Protecting Your Health in Erie, PA | Erie County Medical Society


The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.




11:07 AM
March 15th, 2018

Narcotics Addiction and Overdose

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the recent surge in narcotics related deaths. This surge is superimposed on the steadily climbing number of such deaths over recent years.


One factor contributing to the recent increase may be the emergence into availability of heroin forms that can be snorted or smoked instead of injected intravenously. First, this presents a less repulsive method of administration than intravenous injection. Second, it caters to the mistaken illusion that the drug is less dangerous when snorted or smoked than when injected.


While no “magic bullet” currently exists, progress toward the solution of the problem begins with understanding. Accordingly, we present this information to enhance understanding of the disease.


Scope of Problem

The year 2014 witnessed 47,055 drug overdose deaths in the US compared with 32,675 traffic accident deaths. These data are from the US Centers for Disease Control and the US Department of Transportation, respectively. Meanwhile,

here in Erie County, Pennsylvania, drug-related deaths rose 61% from 59 in 2015 to 95 in 2016.


Fentanyl has become a major factor in drug overdose deaths. Fentanyl is either legally manufactured but illegally obtained, or illegally manufactured and obtained. Fentanyl-related deaths increased 80% in 2014.


Internationally, the US is hit especially hard by opioid abuse. Americans constitute less than 5% of the world’s population, but consume 80% of the world’s opioids. Americans consume 99% of the world’s supply of hydrocodone, the active ingredient of VicodinTM. Finally, Americans consume two-thirds of the world’s illegal drugs.


Causes of Opioid Dependence

Opioid dependence is a disorder with pharmacologic, genetic, social, and psychodynamic causes. It is a true medical problem, not a moral failing or personality shortcoming.


Pharmacologic factors weigh heavily in opioid addiction. Certainly, drugs other than opioids have significant addiction potential; but, opioids, with their rapid development of physical dependence and their severe protracted abstinence syndrome, make abstinence especially difficult.


Genetic factors also contribute. There is a high degree of heritable vulnerability for opioid dependence. Gene polymorphisms for receptors for dopamine, serotonin, and other neurotransmitters also seem associated with opioid dependence vulnerability. Perhaps future medications can be designed to take advantage of these genetic factors.


Psychopathologic diagnoses seem to factor in. Preexisting mental health diagnoses seem to increase risk for long-term opioid use among adolescents with chronic pain.


Social factors have notable influence as indicated by the high rate of drug use in areas with poor parental functioning, high crime, and high unemployment.


Signs of Opioid Abuse

Opioid abuse is evidenced by any two of the following signs occurring within a 12-month period.

  1. Taking larger amounts than intended.
  2. Unsuccessful efforts to reduce use.
  3. Spending substantial time and activity related to opioids.
  4. Craving opioids.
  5. Failure to fulfill obligations of home, work, or school.
  6. Continuing opioid use despite opioid-related problems.
  7. Relinquishing social and other interests because of opioid use.
  8. Continuing opioid-related activities when those activities present a physical hazard.
  9. Tolerance and withdrawal, except when the opioids are used exclusively for medical reasons and under close medical supervision.

Tolerance, Withdrawal, and Addiction

Tolerance, withdrawal, and addiction are three separate entities. They are not just different ways of saying “addiction.”


Tolerance is the requirement for increased doses of the drug to achieve the same effect. Thus, increasing doses of the drug are needed to induce the same euphoria.


Withdrawal is the occurrence of symptoms on abrupt cessation of the drug. The onset and duration vary with the drug. Heroin withdrawal symptoms tend to peak in 36-72 hours and last 7-14 days.


The symptoms of withdrawal are typically diarrhea, runny nose, nausea, “gooseflesh,” restlessness, tremors, abdominal cramping, muscle aches, and craving for the drug.


Addiction consists of drug craving, compulsive use, and strong tendency to relapse after withdrawal.



At some unspecified point, the side effects of opioid use turn into toxicity. The typical side effects are small pupils, loss of appetite, sleep disturbances, and constipation. As side effects become toxicity, blood pressure may fall, stupor develops (sometimes to the point of unresponsiveness), and respirations slow (sometimes to the point of stopping).


Toxicity Treatment

Clearly, respiratory insufficiency is an emergency, as inadequate respirations lead to death or irreversible brain damage in only a few minutes. The treatment is to begin artificial respiration and reverse the opioid.


