For 76-year-old Alice Speth, manganese has become something more than a pesky mineral in the city's water mains.

Speth was recently diagnosed with elevated manganese levels and her doctors suspect the finding could account for numerous physical problems she has struggled with in recent months.

Walking is painful and difficult for her and she's taken to using a walker. Her hands shake. Her fingers and mouth are numb.

"I never had tremors before," Speth said last week. "And I've lost my equilibrium. I felt like I was getting off a ship all the time. And I used to be able to knit. I was one of those women who always carried her knitting around with her."

Speth was diagnosed with elevated manganese in April and is now being treated by a neurologist at UW Hospital.

While Speth is convinced that her condition is from drinking contaminated city water, her physicians are less certain.

And city health officials say it is unlikely that Speth could have been exposed to enough manganese in the drinking water to account for her condition.

"The only real fact we have is that she has high levels of manganese," said Dr. Benjamin Brooks, Speth's neurologist at UW Hospital. "Where it's coming from, we don't know for sure."

Complained about water Brooks said he is in the process of interviewing Speth about her diet and about any medications or vitamins that might be the source of the excessive manganese. But he added that exposure to manganese in drinking water also remains a possibility.

Speth said she eliminated several foods known to contain manganese from her diet and does not take vitamins or other dietary supplements that might harbor the mineral.

She has lived in an apartment in the Meriter Retirement Community at 110 S. Henry St. for about 2 1/2 years and has registered complaints with the Madison Water Utility and the Madison-Dane County Health Department about her water there being discolored and containing the black flakes indicative of high manganese levels.

Before moving to Meriter, Speth lived for four years in another apartment on the Isthmus where she said her water was also frequently discolored. Both that apartment and the Meriter Retirement Community have received water from well No. 3, one of the city wells that has tested high for manganese.

But John Hausbeck, an epidemiologist with the Madison-Dane County Health Department said that in December of 2005 and January of 2006, water at the Meriter retirement apartments was tested in response to Speth's complaints and found to have relatively low levels of manganese.

A drinking fountain in the building tested at 14 parts per billion and water from a faucet in an apartment tested at 25 ppb. The federal Environmental Protection Agency sets advisory standards for manganese of 50 ppb for aesthetics and 300 ppb as a recommended lifetime health standard.

Speth's is at least the second definitive case of manganese poisoning to surface in Madison in the past couple of years.

In September 2005, a pediatrician with Associated Physicians reported to the city that one of her patients, a 17-year-old resident of Nakoma, had tested high for manganese and had symptoms of manganese toxicity.

Nakoma is served by well No. 10, where manganese has also been a problem.

Dr. Thomas Schlenker, director of the Madison-Dane County Health Department, said he recently received a call from a physician with a patient who tested high for manganese. Schlenker said the patient is being tested a second time.

The call from the physician was the first Schlenker has received from a Madison doctor concerning elevated manganese levels in a patient.

Such cases are of interest because of the city's recent struggles with high levels of manganese in three city wells, in many water mains, and in some homes.

Although manganese is naturally occurring and is a necessary part of a healthy diet, too much of the mineral has been shown to cause neurological ailments with symptoms similar to Parkinson's disease.

The Madison Water Utility has embarked on a citywide, high-velocity flushing program to cleanse pipes of the mineral, which settles in the bottom of mains and can be knocked loose by disturbances such as water main breaks.

Most susceptible to manganese poisoning are people with liver problems, who can't properly process the mineral, and infants up to six months old, who may be drinking formula that already contains high levels of manganese.

Schlenker issued health advisories for both groups, recommending against their using tap water while mains are being flushed in problem neighborhoods.

Schlenker said last week he is skeptical, because of information available in the scientific literature, that anyone in Madison has been exposed to enough manganese over a long enough period of time to cause illness. That research, he said, suggests that to get sick from manganese, an individual would have to be exposed to manganese in drinking water at levels of 1,000 ppb or greater for at least two years.

It is unlikely, Schlenker said, that anyone in Madison would drink enough water to be chronically exposed, first because levels of manganese in most areas of the city have not been beyond the advisory health standard and also because water that would pose a threat would most likely be discolored.

"It's possible," Schlenker said of the likelihood of chronic exposure. "But I think it is unlikely."

Vaporized manganese Schlenker said he has been unimpressed by recent research that raised the possibility of chronic exposure to vaporized manganese from showering and at levels lower than those that are currently thought to pose a threat.

That research came from John Spangler, an associate professor of family medicine at the Wake Forest University School of Medicine.

In this research, Spangler exposed rats to high levels of vaporized manganese and afterward found elevated levels of manganese in the rats' brains. He then used that data to calculate human exposure to manganese during showering.

The calculations showed that after ten years of showering in manganese-contaminated water, children would be exposed to doses of manganese three times higher than doses that resulted in manganese deposits in the brains of rats.

Adults, according to Spangler's extrapolated data, would be exposed to doses 50 percent higher than the rodents.

The research showed, according to Spangler, that exposure at levels lower than the EPA's recommended safe levels could potentially cause brain injury.

But Schlenker called the research "highly artificial." He said that in order to be exposed at the levels used in Spangler's study, people would have to shower in water that is nearly black. He also said Spangler's extrapolation of data from rats to humans was suspect.

"I think this is very, very far removed from having anything to say about human health," Schlenker said.

Spangler agreed that his work is theoretical, based on animal data and has so far not been tested in humans. But he said there is also other data surfacing from other research projects that raises the same possibility - that perhaps ill effects from exposure to manganese can happen at lower levels than were previously suspect.

"The verdict is still a little bit out on this one," Spangler said. "However, more and more evidence is showing that manganese is not as harmless as we previously believed."

Surveillance form Still, people such as Speth remain concerned about their possible exposure to manganese in Madison's water. Hausbeck said he fields between five and seven calls a week from residents with concerns about their drinking water and health problems.

Despite the concern - and the cases of manganese toxicity that have arisen - Schlenker said an ambitious screening program for more patients with elevated manganese would not be a good idea. Such screening efforts are controversial in the field of public health, he added, because testing, especially for a mineral such as manganese, can be suspect.

"You could identify people incorrectly," Schlenker said, "and potentially lead them down a long road of useless medical workups."

Still, he added, it is a good thing for doctors to be aware of the manganese situation. He said he has sent all clinics and hospitals in the city information about the manganese health advisories at least twice, along with his contact information.

In addition, Schlenker said, he has created a surveillance form that anyone calling with concerns is being asked to complete. The form seeks information about manganese exposure, including water use and dietary and medical information.

"With that," Schlenker said, "we should be able to do a good job of analyzing each concern."