Less invasive spine surgery; implants to improve hearing; edible marijuana dangers: Upstate Medical University's HealthLink on Air for Sunday, Feb. 18, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a neurosurgeon discusses minimally invasive spine surgery.

Ali Hazama, MD: ... We are doing the same surgery, using much smaller area to operate, a much smaller corridor. So that technical skill is much more demanding than what you would need for an open technique. ...

Host Amber Smith: An audiologist tells why someone may consider a cochlear implant.

Jeffrey VanTassel: ... There are electrodes implanted deep inside the ear that are adjacent to nerve tissue, and they work by simply, for lack of a better term, zapping our nerve to get us to hear. ...

Host Amber Smith: And a toxicologist shares some precautions about marijuana edibles.

Michael Hodgman, MD: ... Treat this like any other drug when you have young kids in the house. And that's doing things to keep them out of reach of children. ...

All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical Center. I'm your host, Amber Smith.

On this week's show, we'll hear about cochlear implants and who may benefit the most. Then we'll learn about marijuana-edible precautions. But first, a neurosurgeon discusses minimally invasive spine surgery.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Neurosurgeons can do safer, more effective surgeries on the spine using a minimally invasive technique, which means faster recovery times for patients. Today I'm talking about endoscopic spine surgery with Dr. Ali Hazama. He's an assistant professor of neurosurgery at Upstate and the director of neurosurgery at Upstate Community Hospital. He specializes in minimally invasive surgery and the spine.

Welcome to "HealthLink on Air," Dr. Hazama.

Ali Hazama, MD: Thank you for having me.

Host Amber Smith: I'd like to start by having you explain the differences between an open surgery of the spine, compared with endoscopic spine surgery.

Ali Hazama, MD: Well, that's a great way to start this conversation. Historically and traditionally, spine surgery has been performed using large incisions and exposures through normal tissue of the body in order to get access to diseased body parts, pathology or problems that have to be fixed. There was really no way of getting to those problems without opening a large skin incision going through muscle in order to fix an issue.

And so, with the advent of this technology and a lot of other technologies that have been assistive in this realm, we are able to do these same procedures, achieve the same results, but using much smaller incisions and causing much less damage or trauma to adjacent tissue that is otherwise normal.

Host Amber Smith: Can you describe for me what the endoscope is and what it looks like?

Ali Hazama, MD: The endoscope is something that has been utilized for many years in different aspects of surgery. It hasn't become as popular because of the technology that really wasn't there yet, in terms of, for example, the picture quality or the display quality. And so once we have gotten there with our camera technology, with the 3D monitors that we're able to use, the technology has been more widely adopted. And so the endoscope is basically comprised of a long tube that's the size of a pencil diameter with a camera right at the tip of it.

And this is our eyes, basically, inside of the body. Inside of this tube is an open channel in which we insert those instruments that we use in surgery in order to perform the various procedures that we normally do with the endoscope.

Host Amber Smith: Is it made of metal or plastic?

Ali Hazama, MD: It is a metal tube, and the diameter of it, again, is the size of a pencil. So you can imagine the size of the incision that's needed to be able to get that inside of the body.

Host Amber Smith: So how hard is it to get through the muscle or go past organs or whatever else is in the way there? Does this just slide through easily?

Ali Hazama, MD: Before the endoscope is introduced into the body, to the pathology, there's usually a guiding wire that goes initially, and this wire is beveled so that it really just travels in between the tissue planes, preserving the tissues. And so the endoscope is able to then slide over that and get access to the target area.

Host Amber Smith: Would you say that it requires more surgical skill to do the endoscopic version? Is it more challenging?

Ali Hazama, MD: Absolutely. So again, traditionally, surgeons are trained using the open techniques. So this is, in the beginning, an unfamiliar approach to the spine. And so these procedures tend to be very technically demanding, and so that's why, even though it's a field that is growing, it's a field that is very promising with excellent results, the adoption of it has been slow because of this required training, this extra technical skills that are needed.

And if you take a second to think about it, we are doing the same surgery using much smaller area to operate, a much smaller corridor. So that technical skill is much more demanding than what you would need for an open technique.

Host Amber Smith: Does it make a difference that you're not able to put your fingers on something because you're using these tools instead?

Ali Hazama, MD: Even with open surgery, we typically don't use our hands. Sometimes you're able to palpate things, but the actual procedures are done using tools in either approach.

Now, the tools that we do use in the endoscopic world are much more refined. They're much smaller, and they're just much more targeted to pathology that we're treating.

Host Amber Smith: What about the length of the procedure? How do they compare timewise?

