Addictions

0

97 million Americans with chronic pain and I got a 57 year old screamer in a wheelchair. Back pain, leg pain, pain in places she was not sure of. No, psychiatrists are not supposed to give out morphine.  Yes, I know I have a prescription pad.  But I keep it close to my heart, locked in my file cabinet, or in my purse, because I actually enjoy practicing medicine and do not enjoy the vision of my license certificate on wings on its way out the window. Even if I could have done it fearlessly, I would not have increased her pain medicine.  The more you give, the more they hurt, the more they need.  This is written in a lot of places but you only have to look at the patients who have been created into addicts, and there are plenty of them.

Alternative recommended approach nobody will listen to: A Bryn Mawr college student, apparently not loaded down with clinical cynicism or even clinical experience, came up with this one.

The way it is said is brilliant.  We all act as if we had a pool of attention, and the more of it we place on something that is not pain, the less pain we feel. Experiments cited go from virtual reality to guided imagery to music. Read more on Down With Pain…

Filed under Addictions, prescription drugs by on . Comment#

0

I thought this person should be fired from the county clinic, but most counties don’t let me do that sort of thing.  The state of California has a nice service, where I ask to see who else is prescribing this person the same abusable drugs that I am.  I try to work with people who abuse drugs, I really do.  In one sense, it is the purest of pharmacologies, in that things I usually think are parts of a physician-patient encounter, like conversation and logic, play little or no role. House said that patients lie.  House is a Vicodin (opiate) addict.  Some of my more intelligent substance abusers are House fans. The same way that “Cops” was the most watched TV show in prison, when I was a jailhouse doc.

This person, was getting weaned off amphetamines.  After a lot of  years, I am not very sure I believe in ADHD, or “Attention deficit disorder.”  We all have problems of differential maturity.  These are just people who learn to concentrate later.  They may have other skills like class clowning that are way ahead.  My book learning was ahead of my social skills for a lot of my life. Besides, most anybody brightens up when you give them amphetamines.  Not that the effect lasts very long, mind you.  Even kids who take Ritalin in a quest to do better on the Scholastic Aptitude Test seem to revert pretty quickly to their previous state of dullness. Read more on Getting Amphetamines In Other Places…

1

He looked more like the romantic hero from the era of Lord Byron than a psychiatric patient – he wore his hair longer than today’s style and he obviously pumped iron.  Indeed, I found out that working out was an important part of his life.

He was 28, and he had just been released from a two day stay at hospital and his medication was standard fare — Zoloft (sertraline) antidepressant.

I had no clue why he had to be seen by me on an emergency basis. It turned out he had been admitted to the hospital because he was uncomfortable about his roommate’s anger.  He had been concerned he might get “attacked.” I had no way of telling whether the roommate had an actual history of this sort of behavior or if this was delusional.  But the roommate was not the patient before me. “Just give me klonopin,” Lord Byron said. “Everybody else does.” Read more on Fixing The Problem Is Much Better Than Taking Addictive Drugs…

Filed under Addictions, Substance Abuse by on . 1 Comment#

3

Tinkerbell has come a long way from the light reflected with a mirror in the original J.M. Barrie play of Peter Pan, back in 1904 — l argely through being part of the Disney stable of ideals for young girls. I remember, even though I have always been a lover of personal expression through the visual arts, being asked, as early as the second or third grade, to draw a princess. 

Huh?  Read more on Paris Hilton, Tinkerbell and Girl Bratz as a Role Model…

0

I guess the death of Anna Nicole Smith has become old news.  All I found in the daily newspaper was a short item saying that the trial was going on in Los Angeles.

After more than one internet search, the only mention I found of what is going on online is this one, in what seems to be a Seattle tabloid.

I strongly suspect that this is a road that has been travelled more than I know.  After all, I am not exactly a celebrity watcher. Nevertheless, from what we already know about folks like Michael Jackson, and from what Dr. Nathalie Maullin seems to have said under oath, I think we have a pretty good idea of what it is like to be a drug-seeking celebrity.

