November 2010 Archives


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…


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…

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Veterans day has come and gone.  I was at a meeting when someone asked that all the veterans stand and be acknowledged.  There is always someone who looks at me funny when I do this.  Yes, I am a veteran, too.

You cannot tell military veterans by looking at them, a point well made in this internet page.

A lot of them happen to be women.  Many people do not think very much about this.  I routinely ask women patients if they have served in the Armed Forces.  I mean, they may be able to get medications free or other benefits, so I always ask.

Often women laugh.

“We have equal rights in this nation,”  I tell them.  “We should feel, I think, an equal obligation to service.  At the very least, it is a vocational option for many, as once it was for me.”

My husband made a wonderful photo tribute for my beloved Aunt Sadie, and for me. We both served in the Army.  My aunt is a nurse and by now everyone should have figured out what I am. Read more on Veteran’s Day Salute…

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I try really hard to make my time with patients count. I talk to them just like I would talk to a family member or next door neighbor. Although this occasionally frightens them, they generally get pretty relaxed and ask me questions I can’t believe they would come up with. I think they do this — and I connect with them — because I do something called “mirroring.” Yes, you can try this at home.

I will always be happy that at some point in my residency I dragged myself to Kansas City to sit in some hotel function room and study Neuro Linguistic Programming, now known colloquially as “NLP,” with one of its originators. Read more on NLP And Mirroring…

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People may look at the complex before they look at the obvious — which is a faster answer and closer to the truth. I happened to be talking and I found three more yesterday. Women.  Young, intelligent, and attractive women, who did not have and did not want boyfriends. All three were part of the mental health treatment establishment.

Men losing interest

Men are losing interest in sex

The first time I discovered one of those was some years ago, a few cities ago, and she was a very clever and very talented psychiatric nurse.  She loved her profession, and took good care of people.  She loved nature and animals and plants.  I believe her to have been quite attractive.  She had been turning down dates because she would rather go to her gardening clubs or whatever.

She had also said, without tears or depression, that she expected she would always be alone, would move into the home for old nurses when she was old enough, and die there. She had been on Prozac for about three years. There were a few problems with this. First, nobody had ever talked to her about getting OFF Prozac.  They said she might as well stay on it, since life was that good.

Actually, I have looked at data for depressed folks of varying ages. Sure, there is a risk of side effects, but nobody seems to care.  I cannot remember, off the top of my head, seeing data about the recurrence of depression that suggested anybody needed to stay on antidepressants permanently.

Certainly, nobody under, say, 55 or so.  And she was plenty under.  I mean, there are things you can do to lessen the chance of recurrent depression — psychotherapy, even reading books. And there is the whole question of getting someone off SSRIs.  I have had patients who claim it is impossible.  I’ve had people come to me because the withdrawal effects were horrendous.  Yet I have taken people off easily and (reasonably) quickly with natural substance regimens. It’s not impossible – you just have to know how.

That eliminates many of my colleagues.  Or perhaps they keep their patients on prescription drugs to insure their return and a steady cash-flow.  Naw – doctors wouldn’t do THAT!

There is another problem.  There are drug side effects we know little about or may find hard to measure.  I remember from my days doing clinical trials that at one time, shortly before I left the business, someone adopted a “uniform” side effect reporting system. The trouble with that was trying to fill in the blanks for the questions on the form when the patient is saying things that do not fit in the blanks.

Every one of these mental health professional women had been put on Prozac when it came out, because of the safety and efficacy.  I remember, collecting data, one of the first people I gave Prozac to during clinical trials before that drug was on the market.  She told me that she “felt like a zombie” and that she missed having the full amplitude of emotional expression.  She missed crying at the movies, something she had genuinely enjoyed.  Said she had a feeling of euphoria afterwards — a feeling of euphoria she really enjoyed. Try fitting that one on a uniform side-effects reporting system.

The three women I met yesterday are unlikely to get off their Prozac. They stood in wide-eyed disbelief of my assertions.  Of course, they had just met me and know little about who I really am.  Besides, people seem to have trouble taking advice for which they aren’t paying.  I just reminded them as I remind patients that taking any medication is a choice, and reporting what is going on to a doctor is always a good idea.

