Hi. Let me urge everyone to go to www.slate.com for this story and more. This is the one I gave the interview for earlier today.
explainer Answers to your questions about the news.
How Does a Shotgun Pellet Migrate?
Plus, can birdshot give you lead poisoning?
By Daniel Engber
Posted Wednesday, Feb. 15, 2006, at 6:10 PM ET
The man Dick Cheney inadvertently blasted with a shotgun suffered a minor heart attack on Tuesday morning. A pellet lodged in Harry Whittington's torso appears to have migrated to his heart. Doctors say that Whittington may have between six and 200 pieces of birdshot lodged in his body. How does a pellet move around once it's inside you? And can birdshot give you lead poisoning?
Gravity can move a pellet of birdshot lower in your body, at least until enough scar tissue has built up to hold it in place. If the pellet ends up in a hollow organ like the stomach, it can jostle around or make its way through your digestive tract. Bullets in the brain seem to pose an especially serious risk of further injury—people who get shot in the head have to worry about "moving bullet syndrome."
Bullets or pellets can also move around in your bloodstream. If a pellet manages to pierce one side of a blood vessel but not the other, it might get swept into circulation. The smaller the projectile, the more likely it is to move around in the blood. Heavier bullets tend to migrate downward, while a tiny pellet might be carried along toward the heart. In 1992, the Associated Press described a man who had been shot in the left side of his face. A fragment of the bullet had lodged in his jugular vein; doctors finally removed it from one of the chambers of his heart.
Can birdshot cause lead poisoning? Yes, but it doesn't happen very often. Birdshot is usually made of either steel or lead, but doctors routinely leave pellets (or bullets) in the body because the risks of surgery are deemed greater then the possibility of poisoning. We don't know what kind of birdshot Cheney was using; experts quoted in the news seem to discount the dangers of lead for his victim. Still, numerous case reports and several studies have demonstrated that gunshot injury can cause lead toxicity. A recent survey of about 500 shooting victims in South Central Los Angeles found a significant and consistent increase in blood lead levels over the months following an injury.
The chance of getting lead poisoning increases with the number of bullet fragments or pellets you have lodged inside of you. A large number of very small lead pellets—perhaps like those lodged in Whittington's head, neck, and chest—would be the most dangerous on account of their large surface area. Pellets that end up near large joints are especially problematic; the synovial fluid contained in these spaces seems to increase the rate at which lead dissolves.
The symptoms of lead poisoning might appear within a few days after someone gets shot, but they can also turn up decades later.
Got a question about today's news? Ask the Explainer .
Explainer thanks James Evans of the State University of New York and William Manton of University of Texas.
Related in Slate
Wednesday, February 15, 2006
My recent Slate interview - migrating bullets and Cheney
Dear readers, Well I just finished an interview with one of the contributors to the online magazine Slate (www.slate.com). The topic was the "moving bullets and pellets". The obvious reason for the discussion is the recent shotgun injury to Mr. Whittington of Texas. The reason the reporter called me is the fact that I am the senior author of a recent medical journal article on moving bullets.
Reference = Bullet migration within the inferior vena cava.
South Med J (United States), Jan 2003, 96(1) p96-8
Raghavendran K, Evans JT
I explained at length the problems of bullets and pellets that are lodged in blood vessels following firearms injury. There is the problem of obstructing a vessel, serving as a nidus for clot formation, and mycotic aneurysm formation.
Furthermore, I went into the problems of foreign materials such as clothing and debris including wadding which can also become imbedded in patients shot with shotgun pellets.
The reporter also asked about the problem of lead levels indicating that physicians have been downplaying the need to remove lead fragments and shrapnel. I told him that was not as well documented as since the medical profession had not generally done sufficient research on that topic to provide definitve evidence, but that I had personally changed my trauma practice to now include removal of suspected lead fragments based on the well done though small study from LA. Reference quoted below:
The effects of retained lead bullets on body lead burden.
