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Dear Dr. Roach: I am a 35-year-old female welder. I am very fit and live a healthy lifestyle, but I worry about the effects of all the things I am exposed to at work (heavy industrial) and how to monitor them. I do not have a family doctor, and must rely on walk-in clinics. Are there certain tests I should be having done regularly, especially having to do with the lungs? Thanks!

K.W.

Dear K.W.: Welders are exposed to industrial chemicals, and this can lead to medical complications. Some of the chemicals used in different types of welding cause irritation in the lungs and can predispose a person to respiratory infections. In fact, in the U.K., it’s recommended that welders consider the 23-valent pneumonia vaccine, since their risk of complications from one particular bacteria, Streptococcus pneumoniae, is very high.

Adequate ventilation, however, probably is the most important part of a welder’s safety practices, from the standpoint of chemical exposure. This is particularly significant because some gases produced when welding — such as lead, manganese and iron oxide — have long-term toxicities to the brain and lungs.

Respiratory equipment is recommended if adequate ventilation is not possible. Washing your hands after welding also is recommended (even if you are using hand protection) in order to prevent accidental ingestion.

The ultraviolet light that is produced during welding can damage skin and eyes. This makes proper protection essential. Noise also can be a major problem, so hearing protection may be appropriate as well.

In the United States, the Occupational Safety and Health Administration has requirements for workers in regular contact with certain chemicals. These are publicly available (an easy-to-read form is at tinyurl.com/osha-std), but the format requires that you know what chemicals you come in contact with. Some chemicals require periodic blood or lung testing. An occupational-medicine expert would be an appropriate physician for you to see: Some work in walk-in clinics, though this isn’t optimal.

Dear Dr. Roach: I have low sodium levels. Is there any difference between salt and sodium? All the doctors tell me to eat more salt, but then my blood pressure goes up. I drink lots of water.

H.B.

Dear H.B.: In chemistry, a “salt” is the product of an acid reacting with a base, and there are several important salts in the body. But in everyday terms, “salt” and “sodium” usually both refer to what’s in the saltshaker. That’s table salt, or sodium chloride.

The amount of sodium isn’t equal to the measure of salt, though. The reason is that sodium is only part of table salt. A teaspoon of table salt weighs about 5 grams and has 2.3 grams of sodium. The rest is chloride. Most of the advice about salt intake that is published refers to the sodium component.

True sodium deficiency happens occasionally — in people with severe vomiting, for example, or in those taking too much diuretic medicine.

However, most people walking around with too low of a sodium level in the blood are not actually deficient in salt; giving more salt doesn’t help. Most people with low sodium in the blood have too much water. The treatment then is to reduce water intake.

There are many causes for low blood sodium levels. Talk to your doctor about why your sodium is low.

Email questions to ToYourGoodHealth@med.cornell.edu.

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