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Heroin & Health ConsequencesBy other extreme productions

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Other Extreme ProductionsOther Extreme Productions ©© 20092009

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Skin Abscess Processes SLIDES 6 - 16

Circulatory System Processes 18 - 27

Past Heroin Abscess Scars 29 & 30

Summary & Information 31

Heroin & Health Consequences Medical Condition SlidesHeroin & Health Consequences Medical Condition Slides

Table of Contents

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These Slides

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Skin Abscess ProcessesIntroduction SLIDE 6

Emergency Room 7Admission To Hospital 8ICU 9Sepsis 2nd To Skin Abscess of Right Axilla 10 & 11

Sepsis 2nd To Skin Abscess of Right Thigh 12 & 13

Wound Care Using Wound V.A.C. System 14

Wound Closure – Skin Graphs 15 & 16

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Abscesses Process Abscesses Process –– Introduction Introduction

Had I not gone to the hospital when I did, I would have died. Several months later someone else died in this very house –drug related.

Lying in a dope house I was paralyzed from my waist down and couldn’t urinate for about 3 days. I couldn’t even light a cigarette because my fingers wouldn’t function either. The other addicts finally got me into the wheelchair and pushed me up the street. Shawn was having a difficult time pushing me because I couldn’t keep my legs raised up high enough and they kept dragging on the ground stopping us. He had to pull me backwards so my legs would drag behind, instead of being caught under the wheels. Bill went ahead to let them know they were bringing me in. It was only about five blocks, but it seemed like it took us forever to get there.

ACTUAL HOUSE WHERE I DID HEROIN

Slide 6 Other Extreme Productions © 2009

Everett Providence Medical Center

Everett, Washington

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Abscesses Process Abscesses Process –– Emergency Room Emergency Room

My signature indicates how my condition was at the time of admission. I was a little shaky. I don't remember signing this. Once I arrived in the ER I was fading in and out of consciousness. I vaguely remember the doctor seeing me.The next thing I was aware of was

that I was in a bed somewhere and a nurse came back after she put the catheter in and informed me that I was having kidney failure. I don’t recall worrying or asking questions, I just faded out again. I did mention that I knew Dr. Moskovitz, how he operated on me about 3 months earlier. It must have been hours later when he came in and told me that he would do what he could, but that it looked grave.


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ADMISSION: The patient who has a long history of intravenous and intramuscular heroin and cocaine use was presented to the hospital with a myriad of health issues. The patient complains of weakness and cannot move both of his legs for the last five days. On assessment, the patient is noted to have a draining wound in the right arm region and erythema and warmth to the right thigh. A CT scan of the abdomen and pelvis was obtained revealing that there is an abscess in the anterior right hip and right thigh. The patient is also found to be in acute renal failure and also has a urinary tract infection, rhabdomyolysis and myoglobinuria. His altered mental status and hypotension give him the diagnosis of acute sepsis as well.

Report Taken From Original Hospital Records - Electronically auto-authenticated by Mony Baggett, MD

Abscesses Process Abscesses Process –– Admission To HospitalAdmission To Hospital

Rhabdomyolysis: Rapid break down of the muscle tissue due to an injury caused by physical, chemical, or biological factors. This is what was most likely causing my paralysis. I also could not urinate. By the time I got to the hospital I was begging for a catheter which is intrusive.

Sepsis is a severe life-threatening illness in which the bloodstream is overwhelmed by bacteria. With sepsis, blood pressure drops, resulting in shock. Major organs and systems, including the kidneys stop functioning normally. A change in mental status may be the earliest signs of sepsis coming on. Some of the symptoms are: chills, confusion or delirium and a decrease in urine output.

Myoglobinuria is the presence of myoglobin in the urine, usually associated with rhabdomyolysis or muscle destruction. Myoglobin is present in muscle cells as a reserve of oxygen. Certain drugs and other situations can destroy or damage the muscle, releasing myoglobin to the circulation and thus to the kidneys.


