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.



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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.

 

Toxicity

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 http://emedicine.medscape.com/article/287790-overview

     

    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

What You Should Know About Colorectal Cancer

Colorectal cancer is the third most common cancer and the third most common cause of cancer deaths in the US.

...See More

What You Should Know About Colorectal Cancer

 

Colon

 

Symptoms of Colorectal Cancer

 

Colorectal cancer symptoms include fatigue, weight loss, abdominal pain, rectal bleeding, change in bowel habits, obstruction or perforation, and anemia. However, in early stages, colorectal cancer can be without symptoms.  Screening can detect colorectal cancer in these early stages when it is without symptoms.

 

Demographics of Colorectal Cancer

 

Colorectal cancer is the third most common cancer and the third most common cause of cancer deaths in the US. It is the most frequent gastrointestinal cancer.

The American Cancer Society estimates that 97,000 new cases will be diagnosed in the US this year. Incidence and mortality of colorectal cancer is highest in African-Americans and lowest in Hispanics. The incidence of the disease is about equal in men and women.

 

Risk Factors of Colorectal Cancer

 

Increased risk of colorectal cancer is associated with diets high in red meat and animal fat as well as diets low in fruits, vegetables, and fiber. Processed meats and organ meats are also more highly associated with colorectal cancer. The risk is increased in men and women who do not drink alcohol. It is also higher in obese men and, unexpectedly, in lean women. Increased risk is also associated with cigarette smoking, sedentary habits, and excessive alcohol consumption.

 

Consumption of one ounce of alcohol daily was associated with almost triple the risk of colorectal cancer. Carriers of a gene identified with Lynch syndrome have a 40% lifetime risk of developing colorectal cancer. Age is another risk factor for colorectal cancer and the median age at diagnosis is 68 years.

 

Finally, increased risk of colorectal cancer was associated with ulcerative colitis and Crohn Disease, and those with the gene for familial adenomatous polyposis. Have almost 100% risk of developing colorectal cancer by the age of 40.

 

Screening for Colorectal Cancer

 

Fortunately, colorectal cancer is highly amenable to screening. The disease takes many years to progress from premalignant lesion to cancer, so there is a wide time window in which early action can be taken.

 

The median age at diagnosis is 68 years. This is the reason that all current guidelines recommend routing screening begin at the age of 50 and occur every 10 years. More frequent colonoscopy may be required depending on the patient’s personal and family history as well as on the results of previous colonoscopies.

 

Although screening has already reduced deaths from colorectal cancer, full implementation of screening could reduce deaths by 50% more.

 

Colonoscopy

 

  • Colonoscopy involves your physician inserting a long flexible tube through the anus into the rectum and along the full length of the colon to the point where it joins the small intestine. The tube has channels, one of which is a fiber optic channel through which pictures and video can be taken. Another channel admits the passage of small flexible instruments that can be used to remove small polyps, biopsy tissues, and control any bleeding.

 

Although other technologies are emerging to visualize the colon, colonoscopy remains the gold standard since it allows removing a polyp and consequently definitively treating the precancerous condition.

 

Colonoscopy can be done with various degrees of anesthesia, making the procedure a comfortable outpatient experience.

 

Risk Reduction of Colorectal Cancer

 

Several behavioral alterations can reduce the risk of colorectal cancer. These are

  •        -Screening as recommended by your physician.
  •        -Adopt a diet low in red meat and animal fat.
  •        -Adopt a diet rich in fruit, vegetables, and fiber.
  •        -Reduce processed meats and organ meats.
  •        -Avoid excess alcohol consumption.
  •        -Cease smoking.
  •        -Keep physically active.
  •        -Avoid obesity (especially men).

 

Although earlier data suggested that calcium and vitamin D supplementation might reduce the risk of colorectal cancer, subsequent data showed that such supplementation did not reduce the recurrence of removed colorectal polyps.

 

Some data suggests that celecoxib, sulindac, and dimethylformamine can reduce the risk of colorectal cancer.  

However, aspirin seems to have similar effects with fewer side effects.

 

Treatment of Colorectal Cancer

 

Treatment of colorectal cancer can consist of surgery, radiation, and chemotherapy.

 

Surgery involves removal of the affected portion of the colon along with its areas of lymph drainage. It has the potential to be curative.

 

Radiation is used primarily to treat rectal cancer and metastases from colorectal cancer.

 

Chemotherapy includes both standard chemotherapy agents as well as biologic agents that are antibodies against biologic factors that promote tumor growth and vascularization.

 

Conclusion

 

In summary, colorectal cancer is one of the most common malignancies. However, it is also one of the most preventable. Screening as advised by your physician, along with dietary changes cessation of smoking, and weight reduction

will certainly reduce both incidence and deaths from this disease.

