Health
Richmond, B.C. ‘whippits’ overdose prompts public warning from doctor – Global News
A B.C. emergency room doctor is warning about the dangers of abusing nitrous oxide (N2O), after a young woman turned up at a Richmond, B.C. hospital suffering from hallucinations.
Nitrous oxide, commonly known as laughing gas, is commonly available at retail outlets in small canisters known as “whippits,” used to pressurize whipped cream dispensers.
N2O is also used in medical and dental settings as anesthesia and sedative because of the dissociative state it produces.
The case study was published in the B.C. Medical Journal this month by ER physician Dr. Matthew Kwok and pharmacists Jane de Lemos and Epid Mazen Sharaf.
The study looks at the case of a 20-year-old woman who presented at the Richmond Hospital emergency room suffering visual and auditory hallucinations.
The woman had no history of mental illness or psychosis, but admitted to using N2O daily to get high, and said she had recently increased her usage.
The study said an assessment by a psychiatrist, a neurologist and an addictions medicine specialist determined her psychosis was the result of drug use.
“We’re seeing patients in the emergency department with drug-induced psychosis and neurological effects who’ve inhaled nitrous oxide,” said Dr. Kwok.
“People become addicted to this drug, and its non-medical use can be extremely dangerous.”
“Whippits” are easy to buy at retail stores, with no restrictions on age, quantity or intended use.
Kwok says access to the product should be restricted, with new safeguards implemented to reduce potential harm.
When Kwok and his team tried to report the woman’s case, they also discovered there is no central agency tracking N2O overdoses in the country.
“Our research shows very few reported cases, in part because the nitrous oxide comes from a product marketed for whipping cream and an adverse report would only be accepted if the canister itself was faulty,” he said.
He added that officials need to educate the public about the potential dangers of abusing the substance.
And he said health workers also need to be made aware that patients presenting with symptoms could be suffering from N2O intoxication.
© 2019 Global News, a division of Corus Entertainment Inc.
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Despite volunteering and working out at the gym several days each week, socializing frequently with friends and family, reading all manner of books and doing daily crossword puzzles, 85-year-old Carol Siegler is restless.
“I’m bored. I feel like a Corvette being used as a grocery cart,” said Siegler, who lives in the Chicago suburb of Palatine.
Siegler is a cognitive “SuperAger,” possessing a brain as sharp as people 20 to 30 years younger. She is part of an elite group enrolled in the Northwestern SuperAging Research Program, which has been studying the elderly with superior memories for 14 years. The program is part of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University Feinberg School of Medicine in Chicago.
“I’ve auditioned twice for ‘Jeopardy!’ and did well enough on it to be invited to the live auditions. Then Covid hit,” said Siegler.
“Who knows how well I would have done,” she added with a chuckle. “What I have told my children and anybody else who asked me: ‘I may know an awful lot about Beethoven and Liszt, but I know very little about Beyoncé and Lizzo.’”
What is a SuperAger?
To be a SuperAger, a term coined by the Northwestern researchers, a person must be over 80 and undergo extensive cognitive testing. Acceptance in the study only occurs if the person’s memory is as good or better than cognitively normal people in their 50s and 60s.
“SuperAgers are required to have outstanding episodic memory — the ability to recall everyday events and past personal experiences — but then SuperAgers just need to have at least average performance on the other cognitive tests,” said cognitive neuroscientist Emily Rogalski, a professor of psychiatry and behavioral sciences at Feinberg School of Medicine.
Only about 10% of people who apply to the program meet those criteria, said Rogalski, who developed the SuperAger project.
“It’s important to point out when we compare the SuperAgers to the average agers, they have similar levels of IQ, so the differences we’re seeing are not just due to intelligence,” she said.
Once accepted, colorful 3D scans are taken of the brain and cognitive testing and brain scans are repeated every year or so. Analysis of the data over the years have yielded fascinating results.
Bigger, tau-free neurons
Most people’s brains shrink as they grow older. In SuperAgers, however, studies have shown the cortex, responsible for thinking, decision-making and memory, remains much thicker and shrinks more slowly than those of people in their 50s and 60s.
