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

Avoiding Infections

An ounce of prevention is worth a pound of antibiotics. Preventive hygiene is still the best way to avoid infectious ...See More

Avoiding Infections

Avoiding Infections 



In the past century, science and medicine have provided many weapons to use on infectious diseases. There are antibiotics for many bacterial diseases, antivirals for some viral diseases, antimycotics for many fungal diseases, and even surgery for localized infections. But, the best way to deal with an infectious disease is still not to have it. Prevention remains a tool against infectious disease, indeed, a most efficacious tool with few drawbacks except the modest energy needed to employ it. 



Hand Washing

We touch our hands to our faces, according to some studies, an average of 20 times per hour. But the mucous membranes of eyes, nose, and mouth provide easy access to the body for germs, especially for viruses because of virus’ small size. It would be best for us to keep our hands away from our faces, even when the hands appear clean. However, this is sometimes not practical. Consequently, hand washing is important.


According to the Centers for Disease Control (CDC), frequent hand washing in a community reduces diarrheal illnesses by 31% and respiratory illnesses by 21%.



How to Wash Your Hands

Hand washing is not always intuitive.


First, use plenty of warm, running water and sufficient soap. At faucet temperature, the warmth of the water is not sufficient to kill germs, However, it renders hand washing more comfortable and, therefore more likely to be maintained for a time sufficient to be more effective.


Second, use sufficient soap and rub hands together. The idea is not to kill germs, but to remove them. The soap loosens germs from the skin and the rubbing dislodges them for carrying away by the water. Be sure to wash front and back, all fingers, between the fingers, and under the nails for at least 20 seconds. Twenty seconds is about the time it takes to hum two repetitions of the Happy Birthday Song.


Third, for drying, cloth towels may transfer other people’s germs. Better are electric hand dryers as found in public restrooms. To further avoid transferring germs to your hands, press the dryer’s on-off switch with your elbow. Nevertheless, paper towels, although the least ecological hand-drying option, are the most hygienic. Be sure to use a dry paper towel to turn off the faucet and to touch the door handle when leaving a public restroom. If there is no used paper towel depository by the door, let the paper drop to the floor, the maintainers of the public restroom will get the message to provide a depository.


When to Wash Your Hands

Although frequent hand washing is important, there are times when it is essential, such as



  •      Touching your mouth, including eating, drinking, and tooth brushing.
  •      Helping a sick person.


     Using the bathroom.

     Changing diapers.

      Touching high-hand contact surfaces such as doorknobs, elevator buttons, handrails, and poles and handles on busses, trains,             

          and subways.

     Helping a sick person.

     Blowing your nose.

     Touching an animal, animal feed, or animal waste.

     Touching garbage.

     Tying shoes.


Before and after

     Helping a sick person.

     Treating a cut or wound.

     Preparing food.


Unfortunately, in some investigations, only 31 percent of men and 65% of women washed their hands after using a public restroom.


Hand Sanitizer

Hand sanitizers are a potent hygienic weapon when hand washing is not available. However, while hand washing removes germs and harmful chemicals, hand sanitizers only inactivate some of the germs. Hand sanitizers are less effective when hands are visibly dirty or greasy as the dirt can protect the germs from best contact with the sanitizer. Further, it is senseless to use the sanitizer to smear dirt more widely!


As with hand washing, rub front and back of hands, all the fingers, between the finger, and under the nails. Rub until the hands are dry.


Sanitizers should contain at least 60% ethyl alcohol, which inactivates germs by denaturing the proteins of bacteria and viruses. This only takes about 15 seconds. Unfortunately, sanitizers do not work well against norovirus, which is the most common cause of gastrointestinal illness in the United States.


Children should use hand sanitizers only with adult supervision as swallowing hand sanitizers can cause alcohol poisoning. Children may be particularly likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children.



Fingernails can provide a cozy place under which germs can hide. Fingernails should be kept short, and the undersides should be cleaned frequently with soap and water. Finally, keep any remaining germs away from the mucous membranes of the mouth by not biting fingernails.


Routine fingernail care should also be done hygienically. Before use, nail clippers and files should be properly cleaned, even sterilized, if used among a number of people, as in a nail salon. Also, cuticles act as barriers to infection; avoid cutting or disrupting them.


