Balls and Walnuts
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Category Archives: The Barbarous Craft
Thirteen abused drugs
My my my I’ve been quiet this week. Comes from spending all my time at Daily Kos.
It’s been a while since I did a medical thirteen. As always, going into this I wonder: can I think up thirteen interesting drugs? Sure I can. People put all kinds of narsty sheeit into their bodies.
1. Thyroid hormone. What can be wrong with increasing the rate with which you burn fat and carbs? Thyroid hormone would seem to be an ideal diet drug. Hey — it’s natural! Shame about the risk of dying.
This is an axolotl. Axolotls have something interesting in common with humans: we’re both products of neoteny, i.e., arrested development. We humans are baby chimps — hairless (some of us) and big-headed (some more than others), while axolotls are salamanders who haven’t made it through metamorphosis. But if you add thyroid hormone to an axolotl’s water, he’ll complete metamorphosis and turn into an adult form that has no business walking the earth.
Sometimes I wonder if there’s a similar drug for humans, one which will allow us to complete our metamorphosis and become Neanderthals once again.
2. Banana peels, AKA Mellow Yellow, AKA bananadine: conclusive proof that kids will smoke or swallow anything. No, I never tried this, although I did eat some dried button mushrooms thinking I was eating shrooms. I guess they really were shrooms, too, of a sort. Anyway, Mellow Yellow is an urban legend. Wikipedia has the full scoop.
3. Pemoline. I love the trade name: Cylert. Makes my heart race just to hear it. Pemoline was used by British pilots during WWII to stay awake, and nowadays, folks sometimes still use it for ADD, narcolepsy, or fatigue syndromes. Case reports of liver damage serve as abuser buzz-kills, so watch out.
4. Amanita muscaria, or fly agaric, has a long and fascinating connection with the history of religion. Here are some good bits from the Wikipedia article:
“Amanita muscaria is widely thought to be the Soma talked about in Rig Veda of India,[15] and is less often also thought to be the amrita talked about in Buddhist scriptures.[18]
“John Marco Allegro argues in The Sacred Mushroom and the Cross that the Christian religion is derived from a sex and psychedelic mushroom cult.[19]
“Ethnobotanist and ethnomycologist Giorgio Samorini suggests in his book “Animals and Psychedelics” a symbiotic relationship between toads, flies and fly agaric. Flies, after a lick of Amanita Muscaria become inebriated and delirious prey for hungry toads that may have learned this, therefore hanging out around toadstools.”
Dig the frog!
5. Nasal decongestant sprays like Afrin or Neosynephrine have addiction potential. How does your nose get hooked on sprays? If you use it for too many days in a row, you develop rebound swelling after the initial decongestion. This causes congestion, which prompts some people to use more of the spray. I’ve had patients who go through a bottle a day.
Here’s your public service message for the day: read the damned label and follow directions.
6. THC, the active ingredient of marijuana, for those of you who like the effects but hate the smoke (and are too lazy to bake brownies). Doctors prescribe THC for its painkilling and nausea-suppressing properties. Does anyone abuse this stuff? Hard to believe. All I know is, THC turned my sober Vulcan wife into a giggling Valley girl. I was very disturbed.
My favorite marijuana story (stop me if I’ve told this one):
In med school, I had a patient with Peutz-Jeghers syndrome who chainsmoked joints and was convinced the freckles on her lips were all throughout her GI tract and were showing up on her stools, too. She used to bring in a photo album of her stools to prove it to her doctors.
“That’s okay,” I said. “I’m just the med student. But thanks for sharing.”
7. Poppers. They sound fun, don’t they?
“Hey, Bob, what’s that you’re using?”
“Poppers, Dick.”
“Poppers? Can I have some, too?”
Amyl nitrite and related nitrites relax smooth muscle, thus making anal or vaginal penetration easier, and may decrease the gag reflex, too. The blood pressure drop can enhance the euphoria of orgasm.
8. Ying Yang Huo, another fun one, AKA horny goat weed. According to this questionable-looking site, horny goat weed contains an acetylcholinesterase inhibitor (like ant poison — sounds good so far!) Somehow, that’s supposed to prolong erections. Hmm.
By the way, while we’re on the topic of goat sex: if someone gives you a link that looks like “goatse.cx”, don’t click on it.
9. Diuretics. Diuretic abuse? You’re kidding me, right? No, apparently some folks with eating disorders use diuretics to peel off a few extra pounds.
I’ve heard of body builders doing this before a competition, and of course there’s a long history of diuretic abuse in horse racing (ever hear the expression, “he peed like a racehorse”?) But anorexics? Yikes.
