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This is an addendum to the last blog post, courtesy of the Bride and TN Poison Control Center. I guess this is not such a new recreational drug. She has seen many teens die in the ER and her husband has seen the results as well in Vandy’s ICU. Molly has also been called “bath salts.”

04-04-11 What is in Molly’s Plant Food? (one of the latest recreational drug rages to affect Tennessee’s teens and young adults)

Question of the Week
April 4, 2011
What is in Molly’s Plant Food?  (one of the latest recreational drug rages to affect Tennessee’s teens and young adults)
Molly’s Plant Food is a synthetic hallucinogenic amphetamine marketed as a “plant food” that contains ingredients that produce highs similar to Ecstasy. Molly’s Plant Food is usually purchased at a convenience store and is packaged in a capsule form with a cost of $8-$12 per capsule. The product label warns “not for human consumption”; however it is packaged in a psychedelic colored wrapper and several Internet web sites and chat rooms refer to the product as “legal ecstasy”. The active ingredient is mephedrone, which is not a scheduled (DEA) drug, therefore making it legal.
Over the past six months, The Tennessee Poison Control Center has received an increasing number of calls from emergency departments regarding symptomatic patients who have ingested or snorted Molly’s Plant Food. Clinical effects include euphoria, anxiety, paranoia, agitation, tachycardia, hypertension, delusions, diaphoresis, and weight loss. The treatment is supportive with intravenous fluids and benzodiazepines. Signs and symptoms have lasted an average of 24-48 hours.
This past week brought good news. Under an emergency court order sought by the Tennessee Agriculture Commissioner and the Attorney General, sheriff narcotic detectives have been removing the products from convenience stores in Rutherford County. Since Molly’s Plant Food is titled a “plant food”, it must be registered with the state as a fertilizer (the purported use of Molly’s Plant Food) and clearly list its ingredients. Molly’s Plant Food has neither been registered nor are the ingredients listed on the package.
This question prepared by Marilyn Weber, CSPI, MSN, RN Tennessee Poison Control Center
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This is a morality tale. It’s about trust and medicine and more.

This morning I was trying to figure out what’s happening with Morning Joe? Mika looks mad all the time, and Joe is always elsewhere, thankfully in a split screen from time to time with his audio turned off. When I heard this health writer talk about the rule of 7. He heard a drug rep say that it usually takes 7 visits, face to face, with a doctor in his/her office, before said doctor will trust them…in other words they need to be able to talk about their kids’ soccer games so that the rep can pitch his reasons for prescribing their high priced drug over another. At least that was what I inferred from his use of the word “trust.”

This was an aside, they were talking about the low polling numbers for Obamacare at the moment, but of course Joe had to complain about doctors in general on their iPhones while dealing with patients. About not listening to their patients, about young doctors not looking them in the eyes. Fear and loathing in medicine, that’s the GOP war cry. But let’s extrapolate. If you need to see someone 7 times before they can trust you, maybe a patient also needs to see their doctor 7 times before the patient can trust the doctor?

I didn’t want to write about this, but my MIL Ada thinks I should. She is a lively, active octogenarian. She is still working as a marriage counselor, and traveling the world, but she’s been feeling tired lately, getting leg cramps, and hates to complain. Let it be said, when Ada visits us it’s a whirlwind of activity and her home is usually teeming with friends “dropping by.” So her base level for “tired” may mean she only had one big event this weekend so she decided to clean the refrigerator and invite people over for a pool party. But a recent doctor visit had her worried, her liver enzymes looked high.

So Ada gathered all her drugs in a basket, and went to her pharmacist for a look-see. It turns out, she was double-dosing on a cholesterol medicine. Her internist had taken her off the name brand Lipitor, and prescribed a generic, only Lipitor kept getting refilled right alongside the same exact drug in its generic name!

This, her trusty second opinion doctor/son Bob told her, accounts for the liver problem and her tiredness. And, Bob told her, he sees this ALL THE TIME in the ER. Elderly patients on a cornucopia of drugs complaining of symptoms that to a trained acute care specialist look like drug interactions…and so in ERs all across the country, doctors and nurses are sifting through a patient’s drug record right alongside caring for trauma and stroke and heart attack patients.

I’ve learned that doctors rarely “write” prescriptions anymore – they are emailed to a pharmacy. So where did this system fail my Mother-in-Law? Was Lipitor taken off the doctor’s list of drugs, or did the pharmacist, or pharmacy tech who read the new email Rx just add the generic without thinking? How many other patients are suffering?

