6 answers about heroin

White powderlokking like cocain on dark brown empty Kitchen table

Heroin and other opioid drugs relieve pain and can bring on feelings of relaxation and euphoria, or being high. With prolonged use, an opioid user’s body requires increasing amounts of the drug to get the desired effects.

Who uses heroin?

Experts from the Upstate New York Poison Center say that some users turn to heroin because it is cheaper than prescription pain medicine. They may inject it, inhale it by snorting or sniffing, or smoke it. About half of the young adults who inject heroin report abusing prescription opioids first, according to the National Institute on Drug Abuse.

How does it affect the brain?

Opioids relieve pain by altering a person’s perception of pain signals from their body. With prolonged use, the sites where the opioid works become adapted, and then it requires more of the drug to get the desired effects.

What does it feel like?

Heroin users describe treatment of their pain, relaxation and a sensation of being high. People with chronic pain who use heroin may experience hyperalgesia, where they feel as though they are in greater pain.

Why is this a crisis?

The death rate from drug overdoses is climbing at a much faster pace than other causes of death, according to The New York Times, a trend similar to that of the human immunodeficiency virus in the late 1980s and early 1990s.

In Onondaga County, deaths from heroin overdoses climbed nearly 31 percent in 2015. Most deaths were of white men in their 20s.

How does heroin kill?

Heroin and all opioids decrease central nervous system activity, resulting in a decreased level of consciousness and, eventually, a decrease in the activity of the breathing center. Patients usually die because they stop breathing or breath too little to allow for enough oxygen to reach the brain, and death typically happens one to three hours after injection.

What are some signs of heroin use?

Someone who has started abusing heroin may exhibit a change in behavior or mannerisms or have a new circle of friends. He or she may withdraw from family activities and may react with anger or excuses when questioned why. School grades may deteriorate.

A heroin user may display a lack of motivation, a lack of self-control and/or irrational behavior. His or her temperament may become difficult, or aggressive, and he or she may have constant fatigue.

People using heroin may neglect personal hygiene and appearance and develop an impaired sense of judgment. Their speech may slur, or they may have trouble expressing themselves verbally. The pupils in their eyes may become pinpoints, their lids may be heavy, and needle tracks may be visible on their arms. They may say they feel insects crawling all over their body.

Heroin users could have in their possession “drug paraphernalia,” including tinfoil, weight scales, zip-lock bags, square folded paper envelopes, butane torches or cigarette lighters, small porcelain bowls, hypodermic needles, balloons, mirrors or short straws.

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

Posted in addiction, brain/neurology, death/dying, drugs/medications/pharmacy, poison center/toxicology, public health | Tagged , , , , , | Leave a comment

13 things I learned from the fall issue of Upstate Health

magazine-fall16cvrThe pages of the fall 2016 Upstate Health magazine are loaded with important information and a few surprises. If you’re not on our mailing list, you should be. Send an email with your name and mailing address to magazine@upstate.edu with “Upstate Health” in the subject line, and we’ll make sure you receive the next issue. Click on the picture of the magazine and you can read an electronic version of the fall issue. Meanwhile, I’ll share what I learned in putting it together:

  1. You’re probably familiar with the concept of kidney transplants. Did you know that pancreas transplants have the potential to dramatically improve lives? Some of the people who need kidney transplants may also benefit from pancreas transplants. Sometimes both organs are transplanted from the same donor. Upstate surgeons performed pancreas transplants this summer for the first time since Rainer Gruessner, MD, became chief of transplant services.
  2. Upstate opened a new pediatric emergency department, set apart from the main emergency department, with its own radiology unit just for kids from birth to age 19.
  3. Bezoar. This is a potentially dangerous ball of food that can cause problems for someone with a digestive disorder known as gastroparesis.
  4. Strokes are medical emergencies requiring swift response, but what happens if you’re hours away from a comprehensive stroke center when a stroke occurs? Well, Upstate stroke specialists are using telemedicine to connect with hospitals in rural areas, to help assess and properly treat patients.
  5. Some people trying to kick an opioid addiction have turned to antidiarrheal medications to counter the symptoms of withdrawal — but that’s dangerous. Toxicologists at Upstate issued a precaution by publishing research on this practice.
  6. When people who suffer from chronic pain turn to heroin, they may experience hyperalgesia, the sensation of greater pain.
  7. The increased risk of sustaining another concussion is one of at least five good reasons that athletes who sustain concussions should not continue playing. Laws in all 50 states are prompting coaches and trainers to take these mild brain injuries more seriously.
  8.  Who knew that exposure to fumes from a clandestine meth lab could put someone at risk for lasting damage to memory? Upstate experts report on the case of a firefighter who was exposed in 2001.
  9. If you care for someone facing dementia, you’ll want to read these four simple pieces of advice from Upstate geriatrician Andrea Berg, MD, starting with the axiom,  “Never correct; just redirect.”
  10. More than two-thirds of the workers in five counties around Syracuse made less than $15 an hour in 2014, and many face health problems related to their jobs, too.
  11. You know that doctors working in the emergency department treat patients with all manner of injury and illness. Have you ever wondered what impact that has on their own lives? We asked a half dozen emergency physicians with young children to  share what things they generally forbid in their homes, and why. Foam dart guns, wading pools, hand sanitizers….the list goes on.
  12. One quarter of the babies born in Onondaga County have been exposed to an opioid drug of some sort in the womb. Yes, you read correctly: One quarter of the babies born in Onondaga County have been exposed to an opioid drug of some sort in the womb. It gives Onondaga County one of the highest rates of newborn drug exposure in New York State. Neonatologist Michelle Bode, MD, provides an overview of the problem.
  13. The fastest runner at this year’s J.P. Morgan Chase Corporate Challenge was Upstate’s Lee Berube, a doctor of physical therapy. He finished the 3 1/2-mile course in 17 minutes, 36 seconds.
Posted in addiction, adolescents, aging/geriatrics, Alzheimer's/dementia, brain/neurology, digestive/gastrointestinal, emergency medicine/trauma, health care, organ donation/transplant, poison center/toxicology, public health, stroke, technology | Leave a comment