10. Nutmeg. Another weird hallucinogen. Nutmeg derives its properties from Myristicin A, which “causes symptoms similar to atropine poisoning: flushing of skin, tachycardia, absence of salivation, and excitation of the central nervous system.” And if that’s not enough to get you interested, how about this firsthand account?
At first she felt no effect, but after four hours she felt cold and shivery. Six to eight hours later she was vomiting severely. She saw faces and the room appeared distorted, with flashing lights and loud music. She felt a different person and everything seemed unreal. Time appeared to stand still. She felt vibrations and twitches in her limbs. When she shut her eyes she saw lights, black creatures, red eyes and felt sucked into the ground.
Sounds like a blast! Not.
11. Morning Glory seeds. In case you haven’t guessed yet, hallucinogens fascinate me. Morning Glory seeds contain lysergic acid amides, thus making them about the closest thing in nature to LSD. According to this source, you would have to ingest 100 to 300 seeds to get the equivalent high of 200 to 300 micrograms of LSD. But don’t do it with store-bought seeds, since these are covered with poison to discourage abuse!
That really tickles me for some reason. What’s the message here, if not, We’re so anxious about you abusing this drug, we would rather kill you instead?
12. L’Absinthe. No, this wormwood liquour does not cause hallucinations nor madness, even if you are a Parisian poet or artist. But isn’t it pretty to think so?
13. Viagra, sometimes combined with Ecstasy (MDMA) to form Sextasy (no, I’m not making this up) is now so commonly abused that Viagra addicts have their own AA. Signs of viagraholism include Viagra-seeking behavior and escalating Viagra use. But more fascinating still is alprostadil abuse. Alprostadil is shoved into the urethra or injected directly into the corpora cavernosa. The incidence of penile fibrosis (Peyronie’s disease) with repeated use is around 8%, priapism (often requiring needle aspiration of trapped blood) around 4%. Proving, I think, that some guys will do anything for a boner.
Leave a rude comment and I’ll give you some linky lurve.
Darla’s CFS is kicking her butt. Go give her some love.
Miranda: yet another Canadian visits my blog
SxKitten dreams of Christopher Walken with his clothes on (I think)
Noxcat puts the blame where it belongs
Dean gets all historical on us (with a grin)
Protected Static has teh good taste in tunes 😉
D.
Doctor in the House?
USA is having a House marathon today; Karen has been watching (“because there’s nothing else on but crap”) and I’ve been listening in.
Not long ago, my sister suggested I do a Thirteen on “why I hate medical drama shows.” This is not entirely true, by the way. I have fond memories of St. Elsewhere, particularly since the writers nailed the dynamics between residents and attendings. Plus — Alfre Woodard, Denzel Washington, Ed Begley Jr.? That show had one hell of a cast.
But, yeah, I’ve had it in for medical shows ever since ER opened with the following gem. This guy is crashing in the ER. Trauma to the neck, perhaps — in any case, the ER resident is having trouble securing the airway.
What does he say?
“Wake up ENT!”
Well, eff that actor and eff the writers. Our ER residents worked shifts. On call, we never slept. I never watched another episode (and I only watched the first minute of that one).
Back to House. I like Hugh Laurie, but I like him like this:
or this:
That’s A Bit of Fry and Laurie and Blackadder, respectively. But like so many fine comedians (Steve Martin comes to mind), I guess Laurie got tired of doing his fine comic shtick and took to more serious pursuits. It’s a shame.
Laurie’s House is monotone, monochromatic. His dynamic range extends from nasty to snide and his wit is about what you would expect from a team of writers with modest talent. I would forgive all of that if the team dynamics felt right, or if they got the medicine correct, but (based on the fifteen-second snips I’ve picked up here and there while editing my romance) these writers do neither.
Yeah, yeah, I’m not being fair, you say. I ought to sit through an episode or two. But it pains me, it really does. House’s brilliant deductive skills are the stock and trade of any internist worth his or her salt. At any tertiary care center, the docs are faced with comparable mysteries on a daily basis. (Well, maybe not wives poisoning their husbands with gold-containing arthritis meds from Mexico, but close enough.) But we the viewers are supposed to think this guy is the love child of Sherlock Holmes and Dr. Watson.
I guess what really bugs me is the heavy-handed use of drama in a medical setting. Illness and cure are intrinsically dramatic provided the writer takes care to characterize all the players. Case in point, Alan Rickman’s Something the Lord Made, which I have hyped before (please, please rent this movie). Those writers didn’t need murderous wives, bubonic plague, or herpes encephalitis to capture their viewers’ interest.