Technology is supposed to add fail-safe measures to health care, but how do you build “trust” with a machine? Maybe, just maybe talking and listening to a patient is more important. Here is Great Grandmother Ada, with her “little” doctor.

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You know that part in the Officer Krupke song of West Side Story, when the character says, “Hey, I gotta social disease!”?

http://www.youtube.com/watch?v=pq28qCklEHc

O God, why do I think of life as one long musical comedy? Well I guess it’s better than a Shakespearian tragedy. I was listening to all the talk yesterday about how the AMA has now classified obesity as a disease. Here is what they said at their annual meeting:

“RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”  http://www.npr.org/blogs/health/2013/06/19/193440570/ama-says-its-time-to-call-obesity-a-disease

So, supposedly, if insurance company clerks agree with this assessment, they will pay more doctors for actually taking time to sit with patients and counsel them about the dangers of obesity, and how to fix and/or prevent it from happening. Sounds lovely in writing doesn’t it? So of course I had to ask my doctors what they thought…granted, this will apply to mostly family practice docs, but still.

“Probably just they’ll start covering more gastric bypass surgery,” the Bride said. She takes that global, public policy point of view, citing economic and social issues with our American widening of the collective belt.

“It’s good for the health of the country,” Bob says. More people will be able to access treatment and more insurance companies will have to pay for that treatment. One caveat he mentioned was similar to the Bride’s concern for an increase in gastric bypass surgery and lap bands – citing the fact that no surgery can be done without risk. He also wondered aloud if more drug companies will now push their efforts into finding the wonder drug for weight loss; you know, instead of curing cancer or AIDS.

Semantics – it’s all in a word and how we phrase something. Addiction was always thought of as a social disease. Alcoholics and drug addicts just needed to stop, just put the glass or the needle down for good, cold turkey. In this interview with Russell Brand, we get the sense of its (drugs and alcohol) complete and total mind/body control. http://www.spectator.co.uk/features/8857821/fixing-a-hole/

“I cannot accurately convey the efficiency of heroin in neutralising pain. It transforms a tight white fist into a gentle brown wave, and from my first inhalation 15 years ago it fumigated my private hell. A bathroom floor in Hackney embraced me like a womb, and now whenever I am dislodged from comfort my focus falls there.”

The problem with food is that we need it, we can’t just put it down and stop eating. We can join a 12 step group and leave our bar-hopping days behind, but we still need to sit down at a dinner table. In Mika Brzezinski’s new book, she talks about her struggle with anorexia and her friend’s struggle with obesity as if they are 2 sides of the same coin. https://mountainmornings.net/2013/05/07/and-all-that/ So then it makes sense, if anorexia is considered a disease worth treating, why not treat obesity?

On a lighter note, the Love Bug is absolutely perfect! At her latest pediatric appointment (9 and 1/2 months), her  height/weight charting shows her to be at the 68th percentile for weight, and 84th for height. “Yeah, I’m tall, you got a problem with that?”IMG952245

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How to begin? My Mother used to tell me a couple of things, repeatedly, that I’m sure she never said to my brothers: 1) “You have to suffer to be beautiful,” and 2) “You can never be too rich or too thin.”  I’m afraid that while combing and trying to braid my daughter’s wavy, sand-soaked hair at the beach I may have repeated her first message. Here is the Bride and Bug considering beauty products. I hope she doesn’t hear that message about beauty. photo copy 3

But I tried to banish the second from my mind.

In fact you can be too thin, and if you care to read about one woman’s struggle, Mika Brzezinski and her friend Diane Smith co-wrote a book together, Obsessed. It’s like Jack Spratt and his wife; Brzezinski went from a size 2 to a size 6 (and yes, I guffawed at this) and Smith, a fellow TV journalist, lost 75 pounds.

But Mika was honest about how she may be perceived as the mad, “skinny bitch.” They talked candidly about food as an addiction problem, as a public health problem when I happened to tune into their conversation one morning on Morning Joe, and it was enlightening. They were 2 sides of the same coin, a woman’s body image and our country’s dysfunctional obsession with food. It all started when Mika confronted her friend about her weight gain, calling her “fat and obese,” in case she didn’t hear the fat part. Smith called her a “food Nazi.” And then Mika confessed to a life-long struggle with anorexia and bulimia

Mika said, “How I eat, diet, and look has tied me up in knots my entire life, and I know I am not alone. I have been held hostage by food since I was thirteen years old. My body started filling out more than the figures of other girls in my class, and that set off what has become a thirty-year battle with my body image. Food has been my enemy.” http://tv.msnbc.com/2013/05/06/an-excerpt-from-mika-brzezinskis-obsessed/