The principal opioid reversal agent is naloxone. At one time, this medication was supplied only in glass ampoules for professional use. The ampoules had to be broken open and the medication drawn into a syringe and subsequently injected into a flowing IV line. Administration systems for this medication have been redesigned to be more user-friendly so that the lay public can utilize them in an emergency situation.


In 2014, the FDA approved a naloxone autoinjector for home use by family members and caregivers. The device is designed for use on the outer thigh, through clothing. It has no visible needle, contains two doses of naloxone, and comes with voice prompts that begin playing as soon as it is removed from the box. A trainer mock-up allows the potential user to acquire the “feel” of the device without actually administering any medication.


In 2015, the FDA approved naloxone for intranasal spray. This permits bystander rescue by simply spraying half the naloxone charge into each nostril of an unresponsive patient.


A shortcoming of these two rescue technologies is the short duration of the reversal medication, naloxone. The reversal dissipates quickly and the respiratory depressant effect of the opioid reestablishes itself. The temporary reversal of the opioid requires subsequent transportation to the emergency department (ED) to preclude subsequent respiratory re-arrest. The newly revived patient sometimes refuses such transportation for fear of being put into a situation where the craved opioids are unavailable.


Addiction Treatment


Addiction treatment is a different matter from toxicity treatment. Toxicity treatment involves the emergency treatment of respiratory arrest. Addiction treatment is less emergent but more complicated.


The goals of addiction treatment are

  1. Ameliorating withdrawal symptoms
  2. Reducing cravings
  3. Reducing needle sharing and promiscuous behavior leading to the spread of other diseases as HIV and hepatitis
  4. Reducing relapse rates 
  5. Reducing drug diversionMaintaining longer abstinence


  • The general outline of addiction treatment is
    1. Switch the patient from short-acting opioids to longer-acting opioids. This reduces the “rush” of the rapid opioid onset and the “withdrawal” of the rapid opioid offset. It also reduces target drug craving and replaces the more dangerous target drugs with drugs having a broader margin of safety.
    2. Switch the patient to opioids of a different form, such as subcutaneous implants, that cannot easily be diverted to street sale.
    3. Switch the patient to oral opioids combined with opioid reversal agents that are effective intravenously but not orally. This reduces the risk of these drugs being diverted to intravenous use for the attainment of a “rush.”  
    4. Slowly taper the substituted opioid to reduce withdrawal and craving.
    5. Add adjuvants as clonidine and COMT inhibitors to prolong abstinence and reduce cravings.
    6. Reduce stress with propranolol to reduce the risk of relapse.
    7. Begin cognitive behavioral therapy to help identify and avoid situations conducive to relapse.
    8. Recognize that detoxification alone is not sufficient to effect long-term abstinence.
    9. Institute group therapy to help minimize the social stigma of having lost the ability to control one’s behavior with respect to a substance.
  • Things You Need to Know

    1. Even after prolonged recovery, it is never possible to use the target substance in a controlled manner.
    2. Treatment alone is hardly ever successful without rehabilitation.
    3. Will power is not enough.
    4. Relapse during recovery is not unusual and could be a valuable experience.
    5. Dysphoria, or unpleasant mood effect after abstinence, is the main reason for relapse.
    6. Even after long abstinence, it is necessary to avoid high-risk situations.
    7. A major aid to abstinence is Narcotics Anonymous.
    8. Friends and family must be compassionate but assertive and resist the urge to engage in enabling behavior with the patient.
    9. Finally, remember that addiction is a disease, not a character flaw or moral shortcoming. Addicted patients deserve the attention and respect of the healthcare delivery system.
  • Sources

  • The primary reference here is Dixon and Xiong, which provides much useful information, but is written at a technical level. I have reformulated some of the information to make it more available to the general public.


    Dixon, D., DO, & Xiong, G., MD. (2017, May 03). Opioid Abuse. Retrieved May 31, 2017, from


    Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR. Morbidity and Mortality Weekly Report,64(50-51), 1378-1382. doi:10.15585/mmwr.mm6450a3


 Thomas Falasca, DO

This video is a narcotics overdose case from Saint Paul's Emergency Room in British Columbia

Breast Cancer Awareness

About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime.


& ...See More

Breast Cancer Awareness



About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. Breast cancer accounts for 29% of all cancers in women; it is second only to lung cancer as a cause of cancer death among women.


In 2018, an estimated 266,000 new cases of invasive breast cancer are expected to be diagnosed in US women in the U.S., along with 63,960 new cases of non-invasive (in situ) breast cancer.