FAST response: Swift recognition, treatment saves stroke patient

BY SUSAN COLE

It had been a typical day for Joan Izyk, 72, of Oswego. She had enjoyed a breakfast out and was relaxing in her living room with a coloring project. When her husband arrived home, she stood up to greet him in the kitchen. She never made it. She could hear her husband calling her, but she couldn’t respond.

Joan Izyk, stroke survivor

Joan Izyk, stroke survivor

Izyk had suffered a stroke.

“I just went down, and I could not get up,“ she recalls of that morning at her home. “I couldn’t talk, so I couldn’t yell to him. He thought it was a stroke right away.”

Impaired speech is one of the signs of stroke outlined in the acronym FAST, which is designed to help people act quickly to assist someone who may be having a stroke. FAST stands for Facial drooping, Arm weakness, Speech difficulties and Time.

“Joan’s husband recognized that she was having a stroke, which helped her get the treatment she needed quickly and ultimately led to her positive outcome,” says Josh Onyan, outreach coordinator for Upstate’s Comprehensive Stroke Center.

Rescuers from the Oswego Volunteer Fire Department arrived at the Izyk home and quickly moved her into the ambulance. They noted the right facial droop, right upper extremity weakness and slurred speech, consistent with the signs of a stroke. They rushed her to Upstate. The stroke team had received notice of the 911 call and prepared for Izyk’s arrival while the ambulance was en route.

Doctors and nurses from Upstate’s emergency department and stroke team began treating Izyk immediately. She received the clot-busting medication known as tissue plasminogen activator, or tPA, just 24 minutes after arriving at the hospital. Then she was injected with a dye so that a computerized tomography angiogram could produce detailed images of her brain.

Interventional neurosurgeon Grahame Gould, MD, located a blockage in one of her vessels and quickly performed a delicate clot-retrieving procedure.

“The combination of tPA upon arrival, plus endovascular rescue techniques such as this have been shown to greatly reduce disabilities from stroke,” Onyan notes.

Three days later, Izyk was resting at home, with mild facial weakness, grateful for the fast response of her husband, the fire department volunteers and the caregivers at Upstate.

Extending expertise: Stroke experts in Syracuse consult with rural colleagues via telemedicine

stroke_chartTelemedicine connects stroke specialists from Upstate University Hospital with physicians in rural hospitals throughout Central New York, so that patients can receive prompt assessment and treatment of stroke symptoms.

Five hospitals participate, including Carthage Area Hospital, Claxton-Hepburn Medical Center in Ogdensburg, Cortland Regional Medical Center, River Hospital in Alexandria Bay and Samaritan Medical Center in Watertown. The Fort Drum Regional Health Planning Organization helped deploy the equipment necessary to make these connections possible.

The telemedicine network provides Upstate neurologists with access to computerized tomography scans and the ability to talk with doctors and patients in hospitals many miles from Syracuse.

“Our telemedicine network allows the North Country access to expert stroke care, regardless of geography,” says nurse Jennifer Schleier, program manager of Upstate’s Comprehensive Stroke Center. “We have come to think of this program as stroke care without borders. It is our mission to close the gap between expert medical care and location of the patient.”