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Abscesses Process Abscesses Process –– ICU ICU


Picture Taken After About 2 Weeks In The Hospital

ASSESSMENT: The patient is a 46-year-old gentleman who has a life-threatening soft tissue infection process currently. This is in at least 2 sites, one up in his right deltopectoral groove extending into his axilla and one in his right thigh. Additionally he needs an electrocardiogram and an urgent chest x-ray. I am typing and crossing him for 4 units of packed red blood cells…

Alexander H. Moskovitz MD

Antibiotic Broad-Spectrum Panel Prior To Surgery

Zosyn Vancomycin Penicillin Clindamycin Ciprofloxacin

I recall waking up in a room that had a lot of stuff I knew to be medical equipment, but at the same time, I thought there were zoo animals in my room. I didn’t know it at the time, but I was in the ICU. When I got to what must have been a regular hospital room, I had all kinds of tubes and machines hooked up to me. I didn’t know exactly what they did or the severity of what my condition was. Because this had become routine for me, I was oblivious to the seriousness of the situation. I had a number of things wrong with me. My total stay in the hospital was approximately 3 months.

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FINDINGS: Right deltoid and pectoralis major with some dead muscle along the deltopectoral groove. This was all debrided. There was also a lot of heroin tar staining in the deltoid and along the deltopectoral groove and pectoralis major muscle. There were multiple pockets of pus in and along these sites, as well as, patches of frankly dead muscle, combined with patches of tar staining that made discerning viability difficult. Muscle was debrided back to contractile bleeding, healthy tissue. The risks that I discussed included: loss of life…

Report Taken From Original Hospital Records - Electronically auto-authenticated by Alexander H Moskovitz, MD

Sepsis Secondary To Skin Abscess of Right Axilla Sepsis Secondary To Skin Abscess of Right Axilla

Arrow Points To Area


Debridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. The look at my right shoulder during bandage changes is surreal. This was taken about 10 days or so after surgery. A better camera lens could have shown part of my shoulder cap and bone. Close-Up of Wound

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Sepsis Secondary To Skin Abscess of Right Axilla Sepsis Secondary To Skin Abscess of Right Axilla

DeltoidPectoralis

Major


The medical practice or technique of cauterization is a medical term describing the burning part of the body to remove or close off a part of it. This will destroy some tissue, in an attempt to mitigate damage, stop bleeding, or minimize other potential medical harmful possibilities such as infections. The main forms of cauterization used today are electrocautery and chemical cautery. I had the electrocautery procedure during operation.

The Pectoralis Major is a thick, fan-shaped muscle, situated at the chest (anterior) of the body. It makes up the bulk of the chest muscles in the male and lies under the breast in the female. Underneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. In human anatomy, the Deltoid muscle is the muscle forming the rounded contour of the shoulder. Anatomically, it appears to be made up of three distinct sets of fibers. The Deltoid is a frequent site to administer intra-muscular injections.

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FINDINGS: In the right thigh, there was a massive abscess extending from almost up at the inguinal ligament, down to a few inches above the knee joint. This was nearly the full length of the anterior thigh muscle compartment, and the abscess had eroded a large amount of muscle tissue anteriorly and laterally. There were several merging veins just traversing this cavity, floating within it. All the muscle in and around this cavity appeared grossly contractile and viable. The cavity was so large that, in order to adequately drain it, it required 3 counter incisions medial and inferior, through which Penrose™ drains were placed to keep them open. An elliptical incision was made in the anterior right thigh. Upon entering the abscess cavity, approximately 1 Liter of pus under pressure spouted out of the patients right thigh…with 3 Penrose™ drains going like spokes of a wheel, 1 medially, 1 inferomedial, and 1 inferolaterally. Hemostasis was achieved here with electrocautery.

Report Taken From Original Hospital Records –Electronically auto-authenticated by Alexander H Moskovitz, MD

Sepsis Secondary To Skin Abscess of Right Thigh Sepsis Secondary To Skin Abscess of Right Thigh


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Sepsis Secondary To Skin Abscess of Right Thigh Sepsis Secondary To Skin Abscess of Right Thigh

Penrose™ drains, shown above were placed after the surgeon made three incisions to drain the abscess from the larger cavity as part of the process to heal from the inside out. During the wound care process, the canal that went from the drain hole to the cavity started to heal around the foam, which made it very painful to go through bandage changes even on Dilaudid®, Methadone and Ativan®.