In the Kitchen

The kitchen sink can be a source of spread for many germs. The kitchen floor just in front of the sink often has more bacteria than the trash can. Washing chicken in the sink can transfer intestinal germs such as campylobacter or salmonella from hands to sponges and to faucet handles. The sink should be washed often with special attention to faucets. Wet sponges can be sterilized by placing in the microwave for two minutes.


In the Bathroom

Flushing a toilet can disperse bacteria into the air and contaminate anything within a three-foot radius. Because of this, it is important to close the lid before flushing and to keep toothbrushes away from this radius.


Sharing cosmetics may result in sharing bacteria. Sharing toothbrushes can pass on such blood-borne viruses as hepatitis B and C, and infectious mononucleosis. Sharing razors may share MRSA (methicillin-resistant staph aureus) as well as blood-borne viruses.


Since children, and some adults, may not be conscientious about bathroom hygiene, it is essential to frequently clean bathroom light switches and door handles.


At the Front Door

Taking off shoes on entering the home and leaving them at the door keeps the house cleaner and avoids tracking in allergens and germs.


Although entering the front door in winter conveys a sense of warmth and comfort, the truth is that when the cool air in the house is heated, even with a substantial humidifier, it becomes capable of absorbing more moisture. It thus dries out the mucous membranes of the home's inhabitants, increasing violation of the mucous membranes by germs.



Bleach contains hypochlorous acid, which attacks proteins in bacteria and some viruses. It is a powerful disinfectant, said to be about 99% effective.


Vinegar, thanks to its content of 5% acetic acid, is a disinfectant said to be 90% effective against bacteria and 80% against viruses. It kills flu virus but not staph. Although less effective against bacteria than bleach, it is cheap, nontoxic, and biodegradable.


Electronic Devices

Electronic devices can be an unsuspected source for germ transfer. One research project found thousands of bacteria on an Amtrak touch screen in the train station. Cold and flu germs can live on such hard surfaces for up to 48 hours. Swine flu has been shown to survive in this environment for up to five days. Hand washing, or at least hand sanitizer use, is essential after use of public touch screens.


Even personal electronic devices can transfer germs. One study showed 16% of cell phones to be contaminated with intestinal bacteria. It is imperative to clean the phone regularly, especially after lending it to someone, and to be careful where laying it down.


On Airplanes

Despite the public perception that the major airplane exposure is breathing recirculated contaminated air, the air in a plane is well-protected by high-efficiency filters, which remove more than 90 percent of known particulate matter.


A bigger concern than recirculated germs is low cabin humidity, about 10% when flying at 30,000-35,000 feet. This dries the mucous membranes of the noses and throats of passengers. Consequently, the mucus becomes too thick for easy movement and it remains longer in the upper respiratory tract. This gives entrapped germs more time to penetrate the passengers’ mucous membranes.


The most significant airborne exposure on a plane comes from fellow passengers. The most dangerous neighbors on a plane are those sitting within a two-seat radius since bacteria and viruses from coughs and sneezes do not readily transmit more than six to eight feet.


Airborne exposures aside, the usual concerns about contact surfaces remain, also on a plane. The worst exposure is the airplane bathroom, which has the exposures of other bathrooms but complicated by smaller space. Other important contact exposures on an airplane are seat-back trays and aisle-seat handles.


In a Hotel

Hotels are in the hospitality business and usually try to present a clean appearance. Nevertheless, germs are frequently abundant on bedspreads due to the difficulty in cleaning them. Light switches and bathroom floors are often contaminated with intestinal bacteria. However, the dirtiest site in the hotel room is usually the TV remote control.


Meanwhile, in the hotel restaurant, menus are the biggest carriers of germs, followed closely by the pepper shakers.


At the Gym

Keeping any cuts or injuries fully covered is imperative when working out at the gym. It is also essential to use the solutions and towels provided to wipe down the equipment before using it.


Plantar warts virus and athlete’s foot fungus can easily infect those going barefoot on gym floors and locker rooms. Wearing shower shoes in the shower and locker room is critical.