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

Posted in brain/neurology, brain/spine/neurosurgery, community, death/dying, drugs/medications/pharmacy, emergency medicine/trauma, health care, illness, patient story, stroke, technology | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Concussion concerns: Make sure you know how to react

It's crucial that an athlete suspected of having a concussion not return to play until he or she has been evaluated.

It’s crucial that an athlete suspected of having a concussion not return to play until he or she has been evaluated.

When concussions are properly managed, patients usually have no lasting effects. The key is to recognize the injury when it happens.

An injured athlete needs to be removed from play until he or she is properly evaluated. Symptoms vary but may include blurry vision, ringing in the ears, headaches, trouble with balance and/or concussion. Most concussions happen without the athlete losing consciousness.

Brian Rieger, PhD

Brian Rieger, PhD

Neuroimaging (such as CT and MRI scans) cannot diagnose concussion. Instead, health care providers arrive at a diagnosis based on the patient’s history and the way his or her functioning is affected. Tests may be done to rule out other problems.

The recovery period is typically three weeks and includes a lot of sleep and rest. Patients are instructed to limit their physical and mental exertion, which for students usually affects school attendance and the use of electronic devices. Athletes are usually sidelined, to protect them from the risk of re-injury.

“A concussion is almost always a short-term event, when managed properly,” says Brian Rieger, PhD, an assistant professor of physical medicine and rehabilitation and director of the Upstate Concussion Center.

He says one thing coaches and parents can do is encourage athletes to be honest about their injuries.

Ignoring the symptoms of a concussion is bad because it can delay healing.

What’s worse is to overlook a concussion — and then suffer another. The consequences can be disastrous when that happens, Rieger says, with symptoms more severe and lingering for months or years.

5 reasons athletes with concussions should not play

A concussion is usually a short-term event when it is properly managed. Ignoring the symptoms of a concussion can delay healing.

A concussion is usually a short-term event when it is properly managed. Ignoring the symptoms of a concussion can delay healing.

All 50 states now have sports concussion laws, and with a better understanding of the seriousness of concussion, coaches and trainers take these mild traumatic brain injuries more seriously.

With proper management, the majority of concussions are short-term injuries. But, it’s crucial that an athlete suspected of sustaining a concussion not return to play until he or she has been evaluated.

An athlete with a concussion who continues to play:

* increases the risk of sustaining another concussion;

* is liable to aggravate concussion symptoms including fatigue, dizziness, blurred vision, irritability, anxiety, depression, headache, nausea and vomiting, clumsiness, fogginess, trouble reading and poor mental stamina;

* might prolong his or her recovery time with associated medical, psychological and academic difficulties;

* increases the risk of long-term problems which could include headaches, cognitive and emotional changes and sleep difficulties; and

* in rare cases, risks severe disability or death if he or she sustains another concussion.

The Upstate Concussion Center (315-464-8986) provides comprehensive evaluation and treatment services for concussion and sports concussion. Click here to learn more.

HLOA-4C-VERT-REVmagazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast with Rieger about the latest concussion information, including diagnosis and management, here for an interview about protecting skiers and skaters from concussions and here for an overview of  sports-related concussions, including myths and symptoms.

Posted in adolescents, brain/neurology, disability, health care, HealthLink on Air, illness, medical imaging/radiology, mental health/emotional health, physical therapy/rehabilitation, prevention/preventive medicine, research, safety, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , , , , , , | Leave a comment

Once fatal, now curable: Story of infective endocarditis ‘a miracle of medical progress’

heartUpstate cardiologist Harold Smulyan, MD, and infectious disease expert Donald Blair, MD, tell the tale of infective endocarditis in the August 2015 issue of the American Journal of the Medical Sciences. They call the nearly complete conquest of the disease “a miracle of medical progress.”

Donald Blair, MD

Donald Blair, MD

Endocarditis is an infection of the heart valves and/or the lining of the heart. It’s usually caused by bacteria. It’s not contagious.

Their paper explains that endocarditis was first reported during routine autopsies in the early 1800s, although it was several years before its bacterial cause was identified and a century before medicines were developed to fight the bacteria.

“Before the development of antibiotics, this disease was almost uniformly fatal,” Blair says. Surgery to remove infected tissue was occasionally helpful, but survival rates improved only after antibiotics were added.

The next breakthrough came in the 1970s with the development of a method of capturing ultrasound images of the beating heart.

Harold Smulyan, MD

Harold Smulyan, MD

Smulyan recalls that “echocardiography enabled us to actually look at the valves in the inside of the heart and see infections almost directly.” Doctors could confirm the bacterial infection with a blood test and, through medical imaging, know the location and severity of its damage.