Wound Care Using Wound V.A.C. System Wound Care Using Wound V.A.C. System


The wound-vac machine made healing more effective and efficient. This method was much better than the traditional dressing changes. First, there were some black foam pieces that filled in my wounds, over that a clear plastic covering, like saran wrap. There were tubes that connected so that when they hooked them to the machine it would suck all the air out like shrink-wrap. One way you knew the machine was working properly was if the foam under the plastic wrap had an appearance like a raisin. I quickly learned how to operate all the buttons and switches on the machine myself, as well as, reconnect it. My wound care nurses were the best.

The V.A.C. ® Therapy™ System assists in wound closure by applying localized negative pressure to the surface and margins of the wound. This negative pressure therapy is applied to a special dressing positioned in the wound cavity or graft. This pressure distributing wound dressing helps remove fluids from the wound.

Above: Older model like the one I had.

Below: My thigh with the V.A.C. System

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Wound Closure Wound Closure –– Skin Graphs ShoulderSkin Graphs Shoulder

I shot up in the area between my arm pit and chest where I normally found a vein by just putting the needle into the general area. I called this, “my sweet spot”. Not so sweet now is it? I never noticed a lemon size lump until it popped on the way to the hospital.

My right shoulder after skin graph. Skin for both shoulder and thigh was harvested from my upper left thigh. I still suffer from slight nerve damage six years after surgery extending down my right arm. I have difficulty using my right hand to write for long periods of time. But very thankful to be alive!!! Circled area below is where I shot heroin numerous times.


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Wound Closure Wound Closure –– Skin Graphs ThighSkin Graphs Thigh


FINDINGS: He has a very large 17 x 12-cm open wound along the anterior pectoralis/deltoid region. This wound is down to muscle. There is beefy granulation tissue in the wound. There is no necrotic tissue. On the right lower extremity, there is a large 18 x 11-cm beefy vascular wound with no surrounding erythema. Once his albumin normalizes and his nutritional status and wounds are optimized, I will reconsider closure. Closure will be done with split-thickness skin grafts from the left thigh.

Report Taken From Original Hospital Records - Electronically auto-authenticated by Cynthia W Su, MD

DRAIN HOLE SCAR

ONE OF THE DRAIN HOLE SCARS

CAVITY

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Circulatory System Processes Circulatory System Diagram SLIDE 18

DVT – Deep Vein Thrombosis Diagram 19

DVT – Heroin Components 20

IV Drug Abuse Into Neck Slide 21

Cutting Agent Chart 22 & 23

PE – Pulmonary Emboli 24

Inferior Vena Cava Filter Process 25 & 26

Actual Vena Cava Image 27

18Slide 18 Other Extreme Productions ©2009

Veins in Blue Veins in Blue Blood Flowing Back To HeartBlood Flowing Back To Heart

Arteries in RedArteries in RedBlood Flowing Away From HeartBlood Flowing Away From Heart

CirculatoryCirculatory SystemSystem

Addicts take the chance of shooting into an artery

each time they use. Even experienced addicts can

make mistakes. Because arteries take blood away from the heart and to the body, the drug dissipates

into the leg or arm causing burning, swelling, and loss of limbs in extreme cases.

IV stands for intravenous. An old term for injecting heroin into a vein is called, “mainlining”referring to the main line to the brain. Heroin crosses through the blood brain barrier 100 times faster than morphine because it is highly soluble in lipids.

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The risk of Deep Vein Thrombosis is high for an intravenous heroin addict. Besides there being many impurities in black tar heroin, it has the consistency of molasses, even when diluted with water. The other factor is that heroin is cut with many substances that can cause harm to the blood stream, and other parts of the human body. The other risk is that heroin addicts at one time or another also dissolve narcotic pain pills and shoot them up. Pills have fillers that bind the pills together. These fillers are absorbed in the digestive system when the pills are taken orally as prescribed. In IV drug use the heroin addict puts into their bloodstream the binders in the pills which consist of particles that interfere with the circulatory system, thus clots can form.

Deep Vein Thrombosis Deep Vein Thrombosis –– Blood Clots In Lower LegsBlood Clots In Lower Legs


DVT

Please Note: DVT can be caused by other medical conditions besides using heroin or being an IV drug abuser.

