From this week’s Galway City Tribune: The Coroner for Galway West issued a warning this week against the abuse of highly-addictive opioids which contributed to three deaths that came before Galway Coroner’s Court.
Dr Ciarán MacLoughlin said he was “very sad” to see a number of these cases come before him on Monday and noted that opioids were being abused by people in receipt of them legitimately, by prescription, and by those who were purchasing them illegally on the streets.
“If taken in ignorance, people are not aware that they can, if combined with other drugs, have a synergistic effect – or if taken with alcohol, that can also have a synergistic effect – and as we’ve seen, the outcome can be fatal.
“Doctors who are prescribing these drugs need to be made aware that we are seeing a number of this type of incident,” said Dr MacLoughlin.
This came after the Coroner closed the inquests of three men who all died following opioid abuse.
In the first case, Dr MacLoughlin heard how Niall Caden (43) from Renmore was found collapsed by waiting staff from the King’s Head Bar and Restaurant on the Old Malt Lane in Galway City when they heard a bang against the window.
The inquest heard evidence from Paul Folan, a friend of Mr Caden, that the deceased had been drinking on the day of his death prior to his collapse. Mr Folan said Mr Caden appeared to be asleep on the ground on Old Malt Lane when he arrived at the scene.
Jason McCarthy, who described himself as a friend of Mr Caden going back 22 years, drove into the city centre to assist. He said Mr Caden was “snoring” on the ground but that he and Paul Folan managed to get Mr Caden walking to the car.
When they arrived at Mr McCarthy’s house, Mr Caden was left asleep in the car. Mr McCarthy said he had checked on Mr Caden a number of times throughout the night but at 1.20am, he found him in an unresponsive state and had his wife call an ambulance.
Mr Caden was taken to UHG where he later died following failed attempts to resuscitate him.
The pathologist’s report stated that Mr Caden had gone into cardiac arrest. A tablet that was found in Mr Caden’s possession was sent to the State Laboratory for testing and was found to have been an Oxycodone tablet – an opioid.
Reading into evidence the post mortem examination findings, Dr MacLoughlin said Mr Caden had “lethal levels” of oxycodone in his blood and a blood alcohol reading of 240mg per cent.
“Oxycodone is a prescription medication but it is available on the street with a street name of ‘Oxycotton’. It’s very addictive and we’ve, in the past, had at least one death in the city with this drug,” said Dr MacLoughlin.
Giving a verdict of death by misadventure, Dr MacLoughlin said the cause of death was respiratory depression due to the combined effects of alcohol and opioid overdose.
“It was a reckless thing to do and the effects, unfortunately, resulted in his death. It was not an accident; it was misadventure which is when somebody does something quite risky and unfortunately, that risk materialises – that risk caused his death,” said the Coroner.
Dr MacLoughlin offered his condolences to Mr Caden’s family and to his friends, whom he said had acted responsibly on the night of his death and who were not aware of the seriousness of his condition.
(Photo: Coroner Dr Ciaran MacLoughlin)
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Blue Teapot instilling creativity in people with intellectual disabilities
Graduation day at Blue Teapot’s Performing Arts School for people with intellectual disabilities can be bitter-sweet, according to the school’s co-ordinator, Ana Belle Alvarez.
“In some ways, you feel very sad when they’re gone when they graduate. After three years of sharing moments, and sharing so many things, it can be sad. But then it’s exciting when you have the new people coming in as well,” she said.
The Performing Arts School at Munster Avenue in the city is one strand of the Blue Teapot brand, which is now inviting new recruits for the semester beginning next September.
The other better-known strand is its Ensemble, also based at Munster Avenue, which includes a professional troupe of actors, who stage performances at their own theatre space and elsewhere, throughout the year.
One aim of those who join the former is, ultimately, to land a role in the latter.
“That’s the dream. We don’t have the capacity (to meet demand) but that’s the aim of everyone,” said Ana, a Spaniard, who has been with Blue Teapot for almost six years.
Many in the professional Ensemble were schooled in the Blue Teapot Performing Arts School.