Ali Hazama, MD: The length of the procedure really depends on the pathology being addressed. In general, it takes less time to do these procedures than it takes us to do a traditional surgery, and for that, there are quite a few reasons, the main one being the time it takes to really dissect and open up the body in order to access a pathology, which is then addressed.

That alone, the exposure portion of a procedure, takes quite a long time. There's a lot of bleeding that sometimes is encountered that has to be controlled. There's a lot of retraction that needs to be done.

With the endoscopic procedures, we are able to gain access to the pathology within minutes because what we're doing is, we're traversing the tissue, the normal tissue, without really introducing any damage to speak of, directly and arriving at the pathology immediately, as soon as we start, concentrating on and treating the pathology rather than gaining access to these areas.

Host Amber Smith: Does it require the same type of anesthesia?

Ali Hazama, MD: In a lot of cases, yes, but there are a certain number of cases where we're able to perform some of these surgeries with local anesthesia or sedation, without the need for a breathing tube or the general anesthesia that's traditionally used.

Now, one of the things that allows for this is not just the shorter length of the procedure, but also the lesser pain that is associated with this procedure. Again, making an incision that's 10 inches long, it can be very painful for a patient if they're awake, and I hope nobody would ever have to be awake through something like that.

But when you are going in through an incision that's the size of a quarter of an inch or so, that pain associated is easily controlled. We can give local numbing medication. And these things really allow for an awake procedure in a certain subset of cases.

Host Amber Smith: Are there risks of complications with the endoscopic procedures? Are they similar to the risks of open surgery?

Ali Hazama, MD: Very excellent question. One of the main risks that is associated with any surgical intervention is the risk of infection. And we know that the larger the operation, it's traditionally associated with an increased risk of infection. And so with using smaller incisions, with using less tissue dissection and tissue trauma, we have seen that that risk, for example, is much smaller in patients that undergo endoscopic surgery compared to open surgery.

Other risks in the spine tend to be similar. A lot of them happen on a much, much lower rate in the endoscopic procedures than they do in the open procedures.

And when we talk about risks, one of the things that I'd like to bring to your attention is there is a risk associated with a surgery, a procedure, but then there's always a risk of anesthesia. Going under anesthesia comes with its own risk. And so, spending less time under anesthesia, avoiding anesthesia, is definitely something that makes endoscopic spine surgery that much more of a consideration.

Host Amber Smith: Are there ever circumstances where a patient would require an open procedure instead of endoscopic?

Ali Hazama, MD: Yes, absolutely. So endoscopic spine surgery is an excellent option for, again, a subset of patients, a subset of procedures. There are surgeries that sometimes are not amenable to endoscopic surgery. Some of these are traumas. Here at Upstate, we are a Level 1 trauma (center), so, as you can imagine, we receive traumas that are really complicated, very severe.

So these cases are automatically not candidates for endoscopic surgery. Sometimes, spinal tumors, we're able to sometimes perform a biopsy on some of these to get an identification of a disease process, whether it's an infection or a tumor. But larger tumors sometimes do require an open procedure.

So there are cases where traditional surgery is still the standard of care. And so being trained in endoscopic spine surgery, I think, gives an edge to deciding that certain cases are to be done in a certain manner, versus just doing everything in the same old way that traditionally has been done for years.

Host Amber Smith: So even though things seem to be moving toward endoscopic, the new doctors coming up through medical school, they're learning the open procedure, right? Because that's always going to possibly be needed.

Ali Hazama, MD: Yes, absolutely. And again, there was really no way around learning the traditional anatomy, the traditional ways of performing surgeries. Technology like the endoscope is really something that is best used by somebody who's very well trained in the open (surgery) world, in the open realm, and then really concentrates or spends the extra time and effort into perfecting and adding onto that knowledge and that training the usage of the endoscope in spine surgery.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Dr. Ali Hazama. He's a neurosurgeon at Upstate who specializes in minimally invasive surgery and the spine, and we're talking about endoscopic spinal surgery.

Now, what is robotic endoscopic spine surgery?

Ali Hazama, MD: More recently, technology has been coming to medicine from multiple different fronts. So the endoscope is only one area in which technology has been adopted, in spine robotics. There is really two components to it.

One is neuro-navigation. So just as you would use, on your phone or in a car, a navigation system to take you from one place to the next, we have neuro-navigation that we use as an added measure of safety in order to guide everything that we do. And so the patient's body and anatomy is displayed on a screen, and all of the tools and the instruments that we are either implanting or using to perform surgery are visible on a screen.

