Ah, the good ol spider bite. I work in a prison and hear that one at least 10 times a week.
And this gem, "the only thing that works for my pain is Dilaudid". (Guess what you're not getting?)
Or the ever increasing, "I googled my complaints, pretty sure I know what's wrong." Thanks for doing all the work. Here's the prescription pad, write what you want.
From my EMS days. " I called because you guys will get me in the back faster. " Walk them right to registration and then see them hours later sitting in the waiting room.
Hey Dr. Leap! I recently saw a 22 yo male who recently graduated college. He came into the ER w/ "flu-like symptoms" x 1 week. He had PNA, thrombocytopenia, and elevated LFTs. It turns out that he handled a baby possum who was living in the frat house and ended up with typhus!!
Totally get that it's often harmful. That's why I was responding to Beth and not to you. Cannabis can often be harmful and sometimes helpful can both be true. Patients don't know the risks of many choices and there's such a thing as epistemic injustice can both be true. That ED docs work harder than almost anyone under ridiculous conditions is definitely true.
It's interesting that in decades past, I suspect before it was intentionally grown with higher potency, these were almost never issues. Thanks for the kind word. Of course, we're also adrenaline junkies who often make the bed we lie in...
I think also in previous eras (like when I went to high school in the 80's) weed was not only weaker but it was relatively hard to get in the suburbs, so you made it last. Or tried to grow your own with usually pretty pathetic results, but again you made it last. Now that there are 5 dispensaries in my small city in NY, there's a basically infinite supply close by and easy to get. Believe me, I get the adrenaline junky piece, I bounce between the ED and palliative care (for my job, not my health) so I see the difference! Keep calm, drink some decaf and carry on.
Well, yes and no. It smells like medical paternalism to suggest that patients do not know their bodies and might have some insight that physicians don't have, especially rushed physicians who have many patients to see in an ED, urgent care clinic or primary care practice. I've heard many stories from elderly cancer patients getting (in the pre-legal days) cannabis from their college student grandkids and using it to combat the nausea of chemo or as an appetite stimulant. These are not aging boomers but the generation before that, with no political or cultural inclination to tout the wonders of weed. I'm not saying that cannabis is a wonder drug, nor that it cures anything, or that people don't abuse it; obviously some people become dependent, or at least habituated, and everything has side effects and risks.
In my own case (58 year old who works in a patient supporting non-clinical role in a mid-sized hospital), when I had a really painful condition that included horrible muscle spasms in my lower digestive tract, I was given a one-week prescription of diazapam to help me sleep. It worked pretty good but then I was told I could not have any more, because it's addictive, even though I was in terrible pain, not sleeping and the medicine actually helped. They gave me something else which I was "allowed" to have that didn't do crap. Half a cannabis gummy before bed worked much better than the ineffective RX and I'd have been miserable without it. I tried, so hard, to get medicine that worked, but couldn't.
Look me in the eye and tell me I don't know my body- you know, the one with such a painful condition that I almost passed out in the doctor's office, the one that responded to a little bit of cannabis when the "allowable" RX failed totally. That body. When you have my body and my condition and my pain (now thankfully behind me for many months), then you can post head-slap emojis about people who looked for answers that the medical system could not provide.
PS- please note, lest you write this off as yet another drug-seeking narrative from someone justifying opioid use, I'm so careful about addiction that I don't even drink real coffee, decaf only.
PPS- if you want to suggest that the cannabis gummy (vegan formula only, please) was just a placebo that worked only because I expected it to, well, I can't dispute that as it's an unfalsifiable claim, with no evidence one way or another.
Thanks for the comment! I certainly realize that people have unique situations and responses to therapy. I have no doubt that some have benefited from cannabis. However, the problem we face day in and day out in the ER is not careful use for chronic pain but unfettered use that leads to intractable abdominal pain and vomiting and worsens mental illness significantly. The data on cannabis being associated with psychosis seems pretty solid, and we know it's causing bad GI symptoms as well. What happens is we'll try to explain this to, say, a person with cannabinoid hyperemesis syndrome (vomiting and abdominal pain) and they counter with rolled eyes and anger, and the 'I know my body' sort of line no matter how we explain the connection to their cannabis use. They'll go to multiple GI specialists for scans and scopes when the fix was right in front of them; stop using. Anyway, I'm glad it worked for you; it's just that for some it causes terrible problems. Best wishes.
ER Rant: So true Edwin - through all the years. Just last night I used the "better safe than sorry" statement [to deride it] to my daughter about her 'work-up'. // fb
The antibiotic/radiodiagnostic/laboratory test discussion is too often countered, in the patient’s mind by 1) “I read on the Internet”, 2) “my hairdresser’s sister’s cousin next-door-neighbor who is in medicine(usually a nursing assistant) thinks…” 3) “I know my body (but I’ve read the textbooks) and…” 4) “But insurance will pay for it” 5) but, rarely what would you do if…
Exactly! Although now and then it will be 'my son is chief of neurosurgery at NYU, will you call him?' And when I do he says, 'tell her you talked to me and I said to do whatever you think. Sorry about that.' Very validating.
Ah, the good ol spider bite. I work in a prison and hear that one at least 10 times a week.
And this gem, "the only thing that works for my pain is Dilaudid". (Guess what you're not getting?)
Or the ever increasing, "I googled my complaints, pretty sure I know what's wrong." Thanks for doing all the work. Here's the prescription pad, write what you want.
From my EMS days. " I called because you guys will get me in the back faster. " Walk them right to registration and then see them hours later sitting in the waiting room.
Ed, we definitely work in the same universe!