A SuperAger’s brain, usually donated to the research program by participants after death, also has bigger, healthier cells in the entorhinal cortex. It’s “one of the first areas of the brain to get ‘hit’ by Alzheimer’s disease,” said Tamar Gefen, an assistant professor of psychiatry and behavioral sciences at Northwestern, in an email.
The entorhinal cortex has direct connections to another key memory center, the hippocampus, and “is essential for memory and learning,” said Gefen, the lead author of a November study comparing the brains of deceased SuperAgers with those of older and younger cognitively normal people and people diagnosed with early Alzheimer’s.
SuperAger brains had three times fewer tau tangles, or abnormal formations of protein within nerve cells, than the brains of cognitively healthy controls, the study also found. Tau tangles are a hallmark sign of Alzheimer’s and other dementias.
“We believe that larger neurons in the entorhinal cortex suggest that they are more ‘structurally sound’ and can perhaps withstand neurofibrillary tau tangle formation,” Gefen said.
Gefen also found the brains of SuperAgers had many more von economo neurons, a rare type of brain cell, which so far has been found in humans, great apes, elephants, whales, dolphins and songbirds. The corkscrew-like von economo neurons are thought to allow rapid communication across the brain. Another theory is that the neurons give humans and great apes an intuitive advantage in social situations.
The von economo neurons were found in the anterior cingulate cortex, which forms a collar in the front of the brain linking the cognitive, reasoning side with the emotional, feeling side. The anterior cingulate is thought to be important for regulating emotions and paying attention — another key to good memory.
Taken together, these discoveries appear to point to a genetic link to becoming a SuperAger, Gefen said. However, she added: “The only way to confirm whether SuperAgers are born with larger entorhinal neurons would be to measure these neurons from birth until death. That obviously isn’t possible.”
Can environment play a role?
SuperAgers share similar traits, said Rogalski, who is also the associate director of the Mesulam Center for Cognitive Neurology and Alzheimer Disease at Feinberg. These folks stay active physically. They tend to be positive. They challenge their brain every day, reading or learning something new — many continue to work into their 80s. SuperAgers are also social butterflies, surrounded by family and friends, and can often be found volunteering in the community.
“When we compare SuperAgers to normal agers we see that they tend to endorse more positive relations with others,” Rogalski said.
“This social connectedness may be a feature of SuperAgers that distinguishes them from those who are still doing well but who are what we would call an average or normal ager,” she said.
Looking back at her life, Carol Siegler recognizes many SuperAger traits. As a young child during the Great Depression, she taught herself to spell and play piano. She learned to read Hebrew at her grandfather’s knee, poring over his weekly Yiddish newspaper.
“I have a great memory. I’ve always had it,” Siegler said. “I was always the kid that you could say, ‘Hey, what’s Sofia’s phone number?’ and I would just know it off the top of my head.”
She graduated from high school at 16 and immediately went to college. Siegler got her pilot’s license at age 23 and later started a family business in her basement that grew to have 100 employees. At 82, she won the American Crossword Puzzle Tournament for her age group, which she said she entered “as a gag.”
After seeing an advertisement for the SuperAger program on television, Siegler thought it too sounded like fun. Being chosen as a SuperAger was a thrill, Siegler said, but she is aware she was born lucky.
“Somebody with the same abilities or talents as a SuperAger who lived in a place where there was very little way to express them, might never know that he or she had them,” she said. “And that is a true shame.”
Preventable diseases like measles could follow trends seen elsewhere in the world and spread quickly in Canada due to a drop in routine vaccinations during the COVID-19 pandemic, say pediatricians who are urging parents to ensure their kids are fully immunized.
Provinces and territories log data on vaccinations provided in the community against infectious diseases like measles, diphtheria, polio and whooping cough, as well as vaccines against other illnesses administered in school immunization clinics.
Although much current data doesn’t cover years beyond 2019, provinces with more recent figures are already seeing a dramatic decline in routine vaccinations.
Pediatricians are concerned about possible outbreaks of preventable diseases if too many children were underimmunized or not vaccinated at all while public health clinics focused on COVID-19 vaccines. Widespread school closures and vaccine disinformation that swayed some parents against immunization efforts complicated matters still further.
Recent data from Public Health Ontario shows that for 12-year-olds, vaccination against the liver infection hepatitis B plummeted to about 17 per cent in the 2020 to 2021 school year, compared with 67 per cent in the school year ending in 2019.