If any of these intelligent and well-insured women had gone to a therapist, they could have ended up with some kind of verbally analytic procedure, which obviously would not help.  Or maybe they would be referred for some hormone supplementation, which has biologic risks of its own.  Big ones, like — cancer.

Worse yet, I’ve met two psychiatrists in my 30 years of practice who gave everybody electric shock treatment. Everybody! The first person in whom I suspected a real lack of sex interest had changed her life — the psychiatric nurse — did finally get off her Prozac. If she had any recurrent depression problems, I do not know about them.

She had a date within two weeks, and last I heard, was dating many interesting men, looking for a best boyfriend.

I am convinced that we are looking at a Prozac side effect that the system has made it impossible to measure.  We probably have at least a little of the same side effect with similar drugs in the same class – such as Paxil and Zoloft.  Maybe others, too.

The psychiatric nurse easily agreed her general quality of life had been diminished while she was on Prozac.  She was too undepressed to notice.  When she got off the drug, she suddenly noticed.

Getting a drug past the FDA takes some studies on how it gets into the body and the like.  Nobody ever seems very worried about getting off a psychiatric drug.  That’s been the focus of my private practice for at least the past five or six years.

For the individual, the effect is pretty evident even though I only have one clear cut example. What about the species?  Is this just one of several steps driving humans to …. extinction? People change as time passes.  What affected you in the past may have gone away – as many illnesses seem to do.

Spending your lifetime on a drug when you no longer need it is tragic.  Or having your quality of life changed because of the way a drug reacts in your body – instead of seeking alternatives to control your problems.

I think it is worthwhile for anybody on a psychotropic drug to ask how their life has changed since they have been on a prescription medicine. We researchers have been limited to collecting information on side effects that the FDA and/or drug companies “let” us.

So don’t look toward the government or the drug companies for help.

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Oh, I know most people want to believe, the same way I do, that our federal regulatory agencies are doing their job. The only thing I can say in their defense is that their job is pretty much impossible.

Look, I mean who is going to send someone to check on every blessed piece of glassware? I once actually treated a case of cadmium poisoning in a young man who had been a ceramic artist.  Told him to get some intravenous chelation. Although this remains a controversial procedure for some things – like arteriosclerosis — nobody debates that it is the fastest and best way, when adequately monitored, to get heavy metals, like mercury and cadmium and such, out of your body.  A simple, gentle IV.  It’s mainstream medical practice and its been around for many years.

He didn’t much like the idea of needles puncturing his skin.  Alternative medicine embraces multiple oral protocols that seem to work just fine, so I referred him to another doctor who offered such things. Read more on Heavy Metal Poisoning From Drinking Glasses…

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Eli Lilly gets credit for being economically savvy and the first out of the chute.

Cymbalta (duloxetine) is a much awaited antidepressant that is supposed to be effective especially on the bodily aspects of depression.  Those pesky aches and pains that are associated with depression in one form or another.

They seem to have secured “back pain” as an indication for Cymbalta. Read more on Cymbalta For Back Pain…


Excuse me while I curse — “Oy vays mir!”

Cell Phones and Brain Cancer

Cell Phones and Brain Cancer

That is a pretty mild ethnic expletive in Jewish language as cursing goes and the translation is something like “oh, woe is me.”

I’m sure you’ve heard worse elsewhere.  However, this is engrained deeply in the limbic — deep, reflexive — areas of my brain, I suppose, since sometimes I forget that there is nobody around me who could possibly understand it.   It does not call upon any real or imagined universal powers.  Yet my grandmother of blessed memory spoke it often, when she thought someone around her was being really stupid, and could potentially be harmful — like a butcher who had slaughtered her chicken incorrectly  and we maybe could end up with some bile in the preparation. So by hearing this, you can be assured that I have surely been secreting bile. Read more on Brain Cancer and Cell Phones (Or Not?)…

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