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THE UNREAL WORLD

'The Cleaner' should get to the hospital

September 07, 2009|Marc Siegel

"The Cleaner"

A&E

Aug. 25, 10 p.m.

Episode: "Cinderella"

The premise

While William Banks (Benjamin Bratt), a former drug addict, watches his daughter Lula rehearse for a ballet recital, he discovers that the top ballerina in the troupe, Callie Bell (Ksenia Solo), is addicted to drugs. He observes her snorting a white powder. Syringes, speed (amphetamine) and OxyContin (narcotic pills for pain) are later found in her locker.

While rehearsing, Bell suddenly develops chest pain, has trouble breathing and collapses. Banks brings a doctor to the dance studio who discovers a problem with Bell's upper back and gives her a cortisone shot. Bell's mother, Barbara, reveals that her daughter's initial injury to her neck and back was treated with codeine, leading to this continued dependence on pain medication so she could continue to dance despite the pain. The doctor thinks she may have multiple herniated discs or degenerative spine disease and will need long-term treatment. He recommends that she stop dancing, as continuing to dance in this condition "could lead to very serious complications." Banks helps wean her slowly off the pain meds with intravenous injections of another narcotic. He plans to get her into long-term treatment. But Barbara is resistant and Banks discovers that she is her daughter's drug supplier. Ultimately, Callie is admitted to a pain clinic.

The medical questions

Why would a dancer take -- and end up becoming addicted to -- a combination of narcotics and amphetamine? Why would she suddenly have chest pain and collapse? Could she be safely treated outside the hospital? Could herniated discs in the neck make it dangerous to dance and require increasing amounts of pain meds? Can she be effectively weaned?

The reality

Maintaining low body weight is a major concern of dancers. "She probably used amphetamines to decrease her appetite," says Jim Adams, associate professor of pharmacology and pharmaceutical sciences at USC. Amphetamine also may enhance the ability of OxyContin (oxycodone) to relieve pain. The two drugs have very different effects: Oxycodone relieves pain and can cause euphoria; amphetamine is a stimulant that can cause hallucinations.

Both can cause chest pain and collapse. Amphetamine can strain the heart, provoking irregular heartbeats (arrhythmia) and even precipitating a heart attack. Oxycodone can cause heart failure and cardiac arrest. It is very unlikely that after Bell's collapse she could be safely treated outside the hospital, Adams says. Her untreated addiction and serious spinal pathology are added reasons for immediate hospital admission.

Herniated discs are painful ruptures of the spongy fibrocartilage discs that act as cushions between the vertebrae. Narcotic pain medications are only temporary treatments for flare-ups of herniated discs, says Dr. Michel Dubois, director of research and education at the NYU Langone Medical Center pain program. They should not be used on a longer-term basis without regular supervision from a pain medicine specialist. Dubois adds that herniated discs in the neck can be dangerous, especially for a dancer who pushes physical performance to the limits. Incredible stress is placed on the spine in the sudden moves that occur during dancing, Dubois says. The swelling of the discs could potentially compress the spinal cord (a condition known as cervical myelopathy), which in a worst-case scenario could lead to paralysis.

It is very difficult to wean a patient off oxycodone, both experts say, especially if the person is using high concentrations (which Bell probably was, as the show revealed that she was snorting the drug). A detox center would be the best place for Bell to be treated.

--

Siegel is an associate professor of medicine at New York University's School of Medicine.

marc@doctorsiegel.com

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