Two students who graduated last year are now part of the 11-strong Ensemble, which had two spaces available.
But even those who don’t progress to a professional career in theatre with Blue Teapot will benefit from the course which is Quality and Qualifications Ireland (QQI) accredited, according to one of a handful of well-known teachers at the school, Rod Goodall.
“To be trained in the arts – drama, dance, music and so – does not mean that the student will achieve a career in these disciplines. It means that they’ll enjoy more creativity, more confidence and be better equipped for social interactions in their lives,” said the drama tutor and theatre director.
There is some crossover, though.
“Sometimes, it has been the case where the students of the Performing Arts School, participate in a production with the professional actors,” explained Ana.
“Parallel to that, our drama teacher sometimes produces a theatre show just for the students to showcase to their family members,” she said.
The three-year programme leads to a certification in QQI Levels 2 and 3. It is an opportunity for people with intellectual disabilities, who are aged 18 and over, to access formal training.
Modules include drama, music, drawing, costume, design and event participation. The programme also incorporates life-skills training including interpersonal skills, online safety, health and fitness.
Literacy and IT supports are provided by Galway Adult Basic Education Services.
“Every training programme is very structured and the students work really hard in the classes, learning so many skills and it’s all very practical but they have fun as well,” said Ana.
When asked to describe the sort of people with intellectual disabilities the school is looking to recruit, Ana said: “Anyone who has a passion for the arts; a passion for performing arts; anyone who has a passion for the theatre.”
School is on Monday to Thursday, 10am-3pm. Much of the programme focuses on personal development where learners can fulfil their artistic potential.
“To be able to develop their own potential and their own ideas, everything we do with tutors is based in the student’s own creativity and their own ideas. If they’re creating a mask, for example, it’s based on their own research of what they like, and they transform what they like, and their own personality and creativity, and they transfer that into their final work,” she said.
The company liaises with organisations such as Ability West and Brothers of Charity during its recruitment drive, and it also contacts schools for school-leavers with intellectual disabilities who are seeking a new challenge.
Ana’s biggest problem is that they have capacity for an intake of just five people every year.
“It’s very hard because we have many people applying for the Performing Arts School, and we only have five places. You’d love to take everyone, but the reality is we don’t have the capacity,” she said.
“Photo: Blue Teapot members Michael Hayes and Valerie Egan on the set designed by Sabine Dargent and with costumes designed by Charmian Goodall).
Taoiseach to look at Minor Injuries Unit for Galway
An Taoiseach Leo Varadkar has said the Government will consider a new Minor Injuries Unit for Galway.
During Leaders Questions in the Dáil on Tuesday, Independent TD for Galway West, Noel Grealish made the case for a new Minor Injuries Unit (MIU).
Deputy Grealish said there are 15 of these MIUs dotted around the country, but none in Galway . . . and they are proven to help relieve pressure in Emergency Departments.
“The Emergency Department at UHG remains one of the busiest in the country, without the relief that would be provided by thousands of people being redirected to a Minor Injuries Unit,” he said.
Mr Varadkar replied that MIUs worked extremely well “with people with minor injuries not having to go to very busy and crowded emergency departments and, more important, people with minor injuries who need to be seen and to receive healthcare getting that healthcare in an uncrowded and more humane setting within a few hours.
“We are happy to give consideration to a Minor Injury Unit for Galway but I am not at liberty to make that commitment here and now. We will certainly take it seriously, however,” said An Taoiseach.
Deputy Grealish has also stated that it is unrealistic to believe that a new elective hospital for Galway could be built within four or five years.
“Realistically, it could take 15 years or more, given that the recently-opened radiotherapy unit in Galway took over 14 years to deliver.
“And the Taoiseach himself acknowledged in his response to me that so many important projects in the west have been delayed, particularly the emergency department and the paediatric and maternity units at University Hospital Galway, which, in his own words, should have been under construction by now, let alone have gone to planning.
“Given the track record of the HSE in delivering projects, I believe that a new elective hospital could be years away and a minor injuries unit should be provided in Galway to help provide some relief. I intend to pursue this further with the Minister for Health and the HSE over the coming months,” Deputy Grealish said.