Remember the days before you had a couple Cannabis Hyperemesis syndrome patients every shift? Oh well reglan and haldol work pretty good.
I just want to say thanks for the wonderful comments, shares, etc.
And to you who are new subscribers, thank you so much! I'll try to keep it interesting, relevant and fun.
I appreciate your time, insights and opinions. Have a great day!
After a rather miserable Friday, (the spiders were hard at work), I needed a good laugh this morning. This was it!
I feel you brother. I felt beat down yesterday too. And boy, is that spider discussion a tough one! Hope you have a restful weekend.
Hey Dr. Leap! I recently saw a 22 yo male who recently graduated college. He came into the ER w/ "flu-like symptoms" x 1 week. He had PNA, thrombocytopenia, and elevated LFTs. It turns out that he handled a baby possum who was living in the frat house and ended up with typhus!!
Yikes! That's a scary and also very cool story! (That would also be a great case report write-up. If you're interested in publishing message me!
Totally get that it's often harmful. That's why I was responding to Beth and not to you. Cannabis can often be harmful and sometimes helpful can both be true. Patients don't know the risks of many choices and there's such a thing as epistemic injustice can both be true. That ED docs work harder than almost anyone under ridiculous conditions is definitely true.
It's interesting that in decades past, I suspect before it was intentionally grown with higher potency, these were almost never issues. Thanks for the kind word. Of course, we're also adrenaline junkies who often make the bed we lie in...
I think also in previous eras (like when I went to high school in the 80's) weed was not only weaker but it was relatively hard to get in the suburbs, so you made it last. Or tried to grow your own with usually pretty pathetic results, but again you made it last. Now that there are 5 dispensaries in my small city in NY, there's a basically infinite supply close by and easy to get. Believe me, I get the adrenaline junky piece, I bounce between the ED and palliative care (for my job, not my health) so I see the difference! Keep calm, drink some decaf and carry on.
It all sounds good to me. It is that, I can't always remember things.
Amen re the THC!
But, of course, they know their body…🤦♀️
Well, yes and no. It smells like medical paternalism to suggest that patients do not know their bodies and might have some insight that physicians don't have, especially rushed physicians who have many patients to see in an ED, urgent care clinic or primary care practice. I've heard many stories from elderly cancer patients getting (in the pre-legal days) cannabis from their college student grandkids and using it to combat the nausea of chemo or as an appetite stimulant. These are not aging boomers but the generation before that, with no political or cultural inclination to tout the wonders of weed. I'm not saying that cannabis is a wonder drug, nor that it cures anything, or that people don't abuse it; obviously some people become dependent, or at least habituated, and everything has side effects and risks.
In my own case (58 year old who works in a patient supporting non-clinical role in a mid-sized hospital), when I had a really painful condition that included horrible muscle spasms in my lower digestive tract, I was given a one-week prescription of diazapam to help me sleep. It worked pretty good but then I was told I could not have any more, because it's addictive, even though I was in terrible pain, not sleeping and the medicine actually helped. They gave me something else which I was "allowed" to have that didn't do crap. Half a cannabis gummy before bed worked much better than the ineffective RX and I'd have been miserable without it. I tried, so hard, to get medicine that worked, but couldn't.
Look me in the eye and tell me I don't know my body- you know, the one with such a painful condition that I almost passed out in the doctor's office, the one that responded to a little bit of cannabis when the "allowable" RX failed totally. That body. When you have my body and my condition and my pain (now thankfully behind me for many months), then you can post head-slap emojis about people who looked for answers that the medical system could not provide.
PS- please note, lest you write this off as yet another drug-seeking narrative from someone justifying opioid use, I'm so careful about addiction that I don't even drink real coffee, decaf only.
PPS- if you want to suggest that the cannabis gummy (vegan formula only, please) was just a placebo that worked only because I expected it to, well, I can't dispute that as it's an unfalsifiable claim, with no evidence one way or another.
Thanks for the comment! I certainly realize that people have unique situations and responses to therapy. I have no doubt that some have benefited from cannabis. However, the problem we face day in and day out in the ER is not careful use for chronic pain but unfettered use that leads to intractable abdominal pain and vomiting and worsens mental illness significantly. The data on cannabis being associated with psychosis seems pretty solid, and we know it's causing bad GI symptoms as well. What happens is we'll try to explain this to, say, a person with cannabinoid hyperemesis syndrome (vomiting and abdominal pain) and they counter with rolled eyes and anger, and the 'I know my body' sort of line no matter how we explain the connection to their cannabis use. They'll go to multiple GI specialists for scans and scopes when the fix was right in front of them; stop using. Anyway, I'm glad it worked for you; it's just that for some it causes terrible problems. Best wishes.
Oh if common sense were part of an obligatory yearly class for all.
Many ER visitors definitely deserve a Darwin Award badge upon discharge. Actually they probably need a Darwin Award tattoo!
ER Rant: So true Edwin - through all the years. Just last night I used the "better safe than sorry" statement [to deride it] to my daughter about her 'work-up'. // fb
The antibiotic/radiodiagnostic/laboratory test discussion is too often countered, in the patient’s mind by 1) “I read on the Internet”, 2) “my hairdresser’s sister’s cousin next-door-neighbor who is in medicine(usually a nursing assistant) thinks…” 3) “I know my body (but I’ve read the textbooks) and…” 4) “But insurance will pay for it” 5) but, rarely what would you do if…
Exactly! Although now and then it will be 'my son is chief of neurosurgery at NYU, will you call him?' And when I do he says, 'tell her you talked to me and I said to do whatever you think. Sorry about that.' Very validating.