Of course, those writers had Alan Rickman and Mos Def on hand to bring their characters to life. As much as I like the (comic) Hugh Laurie, he’s no Alan Rickman.
D.
Healer
Seems like Corn Dog and I are trading wacky childhood stories. Here’s another . . . kinda, sorta.
As a child, my first love was a woman who imagined herself perpetually on the verge of death. I am not a well woman! she would holler, and what did I know? I believed it.
The irony is, she wasn’t a well woman. Axis II diagnoses aside, my mother was a breast cancer survivor in the pre-chemo, pre-radiation, pre-tamoxifen era. She beat the odds.
Somehow, I was responsible — for the loss of her breast, her health, her youth. You took the best years of my life. Did she say that to me or to my father? Doesn’t matter; four- or five-year-old Doug took the blame.
I woke up early one Saturday morning (kids: in those days, we only had cartoons on Saturdays. I had no intention of missing a single one) to find a hole in our den’s screen door. My older brother woke up soon afterward and convinced me I had done it. It didn’t take much convincing; I felt certain I was responsible for everything. And so I made up a lie to deflect my mother’s inevitable anger.
“It was a bird!” I told her when she woke up and came into the den. “It, it flew in, and then it flew out, and it made that hole –”
“That bird was your father’s fist,” my mother said.
You mean it’s not my fault?
(Smart guy, my dad. A dumber man would have punched the wall and broken a few fingers.)
Yeah, it was all my fault. And I was always trying to make it better.
***
Don’t worry, be happy
Last night, Karen and I spent a good bit of time reading Corn Dog’s blog. She writes intelligently and poignantly about illness and healthcare, and her non-medical posts are entertaining, too. Consider this a big shout. Corn Dog deserves a bigger audience.
Patients with serious illnesses have to deal with a lot of emotional garbage. ‘Garbage’ excludes the important work: coming to terms with what your illness means to yourself, to your friends, to your family. ‘Garbage’ is garbage, a huge and largely unnecessary manure pile of guilt.
Anyone who has been ill — life-threatening ill, I’m not talking about broken bones here — knows what I’m about to say, or will recognize it soon enough. You see, the patient’s family and friends expect her to cheer them up. They want the patient to say to them, I’m okay. Really! I’m going to be okay, too. Nothing wrong here, oh no.
They want to hear these things because they’re scared and threatened by the patient’s illness. This fear breeds many odd behaviors, none of which help the patient. I’ll mention briefly the blame the patient shtick: “You have cancer? Oh, my. I’m so sorry. Did you smoke?” The healthy person searches desperately for reasons why it cannot happen to him. Doctors, friends, family members — everyone wants to blame the patient for her illness, for her “failure to respond” to treatment, for her “bad attitude.” The unstated assertion: If it’s your fault, I feel much better.
A public service announcement
As a doctor, I often forget that what is common knowledge to me may not be common knowledge to my patients, nor to many of you. Information of vital importance doesn’t always get the attention it deserves.
Thus, I’d like to draw your attention to the following study on reducing the risk factors of prostate cancer (Journal of the American Medical Association, April 7, 2004):
Men who ejaculated most often actually had a 33% lower lifetime risk of prostate cancer, and this relationship grew stronger as men grew older.
For example, men who reported 21 or more ejaculations per month in their 40s had a 32% lower risk of prostate cancer later in life compared with those who reported between four and seven ejaculations per month. Men who reported more than 21 monthly ejaculations in the previous year had a 51% lower risk of prostate cancer.
Overall, an average of 21 or more ejaculations a month during a man’s lifetime decreased the risk of prostate cancer later in life by 33%. And each increase of three ejaculations per week during a man’s lifetime was associated with a 15% reduction in prostate cancer risk.
Hmm. Let’s do the math. In order to achieve a 100% reduction in risk, I need to average only 35 ejaculations per month for the rest of my life.
That’s a lot of sperm.
In order to get the word out, I’m thinking of selling some merchandise through Cafe Press. If you’re interested, let me know.
D.
PS: YES, I know it’s Breast Cancer Awareness month, which is a buttload of controversy all unto itself; but I’m not feeling emotionally or intellectually ready to say anything intelligent about breast cancer. I have my reasons.
Prostate cancer, though . . . something I could get . . . I can work with that, particularly if it means getting out the Sex Is Good For You message.
PPS: Do you think the caption (Ask me how YOU can reduce my risk of prostate cancer) is too subtle? I dunno, maybe this would be better:
REDUCE MY RISK OF CANCER.
FUCK ME.
Yeah, no one would get confused by that.