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You may ask why does the heroin addict need to shoot into the veins in their legs in the first place. The heroin addict averages about 4 injections per day. Over a period of weeks, months, and even years, the addict runs out of veins to use like the back of the arm. They then resort to shooting into veins in other parts of the body. After the arms are used up, the legs become the next natural place of injection. I started to use my legs as a pin cushion and that is why I developed DVT. Addicts also use intramuscular injections which is known as “muscling” this is where you shoot the heroin into a muscle instead of a vein. I have known addicts to shoot up in the jugular vein in the neck. Shooting heroin into an artery by mistake can cause serious problems and even death.

Black Tar Heroin is Thick Like Molasses

Below: Travis uses upper arm intramuscular because his veins are no longer functional.

Deep Vein Thrombosis Deep Vein Thrombosis –– Heroin Components Heroin Components

Lesion scar on my leg from missing a vein while

shooting up heroin.


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Within the circles you see, (although difficult) are some slightly bruised spots on Julie’s neck. Normally one may observe these and think they are “hickys” or something else. Not so, these are small bruises that commonly form at injection sites. Trying to hit the jugular vein is a common practice among heroin addicts. For some reason I have seen this more prevalent in women than men. This is a practice that I personally have never experienced with the exception of in the hospital. The proverbial statement here is; don’t try this at home. Better hope you hit the jugular vein and not the carotid artery, which would bring sudden death. Very dangerous!


I.V. Drug Abuse Into Neck SlideI.V. Drug Abuse Into Neck Slide

Arteries & Veins – One is more oxygenated and has a different shade of red. Can you tell the difference? Could you tell the difference while being on drugs? Would you trust another dope addict to do it for you?

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TALC: In loose form, it is the widely used substance known as talcum powder. Talc is not soluble in water, but it is slightly soluble in dilute mineral acids. Its color ranges from white to grey or green and it has a distinctly greasy feel. Its streak is white.

SUGAR: Sugar, like most any cutting agent, it stretches the heroin to maximize profit. Sugar when heated caramelizes and resembles what a chunk of black tar heroin looks like. This could account for the similarities in look.

FECES: Sometimes heroin when manufactured is dried in fields. These fields are for cattle. Occasionally human feces has been detected in heroin, no logical explanation for this, unbelievable!

COFFEE: This cutting agent is usually used by the street level drug dealer because it has the same consistency and color as black tar heroin, although if too much is used, it is a give away.List continues on next slide

Cutting Agent Chart Cutting Agent Chart –– Heroin Cutting AgentsHeroin Cutting Agents


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Heroin Cutting Agents That Cause DamageHeroin Cutting Agents That Cause Damage


RAT POISON: No logical use for this other than to be just plain mean. Rat poison has been detected in heroin samples that police have confiscated.

QUININE: The bark of the cinchona tree is used to make quinine. Quinine was the first effective treatment for malaria. Back in the early 70’s there was an outbreak of malaria in heroin users spreading the disease through sharing needles. Drug dealers remedied this by cutting the heroin with quinine, the cure for malaria.

STRYCHNINE: is a very toxic, colorless crystalline alkaloid used as a pesticide. Strychnine causes muscular convulsions and eventually death through asphyxia or sheer exhaustion. Strychnine is one of the most bitter substances known and very detectable.

LIDOCAINE: A numbing anesthetic. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic, and in minor surgery.

“China White” Heroin “Mexican Brown” Heroin“Black Tar” Heroin

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Pulmonary Emboli Pulmonary Emboli –– Blood Clots In LungsBlood Clots In Lungs

IV hook-up (arm shown is not mine)

The blood clot lodged in lung image was taken of a cadaver (deceased man) with pulmonary emboli

Eventually the clots moved from my lower legs into my thighs. When this happened, I was hospitalized and put on an intravenous version of the anticoagulant called Heparin®. When I started to withdrawal, I unhooked my IV line from the pole and got dressed, then when they weren’t looking, I just walked out with the IV apparatus still in my arm. Later, I just used their IV setup to shoot heroin into my veins. I did this for only a day or so, the area started bruising and was irritated, this was very scary. The possibility of infection and overdose are high. It is like having a constant pipeline into your veins. After about a week I started to notice I could hardly walk, and I was really winded and short of breath. I went back into the hospital to discover the clots moved into my lungs. This can be deadly; the mortality rate is about 30 percent.