This soon led to the practice of replacing damaged heart valves.

Today, patients who develop infective endocarditis receive antibiotics, often followed by valve replacement surgery.

Heart valves are susceptible to infection because they do not receive a blood supply of their own. For this reason, white blood cells and antibiotics, which fight infection, cannot reach the valves internally and must rely on the circulating blood to reach their targets.

Smulyan and Blair point out that infective endocarditis is a different disease now than when it was discovered two centuries ago. Different types of bacteria are responsible, and different types of patients are affected. Patients who develop this disease today are generally older and likely to have medical problems such as kidney disease or heart disease.

The doctors marvel at the progress made toward curing infective endocarditis. They write in their paper that although the infection can now be cured, prevention remains elusive.

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast with Smulyan and Blair about their research into infective endocarditis.

Posted in aging/geriatrics, death/dying, drugs/medications/pharmacy, health care, HealthLink on Air, heart/cardiovascular, history, illness, infectious disease, pathology, research | Tagged , , , , , , , , , , , , , | Leave a comment

Diabetes app: ways to set, track your goals

behaviors_screenWhat’s the best way to monitor your activity, if you have diabetes?

You can spend lots of money for a fancy activity-tracking device.

You can invest in a pedometer to count your steps.

Or, consider downloading a free app on your smartphone created by the American Association of Diabetes Educators. Upstate physical therapist Karen Kemmis is an executive board member of the association.

“This helps a person set and track goals related to seven self-care behaviors for diabetes self-management, including increasing physical activity,” Kemmis says.

The others include eating healthier, monitoring blood glucose, taking medications as prescribed, learning how to solve ordinary and unusual problems, reducing the risk for complications and coping with emotional issues.

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

 

 

 

Posted in diabetes/endocrine/metabolism, diet/nutrition, fitness, illness, Joslin Diabetes Center, physical therapy/rehabilitation, prevention/preventive medicine, technology | Leave a comment

Meth lab dangers: Exposure can cause lasting effects

(FIREFIGHTER PHOTO BY ROBERT MESCAVAGE)

(FIREFIGHTER PHOTO BY ROBERT MESCAVAGE)

BY AMBER SMITH

Rescuers whose jobs take them to clandestine methamphetamine labs risk exposure to chemicals that can cause what appears to be permanent damage to their memory-making ability.

Specialists in anesthesiology and neurology at Upstate Medical University tell about a middle-aged firefighter who developed profound anterograde amnesia in 2001 after he was exposed to fumes from spilled material that was used to synthesize meth.

Awss Zidan, MD

Awss Zidan, MD

Chemicals commonly used in labs that produce the illegal stimulant are known to cause headaches, respiratory and eye irritation, and nausea and vomiting. Exposure to certain toxic chemicals can produce detrimental cognitive deficits, including amnesia. In a study from 2009, more than three-quarters of police officers reported memory loss after exposure to clandestine meth labs.

Amnesia is memory loss, which may be partial or complete and may relate to stored memories or the ability to commit something new to memory. Anterograde amnesia is when the ability to memorize new things is impaired. Its development indicates that particular regions of the brain have been affected.

Awss Zidan, MD, and Amy Sanders, MD, write about the firefighter’s case in the March issue of the Journal of Neurology and Stroke.

Amy Sanders, MD

Amy Sanders, MD

The firefighter lost consciousness and was hospitalized. He had trouble recalling events of the recent past. “He could not remember dates or names for more than a few minutes,” the researchers write. After he went home, he developed “out of body experiences,” generalized shaking, angry outbursts, depressed moods and impaired cognitive functioning. He had trouble memorizing new things.

The man sought care at Upstate University Hospital 12 years after the incident.

“Although there has been no improvement in his memory impairment since the time of the injury, he has learned to cope with his limitations,” Zidan and Sanders write. “His family provides him with written notes, organizing his chores and tasks, such as shopping or household maintenance, on a daily basis; he is able to follow these instructions. He is able to drive with the help of a global positioning device.”

The researchers suggest the connection between meth lab exposure and memory deficits warrants further study.

People with anterograde amnesia may:

— repeat comments or questions several times.

— not recognize people they have just met.

— have suffered damage to the hippocampus or medial temporal lobe of their brains.

— retain the ability to learn new skills and habits (procedural memory).

— lose the ability to recollect some facts (declarative memory). While they might not recall autobiographical information, they may be able to remember language, history and geography.

— recover functioning for some memories, over time, if the damage is limited to one side of the brain.