Again, you need the basic knowledge of the anatomy, you need the training into doing these. But this is an added measure of safety. Now, once you have adopted the navigation portion, there is a robot that can be coupled with the navigation and would guide certain implants into position by itself.

Obviously, it needs a lot of surgeon planning and surgeon confirmation that this is where it needs to go, and this is how it should be done, but the robot takes away some of the manual work and really ends up placing implants, especially in the spine, in an ideal position, again, taking away the very little human error that can happen in placement of instrumentation in the spine.

Host Amber Smith: Well, let's talk about some of the types of spinal problems that can be addressed endoscopically. What can you tell us about lumbar fusion?

Ali Hazama, MD: So lumbar fusion is only one of the areas that is being addressed with endoscopic spine surgery. The majority of work that is being done with the endoscope actually does not involve spinal fusion.

So when you hear about disk herniations that cause sciatica, the pain that shoots down to the legs, or spinal stenosis, which is the severe narrowing around the nerves and nerve roots in the lumbar spine or the lower aspect of the human spine, the endoscope can be utilized. Again, gaining access through very small corridors in order to remove a disk, free the nerves of compression, treat sciatica, do more general decompressions of the spinal canal that cause the stenosis around these nerves.

So that's really a lot of what the endoscope is being used for. And so since we have gained so much experience with the endoscope in those areas, most recently, over the last couple of years, I have introduced the endoscope because obviously we have it here, available, at Upstate, at both the Community and the downtown campus.

We have introduced it to perform spinal fusions. And again, those, historically, tend to be the most invasive of the spine surgeries. And so, implementing the endoscope in this area has really impacted the way patient care with regards to the spine has been done, with our patient outcomes and, really, multiple metrics in terms of how patients do during the surgery, how patients do immediately after the surgery.

And it also affects patient performance and well-being years down the road from surgery. I'd like to really elaborate on this point: When it comes to using the endoscope, again, it's a great tool. I am more excited about it than anything else that we use here, but it's only a part of this philosophy of introducing less tissue damage to the spine.

So it's not just a cool gadget that we're playing with and using because the pictures are crisp and everything looks cool, which may be true, but it is really a part of a larger philosophy of patient care, of surgical care, where less tissue trauma, less violation of normal human tissue, is really the essence of this line of service.

And so, we spoke briefly about shorter surgical time, less blood loss. So the time of surgery is decreased, patients tend to wake up from surgery faster, tend to recover faster. The pain after the surgery is much better controlled and is generally less than an open procedure.

And then finally, in that same area, the discharge to home from the hospital is much shorter. So the patient is spending in the hospital one or two days instead of spending five days or a week after one of these procedures. So that's on the time during the surgery. When we looked at, and when other institutions, through research and review of these cases, looked at long-term effects of introducing less trauma to the spine, we found that spinal fusions tend to hold up better, tend to be more successful, and tend to cause less issues to adjacent levels, so nearby segments that did not need surgery, that in the future may develop a problem.

Host Amber Smith: Upstate's "HealthLink on Air," has to take a short break. But please stay tuned for more about endoscopic spine surgery with Dr. Ali Hazama.

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith.

My guest is Upstate neurosurgeon Dr. Ali Hazama. He specializes in minimally invasive spine surgery.

So what are the long-term benefits?

Ali Hazama, MD: We spoke about the short-term benefits around the time of surgery when performing endoscopic and minimally invasive spine surgery. Now, on the other hand, there are long-term benefits to performing these procedures.

When we looked at how people did after an endoscopic spine surgery versus a traditional surgery, because of less trauma introduced to the normal tissue and the normal spine around the area of the surgery that was performed in the long term, people that underwent minimally invasive and endoscopic spine surgery tended to fare much better with how their overall long-term performance and recovery was.

And one of the specific areas that I want to mention is a problem known as adjacent segment disease. So around the area of a fusion, there is always a chance that a level above or below, a level adjacent to, the original surgery, may start to wear down and become problematic, just as the initial level was.

And so in these procedures, in the endoscopic procedures, we found that in the long term, this is less of a likelihood to happen compared to an open procedure, which I think is a win-win. If you can avoid additional surgery in the future, that is something that I think I personally would like if I was to ever have spine surgery.

Host Amber Smith: Do you hear from patients who have been told they need spine surgery, and they've avoided it over the years, but now that this is available, they're willing to go through with it?

Ali Hazama, MD: Yes, absolutely. Again, just to add to your question, the best surgery that we do is no surgery, and that's why I am very proud to report, in any venue that I'm invited to speak at, that upwards of 80% of the patients that we see, we're able to manage with conservative treatments, save them from surgery, because historically and from what we know, back pain is one of the most common complaints in health care.