Although the overall US incidence of breast cancer is higher in white women, a larger proportion of African-American women are diagnosed with larger, advanced-stage tumors. In 2015, breast cancer death rates were 39% higher in African-American women than in white women.


Risk Factors


Increased age is a predominant risk factor in breast cancer. The disease is 7 times more likely in women over 50 than in those under 50. Nevertheless, when breast cancer occurs in younger women, it tends to behave more aggressively.


The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age


Family history is a further risk factor. The risk is 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is even greater if the relative was less than 50 years old when diagnosed with breast cancer. Further, ovarian cancer is also a consideration. Ovarian cancer in a first-degree relative doubles the risk of breast cancer.


Current oral contraceptive use seems to increase the risk of breast cancer by about 25%. To put this in perspective, it means that a hypothetical risk would rise from 20 in 10,000 to 25 in 10,000. However, risk returns to that of the average population within about 10 years following cessation of oral contraceptive use.


Increased risk of breast cancer in postmenopausal women has been associated with the following:

     Adult weight gain of 45 pounds above body weight at age  

     Diet high in animal fats and refined carbohydrates

     Sedentary lifestyle

     Consumption of 3-5 alcoholic beverages per week


Finally, increased risk of breast cancer has been associated with first pregnancy at a later age, early onset of menses, and late age of menopause.


On the brighter side, close adherence to a Mediterranean diet is associated with lower risk for breast cancer, especially for types that carry a poorer prognosis in postmenopausal women.




Contrary to popular belief, breast cancer is not a single entity. There are almost a dozen different types of breast cancer. Two of these, infiltrating ductal carcinoma and infiltrating lobular carcinoma, account for almost 90% of cases. The different types of breast cancer are typically identified when the pathologist views the tissue specimens under a microscope. Some types behave much more aggressively than others.


Even within these types, there are certain characteristics that can make some cases behave differently from others. These individual characteristics may make some tumors more susceptible than others to certain treatments.


Signs and symptoms


Early breast cancers usually have no symptoms. Later breast cancers may show

     Change in breast size or shape

     Recent nipple inversion or skin change, including nipple abnormalities

     Skin dimpling

     Nipple discharge, especially if blood-stained

     Lump in the armpit 


Only 5% of patients first consult their doctor because of breast pain or discomfort.




Because of the absence of early signs and symptoms, screening plays an important role in early detection. Some evidence exists that, at 14 years follow-up, screening mammography reduces breast cancer deaths by about 20–35% in women 50–69 years old and slightly less in women 40–49 years old.


Mammography often detects a lesion 1 to 2 years before noted by breast self-examination. Nevertheless, partly due to lack of health insurance, 20-30% of women still do not undergo screening as indicated.


Debate continues among authorities regarding the appropriate interval between mammographic screenings, the age at which screenings should begin, and the age at which they are no longer necessary. However, there seems to be general agreement that annual mammography is more appropriate to younger women, that biennial mammography is more appropriate to slightly older women, and that screening mammography is not appropriate for women with a limited life expectancy. For specifics about ages and frequency intervals, each woman is referred to her own physician.




Each case is different and the most aggressive treatments are not always necessary. Sometimes breast-conserving surgery suffices. Sometimes only partial breast irradiation at the tumor-removal site is appropriate. Sometimes chemotherapy is not required. No one should delay or avoid seeing their physician because of assumptions about treatment.




In brief, breast cancer remains a major death threat to women. There are several types of breast cancer, each behaving with its own degree of aggressiveness. Screening is important since early breast cancers show minimal symptoms. Each woman is referred to her own physician regarding screening specifics. Since each case is different, the most aggressive treatments are not always necessary. No one should delay or avoid seeing a physician due to false assumptions about treatment.





U.S. Breast Cancer Statistics. (n.d.). Retrieved September 15, 2018, from


Breast Cancer: Practice Essentials, Background, Anatomy. (2018, July 18). Retrieved September 15, 2018, from



Thomas Falasca, DO

Halloween Safety from American Academy of Pediatrics


Halloween is an e ...See More

Halloween Safety from American Academy of Pediatrics



  1. Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
  2. Consider adding reflective tape or striping to costumes and trick-or-treat bags for greater visibility.
  3. Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes. Makeup should be tested ahead of time on a small patch of skin to ensure there are no unpleasant surprises on the big day.
  4. When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
  5. If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stumbles or trips.
  6. Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
  7. Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost.


  1. Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.
  2. Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest. 
  3. Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended.