For human papillomavirus, or HPV, which can cause cancer, the vaccination numbers were even lower, plunging to 0.8 per cent last year, compared with 58 per cent in 2019. For the meningococcal vaccine, which helps protect against four types of the bacteria that cause a rare disease, vaccinations fell to about 17 per cent from 80 per cent over the same time. Risks of the potentially deadly illness include meningitis, an infection of the lining of the brain and spinal cord.
“The large decline in coverage in 2019-20 and 2020-21 illustrates the impact of the COVID-19 pandemic, as there was limited capacity to deliver school-based immunization programs,” Public Health Ontario said in a statement.
It said data for uptake of vaccines aimed at protecting younger kids against measles, for example, is not available beyond 2019, and a report on later numbers is expected to be released next spring.
Dr. Monika Naus, medical director of Immunization Programs and Vaccine Preventable Diseases Service at the BC Centre for Disease Control, said in-school vaccines, starting in Grade 6, were delayed, but work is underway to return to pre-pandemic levels.
Younger children missed appointments at doctors’ offices while physicians were seeing patients virtually and public health clinics, which mostly administer routine vaccines for kids outside of the Lower Mainland region of the province, were busy with COVID-19 shots, Naus said.
Dr. Sam Wong, director of medical affairs for the Canadian Paediatric Society, said disinformation and vaccine hesitancy during the pandemic, “combined with the failure of the public health system” to provide routine vaccines, mean certain populations could be left vulnerable to highly contagious diseases like measles, which spreads through coughing and sneezing.
“You could walk into a room an hour after someone’s been in there and potentially get infected,” he said.
“We’re worried, as a group of health-care providers, that if you have lower rates of vaccinations that you’re more likely to have localized outbreaks of vaccine-preventable illnesses such as measles or mumps and chickenpox,” Wong said.
Wong said it’s important for doctors and parents to discuss the importance of routine vaccinations that have been proven effective for decades, adding some people believe young kids’ immune systems are not ready so they’d rather wait until they’re older.
“But that’s why you want to give the vaccine, because their immune system is not able to fight off infections,” he said.
“Some parents don’t want to even have discussions with me about it. But if there is an opening, I’m happy to talk about it,” said Wong, who works in Yellowknife, Edmonton and Victoria.
The Public Health Agency of Canada said Canadian studies have found immunization coverage declined during the pandemic for the measles, mumps and rubella vaccine.
Quebec saw a 39 per cent drop in April 2020 compared with 2019, the agency said, with the greatest impact seen in children aged 18 months.
In Alberta, the agency said vaccination for those diseases declined by 10 per cent in April 2020 compared with the same month a year earlier. Coverage for Ontario children under two decreased by 1.7 per cent, it added.
“The Public Health Agency of Canada continues to work with provinces and territories on an ongoing basis to understand the impact of the pandemic on routine immunization coverage across Canada, and to improve the availability of high-quality data to inform immunization programs,” it said in a statement.
It is currently in discussions with all jurisdictions on ways to monitor coverage of vaccines, similar to a surveillance system used for COVID-19 vaccines, the agency said.
Nova Scotia Health said its last report on childhood vaccines was completed three years ago, and numbers have fallen during the pandemic.
“Anecdotally, we know there was a drop in childhood vaccination, but we do not have the specific numbers available at this time,” it said in a statement.
However, the school immunization program is aiming to help students catch up on vaccines that were missed early in the pandemic, mostly through doctors’ offices, it said, adding that getting an appointment was a challenge for some families.
“We know that a substantial number of Nova Scotians do not have a family doctor. Public Health often works with local primary care clinics to provide vaccines to those who do not have a family doctor and some public health offices will offer clinics to this population.”
Last week, the World Health Organization and the United States Centers for Disease Control and Prevention released a statement saying a record high of nearly 40 million children missed first and second doses of the measles vaccine in 2021 due to disruptions in immunization programs since the start of the pandemic.
The two groups said there were an estimated nine million measles cases and 128,000 related deaths worldwide in 2021, and 22 countries experienced large outbreaks.
Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University in Halifax, said a national registry that could quickly tell doctors which children have not been vaccinated is essential in Canada.
“I feel like I’m banging my head against a brick wall,” she said of her efforts to call for that change.