In addition to that, we know that most back pain is a temporary problem that can be managed with conservative means, whether it's physical therapy, pain management, injections, only the subset of cases where the pain lingers, where it causes neurologic issues, where it interferes with life and activities that people like to do, only at that point does it become a surgical problem.

And so, back to your question, there have been instances where patients have been turned down from spine surgery due to the invasiveness of the procedure and really the risk that it imposes on a patient's overall health. And so with these procedures, we're able to do things that we are not able to perform in the traditional sense, just because of the overall impact of such larger operations on the overall health of the patient.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith.

My guest is Upstate neurosurgeon Dr. Ali Hazama. He specializes in minimally invasive spine surgery.

Can endoscopic procedures be done anywhere along the spine, including the neck?

Ali Hazama, MD: Yes. And actually it's one of my favorite procedures to do. Instead of a spinal fusion in certain pathologies, again, we're able to do a very small incision in the back of the neck to do what's called a diskectomy, or a resection of a disk that is herniated, that impinges on a nerve that comes to the arm that would cause arm pain, for example.

And it's a very gratifying procedure, because usually the pain is so severe, and the patients come out of surgery with much improved pain and really satisfied with the results of their surgery.

And in addition, if you look at the alternative, the alternative to doing that would be doing spinal fusion, which sometimes, again, is a little bit more invasive, comes with some restriction of movement, compared to, obviously, a non-fusion surgery.

Host Amber Smith: Well, let me ask you if you would, please, tell us how you tell patients to prepare for an endoscopic procedure.

Is there anything special they need to do the day before or the morning of?

Ali Hazama, MD: There's really no additional preparation or anything other than undergoing any other surgery.

One of the positives for after the procedure, for people that want to go back to work and resume doing the activities that they like to do, is those restrictions, a lot of times, are much less than those that come with open surgery. So we've had patients that have had spinal surgery using the endoscope on a Friday and went back to work on the next Monday.

Again, it takes the personality and the want to do that, but also, experiencing that amount of relief in the pain helps with being able to do that.

Host Amber Smith: Well, I'm sure it's kind of individualized to whatever the issue was that the person had the surgery for, but initially, is recovery like the open surgery, are they groggy and in pain?

Ali Hazama, MD: The pain is usually much less than open surgery. Patients are able to begin moving much faster. And again, because the pain tends to be a limiting factor for movement, if you move and you get pain, you're really not going to try and move as much. It's, I guess, a protective mechanism against pain.

When you don't have as much pain, I think your ability to move and ambulate and get on the way to recovery is much quicker.

The second point I'd like to make here is the usage of pain medications after surgery. In a lot of these cases, we're able to avoid using medications like narcotics, and it's an epidemic, or an endemic, that the country has been really ravaged by, and so the less opioids that we have to use is always the better. And this is an area where we're able to do that.

Host Amber Smith: Well, this is really encouraging and exciting, and I'm really appreciative that you took the time to explain it to us, Dr. Hazama.

Ali Hazama, MD: Thank you so much for having me. This is a pleasure, and I'd love to come back here for another update, hopefully, in the future.

Host Amber Smith: My guest has been Dr. Ali Hazama. He's an assistant professor of neurosurgery at Upstate and director of neurosurgery at Upstate Community Hospital. I'm Amber Smith for Upstate's "HealthLink on Air."

Host Amber Smith: What to expect from cochlear implants -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Electronic hearing devices called cochlear implants can help people with hearing loss improve the ability to understand speech and hear more sounds. Here to tell us about cochlear implants is Upstate audiologist Jeffrey VanTassel.

He's part of Upstate's otolaryngology ambulatory care.

Welcome to "HealthLink on Air," Mr. VanTassel.

Jeffrey VanTassel: Thank you, Amber. It's good to be here.

Host Amber Smith: Can you start by describing what a cochlear implant is and how it works?

Jeffrey VanTassel: Sure. In the simplest terms, a cochlear implant is an electronic hearing device that works by directly stimulating the nerve in the ear. It takes in sound. There are electrodes implanted deep inside the ear that are adjacent to nerve tissue, and they work by simply, for lack of a better term, zapping our nerve to get us to hear.

Host Amber Smith: So how does it differ from a hearing aid, or do hearing aids do the same thing?

Jeffrey VanTassel: No, hearing aids work in a little bit different manner.