  1. To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations. 
  2. Parents should check outdoor lights and replace burned-out bulbs. 
  3. Wet leaves or snow should be swept from sidewalks and steps. 
  4. Restrain pets so they do not inadvertently jump on or bite a trick-or-treater. 


  1. A parent or responsible adult should always accompany young children on their neighborhood rounds. 
  2. Obtain flashlights with fresh batteries for all children and their escorts.
  3. If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
  4. Only go to homes with a porch light on and never enter a home or car for a treat.
  5. Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or-Treaters:
  6. Stay in a group and communicate where they will be going. 
  7. Remember reflective tape for costumes and trick-or-treat bags.
  8. Carry a cell phone for quick communication. 
  9. Remain on well-lit streets and always use the sidewalk. 
  10. If no sidewalk is available, walk at the far edge of the roadway facing traffic. 
  11. Never cut across yards or use alleys. 
  12. Only cross the street as a group in established crosswalks (as recognized by local custom). Never cross between parked cars or out driveways.
  13. Don't assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn't mean others will! 
  14. Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.


  1. A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats. 
  2. Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
  3. Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items. 
  4. Try to ration treats for the days and weeks following Halloween. 

©2017 American Academy of Pediatrics

Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, l ...See More

Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, lunches, starting school, homework/study habits, and hygiene. Here are some helpful tips on how you can promote a healthier, happier school year.



  • Backpacks should have wide, padded shoulder straps and a padded back.
    The backpack should never weight more than 10-20% of the child’s weight.
    Both shoulder straps should be used so as not to produce uneven strain on either side of the back.
    Heavier items should be arranged close to the midline of the back.
    Do not ignore back pain in a child.
    If a child develops back pain that doesn’t improve, consider a second set of textbooks to keep at home.



  • Consult school menus and consider packing a lunch on days when the menu includes items that your child doesn’t eat.
    Remember that a typical 12-ounce soft drink contains 10 teaspoons of sugar and 150 calories. Drinking just one can daily increases your child’s risk of obesity by 60%.


For Children Starting School

  • Answer any questions about school before classes begin.
    Introduce children to their school and, if possible, to their teacher, in advance.
    If possible, introduce them to classmates before the school year begins.
    Spend time talking with children about what happened in school.
    Make morning preparation as stress-free as possible by laying out books and clothes the night before.
    Let the child know that is normal to be a little anxious about starting school Assign a permanent workspace conducive to doing homework.


Homework and Study Habits

  • Schedule enough time for homework.
    Consider prohibiting TV and similar distractions during homework time.
    Supervise computer and internet use.
    Be available for consultation during homework time but do not do the child’s homework.



  • Stress hand washing before eating and after using the toilet,blowing the nose, tying the shoes, or playing outside.
    Handwashing should continue for as long as it takes to sing the “Happy Birthday Song” twice.
    Give the child an alcohol-based hand sanitizer to use whenever washing is unavailable and after using shared computers, pencil sharpeners, or other community objects.
    Remind the child to keep hands away from eyes and out of mouth.
    Stress the importance of not sharing food, water bottles, or other personal items.


So, with these tips in mind, the school year should bring peace of mind to the adults and new growth to the children.


Thomas Falasca, DO



For More Information Please Visit

American Academy of Child and Adolescent Psychiatry


American Academy of Orthopedic Surgeons


American Academy of Pediatrics: Back to School Tips


American Psychiatric Association


Mayo Clinic

Seasonal Flu

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.   ...See More

Seasonal Flu

What Is Flu?

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.  An episode of flu typically runs its course over several days.  Although usually just a severe nuisance, flu can sometimes result in respiratory failure and death.



An attack of influenza is usually accompanied by muscle aches, headache, fever, sore throat, red watery eyes, runny nose, and cough.  Only some of the symptoms may be present.


These symptoms sound like a cold, and like a cold, flu is a respiratory infection. However, influenza is caused by a different virus and is more severe.



Each year about 200,000 Americans are hospitalized because of flu complications. The number of deaths varies depending on the annual virus strain; but American deaths have recently ranged from 3,000 to 49,000 in a year.  While human lives are most important, it is noteworthy that even mild strains of the flu can impact the American economy by $10 billion annually in lost productivity.



Influenza is typically spread by the aerosol droplets propelled in the course of a cough or sneeze.  Even people six feet from a sneeze are at increased risk of infection from these micro particles.  


