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_ 2A--Presentation by local Redding Neurologist Karen Garnaas, MD
� � �' � � � � � � ' � �' � � ' � ` CITY OF REDDING REPORT TO THE CITY COUNCIL MEETING DATE: November 19, 2024 FROM: Barry Tippin, City Manager ITElVi NO. 2A ***APPROVED BY*** btippin@cityofredding.org "S' �p�an,�`i K i�r� � �I t[�I�Q2� btippin@cityofredding.org SUBJECT: 2A--Presentation by local Neurologist Karen Garnaas, MD Recommendation Presentation by local Redding Neurologist Karen Garnaas, MD, providing information related to health issues associated with the overuse of Nitrous Oxide. , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� kJ��r,������t�f�klii�u��£��as������t}�4g�j#�$}£Yit}t��?��{?}i{tt�zst�'fi��i� 1 � ,#„I�kht.,#�4F'„S;f i 7 i�y,{S 4. 5 5,.,:,i� , THIS IS NO LAUGHING MATTER Neurofioxicity associafied wifih recreafiional abuse of Nitrous Oxide ��{�1,����, Karen Garnaas MD Catalyst NeuroMedical Center ��� � � `� �tt���� ��� � t „ �"` ' ��,.r���� � � �fasuax���� i, �..'us*,:�ax�,�1`t;� r A I � yw+��>iS<k4;l�1hl s .k- e pr2 �j .{` �:; " t4�'s � r F}`�� �n ti�;' wr �.u,.�, ��r��,. ;{„ i Sta �'i" �k yR �'::., �,2,,= : y 1�����t�st'�r: -. �.. ��`, � �.,,r.. u �,:;:: �i>' �r ��" f t�$�{ �. . },. ��r31�1 � r;., a �`i I( �: t it��������� � �� . ��r , 1j{Stt}� ���t�$ £J}f �t��ksi jI�f 7 , }��i", #;Y�{4., ��� � .. j ' ,4'�Et3}+tt 7 r;r r�rtlyl3f�t5�tittr��Iir r,:< P r, . t�'; $ stshjst;r�3lttitr;�rt'r�r,;l��jj����'�����a�1�)1 J �l f , � rt��' 1t``�a: . . ..��s'�}tl,��a�t�F..S�� 3,��,£����G»�5ft�r� }�t1s�tt�jxallt :; ;jt�� � �3ti{t/t;=, ,. . . �ft:U�:+P}�:f;�?'�r4�.,b��{{�',t,�,y�� ,�tr+�+, tttx?#��4r��5$������s�F�t}{ z ;� � ,:{tt,} � �d,'�,,r,���4�r x�;:: .�x�.�t5�'���`.3���:, .m , ;`„v�w:t�;�i'�t�h�������iii'i��r�(4r����,i�,`., � ':..,, ��'.,:��c,�3.. < , �eS�n ``f����'a, . . . . . . . . . . . , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� kJ��r,������t�f�klii�u��£��as������t}�4g�j#�$}£Yit}t��?��{?}i{tt�zst�'fi��i� 1 � ,#„I�kht.,#�4F'„S;f i 7 i�y,{S 4. 5 5,.,:,i� , �� VV � AT ARE VVHIPP �T • Whippets are type of inhalant drug made from nitrous oxide, • Nitrous oxide- also known as la�ghing gas- • used as dental sedative, � �sed in reusable whipped cream dispensers � ������� - � ������ �� � � � � � � ���� � � � �� � �� • Historically sold in small 8 gm cartridges for whipped cream • Now marketed in large canisters size of 02 tanks which can hold 80+ doses in single canister � � � ����iS���t2�st .,� � � �,,; ,: � � �+e�n�s u .zY. „Y� > ,e .�o ��f � �s¢�;�4��afi��t ��t° ,,�u�..� �s k �,��1Y���,,. �..� "� � ;��,�,�,; R' t•, �it'fis'`1}i„�i.,.t,a..,i�t` r 4{, . . • • • • • • • • � � � � � � � • � � t ��ks���r r i � +{ i�rt�i ... 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A p it �,, � � � � ��� , , � u �r{i¢)r )�t ,. �'� ; 4(����'7}t�°��' , r ' i�v'�sc+� �1 i �75�7fSS�' c�'t �t�� �)�'� ���t'r;i r � � '� .'�r t x �?��,i} " ;,;.� . �� �I���7� �. � 1 l�ij a '�f t���2�7 �` t��£ t '� �� �,'�a. , � `���4� `v:�:4 � �t } z ?`�� f� t� ������ ui t � �77�,$ �t�;}��1�+ k �t#,p'') 4 %� ,��� t `'i }({S t � �` t . �^s3. .� .s �tt t . J �}�} .s �7 �j�} )t �,,r�.r „��'{rt ��i�`i�.r, , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� kJ��r,������t�f�klii�u��£��as������t}�4g�j#�$}£Yit}t��?��{?}i{tt�zst�'fi��i� 1 � ,#„I�kht.,#�4F'„S;f i 7 i�y,{S 4. 5 5,.,:,i� , �� HEALTH RI K F VV � IPPET • Nitrous oxide i i binds to cobalt and through oxidation inactivates vitamin B 12 which is a critical vitamin for nervous system health • Repeated �se causes i � i � which manifests with • Brain damage: psychosis, memory impairment • Spinal cord damage: resultant weakness, numbness, balance issues and risk of permanent disability resulting from � � . • Nitrous oxide may also damage blood cells, liver, kidney and result in inadequate oxygen with overdoses, with resultant death. • State ofi intoxication impacts safiety driving and decision making. � through smoke shops, not detectable on drug screens �� readily sold as cheaper alternative to small cartriges 8 gms, leading to 80+ hits a day and patients going through 2-3 L/day: , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� �k�����������������������������r�t��������zz������ � R I I N E P I D � �/I I I N H A TA i!