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

 

 

 

 

Posted in brain/neurology, community, disability, drugs/medications/pharmacy, health care, illness, mental health/emotional health, patient story, poison center/toxicology, research, safety | Tagged , , , , , , , , , | Leave a comment

Safe houses: 11 things emergency doctors ban from their homes

BY AMBER SMITH

Doctors at Upstate University Hospital’s emergency department are on the front lines of the mayhem and mishaps that befall young Central New Yorkers.

kid2They care for people with every imaginable injury or illness at their workplace, the Level 1  trauma center for a region stretching from the state capital through Finger Lakes wine country, from the border of Pennsylvania to Canada.

They handle crises with calm.

Then they go home.

Some aspects of the job go with them, visions such as struggling to revive a child who wandered into a backyard pool, or comforting a parent whose teen who put a gun to his head. Such experiences inform the rules they put in place for their own children in their own households.

Here are 11 things that are so dangerous as to be generally forbidden in the homes of emergency doctors:

1. Trampolines

trampSide nets and completely covered springs are safety features of modern trampolines, but Derek Cooney, MD, still won’t allow a trampoline at his house. “They’re just too dangerous.

“Many of the most serious injuries are related to falls from the trampoline, collisions when multiple people are jumping, and exposed springs that lead to gruesome extremity lacerations,” he explains, adding that serious neck and back injuries, joint or limb fractures are not uncommon.

bouncesk2. Bounce houses

Inflatable bounce houses can lead to collision injuries and falls, as with trampolines, but there’s a secondary reason they’re not welcome in the home of Risa Farber-Heath, DO. “They spread germs.”

3. Motorcycles, snowmobiles or all-terrain vehicles

snowmobile“I see a large number of patients with severe trauma while riding these. Your body is unprotected, and you are going at a high rate of speed,” says Louise Prince, MD. “I do not permit my children to ride them at friend’s houses, either.”

4. Wading pools

poolclrThey’re tiny when compared to a full-size swimming pool, but that doesn’t make them safe. A small plastic or inflatable wading pool can be a drowning risk when kids are unsupervised, reminds Farber-Heath.

5. Dishwasher detergent pods

Kelsey Stack, DO, says dishwasher detergent pods look like bright, yummy candy to kids “but can cause all sorts of issues, the most significant being caustic burns to the mouth, esophagus or airway.

“After seeing many kids in the emergency department who have bitten into them, and the consequences of that one bite, I banned them from our house.”

6. Riding mowers

mowerGrowing up with a pediatric surgeon for a father, Cooney heard of horrible lawn mower accidents long before he began taking care of patients who were injured by lawn mowers. Every summer, he sees children who are run over by parents on riding lawn mowers who did not know their child was anywhere nearby. Some of the children lose limbs or are permanently disfigured, and some of them die.

When the lawn is being mowed, the Cooneys follow the rule that “children should not be outside unless a second adult is directly supervising them and ensuring they are kept well away from the yard,” he says. They do not have a riding mower. If they did, they would not allow older children to use it. Too often he’s seen the result of judgment errors: a mower operated on a slope that rolls and crushes a person, or someone loses a hand or a foot while working on a mower with the engine still running.

7. Hand sanitizers

soapclr“I want my kids exposed to everything and building a strong and healthy immunity,” Jeremy Joslin, MD, says in explaining why his family skips hand sanitizer products in favor of plain soap and water.

(Joslin spoke shortly before the U.S. Food and Drug Administration issued a rule that essentially agrees with him. The FDA is banning several chemicals from over-the-counter antibacterial soaps, calling such soaps unnecessary, possibly dangerous and no better than ordinary soap and water. This will not apply to antibacterial soaps used for hospitals and food services.)

8. Foam dart guns

“I won’t let my kids play with Nerf-type guns unless they are wearing goggles,” says Alison McCrone, MD, medical director for Upstate Golisano After Hours Care. She’s concerned about poor aim, accidental close shots and other moves with the potential for injury.

9. Teapots and coffeepots.

teapot“I have seen so many kids coming in with burns to the face, chest and arms from hot coffee or tea that they have pulled over on themselves, or that a caregiver had spilled on them. It’s terrible,” Stack says. “I only boil water on the back burners and always make sure while cooking that pan handles are turned toward the inside and not sticking out for little hands to grab.”

10. Co-sleeping

babyclrJoslin will not sleep with a baby in his bed. He always makes children sleep by themselves. “I’ve taken care of too many dead babies from co-sleeping arrangements.”

 

11. Gaming systems

game“It isn’t exactly a safety issue as much as the belief that they are time consuming, addictive and have many violent games,” says Prince in explaining why her home contains no game system. “We want our kids to do other things with their time.”