A hearing aid uses what we would consider more of a conventional amplification method. They take in sound, they have an amplifier, much like you'd have in your stereo or in your television, and it takes the sound around you and turns it up to a level that would then be audible for the patient. It then outputs that sound through a speaker, so there's actually a sound coming out of the device.

That differs from a cochlear implant in that the cochlear implant takes the sound in, and it modifies the sound, but there's no speaker, there's no sound that's generated from the device. It generates a pattern of nerve impulses that are perceived as sound by the patient.

Host Amber Smith: So who might need a cochlear implant or benefit from a cochlear implant? Who would be eligible?

Jeffrey VanTassel: Right now, eligibility -- it's usually reserved for people who have very progressed hearing losses.

These are hearing losses that were either very aggressive over a short period of time or may have been systematically changing over long periods of time. And also people who don't derive a substantial level of benefit from their hearing aids. Really, this is a technology that slots in sort of after the patient has had experience with hearing aids, and either has such an extensive amount of hearing loss that hearing aids can no longer provide good listening for them or have had such substantial damage to their system that hearing aids again are not going to be adequate for their communication needs.

Host Amber Smith: Do the implants go in both ears?

Jeffrey VanTassel: Right now, that is actually up to the wishes of the patient and the surgeon. At this time, most insurance companies will certainly support bilateral devices. We will often have that conversation because we do know through a lot of research that listening through both ears provides benefits above and beyond just listening through one ear.

So we will often talk to the patients about their wishes. Do they want to try to use two, or oftentimes, which is more typical, they will try one to see what their level of benefit is. And if they're doing well with it, oftentimes they will then opt to have the second one done.

Host Amber Smith: So insurance will cover this.

Jeffrey VanTassel: Generally, there haven't really been any insurances that have balked at this time. It's been an evolution. I've been doing this at Upstate for, this is my 20th year. I've been an audiologist for 28 years, and when I first started, insurance support for cochlear implants was really sort of a giant gray area. There were some that would. There was some that weren't convinced that it was a beneficial technology.

But as the technology has improved, certainly more and more insurance companies have come on board. And I, in probably in the last five years, I have not noticed any insurance company that would deny support as long as the patient is considered a candidate for the device.

Host Amber Smith: So that includes Medicare, too.

Jeffrey VanTassel: Indeed, Medicare and Medicaid are definitely on board with this.

Host Amber Smith: Now, how long do cochlear implants last? Are they meant to be permanent?

Jeffrey VanTassel: They are. When we talk about the cochlear implants, we have to differentiate between sort of two segments of the device. There is an internally implanted electrode, and then there are external processors that are used to take in the sound and generate the code.

The internal implant -- that is designed to be a permanent implantation. Most of the time, with rare exception, these will last pretty close to a lifetime. Most of the time, the companies will say, "We'll give you a 10-year warranty on this," or what have you. But my experience, honestly, I've been in care of, getting close to 100 cochlear implant patients in my career here, and we've only had to replace two implants out of those.

So they do last a long time. Our impression is that once we implant it, there's going to be a very rare occasion that we'll actually have to go in and replace it.

Host Amber Smith: So you talked about the two pieces, the implanted part and the external part. Are there batteries in the external part?

Jeffrey VanTassel: Actually, the interesting thing that I tend to convey to my patients is that the external part of the device is much like caring for a hearing aid. It's a part that will hook over your ear or attach behind your ear to send the code into the internal array, but it looks a lot like a hearing aid.

It does have batteries. Now, most of the modern devices have rechargeable batteries, which has been quite a benefit to the patients, so they will get a few batteries when the device is initially programmed, and those batteries can last three to four years before they run out of applicable power. So they just recharge them each night, and every day they'll have a nice, fresh, strong battery to be able to use.

Host Amber Smith: Well, I know with hearing aids, you're not supposed to go swimming with them.

Is that the same with cochlear implants?

Jeffrey VanTassel: I'm going to qualify that answer. Usually we say no. A lot of the treatment of the cochlear implant, as far as how it is exposed to moisture, will be similar to that with a hearing aid. Most of the new devices, they're not specifically waterproof, but they are splashproof, so if you get a little rain on them or what have you, those are good.

But there are a couple waterproof devices that are available from a couple of the manufacturers, and the other manufacturers do have sort of an aftermarket system. It's much like, I call it "Tupperware for your cochlear implant." You can actually insert the implant into a rubber sleeve that will reject the water, and it keeps the device sealed, so they will be able to swim with them on, yes.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate audiologist Jeffrey VanTassel about cochlear implants.

So what happens to a person's natural hearing ability when the cochlear implants are implanted?