First, I think it worth noting that Dr. Maullin was on staff at Cedars-Sinai at the time. Now putting aside the PR of the latter (it is allegedly the best in L.A.; they have ads and some top notch publicity firm–) Cedars Sinai is a hospital.  I can testify that to be on staff at any clinic or hospital, they do a background check. Read more on Anna Nicole’s Doctors Couldn’t Have Made Worse Decisions If They Tried…

2

I have a fable that is obviously too late for Aesop’s collection of same.  It is unlikely to make its way into any later anthology. I might as well tell you about a tiny town whose sole virtue that it was on an interstate road that took a lot of people from various parts of California into Las Vegas, that famous refuge for people who are too sober and trying to get rid of excess money, sometimes while getting either married or divorced. Actually Littletown (we will call it that to avoid embarrassment to all two or three law abiding citizens). Had just one more virtue. Their county hired me as a consultant.  I did last in that job for a while, even though it covered three different small clinics, each of which needed me just a day or two a week. Since every morning when I woke up, I had to have my husband remind me not only what day of the week it was, but what city and clinic I was supposed to be at. The clinic buildings looked different from one another on the outside, a fact which didn’t help me very much because I ended up working on the inside and usually ate lunch at my desk. The patients in all three clinics were different from those that I had seen prior to that time in my career, for I had not done more than sporadic work with addicts, and there were a fair amount of people on crystal meth.  I practiced “from the book” and did the best I could (I always do) and helped some people somewhat, to get treatment and put their lives together.  But it was in Littletown, where the stores on Main Street were empty and the only local culture was the yogurt shelf at the (chain) supermarket, that I really learned about crystal meth for the first time. Read more on Once Upon A Time There Was An Explosion…

Filed under Addictions, Substance Abuse by on . 2 Comments#

0

She was exactly my age, with a birthday only two days before mine. Same year.  I know that there are more people born under the sign of Aquarius than any other astrological sign, so I am no longer surprised at the number of people who have birthdays in February. (Especially since, if you count back nine months, you end up with June, which is when everyone’s thoughts turn to love and their thyroids and probably other glands are hyper-secreting.) But  this was one of those people who makes me think I look awfully good my age.  Probably a function of middle class privilege and doing more intellectual than physical work.

This woman had a son who cared about her.  The fact that she came to the clinic with him made her fairly special among those I was serving at the time.  He had been worried when she seemed too sleepy and too angry and not herself.

Like most patients, she really did not want to tell me much about the other doctors she saw or what medications they gave her.  I told her that I could check for interactions, and that her failure to tell me would increase her risk of having problems.  I know that a lot of people get “pain killers” and don’t think that they count for “real medicine.” Read more on The Shrink As Sherlock — Detecting Opioid Addiction…

Filed under Addictions by on . Comment#

0
I never professed to understand French politics as more than an observer.  It was one part of the French civilization that seemed a bit overwhelming.  I remember being told there were over fifty political parties.  It seemed as if getting anything done required an amazing amount of compromise. I was impressed by the fact they had elections on Sundays.  How delightful to have an election day when nobody had to work, let alone request an excuse from the same.  No little “I voted” stickers. I remember thinking we never could have pulled off Sunday elections in the states.  Certainly not in the Boston area, where I grew up.  Home of blue laws, those strange laws that said things like you could not dance in certain places on Sunday, the day of the Lord, so people in bars in certain localities where such laws persisted would park their bottoms on bar stools and tap their feet in all manner of ways, so that no church could define such activities as dancing.

People told me I would have troubles in France because it was a “Catholic” country.  I do not think any trouble I can remember came from the few people who actually attended church regularly. But back to politics.  The parties were grouped into “left,” “right,” and “center.”  The left included the commies, whom I had to reassure that even though I was an American I did not hate them.  I found “rightists” fearing change as obsessively as any conservative (read “ultra-republican” American ever could. Read more on Psychology of Politics (and Politicians)…

Filed under Addictions, politics by on . Comment#