 

Thomas Falasca, DO

 

 

References

 

Dragovich, T. (2018, January 30). Colon Cancer. Retrieved March 18, 2018, from https://emedicine.medscape.com/article/277496-overview

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GERD - What You Should Know

GERD or Gastro-Esophageal-Reflux Disease is a digesti ...See More


GERD - What You Should Know

 

 What Is GERD?

GERD or Gastro-Esophageal-Reflux Disease is a digestive system disorder marked by backward flow of stomach acid, and sometimes bile and pancreatic products, upward into the esophagus.

 

GERD Symptoms

GERD symptoms are of two types: typical and non-typical.

The typical symptoms are digestive symptoms such as heartburn, regurgitation with sudden acidic taste in the mouth, and sudden occasional difficulty swallowing.

 

The atypical symptoms are those often associated with respiratory problems, such as asthma, pneumonia, laryngitis, hoarseness, nighttime coughing, and even dental enamel erosion.

 

Demographics of GERD

GERD has been estimated as affecting, at some time and in some degree, upwards of 25% of Americans. Further, the incidence has been rising in recent years. GERD seems to be more common in Caucasian Americans than in African Americans and is also more common in persons older than 40 years..

 

GERD Risk Factors

Obesity is the most important risk factor in GERD. However, other risk factors are smoking, alcohol, high dietary fat, and increased gram-negative bacteria in the GI tract. Finally, hiatal hernia is a frequent cause of GERD.

 

Causes of GERD 

The esophagus is often called the “food tube,” but this is inappropriate. It suggests that swallowing is a passive procedure, like clothes falling down a laundry chute into a basket in the basement.  

 

Actually, it is movements in the esophagus that propel food along toward the stomach. A sort of valve called the lower esophageal sphincter or LES separates the esophagus and the stomach, helping to keep the stomach contents from returning into the esophagus. Another valve, the pylorus. separates the stomach from the intestines and keeps contents of the intestines, including bile and pancreatic secretions, from returning to the stomach.

 

GERD may be caused when the esophagus does not adequately propel food toward the stomach, when the LES does not adequately keep stomach contents from returning to the esophagus, when the stomach remains too full of contents too long, when bile and pancreas secretions reflux from the small intestine into the stomach and then into the esophagus, or when there is a hiatal hernia.

 

A hiatal hernia permits the migration of part of the stomach from the abdomen into the chest. One of the ways that hiatal hernia can cause GERD is by allowing retention of food into the part of the stomach herniated into the chest.

 

There is another, more sophisticated mechanism by which part of the stomach moving into the chest causes GERD. Here the stomach moving into the chest takes the LES with it. But, the pressure in the chest is negative, this allows the lungs to inflate during breathing. The negative pressure outside the LES assists keeping it open, allowing reflux of gastric contents into the esophagus.

 

Complications of GERD

The most serious complications of GERD are esophagitis, stricture, and Barret esophagus.

 

Esophagitis is damage to the internal lining of the esophagus on continuing exposure to reflux. It occurs in about 50% of untreated GERD patients.

 

Stricture is a narrowing of the esophagus due to deeper tissue injury. It can result in difficulty swallowing and vomiting of undigested food. This typically requires surgical consultation.

 

Barrett esophagus is the most serious complication and affects 8-15% of untreated GERD patients. It changes the character of the lower esophageal lining cells to somewhat resemble those of stomach lining cells. Barrett esophagus increases the risk of esophageal cancer 30-40 times. Barrett esophagus also needs surgical consultation.

 

Treatment of GERD 

Treatment of GERD typically depends on severity and falls into three categories: lifestyle changes, medication, and surgery.

 

Lifestyle changes include

  •      Losing weight
  •      Stopping smoking
  •      Avoiding alcohol, chocolate, citrus, and tomato along with peppermint, coffee, and onion.
  •      Avoiding large meals
  •      Waiting 3 hours after meals before reclining
  •      Elevating the head of the bed by 8 inches
  •  

Medications include

  •      Antacids
  •      Histamine-2 receptor blockers such as ranitidine, cimetidine,famotidine, and nizatidine.
  •      Proton pump inhibitors such as omeprazole, lansoprazole, rabeprazole, and esomeprazole.

 

Surgery

  •      The most common surgery is the Nissen fundoplication, in which a portion of the upper stomach is sutured around the lower part of the esophagus to strengthen the function of the LES.

 

Conclusion

The most important things to remember are that GERD is common, that there are effective treatments for GERD, and that GERD should not be ignored. Left untreated, GERD can result in such serious problems as esophageal stricture and esophageal cancer. Nevertheless, your physician can offer effective treatments for GERD.