Groundbreaking coronary operation at UHG offers vision of future healthcare
The announcement this week that Galway University Hospitals carried out the first robotic guided coronary intervention in Ireland and UK, has given researchers a glimpse into the future possibilities presented by this medical breakthrough.
Currently, University Hospital Galway is the centre of excellence for cardiovascular medicine for one million people in the West and North West.
It’s where patients from Sligo, Donegal and elsewhere go for coronary procedures, such as the insertion of stents to relieve blockages in the arteries of the heart.
That involves hours of travel, on top of lengthy procedures, which can be exhausting for patients.
But one potential benefit of new robotic technology is the prospect of remote procedures, explained Professor Faisal Sharif, Consultant Cardiologist, who carried out the first procedure in Ireland or UK, at UHG.
“I think we will see in the future more advantages, and value, when these procedures can be done remotely,” Prof Sharif told the Tribune.
This would involve a patient going to Sligo University Hospital or Letterkenny University Hospital to have a stent procedure, which would be carried out via the internet by a robotic ‘hand’ controlled by a consultant cardiologist based at UHG.
Obviously, the basic structures and a trained crew would need to be available in Sligo or Letterkenny, including nurses and junior doctors.
And Prof Sharif cautioned that for remote procedures to become reality here, there needs to be more research and development and more funding.
“That’s the potential and that’s the future but it hasn’t come yet,” he said.
What has come is exciting, too, though.
Before Christmas, Prof Sharif carried out three procedures which combined the benefits of coronary intervention with the precision of robotics.
The new technology is used in stent procedures to relieve blockages in the arteries of the heart. It allows for greater precision in positioning stents, allowing the interventional cardiologists to move the stent a millimetre at a time.
It also allows the medical team to have an enhanced, close-up view of the angiographic images and information during the entire procedure.
The new technology allows interventional cardiologists to use the robot as an extension of their own hand, allowing for robotic precision and details visualisation when positioning of guide catheters, guide-wires and balloon or stent catheters.
Prof Sharif said the technology was beneficial both to the patient and to the cardiologist.
“The main advantage of robotics is that it is safe and very precise in stent placement. It allows the accurate placement for up to 1mm at a time,” he said.
For the patient, this increased precision means less metallic material in the arteries, “and so less long-term side effects from that metal”.
The use of robotics also benefits staff, meaning fewer back injuries, less exposure to radiation and more precise placement of stents, he said.
Prof Sharif said UHG would be performing these procedures more regularly. They’ve started with straightforward cases, and over time, when they understand more about it, and the volume increases, they will increase complexity.
Seven more procedures are planned for the next fortnight but won’t entirely replace the traditional method, he said.
“Physicians learn a technique to do things over many years. That’s our livelihood, that’s what we do. If we bring machines in, there is going to be resistance. But at the moment, it’s to see the positive side of things, see how it can improve outcomes, how it can do things more safely, how it can take the load off physicians, who will still be fully trained to do it.
“It is just assistance. I think we need to learn what the potential is. It won’t replace anything. If any hospital has 10 operators, four or five may adopt it, others may stay the traditional way. I think the change will be slow. But I hope over time when they see the results they might like to change,” he said.
Originally from Pakistan, Prof Sharif’s home for 26 years is Ireland. As well as clinical work, the academic part of his job involves University of Galway tutoring and research commitments.
He’s a founder member of a university programme on medical device innovation called BioInnovate Ireland, which has developed start-ups over 10 years.
That synergy, as well as funding through Science Foundation Ireland, led to the first robotic procedure in Ireland and the UK taking place in Galway.
“In Galway we have a big medical device sector. It’s the ideal place to be for medical device developments, especially cardiovascular,” he added.
Chris Kane, General Manager of Galway University Hospitals welcomed the new technology.
“Innovations such as this are transforming medicine . . . this state-of-the-art robotics will enhance patient care for our patients across the West and Northwest of Ireland,” she added.
(Photo: The robotic guided coronary intervention at UHG. It was the first such procedure in Ireland and the UK).