Jeffrey VanTassel: Unfortunately, this is the part that we have to have the real frank conversation with the patients about, because when we implant the electrodes into the ear, a lot of their remaining hearing, unfortunately, does not survive the process. So we have to be very frank with them about the fact that when we go through this process, if, in the rare event that there is some issue that happens, we can't go backwards. Using a hearing aid in an ear that has a cochlear implant in it just will not be effective after the surgery, unfortunately.

Host Amber Smith: So how do you help a patient decide if it's worth trying, if a cochlear implant is good for them, or what do they have to think about?

Jeffrey VanTassel: Well, one of the things we do, we have some very extensive testing that we have to do, first of all, just to be able to demonstrate to the doctors and the insurance companies that this patient is a candidate for the device and would benefit from the device.

Usually it's the results of that type of testing that can really give a good picture to the patient as to where exactly they are in terms of their function, their communication abilities and what type of benefit they may get. We look at the type of benefit they're getting with the hearing aids, and we can contrast that to what we would expect that we can get with a cochlear implant to try to sort of paint a picture for them to see if that step is worth taking.

Host Amber Smith: So if they go with the cochlear implant, if they went to a music concert, for instance, or even just watching TV at home, would that sound different than they were used to hearing it before the cochlear implant?

Jeffrey VanTassel: Generally speaking, it will. There's really two reasons for that.

One reason is, as I talked about earlier, the method that we use to apply the sound to the patient is now sort of an electronic stimulation rather than creating a sound wave, and that comes with some side effects. Now over time, those tend to diminish. At the outset, people will tell me, "Oh, your voice sounds robotic," or "Sounds like a cartoon character" or things like that. But as time goes on, that actually will settle into a more natural type of sound quality. The other thing is that with the cochlear implant, we're able to provide awareness to sounds that the patient had not been typically hearing with their hearing aid. So the quality of sound changes dramatically.

Now, whether or not they can comfortably hear on the television, I usually tell my patients there's a lot of factors that go into that, but if we can get them good, comfortable hearing when they're talking to their friends and family, usually they can hear the television well. But that then depends upon what station they're on, what program they're on, et cetera.

Music, however, that's another can of worms because of the diverse nature of music and how music is performed, how it's generated and things like that. We can't always guarantee that they'll get great perception of music. Most patients will say, "I can listen to music. I understand it. It sounds a little different because the pitches are kind of presented to me in a different way," but most of them understand that music is sort of a secondary benefit of the device, and oftentimes it'll accept a little bit of shifting in that regard.

They still enjoy it, but they will say it's certainly different.

Host Amber Smith: So once somebody decides that they do want to go forward, how do you advise them to prepare for the procedure?

Jeffrey VanTassel: The procedure itself, I usually give them sort of an overview of what the procedure is. The procedure, it's pretty straightforward, but really, as far as preparing for the entire event, it's much like any other surgery.

They'll have to understand they're going to go o into the hospital, they'll have anesthesia. Now, under most normal circumstances, this is an outpatient procedure. They'll go home the same day as long as there aren't any substantial side effects.

But the one thing that's very important that they understand is that when we do the surgery, they're unable to hear in that ear. We have to let the surgical site heal. There's a lot of swelling, there's stitches, and we have to let the scar tissue form on that side because we have to place a device right where the surgical site is, and we can't do that right away for fear of irritating the site and causing a lot of healing problems.

So there's typically a four-week delay between the time they go through surgery and the time we're able to activate their implant. And they have to understand that in that four-week period, they will not have hearing in that one ear, or, in a more dramatic case, if they have bilateral implantation, they won't be able to hear out of either ear for that four weeks.

So they need to prepare to be able to have some sort of alternative communication available, or a method to communicate with people for that short term before we get them activated.

Host Amber Smith: Do you have people who want to do both ears, but will space it out so that they don't lose hearing for four weeks, essentially?

Jeffrey VanTassel: I do. That's a very big consideration for a lot of patients, is they don't want to feel like they've become disconnected from their environment for that period of time. So oftentimes they know that it is a feasible option to do one, and then within a period of time do the second one.

And they oftentimes feel more comfortable, yes, saying, "I'll do the one, but then I can use a hearing aid in my other ear, which will allow me to have that connection to my environment, to my friends, to my family, so I won't feel that's such a great loss for that month while I'm healing from the surgery."

Host Amber Smith: So after that month, is it a second procedure to have the external part put on, or how does that go?

Jeffrey VanTassel: It's not a procedure per se, it's more like fitting a hearing aid. They would come into my office, I give them a thorough overview of what all the components are, how they work, and how the patient will operate them on a day-to-day basis.