For yoga aficionados, it is important to bring one’s own yoga mat and to wear socks when not on it. 


At Work

One of the most important rules to follow for work is not to go if you are contagious. This rule is becoming easier to follow now that there are increased opportunities to work from home.


If someone at work is coughing or sneezing, maintain a social distance; as mentioned, six to eight feet is usually sufficient.


Other precautions to observe at work are

  •      Covering coughs and sneezes.
  •      Washing hands frequently.
  •      Regular cleaning of often-touched surfaces.


Flu Shot

Since meticulously following all of these precautions is not always possible, it is important to get an annual flu shot. The flu virus spreads from person to person through droplets coming from the nose and mouth when a contagious person coughs, sneezes, or talks. The flu virus may also spread when someone touches a surface with flu virus on it, and then touch their eyes, nose, or mouth. An annual flu inoculation helps protect from these exposures.



Again, the best way to deal with an infectious disease is not to have it. Prevention is a most efficacious tool with few drawbacks except the modest energy needed to employ it. 


Thomas Falasca, DO


Sources and Recommended Reading

Centers for Disease Control and Prevention.

Fox, B. (2015). Introduction to Infectious Diseases. Chantilly, VA: The Great Courses.

Handwashing: Clean Hands Save Lives. (2018, October 09). Retrieved from

Water, Sanitation & Environmentally-related Hygiene. (2011, February 01). Retrieved from   

Water, Sanitation & Environmentally-related Hygiene. (2009, December 30). Retrieved from

Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here ar ...See More

Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils, so here are some helpful tips.


First and foremost

  • Check with your doctor. Shoveling stresses the heart because of both exertion and cold. Consider hiring someone for the task.
    Do not shovel after eating or smoking as these activities reduce blood flow to the heart.
    Stop if you feel chest pain, or get excessively tired or have shortness of breath. You may need immediate professional care.
    Dress in layers with water-repellant clothing outermost. Remember hats, gloves, and warm socks because substantial body heat is lost from these areas.


Choose an appropriate snow shovel.

  • A curved-handled shovel helps keep your back straighter when shoveling.
    Choose a shovel with an appropriate length handle. The length is appropriate when, at the beginning of the shoveling stroke, it allows you to slightly bend your knees and bend your back less than 10 degrees while still holding the handle comfortably.
    A plastic shovel blade adds less weight to the lift than a metal blade.
    A smaller shovel blade may add to the time of the task; but, by picking up less snow, it reduces the risk of a heavy shovel load.


Be mindful of your shoveling actions.The American Academy of Orthopedic Surgeons recommends

  • If you must lift snow, squat with legs apart, knees bent, and back straight.
    Lift with the legs instead of bending at the waist; this reduces strain on the back.
    Scoop small amounts of snow with the shovel and walk to the dumping area.
    Outstretched arms exaggerate strain on the back.
    Remove deep snow in layers of an inch or two in thickness.
    Move feet instead of twisting.


In addition, remember that

  • Pushing the snow instead of lifting it reduces strain on the back.
    Gripping the snow shovel with your hands at least 12 inches apart increases leverage and decreases body strain.
    Throwing snow over your shoulder is dangerous. It twists the back and predisposes to injury.
    Warming up muscles before shoveling reduces the risk of strains and sprains.
    Frequent breaks to gently stretch back, arms, and legs reduce stress to these areas and distributes over time exertion on the heart.
    Wet snow is especially heavy and one shovelful can weigh 25 pounds.
    Clearing snow early and often to avoid dealing with a large amount of heavy, packed snow.


So follow these tips and avoid becoming a snow-shoveling casualty.


For more information, consult
· Colorado Spine Institute
· National Safety Council
· Toronto Emergency Medical Services


Thomas Falasca, DO

Enjoy this fun and informative video from the Boston Public Health Commission!

Cold Hands - Innocent or Not?

The common cold hands can be an okay phenomenon, but sometimes it can be serious. This article describes when it is i ...See More

Cold Hands - Innocent or Not?


Who Gets Cold Hands?

Cold hands or feet in wintertime are commonplace.  Sometimes, however,cold hands can be a sign of something more serious.  Here are things you need to know about what is innocent, serious, or emergent.