 

Thomas Falasca, DO

 

 

References

 

Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Gastroenterol Clin North Am. 2010 Mar. 39(1):39-46.

 

Heartburn across America: a Gallup Organization national survey. 1988.

 

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007 Mar. 11(3):286-90.

 

Loffeld RJ, van der Putten AB. Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy. Digestion. 2003. 68(2-3):141-4.

 

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov. 21(11):953-6.

Patti, M. (2017, October 17). Gastroesophageal Reflux Disease. Retrieved December 07, 2017, from http://emedicine.medscape.com/article/176595-overview

 

Shaheen N, Provenzale D. The epidemiology of gastroesophageal reflux disease. Am J Med Sci. 2003 Nov. 326(5):264-73.

 

 

 
 
 
 

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the rec ...See More


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.

 

Toxicity

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

 

 

 Thomas Falasca, DO

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

Seasonal Allergies

Every springtime 35-40 million Americans struggle with the problem of seasonal allergies. Allergies are one of the mo ...See More


Seasonal Allergies

INCIDENCE

Every springtime 35-40 million Americans struggle with the problem of seasonal allergies. Allergies are one of the most common reasons that people miss or underperform at work or school. They are thought to be responsible for 10,000 school absences daily.
The incidence of allergy is 10% in children below 10 years of age, but doubles in the child’s next 10 years. So it may be wishful thinking to hope that the child will outgrow the problem. But, on a brighter note, studies show that allergic kids who are treated do better at school than those who are not.

 

POLLEN

Seasonal allergies are typically triggered by pollen, tree pollen in early spring, with grass pollen causing problems in late May or June. Here, in Erie, there is little problem with mold until later in the season. Finally, ragweed becomes the offender in August and September.

 

When a sensitized allergic individual comes in contact with pollen, an immunologic reaction occurs that releases mediators, which, in turn, cause symptoms.

 

SYMPTOMS

The most common allergic symptoms are nasal stuffiness, runny nose, watery eyes, sneezing, coughing, itchy eyes and nose, and dark under-eye circles. These symptoms interfere with restful sleep producing next-day tiredness and difficulty in thinking. Additionally, asthma patients who have allergies may experience an increase in their asthma symptoms during the allergy season

 

Allergic tendency runs in families. But specific symptoms and triggering allergens can vary among the family members depending on each individual’s exposure and other factors currently under investigation.
The three ways to address allergy are avoidance, medication, and immunotherapy (“allergy shots”).

 

AVOIDANCE

Most importantly, don’t let the pollen get to you!

  • Keep doors and windows closed to reduce indoor pollen.
    Keep car windows closed and set the ventilator to “recirculate” to minimize the vehicle’s pollen intake.
    Avoid hanging clothes outside to dry; this gives pollen a “free ride” into your home.
    Especially avoid mowing lawns and raking leaves, activities that only stir up pollen and molds.
    Minimize outdoor work on heavy pollen days, and wear a mask.
    When returning home from outdoors on heavy pollen days, shower, wash hair, and change clothing to avoid transferring the sticky pollen into your home.

 

In general, pollen counts are highest on dry windy days and lowest on rainy days. Fortunately, you can learn the specific pollen count by listening to the local weather forecast or by consulting the website of the American Academy of Allergy, Asthma and Immunology at www.aaaai.org. This website even has an “app” that you can download to your smart phone!

 

MEDICATION

For mild cases of seasonal allergy, you may find it helpful to try nonsedating over-the-counter, known as “OTC,” antihistamines. But it is better to avoid those antihistamines that can cause drowsiness as well as oral decongestants that can cause tremors or aggravate hypertension and glaucoma. Be aware also that decongestant nasal sprays can cause rebound swelling of the nasal passages, especially if used improperly or for more than seven days. Of course, if symptoms persist, you should see your primary care doctor who can treat you with prescription nasal sprays and/or eye drops.

 

IMMUNOTHERAPY

If even prescription medications fail to control symptoms or if these medications must be taken for an extended period of time, it may be time to consult a specialist physician called an allergist. If the allergist thinks that immunotherapy is appropriate, he or she can initiate skin and/or blood tests to identify the specific problematic allergen or allergens and begin the appropriate injections to help create immunization against them.

 

With the treatments now available people should enjoy the spring comfortably. So don’t suffer in silence. You can reduce the problem of seasonal allergies.

 

The Erie County Medical Society wishes you a pleasant welcome to the nicer weather and a springtime free of seasonal allergies.

 

Thomas Falasca, DO

Philip Gallagher, MD

For further information please see:

Asthma and Allergy Foundation of America at http://aafa.org

Allergy and Asthma Network Mothers of Asthmatics at http://www.aanma.org

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