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Inferior Vena Cava Filter PlacementInferior Vena Cava Filter Placement


FINDINGS: The Patient was admitted with deep venous thrombosis and pulmonary embolism, documented by a ventilation perfusion lung scan. He was placed on Heparin®and Coumadin® and an inferior vena cava filter was placed by interventional radiology. Sinus bradycardia secondary to the pulmonary embolism was discovered but resolved spontaneously. A 4-French pigtail-shaped catheter was advanced into the inferior vena cava from a right common femoral vein antegrade approach. A IVC -Gram and Venogram was used for identity and placement verification of the filter.

Electronically authenticated, but not proofread by: Salwa Labib, MD

Blood Clot Lodged In Lung

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Inferior Vena Cava Filter PlacementInferior Vena Cava Filter Placement

The purpose of the vena cava filter is to prevent any future blood clots traveling from the legs up into the heart or lungs. In my case, the medical staff had no confidence that I was going to discontinue my heroin use any time soon. By continuing to shoot heroin into my lower extremities I ran the risk of developing more blood clots. I continued to use heroin intravenously. A heroin addict is also at greater risk of reoccurring DVT or PE. This is due to the neglect of normal functions like taking the medication in the proper amounts and at the proper time. A patient on Coumadin® has to have their blood checked at least once a week to monitor the levels. Drug seeking behavior takes priority over health care for the heroin addict. The process of placing the filter was virtually painless, but then again I was sedated and I was semi conscious for the procedure.


Vital Organs – Heart & Lungs

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Actual Vena Cava Filter


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Past Heroin Abscess Scars

Image – Lower Right Flank SLIDE 29

Image – Shoulder & Hip 30

29Slide 29 Other Extreme Productions © 2009

Past Scars From Abscesses Due To Black Tar Heroin Past Scars From Abscesses Due To Black Tar Heroin

Horsewhipped?This scar , which was shown in the video, is my right flank area. The abscess grew over a period of about a month before reaching approximately 10” in diameter. It was convex and looked like the top 1/4 of a soccer ball pushing out against my skin. It required major surgery to drain and remove. I was in the hospital for about a week. I also had to undergo an extensive outpatient convalescence. Once released from the hospital I went back working for the drug dealers and using heroin. It was difficult keeping the wound clean. I managed with a baby diaper and some duct tape. Abscesses have to heal from the inside, so the wound is left open. When it closes it leaves scar tissue as you can see.

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Past Scars From Abscesses Due To Black Tar Heroin Past Scars From Abscesses Due To Black Tar Heroin

To the left is a scar from my right hip area exactly where my belt line is. This also required surgery and hospitalization. The wound shrunk as it healed, however you could stick your fist inside of this wound as far as the width and depth of it.

I have had 2 other major abscesses that had to be surgically removed and hospitalization was also necessary. Both were in the buttocks (not shown)

This scar is on my upper left arm in the area of my back. I am not quite sure how I got this one. It became apparent when I went to the hospital for my other 2 large abscesses shown in the previous slides. One theory that the medical staff had was the bacteria moved across my shoulder from the other wound and caused a pocket of puss. The skin graph didn’t take so good here.


31Other Extreme Productions Other Extreme Productions ©© 20092009


Summary & InformationIn summary, the purpose of this slide presentation is twofold. I wanted to give you access to some of the diagrams and images that were in the video for a longer study of them. I also wanted to document my experiences as a credible witness to heroin addiction. Perhaps these slides would also be viable to the medical community.

I want to thank the many nurses and professionals who served me in my distress. Although most chose to remain anonymous, I remember you and won’t forget your good work. For More Information on myself or other drug prevention & education resources please go to any of our websites:

www.otherextremeproductions.com

www.dontmarrythedragon.org

Full Medical Report Available Online – For Viewing Only

www.otherextremeproductions.com/pdf/hhc-medical-records.pdf

All slides are my original work with the exception of the following: Some images used in the making of slides, all or in part, have been determined to be public domain and are used accordingly. Circulatory Diagram - This image has been released into the public domain by its author, LadyofHats – All Trademarks are property of their respective companies. Images of the 3 different types of heroin from DEA used by permission.

http://www.otherextremeproductions.com/

http://www.dontmarrythedragon.org/

http://www.otherextremeproductions.com/pdf/hhc-medical-records.pdf

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