When It’s Innocent

Cold hands can be a normal response to stress.  Under stress, the body tends to divert blood away from the skin and peripheral areas of the body in order to better supply muscles and vital organs.


Intense cold hands also occur in response to decreased temperature.  First, cold is a stress.  Second, heat dissipates more rapidly from peripheral and well-perfused areas of the body as hands, feet, and head.  Third, the body responds to this heat loss by decreasing circulation to the hands and feet in order to reduce the heat loss.


But about 10% of people have an exaggerated response to stress and especially to cold.  This is called “primary Raynaud phenomenon.”  In addition to feeling cold, the hands or feet often exhibit a color change that begins with white, then becomes blue, and finally, shifts to red when circulation returns.  Pain, tingling, or numbness may also occur in the affected area.


These changes are bilateral and symmetric, i.e., they occur to a similar extent and at the same time on both left and right.  Women are more subject to these changes than men.  The phenomenon often begins in a person’s teens or twenties and tends to persist.


This situation is innocent when the episodes are short-lived, reverse rapidly on rewarming, and involve no other changes.  The phenomenon very rarely becomes serious when the decreased blood flow to the affected area results in tissue damage.  Some evidence suggests that persons exhibiting the Raynaud phenomenon have a somewhat increased risk of cardiovascular disease.


When It’s Serious

Raynaud phenomenon is serious when it is associated with tissue damage and when there is an identifiable underlying cause.


The underlying cause can be an occupational disease, blood disease, autoimmune disease, infectious disease, metabolic disease, malignant disease, or even a medication.


Some of the occupational causes are past frostbite, or other injury, use of vibrating tools, lead or arsenic exposure, and exposure to organic solvents such as polyvinyl chloride, xylene, toluene, or acetone.


Some blood diseases associated with the phenomenon are polycythemia, cryofibrinogenemia, and paroxysmal nocturnal hemoglobinuria.


Autoimmune diseases implicated in the phenomenon are scleroderma, lupus erythematosis, rheumatoid disease, vasculitis, and Sjøgren Syndrome.


Infectious diseases associated with Raynaud phenomenon are hepatitis infections associated with cryoglobulinemia and Mycoplasma infections with cold agglutinins.


Metabolic diseases with links to Raynaud phenomenon are diabetes mellitus, pheochromocytoma, myxedema, and acromegaly.


Malignant diseases related to Raynaud phenomenon are leukemia, lymphoma, myeloma, and adenocarcinoma of the lung.


Finally, even medications can be associated with Raynaud phenomenon.  Some of these are oral contraceptives, ergot alkaloids, beta-blockers, cyclosporin, methylphenidate, and some cancer chemotherapeutics.


When It’s an Emergency

Of course, a white or blue color change that doesn’t rapidly reverse, or that reverses and then becomes painful or numb, is an emergency.  This is especially true  if the affected area had become white and hard or if it had been subjected to prolonged immersion in cold water.  The problem here may be frostbite, thromboangitis obliterans, or arterial embolus.  These circumstances warrant a trip to the hospital emergency room.


What To Do

The treatment for Raynaud phenomenon depends on whether it is innocent, serious, or an emergency.


The treatment for innocent Raynaud phenomenon is straightforward.  Insofar as possible, avoid exposure to cold air, cold liquids, and cold surfaces.  Wear substantial gloves, or preferably mittens, and substantial socks.


Since circulation to hands and feet is reduced to prevent further loss of heat from the body in general, it is important to avoid overall heat loss.  Dress warmly in general and wear a substantial hat, since a great deal f heat is lost from the head and face.


Avoid smoking and caffeine as these reduce blood flow to the extremities.


Report these symptoms to your physician since some of your medications may contribute to the problem and your physician may want to reevaluate them.

The treatment for serious Raynaud phenomenon is more complex.


Of course, the common sense solutions still apply.  It is always good sense to avoid cold exposure, dress warmly, and stop smoking.


But now, you need to have your physician evaluate you.  First, you may have one of the aforementioned underlying diseases that can cause Raynaud phenomenon.  These diseases may require treatment in themselves; and, the Raynaud may not improve unless the underlying problem is addressed. Second, your physician may be able to offer medical treatment that makes the phenomenon less troublesome.