My psychologist brother Jim has often said that people are either wrapped too tight or too loose. I worried when the Bride went off to Duke. She was surrounded by Type A young women who were wrapped pretty tight with body dysmorphia – exercising too much, throwing up in bathrooms. It was hard not to see it and not to buy into it. But my daughter is a smart cookie IMHO, and moderation was always her approach. I once heard a friend of hers in med school describe some food as “bad,” and I couldn’t help lecturing her about how food can’t be “bad” or good for that matter. Applying a moral code to ice cream for instance is ridiculous. But putting the spoon down before the pint is finished is a matter of choice. And I realize now, it’s much harder for some of us.

I had a dance teacher who used to say, “I only need a taste,” to be satisfied. What will power, what control she had over her hunger. I was always thin, without trying. I would drink a frappe in Boston on my way back from a dance class. But approaching 40, I was unhappy about moving from MA, I had put on about 10 pounds (don’t laugh, I was a size 10 and these things seemed important at the time) and took my anger out on food. I found an aerobic dance class I loved and started restricting food until I got down to 118, a size 6, with my clavicle protruding. Oh, the attention I got. People said I looked so good and yet I was desperate inside. Thankfully, my self-abusive relationship with food didn’t last long. We moved out of a suburb I hated to live close to the beach, in a town that was very much like New England. And I started writing again for another newspaper.

My feminist brain just loves to think – would this ever happen to a man? Do people ask men how they will juggle this new job with a family? Does that shirt make them look fat? So, here is a little play on that Dove commercial about women and body image. Enjoy!

http://www.huffingtonpost.com/2013/05/01/dove-real-beauty-parody-b_n_3191883.html

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The first night in Nashville I left my book club book in the car. Not wanting to go downstairs and back outside in my nightgown, I picked up a little paperback I found on the bedside table, The Spirit Catches You and You Fall Down, by Anne Fadiman. Little did I know how much I would enjoy reading about the Hmong people of Laos…currently living in California.http://www.nytimes.com/books/97/10/19/reviews/971019.19konnert.html

It’s a story about seizure disorder, and about the many ways modern medicine can fail a refugee population. Cultural dissonance is bound to happen when doctors want to order invasive tests for a baby who’s only problem is that her older sister slammed the door coming in and so an evil spirit invaded her body. For the Hmong, animal sacrifices, amulets, and strings around the wrist should cure her, but instead her parents, who speak no English, are supposed to dose her with a varied cocktail of drugs many times a day. You can see where we’re going.

But it’s not all medicine. I’m almost done with the book and I’ve had quite a history lesson on Southeast Asia. I was talking about the book to one of the Bride and Groom’s friends, an academic internist at Vanderbilt. She said it was required reading in her medical school. “Which medical school did you go to,” I asked. “Yale,” she said.

This morning, after working all night, my ER doctor asked me to read this article.
http://www.theatlantic.com/magazine/archive/2013/05/how-not-to-die/309277/

Have no fear, yes, it is about dying. Let’s face it, the spirit eventually does leave us and we all have to think about this stuff, unless of course denial works for you. It’s about a doctor who becomes an educational/documentary film maker. He makes short films that actually show people what advanced dementia (among other maladies) looks like, and he tells us to have “The Conversation” with our doctors:

“In the health-care debate, we’ve heard a lot about useless care, wasteful care, futile care. What we”—Volandes indicates himself and Davis—“have been struggling with is unwanted care. That’s far more concerning. That’s not avoidable care. That’s wrongful care. I think that’s the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”

Which made me think. Sometimes, even when you speak the same language, you still can’t communicate.
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Don’t worry, I’m not going to get all biblical on you. I have my fond memories of Sacred Heart Church shrouded in purple, singing in the choir, fake green grass in a basket, biting off the head of a chocolate Easter bunny. And later, hiding colored eggs and candy around my friend’s yard so all our friends’ children could come in their little Wellies and hunt for treasure. Spring is in the air, robins are bobbing their heads.

And hospital and health and safety workers are on the job year round, 24 hours a day. For them, pausing for a big family dinner, let alone searching for jelly beans, doesn’t really happen. What happens is saltines and peanut butter at the nurse’s station. The Bride is working, and so is Bob. And here’s what happened at my daughter’s ER.