Flu can also be spread from surfaces.  If a person coughs into their hand or sneezes into a handkerchief and then touches an object such as a doorknob or computer keyboard, that object becomes contaminated. A person who touches the object shortly afterward can be infected, usually when they transfer the virus from their hand to a mucous membrane such as the nose, mouth, or eye.


Because of the high level of contagion, it is important that flu patients remain home to avoid infecting co-workers.



Once a person becomes infected by the virus, it takes 1 to 4 days before they exhibit symptoms.  However, they may transmit the virus to others even before symptoms become evident. Thus it is not sufficient to avoid persons who appear to be sick.  It is important to make a habit of frequent hand washing as this can reduce both virus dissemination and acquisition.



Occasionally influenza does not run its normally uneventful course but instead results in complications.  Some of the most serious of these are viral pneumonia, bacterial pneumonia, respiratory failure, an inflammation of the heart (myocarditis), an inflammation of the membrane surrounding the heart (pericarditis), and multiorgan failure.



Fatalities are most common in infants and the elderly. Thus it is important that senior citizens receive vaccination, the “flu shot.”  Vaccination is also important for pregnant women.  Pregnant females are not at risk from the flu shot and they need vaccination because they are at increased risk of complications from flu and they need to pass on their immunity to the newborn.

Others who are at increased vulnerability are those who are immunocompromised from disease or chemotherapy.



A pandemic is an epidemic that occurs over a broad area.  Four flu pandemics have occurred in the last century.  These epidemics occurred when a highly contagious and aggressive strain of the virus emerged.  


The infamous “Spanish flu” of 1918 killed nearly 675,000 people in the US and a possible 50 million people worldwide.  


The “Asian flu” of 1957 killed about 69,800 people in the US.  


The “Hong Kong flu” of 1968 took the lives of 33,800 people in the US.  The relatively modest number may have been largely due to the availability of antibiotics to treat secondary bacterial infections.  


The “swine flu” of 2009 caused between 9,000 and 18,000 deaths.  The reduced number of deaths in this epidemic may have been due to the fact that 80 million people were vaccinated.


Flu Vaccination Does Not Cause Flu

Vaccination against flu can be by injection or nasal spray.  The injection contains virus that is inactivated (“killed”). The nasal spray contains virus that is attenuated (“weakened”) and so altered that it can be active only at the cooler temperatures of the nose and not in the warmer temperatures of the lungs. The result is that flu vaccination does not cause the flu!


Vaccination Side Effects

Serious vaccination side effects are quite rare.  They are circumvented by avoiding certain flu vaccinations in specific groups of people.


Traditionally, flu vaccine was produced using chicken eggs and was contraindicated in persons with egg allergy.  Since 2012 a vaccine prepared in a different manner has been available for persons 18 years of age and older who are allergic to eggs.


An inactivated virus vaccination rather than an attenuated virus vaccination is generally appropriate for persons with weakened immune systems congenitally, from illness, or from chemotherapy.


In short, some type of flu vaccination should be appropriate for most individuals 6 months of age and older.


So If I Get Vaccinated, I Can’t Get the Flu, Right?

Not quite!  In the recent past flu vaccination has had 70% effectiveness against influenza B and 60% effectiveness against influenza A.  This is so because:

  • The US Center for Disease Control (CDC) must project in advance the virus strains of the upcoming flu season.
  • Different individuals have different capabilities of manufacturing antibodies in response to the stimulus of the vaccine.
  • It takes 1-4 days after infection for flu symptoms to emerge.  Persons can be infected before they receive the vaccination.
  • It requires 7-14 days for the body to build antibodies from the stimulus of the vaccination. Vaccinated people can be infected with flu during this time period.
  • Symptoms of flu can be simulated by other virus infections.  Flu vaccinated persons who seem to get the flu may have these other infections.


How Can I Prevent the Flu?

The best method of dealing with the flu is not to have it!  In order to greatly reduce chances of getting the flu, it is most important to take these precautions:

  • Practice frequent hand washing, especially after contact with objects touched by infected persons or the general public.
  • Avoid proximity to infected persons.
  • If infected, stay home and avoid contact with others. Bear in mind that you are infectious for 4-9 days after onset of symptoms.
  • Finally, present yourself for vaccination.  This is your surest way of protecting yourself from flu.  As an added benefit, remember that by getting vaccinated, you are also protecting newborns, elderly, chemotherapy patients, and others unable to fully benefit from their own vaccination.



So please stay well this season and protect yourself from flu.


Thomas Falasca, DO

View this fact-filled video on flu symptoms from the US Centers for Disease Control!


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