Bath Salts and Synthetic Drugs in Central NY

A few weeks ago, I had a research article published in Clinical Infectious Diseases, "Cardiac Infection and Sepsis in Three IV Bath Salts Drug Users".  It detailed three cardiac infections seen in IV bath salts users over the previous summer in Syracuse.  These patients were terribly sick and likely would have died if they had not been seen and treated as quickly as they were.  All of them first were seen in local hospitals and then transferred to the Syracuse hospitals.  Syracuse and the Upstate/Central NY area has had terrible issues with bath salts and other synthetic drugs in the past few years.  There have been some horrifying incidents and families and individuals have been hurt.  Meanwhile, a local "entrepreneur" managed to make a decent fortune off of this epidemic.  He has since pleaded guilty to drug distribution.

Steuben County did not manage to escape this phenomenon.  I hope that, with the shut-downs of the storefronts that were selling these chemicals, the tide has turned.  Health care is about people taking care of others in their community, and, as someone training for a health care career, it is frustrating to see things like the bath salts retailers attempting to make money off these drug sales regardless of the suffering that it imposes on their customers and their communities.

Healthy Families Steuben

This month I am writing on health care teams in Steuben County, and I'd like to focus on an interesting organization.  Healthy Families Steuben is part of the larger Healthy Families NY group of organizations, funded by the state government.  Starting in the pre-natal period and continuing through to age 5 or pre-school, the organization identifies at-risk families and then works to facilitate "positive parent-child interaction and healthy childhood growth and development".  The team there consists of one Program Manager, three Supervisors, one Family Assessment Worker, and nine Family Support Workers for a total of 14 people.  The Family Assessment Worker assesses whether the program is appropriate for the family situation.  Referrals are received from the two local hospitals, Corning and St. James Mercy.  The goal of the intervention is to improve child mortality and the family environment in the client families.  Steuben has been relatively successful in these efforts.  The infant death rate in the county is 2.6/1000, as compared to 5.1/1000 in NYS as a whole.
By working together in teams, whether between different individuals in an existing group or between organizations, such as the Institute for Human Services, which brings together many human services organizations in Steuben and other areas of the Southern Tier, we can make sure that individuals and communities receive the care they need.

County Health Rankings Website

This month I am talking about county-wide health indicators.  There are many different ways to measure this, and based on the Steuben County Health Assessment, I had thought that Steuben performed pretty well.  Steuben has an aging population, which skews certain health measures (such as death rates), but in many areas, such as teen pregnancy, it seemed to be doing pretty well.  As the report noted, "the teenage pregnancy rate from 2005 to 2007 for those 15 to 19 years old is 34.6 and lower than our regional rate of 47.1 and the NYS rate of 58.7."

I have recently been made aware of a website that attempts to comprehensively rank counties by health, County Health Rankings and Roadmaps.  Like many global assessment tools, this weights different measures to come up with a comprehensive measure.  I am a bit wary of these methods, as the weighting can largely determine the outcome.  The US News and World Report college rankings are similarly criticized, as depending on the weighting, the rankings can completely change.  I appreciate this site as it collects and displays commonly used and accepted health measures in a graphically accessible fashion, allowing a quick and convenient comparison between different counties.

However, there seems to be some issues with the data on this site.  For example, it gives a teen birth rate of 30/1000 for Steuben, whereas the County Health Assessment gives a rate of 34, and it gives a NYS rate of 27, versus the report level of 58.7.  I can not say definitively if this is not an issue of reporting period, but it seems off.

One area that certainly needs improvement is smoking.  Steuben is reported with a rate of 28% - I do not know the source of this, but it is very high if it is accurate.

Dr. Joseph Mathey and the Doctor-Patient Relationship

This month we have been asked to reflect on the doctor-patient relationship.  In Steuben County, an extraordinary provider has been Dr. Joseph Mathey, who has over 35 years of experience.  Dr. Mathey was chief medical officer at Corning Inc., and is part of a small family practice office in Corning, NY, part of the Arnot Health network.  His connection with the local community has been extraordinary.

While at Corning, he helped rescue a remote acquaintance who developed appendicitis in Shanghai.  The connection: the patient's roommate's mother called Dr. Mathey, who then felt called into action, arranging the woman's medical care in Shanghai and making sure that international payment wouldn't be a barrier.

In 2010, Dr. Mathey was recognized as provider of the year by Steuben Rural Health Network, and in 2011, Dr. Mathey received the Dr. Gary Ogden Rural Health Practitioner of the Year Award from the New York State Association for Rural Health.  The citation from NYSARH noted that Dr. Mathey "assist[ed] patients with chronic or terminal illness and establish[ed] the support systems they need, includ[ing] going out of his way to help an adult child find local employment so they could return home to provide support for a dying parent."  He also did an extraordinary job in occupational health at Corning, establishing their tobacco-free corporation status and also the employee assistance program.