“How can we do proper health-care planning when we don’t have the data?”
Canada is an “outlier” that lags behind most European countries on the measles vaccine, she said, adding a coverage rate of 95 per cent is needed to create so-called herd immunity against the highly infectious disease.
Canada recently had 84 per cent uptake of the second dose of the measles vaccine. MacDonald said Australia, in comparison, had 94 per cent based on the most recent data from the WHO. She used the two countries as an example because they had a similar number of births — 368,000 in Canada, and 300,000 in Australia in 2021.
“We are just not in the same league, and we should be embarrassed.”
This report by The Canadian Press was first published Nov. 27, 2022.
This story was produced with financial assistance from the Canadian Medical Association.
Health
Cobourg resident first at Peterborough Regional Health Centre to receive new cancer treatment
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Two years ago, a doctor looked at a CT scan of Stuart Morley’s kidney and saw a tumour. It was small — only 15 millimetres — but the Cobourg resident was over 80 years old, so major surgery wasn’t the best option for him. Instead, he was a candidate for a minimally invasive interventional radiology procedure.
Stuart became the first-ever patient at Peterborough Regional Health Centre (PRHC) to receive life-changing cancer treatment by interventional radiology-radiofrequency ablation.
The amateur photographer and retired radiographer tells how PRHC’s Dr. Kebby King put a metal probe through a small cut in his skin and, using a CT to guide her, found the tumour and dissolved it with radio waves.
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“It was amazing,” Stuart recalls. “I felt no pain and I was able to go home later that afternoon. Now I’m back taking photos and looking forward to travelling the world again. I worked in diagnostic imaging for 12 years. But back in the ’60s, we could never have imagined the kinds of things doctors can do these days.”
Interventional radiology is often described as ‘the future of medicine’. It’s used to diagnose and treat a wide range of emergency and chronic health conditions such as cancer and other illnesses, without the use of conventional surgery and the associated pain, complications, and longer hospital stays.
For patients in the Peterborough region, this means they can go home sooner, with less pain and less risk, all without having to travel far away.
VIDEO: Interventional Radiology is helping to revolutionize cancer care at PRHC
Interventional radiologist Dr. King describes that difference as “night and day.”
It’s remarkable how many life-threatening health conditions can be diagnosed and treated with this innovative specialty. It can be used to biopsy or treat tumours like Stuart’s, put in ports for chemotherapy, or stop bleeding — in as little as an hour.
Dr. King and her colleagues already perform 6,000 interventional radiology procedures each year at PRHC, and the need for this kind of care is only growing in our region. PRHC’s interventional radiology suites are 14 years old, however, and are too small to fit new advanced technology and the staff required to use it.
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A $6 million investment in state-of-the-art equipment, upgraded suites, and an expanded recovery room is essential to meeting the need — so more patients with more complex conditions can be diagnosed and treated close to home.
Grateful for the great care he received and determined to help pave the way for new ground-breaking therapies to be offered at PRHC in the near future, Stuart donated to the PRHC Foundation for the first time. He wants to support the interventional radiology renovation and upgrade, and he knows that the government doesn’t fund hospital equipment.
“Our regional hospital needs our help,” Stuart says. “I’m asking everyone to join me in donating to support the interventional radiology facilities. Pictures can save lives. I know this because medical imaging saved mine. Now, our donations will help others. Thank you for helping to give people like me a brighter future.”
Not only do donations fund state-of-the-art technology not funded by the government, fuel innovation, and bring new services to our region, they also help PRHC attract and retain the best and brightest healthcare professionals. Doctors, nurses and staff want to do their jobs to the best of their abilities, and advanced equipment and innovative treatments support them in doing that.
This holiday season, donors and grateful patients like Stuart can help ensure PRHC’s frontline workers have the tools they need to provide expert, compassionate care, and receive some good cheer. Tribute donations can include a message of thanks or best wishes to a hospital department or individual physician, nurse or staff member when made online at prhcfoundation.ca or by phone at 705-876-5000.
To donate, find out more about interventional radiology, or share your own PRHC grateful patient story, please visit prhcfoundation.ca or call 705-876-5000.
This branded editorial was published in partnership with the PRHC Foundation. If your organization or business is interested in a branded editorial, contact us.
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