§`b�.�"ft�11774 AS.S# ti�4 S},.,:,i� , #Iktt #14Ft,sf �-S�{,':,; .,,r�,., :''.,.:', ",'�."�; . . ,.,:. U � TY • Neurologist for 30 years, past 4 years here in Shasta County, specializing in neuromuscular disorders. I had never seen a case of Whippet neuromyelopathy until this summer. • July 2024 First case 58 year old male, progressive painful sensory neuropathy, using NO to avoid detection. � � � , i � � hospitalized between 3-6/2024 • Ages 22-38 years, duration of use ranged from 3 weeks to 6 months • Subacute numbness and weakness of legs then arms, trouble walking, standing, 6 patients hospitalized with extensive testing and treatment for other conditions. • Vitamin B12 levels <150 (normal 350-1800) • Despite some improvement treatment with B 12 shots, � � i � �° � � � r � � � • All 5 that had scans demonstrated spinal cord degeneration, swelling occurring throughout the community within our MediCal outreach clinic, hospitals and emergency rooms. Escalating use nationwide, northern CA , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� �k�����������������������������r�t��������zz������ � P I � A L R D I �/I A I � i!§`b�.�"ft�11774 AS.S# ti�4 S},.,:,i� , #Iktt #14Ft,sf �-S�{,':,; .,,r�,., :''.,.:', ",'�."�; . . ,.,:. AB � R �/IALITI E ta,a,&aa an".W�AaP �iS.N+�9� BdP�q'.9ri"�k;� � 3't.. wMa9,:*:mF�AnN �. � �.�' :"�, r : , ��a�s �a`at��& ' S `�' aan��az:mn � � . : , , ' { ' s t r..,. �, t ,^ {��r`�,�� „s ,}�„� .4 �` :�%�. ��� �e� � �4, ��� i+i� r�� m�ae�� �� ����� �„��{,,� 4�. � i � .n 7 s,�,��,,, �Jt�#�§4i1�}�� ���'yw�n� �tuwvae Y.&&. � � �. � .', <�, ., ,t�e «. ��)!ri i I �ti?°r�;w�� ,. 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'� r;�i 3r �'M ;'`#`„u ! r ` { a � + } � ���, �' }j » ��s �� . � � � ! t'4 t�s t 1"3 ��� � r �c " '� � ��� `� s '�' tSs� � ��X �`y,, v! �� , �. � �i3 r�:,`�'isy ��i�Z� � z,v„ ; �.�. � �'.m l'��1#����..;, '� ` ��}f, ,�. + d 15 ..Sl • ' ��.•,= 2 ,u�,i �., .;, a . a,* � , "4 ..�'i, a, w+r�, . www � � t »t ��.� ' 7 . �. m�w.�„�,.�ww«r , � , �� ��� I �r.= n,N„�����.� ��' � t�,<«,��a v �„.� w:. �v�� d � 3�<,r.,t.,�;�� �� � ��..,,.�,,.,,. �„.. r, �, ��1����, ,� '� ,��, � �,� , _ . .'� �: �� � ������� �,:,u�r� � )S}@t�t��fynti`}}�s �f ir?� � �'r�§t �.< r # �,'b�,7��,�g�'.�t�t'�'� a R t,��fei��'�rt�';�'�=x��`�,wk��.�"�e�a�,�i;�ds�st Y7 �� �k�����������������������������r�t��������zz������ � VV H AT A � VV E D T P R T E T i!§`b�.�"ft�11774 AS.S# ti�4 S},.,:,i� , #Iktt #14Ft,sf �-S�{,':,; .,,r�,., :''.,.:', ",'�."�; . . ,.,:. � R � � u � � TY � i� i i � i � • Working with Dr James Mu, Shasta County Public Health Offiicer • Increase public awareness of risks of Whippets • Educate health care providers in our region as to signs and symptoms of Nitrous Oxide myeloneuropal�hy � KRCR story this week • Investigating true incidence of NO associated B12 deficiency in our community with case series with SRMC internal medicine resident Dr Puttam • Need to develop ambulatory care program for patients dia nosed with this condition as abstinence of NO is key as well as B 12 repletion, treatment o� their other substance abuse issues � � i i � i 1 '� � i � � � � Together we can collectively and quickly prevent our Young adults/youth to ex erience irreversible dama e/disabilit p g Y THANK YOU FOR YOIJR ATTE �TION ! 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