A man in his 30s walked into the waiting room and promptly collapsed in a chair. He lost consciousness, nobody even heard a chief complaint. When they hooked him up to an EKG it was obvious he was having a major heart attack; I think they call it Vfib? My doctor daughter had the biggest guy in the room, a tech, pound on his chest while she got the paddles ready. The pounding didn’t help, so she shocked him with the paddles, and he converted but unfortunately he got belligerent and pulled everything out, then passed out. She shocked him again.

And he came back to life. He was discharged from the hospital yesterday.

He has a wife and 3 children and probably will never meet my daughter. And it made me think of the husband of a friend of mine in Pittsfield, MA. In his 30s too, he woke up one July 4th morning sweating, and instead of going to the ER, he took a shower. That is where he died, while his wife tried calling his doctor and finally called an ambulance, before 911. She had a new baby and a toddler so I made baked ziti for the shiva. And I helped her collect pictures of her husband for her children, because i know what it’s like to lose a father so young.

On this Easter morning, Christianity teaches that rebirth can happen to all those who seek God, who walk humbly. As my dear friend Eve quotes:

“I cannot help but think, on this Easter morning, of how many times I have been resurrected. Like so many others, I have known moments when I thought my life had entered a tomb. I saw that great stone rolling between me and the hope of any future I could imagine. But then, through God’s grace and healing, I emerged into a garden to find people who cared for me waiting, waiting for me to return to life. I pray, therefore, for all of those who have been resurrected like me. I celebrate this new life with all of you who have stepped out of the grave into the light of Easter.” S. Charleston

Many thanks to all those emergency personnel who are working today, and just a little note to the Easter bunny – really, you need a break?
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If I may, I’d like to give you some tried and true suggestions for raising teenagers in the White House.

!) Keep up the no Facebook policy: I’d like to think if there were such a thing when I had teens it would have been verboten, like MTV. Oh and let them watch more than 2 hours of TV a week, maybe 4 not counting sports?

2) Make them pay half for their first car: I know they probably don’t have a part-time job, like working at Starbucks or babysitting, but make it clear you expect a contribution.

3) Set a reasonable curfew: Figure out when the bars close in DC, and make it an hour before that as long as it’s before midnight. We all know bad things happen after midnight.

4) Make no drugs or alcohol a sacrosanct rule: Destroy all paraphernalia you find immediately and have the Secret Service (SS) deliver any drunken teenage boys they might find on your lawn to their own homes pronto.

5) Make no exceptions to Rule #4, except: Have them sign a contract that states they can call you at anytime if they have eluded the SS and are drunk and need a ride back to the White House; no questions asked.

6) Cellphone criteria: There will be NO sexting, instagram or tweeting. Zero, zilch, none.

7) Dating Dilemma: Have a realistic sex talk please, if you haven’t already. Mom and Dad-in-Chief will have to meet and approve of each date; football games, movies, concerts. Of course the SS will have fully vetted said date, and will accompany them. There will be no dating of bodyguards!

8) Lighten up on Health: We all know body image problems may set in when hormones surge. Eat fewer carrots and more pie. Practice yoga and not spinning. Allow NO permanent body changes (such as tattoos or body piercing) until age 18. Wear less sleeveless shirts, those arms are intimidating.

9) Do NOT hire a college counselor: You are an educated woman, surely you can require the dreaded college essay and application packet be delivered on time. Suggested topic: “How to Elude the SS.”

10) Be Proactive: Invite their friends over on weekends, start a bowling league in the basement or set aside an arts and craft’s room near the Blue Room. Keep their friends close.

I hope you take my suggestions freely and without any mental reservations.
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1) To get serious about yoga

2) To cook more tofu

3) To walk more, even if it’s cold

4) To do something that scares me (Karaoke?)

5) To laugh loudly and often

I’ve never been a New Year’s resolution type. I used to attend the Borough Hall Annual Reorganization Meeting at noon on New Year’s Day and take copious notes through a hangover haze for the newspaper. “Each year at the Reorganization Meeting, the Council adopts a resolution setting the order of business for each Council meeting.” It takes forever, so and so police officer was awarded something; the zoning plans have changed to reflect such and such.

But now I’m only required to attend a hospital gala on New Year’s Eve, to dress to the nines and make merry at a local winery. I can sleep in without children at home or a care in the world…well, maybe a few.

I have a cold. It’s not the flu, got the shot, but some bugs got through to make my nose run and my throat scratchy. Bob is working, so I’m on my own to push fluids and make my own chicken soup. I managed to try my second martini in 40-something years last night, and decided it still tastes like gasoline. I thought it might help my throat, and the 2 sips I took did seem to numb my tonsils.

