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Mon Nov 20 19:43:16 GMT 2006

Andrew,

Your post made me curious enough to Google Dr. Young, as you probably did.
The parts of his CV available on the internet are a little confusing to me
as it appears he finished medical school in one year. As far as I can tell
he did two years of training after receiving his MD. So again as far as I
can tell he has not practiced as a neurosurgeon and does not seem to be
actively involved in the clinical care of spinal cord injury patients. A pub
med search lists 11 citations for him. He is not the lead author on any SCI
research in that search. He does have other citations on other sites. For
instance he is listed as the 12th author on a study with Bracken in 2000 JOT
about controversies in methylprednisolone and SCI. As I don't know Dr. Young
and am not familiar with his work, all this could be wrong.

The only reason I sought information about Dr. Young was because the
forceful nature of the comments attributed to him in your post made me
curious about "where he was coming from". From my association with
practitioners in both acute and rehab, I know that everyone wishes
desperately for something that will give the families and patients some
degree of hope. But sometimes there isn't any and false hope is worse that
none. If I were a family member of an acute SCI pt. and read those comments,
I might be very angry if high dose steroids were not given to my loved one.
As a more informed clinician I might be very glad and respectful of the
thoughtful care if they were withheld.

Rob Smith

Robert F. Smith, MD, MPH
Attending (Vol), Dept. of Trauma
John H. Stroger Jr Hospital of Cook County
Associate Professor of Emergency Medicine, Rush University

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Andrew J Bowman
Sent: Monday, November 20, 2006 11:24 AM
To: Trauma List
Subject: Interesting Promotion of Steroids for SCI

Found this while trolling the net.
Very strong sounding advocate for steroids in SCI.
Andrew

Acute Spinal Cord Injury

14 April 2003

Wise Young, Ph.D., M.D.

W. M. Keck Center for Collaborative Neuroscience

Rutgers University, Piscataway, New Jersey 08540-8082

Email:  wisey at pipeline.com, http://sciwire.com 

I receive many calls and emails from people and families with spinal cord
injury.  It is better today compared to 1977 when I took care of my first
spinal-injured patient and had to tell the family that there was nothing
that we could do.  Here is what I say to families now.  

.  Focus on solvable problems.  Make sure that methylprednisolone is given
within 8 hours after injury (this drug may improve recovery by 20%).  Find
the best and most experienced surgeon.  If the spinal cord is compressed,
make sure that it is decompressed as soon as possible.  Prevent
complications by insisting on aggressive care of lung, bladder, and skin.
Start rehabilitation as soon as possible. 

.  Recovery is the rule and not the exception in spinal cord injury.   Most
people recover some function after spinal cord injury.  On average, people
with "complete" injuries recover 8% of the function they had lost, compared
to 21% if they received methylprednisolone.  People with "incomplete"
injuries recover 59% of lost function, compared to 75% if they received
methylprednisolone.  Recovery takes a long time and work.  Many people
recover function for 2 or more years after spinal cord injury.

.  Do not give up hope.  Most scientists believe that it is not a matter if
but a matter of when therapies will be available to restore function in
spinal cord injury.  Clinical trials are testing therapies to restore
function after injury.  Weigh potential risks and benefits carefully before
participating in such trials.  Remember that the therapies will get better
over time.  

What to ask your doctor?

Families and friends often don't even know what questions to ask the
doctors.  Here are some questions to ask in the first hours after injury:

.  Was methylprednisolone given?  This is the high-dose steroid (30 mg/kg
intravenous bolus followed by 5.4 mg/kg/hour for 23 hours if it is started
within 3 hours and for 47 hours if between 3 to 8 hours after injury).  It
should not be started more than 8 hours after injury.  Clinical trials have
shown that this treatment improves recovery by about 20% when given within 8
hours after injury but does not help when started more than 8 hours after
injury.  While methylprednisolone is not a cure, every little bit helps.
Complications are minimal.

.  What is the level and severity of spinal cord injury?  The consequences
of spinal cord injury depend on the level and severity of injury.  Surgeons
determine injury levels from the fracture site on the spinal column.  This
may differ from neurological level determined from sensory and motor loss.
Spinal cord injury causes loss of sensation and voluntary movement below the
injury site.  If the person has motor or sensory function below the injury
level at the time of admission, the likelihood of substantial recovery is
high.   

.  Has the spinal cord been decompressed?   The spinal cord injury usually
results from fracture of vertebral bones that compress the spinal cord.
Continued spinal cord compression increases tissue damage and reduces
functional recovery.  If the neck or cervical segments are fractured,
traction may straighten out and decompress the vertebral column.  Chest or
thoracic fractures cannot be decompressed by traction.  Surgery may be
necessary to decompress and stabilize the spinal cord.

.  Has anticoagulation been started?  Blood clots may form in the legs and
migrate to the lungs.  This is a serious complication that can be prevented
by giving anticoagulants such as heparin or coumadin.  It may be necessary
to place a filter (Greenfield filter) in the vein to the heart to catch
clots. 

.  Pulmonary, bladder, and skin care?   Spinal cord injury may compromise
breathing and coughing.  After cervical spinal cord injury, artificial
respiration may be necessary and pneumonia is common.  Spinal cord injury
paralyzes the bladder and a catheter must be placed in the bladder to drain
urine.  Continued pressure causes skin sores called decubiti.  Cushioning
vulnerable areas and regular turning prevents this.

Some frequently asked questions and answers

Families and friends often search the Internet and encounter a bewildering
array of information that is often out of date and contradictory. Here are
some commonly asked questions and quick answers:

.  Will he/she recover?  Recovery is the rule and not the exception after
spinal cord injury.  The probability of recovery is high, especially after
"incomplete" spinal cord injury.  Clinical trial data indicate that if a
person had even slight sensation or movement below the injury site shortly
after injury, they will recover an average of 59% of the function they lost
and, if they receive high-dose methylprednisolone, they will recover an
average of 75% of what they had lost.  People admitted to hospital with no
motor or sensory function below the injury site recover an average of 8% of
the function they had lost but will recover an average of 21% if they
received methylprednisolone. 

.  How long will recovery take?   Recovery takes a long time.  Most recovery
occur within 6 months but many people continue to recover function for a
year or more.  A recent poll of the CareCure Community suggests that 61%
recovered function more than one year after injury.  In another poll, 16-18%
of people who are "complete" spinal cord injury recovered additional
function 3 or more years after injury.  A recent study detailed how
Christopher Reeve recover function over 7 years after his injury.  So,
recovery frequently continues for years after injury.

.  What experimental clinical therapies are available?  Several clinical
trials are assessing therapies that are applied within 2 weeks after injury.
These include activated macrophages (which may help repair the injured
cord), alternating currents (to stimulate regeneration), and AIT-082 (a drug
that may stimulate growth factors and stem cell proliferation).  The
macrophage trial is limited to people with "complete" thoracic spinal cord
injury and requires surgery.  Please consider the risk and benefits of the
trial carefully, including the risk of moving somebody to another center.

.  Do therapies have to be applied shortly after injury?  Several
experimental therapies are aimed at restoring function in chronic spinal
cord injury, when recovery has stabilized a year or more after injury.
These include 4-aminopyridine (a drug that increases excitability of
demyelinated axons), porcine fetal stem cell transplants (stem cells from
pigs), and olfactory ensheathing glial transplants (cells from the nasal
mucosa or from olfactory bulbs).  Other experimental therapies are being
planned, including drugs and chemicals that block growth inhibitors.  Thus,
there will be many opportunities to participate in clinical trials.  
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Interesting Promotion of Steroids for SCI