 

Three more dangers

So far this year authorities from the Upstate New York Poison Center, which fields phone calls from 54 counties outside of New York City, have noticed an increase in the number of calls about emergencies involving someone 19 or younger and laundry pods (similar to dishwasher detergent pods), electronic cigarettes and button batteries.

Item                        All of 2015   First half of 2016

Laundry pods                217                         105

E-cigarettes                   2                              4

Button batteries           35                            26

(Source: Michele Caliva, Upstate New York Poison Center)

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

Posted in adolescents, community, emergency medicine/trauma, entertainment, health care, poison center/toxicology, prevention/preventive medicine, public health, safety, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , , , , , | Leave a comment

Quick call to 911, prompt response and fast flight to Upstate stroke center helped save the life of Larry Deshaw

Larry Deshaw, 78, (center in red) survived what could have been a fatal stroke because of multiple crucial decisions that were made quickly, including: 1. Wife, Nancy Humphrey (behind him) recognized the signs of a stroke and immediately called 911. 2. Rescuers in Clayton made the decision to send Deshaw directly to the comprehensive stroke center at Upstate University Hospital by helicopter so he would arrive as quickly as possible. 3. Stroke specialists at Upstate led by Gene Latorre, MD, (to the right of Deshaw) established a protocol that directs every patient suspected of having a stroke straight to the computerized tomography suite in the emergency department on arrival. The prompt CT scan reveals whether it's safe to give the patient clot-busting medication. A rapid CT angiogram was then used to identify the blocked artery and plan interventional treatment. 4. The hospital is outfitted with a modern interventional radiology suite that is available around the clock and staffed by doctors including Hesham Masoud, MD, (to the left of Deshaw) who have expertise in endovascular surgical neuroradiology -- which means they are skilled at swiftly retrieving blood clots from the brain.

Larry Deshaw, 78, (center in red) survived what could have been a fatal stroke July 19 because of multiple crucial decisions that were made quickly.

wdtTuesday afternoons are usually when Nancy Humphrey golfs. But she was still home a little after 4 p.m. on July 19 because that day’s tournament didn’t start until 5 p.m., and the Clayton Country Club is only about a quarter mile from the home she shares with her husband, Larry Deshaw.

They were watching CNN. She was on the couch. He was in his recliner.

“All of a sudden I was seeing double. The room started spinning,” recalls Deshaw, 78. “I hollered Nancy’s name twice. I knew I had something going on. That was the last I could speak.

“My left side went limp. My right side had contractions in the leg. My right arm was the only thing I could move at the time. I couldn’t talk. My jaw was clamped shut.

“I could hear everything going on around me, but I couldn’t speak. It was the scariest thing I’ve ever been through.”

Nancy Humphrey knew what to do when her husband, Larry Deshaw displayed signs of a stroke.

Nancy Humphrey knew what to do when her husband, Larry Deshaw, displayed signs of a stroke. Deshaw, 78, of Clayton is a veteran of the Army who worked in a paper mill until retirement.

Humphrey quickly dialed 911.

“His wife is what saved his life,” Upstate interventional neurologist Hesham Masoud, MD, says plainly. “If he was not found in a timely fashion, he would not have survived.”

Masoud is a stroke specialist who received his medical degree in Cairo before completing his internship and residency training at Case Western Reserve School of Medicine in Cleveland. He went on to gain additional stroke therapy expertise with additional fellowship training in endovascular surgical neuroradiology and vascular neurology at Boston University School of Medicine — the precise skills Deshaw needed when a clot the size of a raisin lodged in the basilar artery at the base of his brain.

Deshaw’s wife called for help at 4:15 p.m.

On their drive to the couple’s house, Thousand Islands Emergency Rescue Service paramedics Pamela Jones and Eimile Parker made the important decision to alert LifeNet of New York – and a helicopter based at Watertown International Airport in nearby Dexter was readied for flight, just in case. Patients in rural areas such as Clayton with certain medical emergencies including strokes or diabetic complications have better survival odds the faster they receive definitive medical care.

This story appeared in the Watertown Daily Times

When she laid eyes on Deshaw at 4:22 p.m., Jones remembers he had “that look” of a man suffering a stroke, or a seizure, or both. His face had a subtle droop, he had weakness on his left side, and he was unable to respond. Humphrey told the paramedics how healthy and active her husband was, and Jones made a silent vow to do what she could to bring him back.

The paramedics knew Deshaw urgently needed to get to Central New York’s first and only comprehensive stroke center, some 90 miles away at Upstate University Hospital in Syracuse, and the quickest way was by air. They made sure LifeNet was on the way and radioed the fire department to set up a landing zone for the helicopter.