My order of business for 2013 is staying true to my philosophy of small steps. In order to grow, we must change and challenge ourselves, to do something scary. Notice I didn’t resolve to go to the gym and lose 20 pounds – just to walk… even in the cold and cook tofu. To quiet my mind with yoga and lighten my heart with laughter. The Love Bug is learning to laugh, and just being with her brings me great joy.

I wish you all a peaceful and joyous New Year! We may not be able to influence those in Congress today who are playing games with our country’s reputation in the world, but we can vote them out tomorrow. And we can start the New Year introspectively, as the Dalai Lama says, “The inner peace of an alert and calm mind are the source of real happiness and good health. Our human intelligence tells us which of our emotions are positive and helpful and which are damaging and to be restrained or avoided.”
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There’s snow on the ridgeline this morning. I’m back in my mountain home after 10 hours on the road with my 4 month old Bug and her parents. She did well for about 7 hours with many stops, which is 1 hour more than my limit in a car. And yesterday I did the hand off to the other set of grandparents for their New Year’s week visit. In the midst of this transition, after my long stretch of babysitting, I had a nightmare.

The Bride was leaning back on the balcony of a large white iconic building (hospital?) and she fell slowly over the edge. I watched incredulously but could not reach her in time. When I looked over, she was hanging on by her fingertips. “Help her!” I yelled at Bob and then promptly woke up in a sweat. She had worked 5 straight nights in a row (including Christmas Eve and Christmas) and before that, 4 daytime shifts. Shift work takes its toll on a body, just ask any nurse or police officer.

“Society is oriented toward traditional daytime work hours and work at night will often intensify fatigue and reduce alertness. Workers generally will not acclimate to night work, and sleep patterns will generally be disrupted so the non-work periods do not provide full recovery, resulting in sleep deprivation. Studies suggest that it can take up to 10 days to adapt to a night time work schedule.” http://www.osha.gov/OshDoc/data_Hurricane_Facts/faq_longhours.html

When I was writing about normal holiday stress, I didn’t factor in having to change your circadian rhythm or nursing a 4 month old baby. I always joked that Bob became a director because he didn’t want to work nights; only it’s not a joke. He won’t do nights, he sleeps…at night. If he met a doc who wanted to work nights, he would hire him/her immediately. Keep this in mind future EM residents, if you are a night owl, you have an advantage.

Naturally, the Love Bug is off her schedule. Babies will change it up just when you figure it out, but this little nugget has been in 2 different homes the last few days and her mama was away many nights and sleeping-in many mornings. I tried to explain it all to her, I told her that she can be very proud of her mommy for saving lives. I told her that things will get better in the New Year. Her daddy and I did our best to play guitar and sing her to sleep at night. Hang on baby girl. Our country may sail over a cliff, but your mama is on solid ground.

My big news of Christmas week is the birth of 2 brand new baby girls! Congratulations and welcome to the world Great Nieces’ Francesca Lynn and Evan Margot. Have a very happy and healthy New Year everyone!
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Someone once told me that you have to live in a place for at least 10 years before it becomes home. When I was young, I called Victory Gardens home. It was a development in NJ for the support staff that worked at an arsenal during WWII. It was meant to be temporary; four rooms and one bath made out of concrete. We lived on Washington Avenue, all the streets were named after presidents. I would dream about this house for years, because this is where I learned what love is.

When you marry an Emergency Physician, you also learn to love moving. It was never easy. I’ve made friends in other states that will never be replaced, the kinds of friends who know where the spoons are in your kitchen. Women who would supply all the flowers and food for the Rocker’s bris without ever asking or saying a word about it. Women who would show up to escort an au pair to the train station, thereby saving her from physical harm and me from an arrest record.

And I learned to love each place. The snowy farmhouse at the edge of a bird sanctuary in the Berkshires. The brick, mid-century modern between two rivers on the Jersey Shore. And I’m learning to love my view of the Blue Ridge, on the cusp of Mr Jefferson’s Monticello and his Academical Village. This is the place where the Bride met her Groom and now the next generation is just beginning. They are making their home in the Music City and the Rocker and Ms Cait are feathering a new nest after super storm Sandy.

“Home” is the best gift we can give our children. That feeling that we belong, that we are loved unconditionally. It doesn’t matter where we find ourselves today. We were all tucked in our beds, in TN, VA and NJ. Well except for the Bride. Santa found her anyway. Wishing you all a warm and lovely Christmas.
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