We then show them how to place the device. The device is very simple. Like I said, it looks like a hearing aid. It's magnetic, so you place it on your ear, and there's a magnet that sticks over the implant that we put under the skin, and then it's just a matter of pursuing programming to start to get them to hear well. So, there are no other very in-depth medical procedures that are required.

It's more of just teaching them how to use the device, and then teaching them how to hear again.

Host Amber Smith: So I've seen dramatic videos of babies that are born unable to hear. And when they get the cochlear implant, it opens a new world for them, essentially. But these are generally people who are older and have been able to hear ...

Jeffrey VanTassel: Uh-huh. Right.

Host Amber Smith: ... it's probably not as dramatic, or does it sound different enough that they are surprised?

Jeffrey VanTassel: It can be.

And I'll say one thing. Those videos on YouTube are great because you see children that smile and giggle and stuff, but that's not always the case. That's sort of our little behind-the-scenes secret.

Most of the time, a child that hasn't heard before is absolutely petrified of sound that they don't understand. So oftentimes, because I do work with pediatrics and I do work with older patients, oftentimes when we activate a child, they cry for quite a period of time before they start to settle in and understand that all of a sudden they're hearing sound around them.

But that, I tell the parents, that's a very positive thing because I've changed their perceptual scheme. Now they understand that there's something else here that they have to work with.

Now, with older patients, they have a history of hearing that they can fall back on, so they can immediately start to listen and make comparisons to what they think it should sound like and things like that.

So the reactions can span a sort of a wide range. There are certainly patients that will come in thinking that when I activate the device, everything's going to fly right back to really good. And they don't on day one. It's just the reality of the situation. It takes practice and training to really get your hearing back.

So they'll sort of be a little skeptical, but there are number of other patients that even on Day One, are just like, "I can see where this is going, and I'm already extremely excited," so, it's very rewarding regardless of what the reaction is because I know that I've taken them a big step forward in their hearing health.

Host Amber Smith: Now, do they stay in contact with you if they have questions or issues that come up after the cochlear implant's done?

Jeffrey VanTassel: Absolutely. I provide long-term care for all my patients. Part of the cycle, especially when we're trying to get them to be able to hear, is I will see them almost on a monthly basis or every few weeks to really start, (and) keep, fine-tuning the device as they start to get used to it and to provide them with good sound.

But even when they're sort of settled in, I typically see my patients every six months to a year, almost like our eye care, just to make sure that they're doing well, that there's not any outstanding issues, and that their equipment is functioning well and doesn't need any sort of mechanical attention.

So yeah, I keep in very close contact with my patients.

Host Amber Smith: Well, I appreciate you making time for this interview, Mr. VanTassel.

Jeffrey VanTassel: Certainly. It's been my pleasure.

Host Amber Smith: My guest has been Jeffrey VanTassel. He's an audiologist at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Michael Hodgman, a toxicologist in Upstate's department of emergency medicine, and the Upstate New York Poison Center. What's important to know about marijuana edibles?

Michael Hodgman, MD: Edible products are the growth industry, or growth product, for marijuana producers, you might say. For example, in Canada, they legalized marijuana. I don't recall the (year), maybe 2019 or so. But it was about a year later before retail sales were allowed in Ontario, and on the first day there were retail recreational marijuana products for sale, the stores in Ontario sold out of edible products. I mean, it was, it was crazy.

And we're seeing the same thing in other states where the products that are having the greatest year-to-year change in growth are these edible products. These edibles are very attractive. They look like candy. They look like food. There's infused beverages. We've even had a few cases with infused hot sauce, infused barbecue chips. I mean, it's just crazy.

I think the No. 1 exposure product that we get called to the poison center are gummies. I mean, they're just unbelievably popular. And again, they're easy to leave laying around, and these young kids get into them, and it's been a real issue.

Our real focus is on prevention, and particularly in young kids with edibles. And so, in the home, what we encourage is to treat this like any other drug when you have young kids in the house. And that's doing things to keep them out of reach of children. And one thing we in particular support here is the use of a lockbox, like you might for your medications. Use a lockbox to keep your edibles in it as well, and try and reduce that potential that one of your kids is going to accidentally get into one of these products.

Here in New York state now that marijuana is legal, there are very specific packaging laws for these products so that the packaging has to be child-resistant and tamper-proof. And it has to not be attractive to children. I mean, it's not supposed to look like a candy. You know unfortunately, there's a lot of illicit products out there that violate every one of those rules. So a lot of these products, they're not following the New York state labeling.