Jones checked Deshaw’s blood sugar level and connected him to a cardiac monitor while Parker covered his mouth and nose with an oxygen mask and checked his pulse and blood pressure. Then Parker started an intravenous line in his arm. All the while, Jones spoke to Deshaw, explaining what was going on. It felt strange because he never responded, but she kept talking as she was trained to do. A month later when Jones checked on his recovery, Deshaw told her how much her talking had meant to him.

The Thousand Islands ambulance drove Deshaw about a half mile to the fire department parking lot, where the helicopter landed. Flight nurse Rod Kester and flight paramedic Jeff Simons climbed out. Once Deshaw was secured to their stretcher, they opened the door beneath the tail of the helicopter and wheeled him in. Deshaw remembers the feel of the heat rising up from the asphalt.

Driving the patient to Syracuse, even using lights and sirens, would have taken almost an hour and a half. Flying took 25 minutes.

Paramedic Pamela Jones with flight nurse Rod Kester and flight paramedic Jeff Simons.

TIERS paramedic Pamela Jones (left) with LifeNet flight nurse Rod Kester and flight paramedic Jeff Simons.

Once LifeNet pilot Scott Talon pointed the helicopter toward Syracuse, the LifeNet crew radioed the emergency physician on duty at Upstate, Brett Cherrington, MD. At 5:17 p.m., he activated the hospital’s stroke team.

Masoud’s pager notified him, and he gathered in the emergency department with the other physicians and nurses who are part of the acute stroke team. They were ready for Deshaw even before his helicopter landed on the helipad at 5:27 p.m.

Deshaw remembers everything.

“They were waiting for me,” he says. “They took me immediately in. I remember them rushing, going fast with me on the gurney.”

Members of the team told Deshaw what was going on as they cared for him. They wheeled him straight to the computerized tomography suite in the emergency department for a CT scan, with the interventional neurologist, Masoud at his side.

Larry Deshaw's stroke was in a particularly dangerous location in his brain. Interruption of blood flow in the basilar artery is particularly dangerous because it’s the route oxygenated blood takes to get to areas of the brain responsible for vital functions such as consciousness and breathing – and there are no alternate routes, what doctors called collateral circulation. If the artery bursts or is blocked by a blood clot, patients usually sustain severe brain damage or organ malfunction, or they die. The basilar artery is located at the base of the skull, where two vertebral arteries meet. It carries blood to the brainstem, which controls heart rate, sleeping, eating and breathing; the cerebellum, responsible for posture, balance, coordination and speech; and the occipital lobe, which handles visual processing. Multiple arteries branch from the basilar artery leading to other areas of the brain including the temporal lobe, where sound is processed, and the pons, where information is relayed between different areas of the brain.

Interventional neurologist Hesham Masoud, MD, explained to Larry Deshaw that his stroke was in a particularly dangerous location, the basilar artery. This is the route oxygenated blood takes to get to areas of the brain that are responsible for vital functions such as consciousness and breathing, so any interruption of blood flow can be devastating.

Deshaw had symptoms that suggested that he had a seizure or a stroke. “Anyone with these symptoms gets an immediate vessel imaging study. That way, we can identify the blocked artery and plan for immediate therapy,” Masaoud explains.

Nurse Jennifer Schleier is the stroke coordinator. She says the CT scan helps rule out whether a vessel has burst within the brain. Patients with hemorrhagic strokes, in which a vessel bursts, are treated differently than those with ischemic strokes, in which a clot blocks a vessel.

Deshaw received an injection of the clot-busting medication, tPA, or tissue plasminogen activator, at 6:18 p.m. through the intravenous line paramedics inserted at his home. Then he returned to the scanner for a CT angiogram, another set of images that rely on a contrast material so details of the arteries and veins are visible.

There, deep in the basilar artery of Deshaw’s brain, was the clot.

Time is crucial anytime someone suffers a stroke. In many cases, other healthy arteries can temporarily keep the brain alive while we try to reopen the vessel. But for patients with clots lodged at the base of the brain, those other arteries aren’t there to help,” Masoud says. “For those strokes, time is exceedingly important.”

Strokes in the basilar artery are rare, and the outcomes are usually poor. The brain area that can be damaged in this type of stroke controls essential functions such as consciousness, breathing and heart rate, balance and coordination and vision. “In my experience, a majority of these patients die, within a couple days of having the stroke,” Masoud says.

Deshaw experienced what the interventional neurologist considers “a miraculous recovery.”

The emergency physician inserted a breathing tube. Then Deshaw was wheeled to the interventional radiology suite two floors above the emergency department.

Hesham Masoud, MD, shows the clot retriever.

Interventional neurologist Hesham Masoud, MD, shows the clot retriever device that can restore blood flow to patients suffering from ischemic strokes.