Finally, if the problem is an emergency, you need to go to the hospital emergency room.  Conditions such as frostbite, thromboangitis obliterans, and arterial embolus require serious intervention, or even surgery, to prevent possible loss of fingers, toes, or an extremity.


So Now You Know

Now you understand some of the mechanisms behind cold hands and when this phenomenon is exaggerated.  You know that if this problem bothers you, avoid cold, dress warmly including mittens and a substantial hat, and avoid caffeine.  And, you now have one more good reason to stop smoking!  If the phenomenon is particularly troublesome, consult your physician.  If the white or blue discoloration does not rapidly reverse or is accompanied by pain or numbness, visit the hospital emergency room.  Armed with this knowledge, you should get more enjoyment from the colder months.


Thomas Falasca, DO              




Dangers of Binge Drinking

Binging means me ...See More

Dangers of Binge Drinking

What Is Binge Drinking?

Binging means men drinking 5 or more alcoholic drinks or women drinking 4 or more alcoholic drinks within a 2-hour  time period.  A “drink” is considered to be 12 ounces of beer, 4 ounces of wine, or 1 ounce of 80-proof liquor.

Most people who binge drink are not alcohol dependent.


Prevalence of Binging

Binge drinking is more common among young adults aged 18-34.

1 in 5 high school girls binge drink.

About 90% of the alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinks.


Consequences of Binging

The most obvious consequences of binging are injuries resulting from impaired judgment or impaired reflexes and reaction time.  Impact injuries result from car crashes and falls. Exposure injuries include burns, drowning, and cold exposure.

Binge drinking is especially dangerous in combination with cold exposure.  First, it impairs judgment so that the dangers of hypothermia are not readily appreciated.  Second, alcohol dilates the peripheral blood vessels so that heat is lost from the body at an accelerated rate.  This unfortunate combination has resulted in three recent regional fatalities.

Additionally, incapacitation produced by alcohol renders bingers prone to victimization.  Bingers may find themselves the targets of sexual assault, robbery, and other violent crime.

Further dangers to the binge drinker include alcohol poisoning, unintended pregnancy, and sexually transmitted disease.

A recent study by the Harvard School of Public Health compared frequent bingers with non-bingers and found the following behavior differences:

  • Missed Classes: 62% vs. 9%
  • Unplanned Sexual Activity: 42% vs. 8%
  • Unprotected Sex: 22% vs. 4%
  • Forgot Past Actions: 55% vs. 9%
  • Actions Later Regretted: 62% vs. 16%
  • Police Involvement: 13% vs. 2%
  • Injury: 26% vs. 3%
  • Drove after Drinking: 69% vs. 22%
  • Rode with Drunk Driver: 53% vs. 10%


Binge Drinking Precautions 

Binge drinking does not have to be part of the socialization culture.  The culture can change if individuals behave responsibly and follow a few suggestions:

  • Understand what a standard drink is and that sizes commonly served may be larger than a standard drink. 
  • Plan ahead. Set a limit to alcohol consumption and stick to it.
  • Alternate between alcoholic drinks and water.  This reduces the amount of alcohol consumed, maintains hydration, and reduces the rate of alcohol absorption. 
  • Always have a designated driver.
  • Eat before and during drinking to slow alcohol absorption.
  • Avoid all types of drinking contests or games.
  • When going out, stick with friends who share a similar outlook on binge drinking and avoidance of risk taking.  Look out for one another.
  • Avoid drinking quickly so that you don’t miss your body’s signals telling you how intoxicated it is becoming.
  • Don’t set drinks down.  Retaining them in your hand reduces the risk of drink tampering.
  • Avoid drinking from pitchers and punch bowls.  It is easy to tamper with their contents and difficult to estimate the amount of alcohol being consumed from them.  
  • It is okay not to drink!  Ask for a soda or water instead of an alcoholic beverage.



Every life lost or irretrievably changed by binge drinking is a tragedy that no family has to endure.  The Erie County Medical Society strongly supports individual and community efforts to change the behavior and culture of binge drinking on college campuses and elsewhere in our society.


Thomas Falasca, DO

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