: http://www.cdc.gov/niosh/npg/npgd0323.html

*For your physician:
http://www.emedicine.com/neuro/topic378.htm

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]

To answer your question regarding the possibilities of improving over time, I wish that I could provide a definitive answer. If your problems are due to autonomic nerve damage and you are no longer being exposed, then there is a good chance that the nerves will recover.

I encourage you to continue to be proactive with your health care providers in pursuance of diagnostic studies to fully evaluate your symptoms.

You are welcome to continue posting here with your questions and comments.

-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.

[callum07]

Thank you Dr. Parks for your detailed and informative response, and yes, it was very helpful. In answer to your questions:

1.) I did try to use respiratory protection when I was directly working with the chemical, but unfortunately, the product was utilized in an enclosed office environment. Even if the individual using the product was wearing a respirator, with the door closed, the fumes, without an exhaust fan, filled the entire office so everyone was exposed in the vacinity, sometimes for hours at a time. I knew the product was hazardous, but not as hazardous as I came to realize after reading the MSDS information.
2.) Yes, I do have intermittent numbness and tingling in my arms, hands and legs, and the left side of my face. I've recently seen a neurologist who has scheduled an MRI for this week, and blood testing to rule out MS and Myasthenia Gravis. He said he does not believe I have periferal neuropathy. A rheumotologist thought these symptoms were either nerve damage or fibromyalgia.
3.) My co-worker has not seen a medical provider specializing in occupational medicine or toxicology, I believe he has only seen his primary and then a GI specialist. He never discussed the chemical exposure with his doctors.
4.) Yes, I have had extensive testing so far. While I do have a history of Hashimoto's, all thyroid blood tests have been normal, an ultrasound, and two CT scans of the thyroid area were also normal and had no nodules. A thyroid biopsy was not done. Testing for Crohn's, Celiac's, stomach and esophagus biopsies, lyme's, Sjorgen's, Lupus, Hep C, all negative,  Vitamin D, Sed rate/ANA, barium swallow (normal), no signs of infection, although antibiotics and prednisone were tried, but to no improved effect. Chest x-rays, and EKG's both normal. An endoscopy in my stomach indicated a lot of bile and "atrophic changes," which led my doctor to suspect gastroparesis, although I don't have diabetes and he couldn't discern a cause for the gastroparesis. Also, as I mentioned before, I haven't had a gastric emptying study yet to confirm that diagnosis. Prior to this period of illness, I'd hardly ever even had heartburn. When I discussed the chemical exposure with him, he became concerned that this could be the source.
5.) I had an initial blood test for the ulcerative colitis, but a colonoscopy and biopsy are scheduled in two weeks. The GI doc seemed to think this issue was in addition to whatever else might be going on with my stomach and esophagus.

My co-worker is a male in his early 50's and yes, he does have a similar exposure history, but actually a bit longer then mine and he, unlike myself, was directly working with the chemical nearly daily, often with only a surgical mask for protection. He became extremely ill directly after a period of 3 weeks, where the chemical product was used more extensively than it ever had been prior. He wasn't able to return to work for about 2-3 months and lost 20 pounds. I was hired at the beginning of that three week period and began to have stomach difficulties within two months, but did not become very ill for 4 more months.  Although to my knowledge none of the other workers have become ill.

If my issues could be related to my occupational exposure, you mentioned that nerves heal very slowly. If I do indeed have nerve damage in my stomach, in terms of long-term prognosis, can I hope to improve over time if I am no longer being exposed? (the last exposure was mid October, after which management agreed to no longer use the product in the office.) I've been concerned that I will be stuck eating baby food for the rest of my life. thank you again for taking the time to respond to me.