Pages

Saturday, April 30, 2016

There is a fine line between tolerance and death


This really breaks my heart. I feel like I grew up under his Purple glory. If Narcan had really been given like this article states, then this probably was an accidental overdose.

With these drugs, the difference between tolerance and death is a fine line. Rebound pain is a symptom I see frequently with opiate use. When the levels of the opiate drops in the blood, the dependent brain senses the drop and creates symptoms to get what it thinks it needs. These symptoms are "flu like" with increasing pain. The brain creates and escalates pain to get more drug. Rebound pain is a common cause of accidental overdose.

The treatment is to detox off opiate meds to extinguish the rebound effect and treat the underlying cause of pain--here possibly minimally invasive hip surgery. Also motivational psychotherapy to minimize tolerance in the future, is tremendously helpful.


Music superstar showed few signs of apparent dependency on prescription drugs
IRISHTIMES.COM


Sunday, July 26, 2015

Adderall Cheaters


Everyday in my practice I see patients who want these drugs. They usually don't have ADHD and present very normally on mental status examinations. Using these drugs for performance enhancement is unethical. I treat disease. I have seen patients get angry and leave bad reviews because I refuse to give out these controlled substance prescriptions. They always refuse the non-stimulant medications for ADHD and insist on getting their Adderall.

Guess what, I insist on not colluding with these patients and their manipulations.

I find the PDMP website helpful in recognizing prescription drug misuse and check these files on all patients.

Monday, June 15, 2015

MIND your Health


This summer MIND your health. Besides exercising and eating right, think about how your brain is doing. 

Are you sleeping 8 hours most nights? 
Are you restless and feel nervous all the time? 
When was the last time you really enjoyed anything? 
Are you bored? 
Do you feel stuck? 
How is your energy, motivation and concentration? 
Are you irritable and moody all the time? 
Do you smoke marijuana or tobacco to relax? 

These are all signs of mental illnesses that could shorten your life.

Sunday, June 14, 2015

The Good, Bad and Ugly


When I see patients, I begin by using a biopsychosocial model.This kind of orientation allows me to organize treatment plans that are comprehensive and keeps the big picture in mind. It also prevents me from missing the details that are important to your healthcare.

The Good is in reference to biology. Is your health good? Is there a medical condition or history that is relevant now? Is there a drug use issue that is impacting you? Are there side effects from medications you use for other medical illnesses? Are you healthy without other undiagnosed illnesses causing problems? Are you nutritionally sound? Are there polypharmacy issues where drug interactions are causing changes in your mental status? Is there a history of mental disorders that could be genetically relevant? These are just some of the questions that I consider.

The Bad usually refers to the bad coping skills that are abnormal psychological processes involved in mental diseases. All people have experienced distress at sometime during their childhood. Most of us got through these trying times with successful resolution of  these conflicts. Some of the solutions we learned in response to conflict in the past, may not be sufficient now. In fact not only are they inadequate, they can be harmful. Understanding insufficient or harmful coping skills and learning better coping skills not only feels better but prevents future mental disease escalation and relapse. In fact, learning better coping skills can be curative.

The Ugly is usually the devastating social consequences of mental diseases in our lives. I typically see patients divorce, lose jobs, lose everything important in their lives. The ugly is usually the worse part of the diseases I treat. Families destroyed, individuals desolate. We are a social species, our survival individually and as a group depends on our social viability. A healthy person is socially engaged, fulfilled and happy.

As I continue with my postings, I will show how I use the good, bad and ugly (biopsychosocial approach) in the specific disorders that I treat.

Sunday, March 22, 2015

Photo shows ER doctor's grief after losing 19-year-old patient


Photo shows ER doctor's grief after losing 19-year-old patient: Photo shows ER doctor's grief after losing 19-year-old patient.

When I saw this photo I started crying again. It reminded me of the time several months back when I treated a patient who at 28 years of age was suffering from end-stage renal disease. This patient had been referred to me by a nephrologist who was concerned about the level of pain medication his patient was using. He was using a lot of dilaudid that had started when his initial shunt was placed. These arterial shunts are used for dialysis to filter the blood. These shunts are large, disfiguring, and are usually placed in the upper arm. The placement and the continual maintenance of the shunt is exhausting, depressing and painful.

When I met with Danny for the first time he told me the pain medication wasn't working and that he thought marijuana seemed best to manage the pain. I told him that even though the pain might be better he looked tired and exhausted. Although he had been eating he was still thin. It took much convincing, three appointments actually, to get him to try an antidepressant called mirtazapine. This medication allowed him to sleep and also increased his appetite. Because it's an antidepressant it improved his energy his motivation and concentration. Starting to feel better he was able to trust me to taper off and complete a detox from all his opiate medication and marijuana. He was stoked and felt that his life had really started to turn around and that maybe, just maybe he could get a job and start being a normal person again. Even though he was going to dialysis three times a week four hours each time, he was able to get some part-time work and had started an online class to train in auto mechanics. I like cars too and talking to him about the latest Top Gear episode is something we both understood as natural.

With Danny I met him regularly, usually every six weeks once he was stable. He had missed an appointment with no call which I didn't think much about; I knew that dialysis life support treatment takes precedence and that eventually he would reschedule an appointment time. I went happily about my business not noticing it had been four months since I last thought about my patient.

It was a busy day I was seeing patients every half hour, I was literally squirming around because I had to pee. I walked out the door trying to get to the bathroom when a man who looked somewhat familiar stopped me asking if I was Dr. Bacchus. I groaned in my head thinking "Jesus" what now? I figured this was someone possibly referred by some therapist in the building. "Dr. Bacchus I'm Danny's father, do you remember him?" I was surprised noticing the resemblance and said "yes what's happening"? "I just wanted you to know my son died a week ago" he said. I thought about Danny's smile and the last time we talked about the Dodge Hellcat Challenger. I looked down trying to hide my face as I started crying. I cried silently with swallowing sounds, I couldn't say anything. Danny's father started crying too and told me that Danny was happy that I did the best that I could. He said his son died suddenly and that now visiting his friends and talking about him made him feel better. We finished with awkward conversation and his father left.

I cried again wondering how I was going to feel better. This photo reminds me how hard that was to do.