Substance Abuse

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Hello health care system.  This is weird, to put it mildly.

As far as anyone seems to be able to figure out what happened, this 38 year old nurse killed five dialysis patients and “assaulted” five others by putting sodium hypochlorite – bleach — in their dialysis tubing.

She had some problems with domestic violence and public intoxication and such.  But according to the relevant statements, that was all resolved before she did this.

Jurors have convicted her of capital murder, but she is not going to get the death penalty.  Mostly, this is because she is deemed to be of no further danger if she’s kept out of health care.  Her daughter seems to be taking it hard.  This is an indication for counseling, but not a change in Mommy’s sentence. Read more on When Nurses Kill…

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“Old Marley was as dead as a doornail.”

— A Christmas Carol (1843)

Thank you, Charles Dickens, for creating such a wonderful, enduring story, and such an apt simile.  If you hadn’t heard it before, that’s probably because it is usually omitted from the children’s versions of the oft-told (and filmed and broadcast) tale.  With everyone from Michael Caine to (my favorite) Mr. Magoo starring as the wickedest man who ever snorted “Bah Humbug!” and was converted to the most ardent celebrant of Christmas by the end of the story.

A wonderful, happy story — and it deserves to live forever.  But death is not terribly suitable material with which to start a children’s story.

Young women (and men) — some no older than children and many who could be termed “recent children” — were ardent fans of singer Amy Winehouse — who is now “dead as a doornail.” Read more on Amy Winehouse Proved Drugs Aren’t Glamorous…

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A Minneapolis nurse was accused of stealing pain medicine from a patient.  She had a fentanyl habit to feed, and didn’t seem to mind that it left her patient in substantial pain. Unfortunately for her, the patient was a Dakota County Sheriff’s Deputy.

Some women just make bad choices.

The reason I bring this up is not to wonder about if this woman is guilty or not.  I can tell you that I share one opinion with the judge — that people who ask for a lot of continuances may be getting everyone angry. Read more on Addiction And Nurses…

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It took me a while at first to realize that everyplace I saw a green cross, it was going to be a medical marijuana facility. After all, the green cross is some kind of an international symbol for a “druggist,” for someone who sells prescription drugs (primarily) as prescribed.  In France, as well as in Canada, I remember following such signs to get a prescription filled.medical marijuana

This one substance, this marijuana, is unique in a couple of ways. First, it is the only prescription drug that has never been required to be tested for safety or efficacy.  Second – there is no government oversight as to quality or purity.

Marijuana seems to be something that people want first, then figure out a reason for later. The results are not exactly what I consider beneficial. Read more on Medical Marijuana Can Become Big Business…

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Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:

“No, there is no way in hell I am going to renew that prescription as written.”

“Read my lips.  No more oxycodone.  We gotta get you into a rehab, sweetie.”

“Sure, you can see another doctor.  I don’t know how long it will take to get an appointment.  If I am your doctor, you go on a tapering schedule.  Today.”

“If I did what you want, I could kiss my license goodbye.  I am not prescribing outside my specialty and certainly not this crap.  Yes it is crap.  I am sorry you don’t like how I talk, but it is crap.  I can start getting you off it.”

These are all things I have actually said.  Usually loud, yelling over the patient. Read more on Pill Mills Are Death Traps — Marginally Legal…

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Recent research by the Centers for Disease Control and Prevention’s National Center for Health Statistics has confirmed a longstanding trend — namely that whites live longer than blacks pretty much consistently, and have for a long time. People have attributed this to the increased difficulty of containing blood pressure in black people — probably a genetic difficulty– which leads to increased rates of both stroke and of heart disease. Both have long been established as being deadly. Plenty of well meaning people have at least tried to deal with this. One of the well-meaning people is me. Many times I have seen people of color for other reasons, checked their blood pressure, been concerned, and referred them to appropriate blood pressure followup by general medical personnel. Of course, I have no way of knowing how many (if any) went where I told them, but I tried.  

I mean, I would tell them, “If there is something extra that can be done to make sure you are around for a  few more years, to see the grandchildren grow a bit or whatever is precious, then it should be done.”   I usually have no problem getting the person to agree, at least in my presence. Menthol cigarettes are a different kind of issue, and therefore a little tougher to be unequivocal about. Read more on Ban Menthols? Our Government To The Rescue!…

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Ahh – 19 years old!  It is a magical age.  At least it has been my experience in public mental health clinics.

You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.

I don’t know what it is about 19.

Caffeine addict sitting at computer with IV drip of coffeeOne of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.

Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college.  He wanted to be a performance artist.

Read more on Yes, Virginia — Coffee Can Cause Illness…

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I have not been a chronic television watcher since early childhood, mainly because the projections on a two dimensional screen seem to be to be — at best — a weak distillation of the human drama that happens in my office.

Hamburber Helper puppet needs a helping hand -- in Rehab

Hamburger Helper puppet needs a helping hand -- in Rehab

But for my patients, I know well that the line between what they see on television and what they see in their living room is blurred at best.

I have, however, been compared to various TV shrinks — which I have been told is a compliment.  The first person who told me I was like one, I asked why.  When she said “because you always say the right thing.”

I was obviously flattered since you better believe I am NOT scripted.

Read more on Has A Celebrity Got A Chance At Rehab?…

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For the kids who can’t manage to keep appointments — let alone blood tests — there are lots (and I mean lots) who qualify for the anti-psychotics that are also FDA approved as mood stabilizers.

Thorazine was developed to keep psychotic patients quietThose who know me as The Renegade Doctor sometimes get the mistaken idea that I am against all prescription drugs and that pharmaceutical treatment should always be avoided.  That could not be further from the truth.  I believe in the proper treatment for the proper condition.  At times, I may disapprove of the methods and conduct of “Big Pharma,” but I will always use the best treatment for my patients – especially if it is FDA approved and a legitimate indication.

My favorite mainstream choice in the above example is usually arapiperazole (Abilify). The case study I’ll share with you is a patient who sometimes hears some voices and would like to get rid of them. So that is the medicine I offer this 22 year old hip hop composer with one of those cylindrical “spreaders” that resembles a manhole cover in his right ear lobe (I wouldn’t have picked it myself, but he told me his girlfriend thought it was real hot).  Now sometimes this drug is stimulating and people have trouble sleeping.  So my usual suggestion with this would be a touch of Benadryl (diphenhydramine) – an over-the-counter allergy pill – which causes drowsiness and could help him sleep.  It’s even available in those “99-cent” stores that dot the countryside. Read more on Promethazine On The Street…

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My husband told me something that I thought was a joke, but he convinced me it was serious.

During “drive-time” he heard an advertisement for a medical marijuana dispensary on the radio.  Among the many conditions it promoted marijuana as helping was eating disorders.

My thoughts went immediately to stoners with the midnight munchies making an emergency run to 7-11 for Cheetos or the late-night drive through at Burger King. Read more on Standardizing and Regulating Medical Marijuana — Who Are We Doing It For?…

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