J Trauma. 2001; 50(5):892-9 (ISSN: 0022-5282)
McQuirter JL ; Rothenberg SJ ; Dinkins GA ; Manalo M ; Kondrashov V ; Todd AC
Department of Oral and Maxillofacial Surgery, Charles R. Drew University of Medicine and Sciences and the King/Drew Medical Center, 1731 East 120th Street, Los Angeles, CA 90059, USA. jmcquirter@dhs.co.la.ca.us
BACKGROUND: Numerous case reports have demonstrated that lead poisoning with potentially fatal consequences can result from retained lead projectiles after firearm injuries. To assess the impact of retained projectiles on subsequent lead exposure in the population, one cannot rely on self-selected cases presenting with symptoms of lead intoxication. This preliminary study seeks to identify increased lead burden and identify risk factors of elevated blood lead levels for individuals with retained lead bullets. METHODS: Forty-eight patients were originally recruited from gunshot victims presenting for care at the King/Drew Medical Center in Los Angeles, California. An initial blood level was measured for all recruited patients and repeated for the 28 participants available for follow-up, 1 week to 8 months later. Medical history, including a history of prior firearm injuries and other retained projectiles, was taken, along with a screening and risk factor questionnaire to determine other sources of lead (occupational/recreational) to which the patient might have been, or is at present, exposed. The participants also had K-shell x-ray fluorescence determinations of bone lead in the tibia and calcaneus in order to determine past lead exposures not revealed by medical history and risk factor questionnaire. Multivariate models of blood level were made using risk factor and bone lead concentration data. RESULTS: We demonstrated that blood lead tends to increase with time after injury in patients with projectile retention, and that the increase in significant part depended on the presence of a bone fracture caused by the gunshot. CONCLUSION: We encountered evidence suggesting that the amount of blood lead increase in time after injury is also dependent on the tibia lead concentration. There were too few cases in the study to fully test the effects of bullet location, or the interaction of bullet location with bone fracture or bullet fragmentation.
Well readers, that's all for now. JTE aka Jedimaster.
Reference = Bullet migration within the inferior vena cava.
South Med J (United States), Jan 2003, 96(1) p96-8
Raghavendran K, Evans JT
I explained at length the problems of bullets and pellets that are lodged in blood vessels following firearms injury. There is the problem of obstructing a vessel, serving as a nidus for clot formation, and mycotic aneurysm formation.
Furthermore, I went into the problems of foreign materials such as clothing and debris including wadding which can also become imbedded in patients shot with shotgun pellets.
The reporter also asked about the problem of lead levels indicating that physicians have been downplaying the need to remove lead fragments and shrapnel. I told him that was not as well documented as since the medical profession had not generally done sufficient research on that topic to provide definitve evidence, but that I had personally changed my trauma practice to now include removal of suspected lead fragments based on the well done though small study from LA. Reference quoted below:
The effects of retained lead bullets on body lead burden.
J Trauma. 2001; 50(5):892-9 (ISSN: 0022-5282)
McQuirter JL ; Rothenberg SJ ; Dinkins GA ; Manalo M ; Kondrashov V ; Todd AC
Department of Oral and Maxillofacial Surgery, Charles R. Drew University of Medicine and Sciences and the King/Drew Medical Center, 1731 East 120th Street, Los Angeles, CA 90059, USA. jmcquirter@dhs.co.la.ca.us
BACKGROUND: Numerous case reports have demonstrated that lead poisoning with potentially fatal consequences can result from retained lead projectiles after firearm injuries. To assess the impact of retained projectiles on subsequent lead exposure in the population, one cannot rely on self-selected cases presenting with symptoms of lead intoxication. This preliminary study seeks to identify increased lead burden and identify risk factors of elevated blood lead levels for individuals with retained lead bullets. METHODS: Forty-eight patients were originally recruited from gunshot victims presenting for care at the King/Drew Medical Center in Los Angeles, California. An initial blood level was measured for all recruited patients and repeated for the 28 participants available for follow-up, 1 week to 8 months later. Medical history, including a history of prior firearm injuries and other retained projectiles, was taken, along with a screening and risk factor questionnaire to determine other sources of lead (occupational/recreational) to which the patient might have been, or is at present, exposed. The participants also had K-shell x-ray fluorescence determinations of bone lead in the tibia and calcaneus in order to determine past lead exposures not revealed by medical history and risk factor questionnaire. Multivariate models of blood level were made using risk factor and bone lead concentration data. RESULTS: We demonstrated that blood lead tends to increase with time after injury in patients with projectile retention, and that the increase in significant part depended on the presence of a bone fracture caused by the gunshot. CONCLUSION: We encountered evidence suggesting that the amount of blood lead increase in time after injury is also dependent on the tibia lead concentration. There were too few cases in the study to fully test the effects of bullet location, or the interaction of bullet location with bone fracture or bullet fragmentation.
Well readers, that's all for now. JTE aka Jedimaster.
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