But if the label's proper, first of all, it's got to be kind of a bland label with bland font for the print. It can't be like real colorful print or anything. And it has to have what the total amount of THC (tetrahydrocannabinol) is in the package, what the unit dose is. There's also rules on the maximum unit dose that's allowable as a recreational marijuana product.

The maximum unit dose for a single dose for an adult is 10 milligrams. And so the product has to have that, the total dose. It also has to have precautions on it about the differences in when you experience the clinical effects when you ingest THC versus when you smoke it.

When you smoke marijuana, the absorption through the lungs is very rapid to the brain, and the clinical effects are within minutes. When someone ingests a THC edible, the onset of clinical effects may not be for 60 to 90 minutes after you ingest the product.

And there's a real risk there. Somebody can take it and a half hour later say, "Huh, nothing's happened. I'm going to eat another one." This is something we call "dose stacking." And so by the time you start getting the effect from the first one, then there's more after that. So the onset of effects is delayed, and that can affect anyone who's not aware of that.

And the duration of effects from edibles is more prolonged than it is from smoking because, again, when somebody smokes it, they have the clinical effect very rapidly. And so they're able to titrate the effect because then they stop. Whereas with these edibles, if you've still got more that's going into your system, it can last a lot longer.

The other problem with young kids is whatever a unit dose is, that's a big dose for a little child. When you consider that a 10 milligram dose is what an adult should get, you get a 2-year-old that takes that same dose, that's a lot more.

But the problem is also it's a gummy. It tastes good. Or it's a piece of candy. It tastes good. So how many stop with one or two pieces of candy, or how many people have only eaten one barbecue chip? The dose effect in these young kids can be really, really significant.

We don't know, sometimes, how many they took. But if we just consider maybe a 2-year-old child that weighs, let's say, 30 pounds, or about 15 kilograms that would be. And there have been some estimates that a dangerous dose in a kid that age could be about 1.7 milligrams per kilogram, or that might be maybe 25 milligrams. So you could say a kid, a young child, who just eats two to three gummies, they've already crossed that threshold to the potential for severe intoxication.

A lot of the kids that we see that just get into a few, I mean, their clinical course is like you might expect with an adult. They're a little goofy, a little lethargic. Their behavior isn't quite normal. But then, the more severe effect, we can sometimes see, is really profound sedation. Paradoxically, some kids will get very, very agitated and restless. And so we can see the whole spectrum of changes there.

Host Amber Smith: You've been listening to toxicologist Michael Hodgman from Upstate's department of emergency medicine and the Upstate New York Poison Center.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: There is now awareness and emphasis on mental health. Two of our poets gave us a sense of how a child's struggles with such illness also affects the parent. First is poet W.F. Lantry, who describes what the illness does to his son in his poem "Extreme Ways."

There is an epigram to Ernest Dowson:

"-- Those scentless wisps of straw, that, miserable, line

His straight, caged universe."

He had to discard everything, his songs,

and everyone who tried to hold him close.

It's like he lived inside a Moby riff,

played endlessly, shut down within his mind,

his thought unknowable, a hieroglyph

I cannot read. Did he forget his dose,

or tell himself, again, he didn't need

what others knew? I could not intercede.

In other times, he held the chickens' wings

quite gently while I clipped one half their flights

so they'd be grounded close to earth, confined

within their fence. My reckless heart delights

in memory the images it brings:

once, walking with his mother on a strand,

I fell behind, and saw him take her hand

to help her balance on the title stones.

But where's the balance now? These double doors,

Locking behind us, buzz in turn, designed

to block out everything our sense adores,

reduce his worlds to exclusion zones,

and hold him where no conscious love belongs.

Ann Weil has stark images and searing emotions in her poem "Choices for the Mother of a Son with Mental Illness."

I could ...

Cut a slit and peel back the dewy blanket of grass.

Crawl beneath the sod, pulling its cover over my head.

Let the earth, warm with the spring sun, heal my ache.

Stand on the street corner and rage-scream at the traffic.

Fall to my knees, gutted by panic's sharp knife.

Run fast and far, a rabbit fleeing the rabid dog.

Climb to the jagged peak of understanding.

Know too little and too much.

Cover the wounds with powder and blush.

Bargain with the Devil, make a deal with God.

Open the cupboard of my chest.

Squeeze my heart, bring it back to life.

Knock gently on his door, wait for the invitation.

Ask, How are you today? Prepare his favorite foods.

Tell him he is loved. Hold him as he weeps.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," a solution for spinal muscular atrophy.

If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.