The Norwalk Hour

High cobalt levels concern reader

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr Roach: Iam having significan­t issues with my hip replacemen­t that was performed 10 years ago. It can get quite painful after lifting heavy objects or sitting in some chairs. My doctors are not sure what is causing the pain.

My cobalt levels were high, but not toxic (3 mcg/L). I was recently retested and now have a level of 6 mcg/L, which I understand to be toxic. My physicians don’t seem to want to address this issue, but I am greatly concerned. I suggested chelation, dialysis and even having periodic units of blood withdrawn, which were all refused.

Is there anything I can do to reduce these levels and prevent damaging my cardiovasc­ular and nervous systems?

D.M.K.

Answer: Cobalt toxicity is not common. By far, the most common time I see elevated levels of cobalt is in people who have a hip replacemen­t that is wearing out and failing. Very occasional­ly, the cobalt is high enough to cause symptoms of toxicity, such as heart or nerve symptoms; thyroid issues; smell, hearing and taste loss; rashes; muscle weakness; and fatigue.

When a metal-on-metal prosthesis wears out, the cobalt in the prosthesis can enter the blood. A level above 10 mcg/L suggests that the prosthesis has excess wear. Even though yours is still below that, the fact that the number is rising in the last year, along with the symptoms you have, strongly suggest that your hip may indeed be in need of replacing.

Exactly what cobalt levels should bring concern is a topic that there seems to be uncertaint­y about. Some sources say that systemic symptoms are unlikely at a level below 100 mcg/L, but several well-respected authors have suggested that a level above 20 mcg/L might be enough to cause local symptoms. Your levels are unlikely to cause symptoms.

Since, in your case, it is virtually certain that the cobalt is coming from the hip wearing out, the correct treatment is not chelation or dialysis, but removing the source of the cobalt — your prosthesis.

These levels indicate it is wearing out, but are not high enough to be considered an emergency.

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