At 7:10 p.m., Masoud inserted a small catheter into the artery of Deshaw’s right leg. Guided by an X-ray and contrast dye, the doctor delicately advanced a wire-like stent along the inside of the artery and into the brain. The stent wrapped around the clot, trapping it as if in a cage. Masoud gently backed the device out, removing the clot and restoring blood flow with a single pass of the device.

Deshaw’s wife arranged for her brother from Watertown to drive her to the hospital. By the time they arrived, Deshaw was already in surgery.

Surgery was complete at 7:43 p.m., and around sunset Deshaw was settled into the neurosurgical intensive care unit. The ninth floor hospital unit is staffed by nurses and technicians with specialized training in the care of patients with stroke and other neurological emergencies.

“I didn’t really wake up until the next morning,” Deshaw says, “but when I woke up, everything was working.”

A steady stream of impressed doctors stopped by to see the patient who not only survived “basilar artery thrombosis” but was up and walking the next day.

After a stroke, many patients go through what can be a lengthy rehabilitation program. Deshaw was healthy enough to be discharged to his home three days later. #

Larry Deshaw and his wife, Nancy Humphrey (center) reunited with rescuers in Clayton about a month after he suffered a stroke. This is the parking lot of the Clayton Fire Department, where the LifeNet helicopter picked Deshaw up to transport him to the comprehensive stroke center at Upstate.

Larry Deshaw and his wife, Nancy Humphrey (center) reunited with rescuers in Clayton about a month after he suffered a stroke. This is the parking lot of the Clayton Fire Department, where the LifeNet helicopter picked Deshaw up to transport him to the comprehensive stroke center at Upstate.

Posted in brain/neurology, brain/spine/neurosurgery, community, emergency medicine/trauma, health care, patient story, public health, stroke | Leave a comment

Helping newborns by helping moms off drugs

baby feet and oxygen saturation monitor

BY AMBER SMITH

One quarter of the babies born in Onondaga County have been exposed to an opioid drug of some sort in the womb, making for one of the highest rates of newborn drug exposure in New York state.

That doesn’t mean women in Central New York are more prone to drug use. Neonatologist Michelle Bode, MD, an assistant professor of pediatrics at Upstate,  explains that “in New York City they don’t have a problem because they don’t test.”

Michelle Bode, MD

Michelle Bode, MD

Pediatricians who serve the three Syracuse hospitals with maternity care screen for drug use in the same way, Bode says, “so we’ve got some cohesiveness that isn’t necessarily found in other areas of the state.” Upstate University and Crouse hospitals and St. Joseph’s Hospital Health Center deliver most of the babies from Onondaga and 14 surrounding counties.

Still, Bode says, the numbers are troubling.

In 2001, 5 percent of newborns were exposed to an opioid during pregnancy. Today it’s up to 25 percent. The majority of exposures come from prescription opioids such as hydrocodone or oxycodone, but the number of babies exposed to illicit opioids such as heroin has increased, too.

Bode says data from birth certificates for babies living along the Interstate 81 corridor shows 2.1 percent were affected by illicit drug use in 2006. Almost three times as many – 5.9 percent – were affected in 2015.

Whether exposed to legal or illegal substances, the babies are born with what is called neonatal abstinence syndrome. “These infants do not have a normal newborn experience,” Bode says.

Often free of symptoms at birth, the babies within the first week become irritable and jittery, with a shrill cry. They don’t feed well or sleep well, and they have diarrhea. Hospitalization may last three days or more than three weeks as they go through withdrawal, depending on the substance they were exposed to and for how long.

Long-term consequences can include birth defects, problems with development and behavior and a greater risk for sudden infant death syndrome. If the mother gets help for her addiction, and if she brings the baby into a loving and stable home, there may be no lasting effects. “The environment the child is raised in will determine their outcome,” Bode says.

She points out that mothers-to-be who admit to opioid use during prenatal visits can receive expedited referrals to addiction treatment services in Central New York.

Studies show that pregnancy can be a window of opportunity to get women into treatment. Ask 100 pregnant women how important their baby’s health is to them, and, Bode says, fewer than 1 percent will say it is not important. If health care providers explain how halting opioid use can help the woman have a healthy baby, she is likely to be receptive to addiction treatment. And, Bode notes, women have a slightly higher success rate for treatment when they are pregnant.

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast in which Bode discusses opioid use during pregnancy and its effects on newborns.

Posted in addiction, drugs/medications/pharmacy, health care, HealthLink on Air, maternity/obstetrics, poison center/toxicology, public health, Upstate Golisano Children's Hospital/pediatrics, women's health/gynecology | Tagged , , , , , , , , , , , | Leave a comment