While accolades and articles may be one measure of Dr. Mathey's success, I find smaller recognitions like this one, a family written obituary for an elderly Corning resident, to be the most touching.  The obituary noted that the family's gratitude to "her Corning physician, Dr. Joseph Mathey who always had the time to converse and share stories with her."  One extraordinarily powerful role for physicians is to comfort the sick and elderly, and the recognition from the families of his patients attests to Dr. Mathey's dedication and achievement.

Substance Abuse Treatment Options in Steuben County

The explosion in prescription drug and methamphetamine abuse in recent years has stressed the health care resources of many rural areas.  The networks needed to guide rural substance abuse patients through treatment and re-integration in the community were not developed enough to deal with the sudden onslaught of patients.  During my summer rotation program at Upstate/Crouse, I encountered an extraordinary number of people hospitalized as a result of the illnesses they had acquired through drug use.

However, I think that Steuben County has done a very good job in this respect.  I would like to highlight some of these excellent programs:

For veterans, the Bath VA Medical Center runs a long term inpatient treatment program for those suffering from substance abuse and related chronic health problems.  I think this program is particularly impressive that it is able to facilitate stays in treatment for three to six months.  Recovery from addiction is a very long term process, and being able to provide a therapeutic environment for that long provides the best possible shot for these troubled veterans.  Similarly, the Bath VA also runs a monthly family support group for the family members of veterans suffering from PTSD, substance abuse, and similar issues.

Steuben County also has a rural health network devoted to educational initiatives combatting drug/alcohol abuse, the Steuben Council on Addictions.  They also provide substance abuse screening and treatment referral and also have a close relationship with the self-help groups (AA/NA) in the county.  There are also several professional treatment providers in the area outside of the VA system.

In my future practice, I hope that I can ensure that patients that have substance abuse issues receive a continuity of care: inpatient/outpatient/group involvement.  As Dr. Norman Wetterau made clear in his recent talk to the Upstate Rural Medical Scholars group, recovery is a long term process, and I hope that I can help my patients stay on that journey.

The Residual Effects of Occupational Exposures Among Rural Residents

While a number of efforts have been made to improve air quality and air safety at industrial and minerals/mining businesses in rural areas like Steuben County, health care providers continue to see the lingering effects of these exposures in their patients.  In Sept. 2009, Dwight Casey Miller, aged 58, died of silicosis at Corning Hospital.  Silicosis is a progressive lung disease that is generally related to work exposures to silica dust, including "hard-rock mining, silica milling, quarrying and stone work, foundry work (quartz sand is used to make molds), sand blasting, pottery making, glass making, and cleaning boilers."  I was unable to find where Mr. Miller had worked, but a number of these trades are common to Steuben County residents.  Along with emphysemic trapped pockets of air, there is fibrotic development in affected lungs in silicosis: "Silicotic nodules are made of centrally located whorls of collagen and reticulin with surrounding macrophages, fibroblasts, mast cells, and lymphocytes."  The foremost treatment is to avoid exposure, including in patients that have yet to develop marked symptoms.  Once symptomatic, other than avoiding further exposure, most measures are supportive: supplemental oxygen and sometimes steroids can bring some relief.

Rural physicians treating individuals with shortness of breath and chronic bronchitis need to be aware of silicosis as a possible diagnosis, and carefully review the patient's occupational history to see if they have any exposure to airborne irritants/carcinogens such as silica dust or asbestos which may explain their patient's symptoms.

Medical source:  Carrier D.D., Newman L.S. (2003). Chapter 31. Pneumoconiosis. In M.E. Hanley, C.H. Welsh (Eds), CURRENT Diagnosis & Treatment in Pulmonary Medicine. Retrieved September 10, 2012 from http://www.accessmedicine.com/content.aspx?aID=577842.

[reposted from Facebook; from March 1, 2012]
In its most recent Community Health Assessment, Steuben County identified chronic disease as a priority area. Towards that end, two Steuben members of the Southern Tier Diabetes Coalition recently received a grant to travel to the CDC for d

iabetes prevention training. One of the grantees was from the Steuben Rural Health Network, which provides diabetes prevention services through their Lifestyles Embracing Activity & Nutrition (LEAN) program. I have already covered their youth program, BodyWorks, but they also run an online community, a program for pre-school aged children, and an adult worksite wellness program. By directing their efforts across the community, Steuben County Health Dept. and Steuben Rural Health Network can reinforce the messages that they are giving children and their parents.