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5 Drugs we’re seeing in ED & Psych right now and what you need to know.

5 Drugs we’re seeing a lot of right now!  What you need to know!

Images of parents and grandparents passed out from Heroin overdoses and their child (grand child) in the back seat flooded Facebook and social media platforms in the past few weeks.  This drug epidemic is not isolated to the northeast, California or far removed areas – this drug epidemic is seen in all locales, countries and cities and is absolutely non-discriminatory affecting all races, religions, socio-economic backgrounds, ages and sexes.  The following is a list (in no order) of the 5 most common drugs we are currently seeing in Emergency Departments and Psychiatric facilities, especially here in Palm Beach County.

  1. Heroin – We have seen an explosion in the number of heroin addicts in recent months and years some of which can be attributed to the closure of pill mills but truly many of my patients were introduced to heroin through “friends” in school and college. Sadly, much heroin today is being “cut” with dangerous fillers such as Fentanyl, Dibutylone, Carfentanil and even Flakka which is why we are seeing so many overdoses.   These added substances directly affect the patients breathing so much that patients cannot support their own breath.
    1. Class Opioid
    2. How is it used: Snorted, Smoked, Injected, Inhaled?
    3. Signs/Symptoms: Overdose, “nodding” excessive sleepiness,
    4. Additional Problems: Hep C, HIV, Abscesses, Septicemia, Endocarditis, physical dependence – many of these life threatening.
    5. Treatment: Buprenorphine (now also implantable), Detox and Rehab, Methadone
  1. Cannabis – While medical marijuana can be extremely beneficial for certain conditions we are seeing a rise in patients being seen in psychiatric facilities more for the side effects of excessive use than sheer numbers of those addicted. For example, of all substances addicted to cannabis patients have the lowest level of encounters in Emergency Departments or Psychiatric facilities.
    1. Class: Cannabinoids
    2. How is it Used: Smoked, Dabbed, Inhaled (Vape), Ingest (edibles)?
    3. Signs/Symptoms: Extreme Paranoia, hallucinations, depression, Dry mouth, dizziness, coughing
    4. Additional Problems: Has been linked to increased schizophrenic breaks, Tachycardia (sustained heart rate at 120 beats per minute).
    5. Treatment: Abstinence! and treat the symptoms hydration, possible arrhythmic if elevated heart rate persists, watchful monitoring.  Patients can return to normal in most cases by refraining from use.
  1. Synthetics – Remember the face eating patient in Miami a couple of years ago and most recently the cannibal patient in Jupiter, both patients had apparently used “synthetic” drugs, drugs mostly manufactured in China, in large commercial factories. This is a really hard class of drugs to detect initially as drug developers stay one step ahead of drug tests. But the behavior we see is unforgettable. Patients often arrive combative, with superhuman strength, paranoid with dangerously elevated temperatures and its not unusual for them to remain in this state for 2-4 days and more. Unfortunately, some patients do not recover!
    1. Class: Synthetics
    2. Common Names: K2, Spice, Flakka, Gravel
    3. How is it Used: Smoked, Injected, Inhaled, Ingested, Snorted?
    4. Signs/Symptoms: Extreme Paranoia, hallucinations (visual and auditory), delusions, superhuman strength, elevated body temperature (remember the pictures of patients running in traffic and stripping off their clothing) aggression, violence, seizures, chest pain.
    5. Additional Problems: Rhabdomyolysis, a dangerous condition affecting the kidneys and often requiring the patient to have to undergo dialysis.  Chest pain leading to heart attack, self harm and suicide, Hyperthermia
    6. Treatment:  Initially our main concern is medical stabilization of the patient.  Treat the rhabdo, hyperthermia and other medical issues such as trauma and then treat the addiction with inpatient detox and rehabilitation
  1. Prescribed Medications This is a huge category and everyday we see patients addicted to prescription medications that include Opiates such as Percocet, OxyContin, Fentanyl, Dilaudid.  Benzos such as Valium, Klonopin, Ativan, Xanax.  Anti-Epileptics such as Gabapentin and Neurontin and while these medications are supposedly not “addictive” we do see misuse and signs of withdrawal with psychoactive effects.  Patients will increase dosages to get better effects, can seize if they miss a dose and will purchase medications on the street (Yes, Gabapentin does have a street value). Miscellaneous Analgesics – Tramadol (non narcotic with narcotic like properties) but now a scheduled drug.
    1. Class: Multiple Opiates, Benzodiazepine, Anti-Seizure, Analgesics
    2. Common Names: OxyContin, Klonopin, Gabapentin, Tramadol
    3. How is it Used: Oh yes we have seen Smoked, Injected, Inhaled, Ingested, Snorted, insertion (rectal and vaginal)
    4. Signs/Symptoms: Depending on drug type Opiates will mimic the signs and symptoms of heroin such as drowsiness, sleep, decreased respirations.  Benzos are much like opiates we also see slurred speech and lack of coordination.  Anti-Epileptics – weakness, loss of balance, headaches, slurred speech and seizures/   Analgesics – headache, nervousness, anxiety
    5. Additional Problems: Liver toxicity, Seizures, end organ damage.
    6. Treatment:  Our main concern is medical stabilization of the patient as there are so many side affects associated with withdrawal not least of which is seizures and falls.  We will treat all medical problems and in addition try and make the patient more comfortable throughout the detox process.  Nausea and vomiting will be treated with antiemetic’s such as Zofran.  Persistent Diarrhea with antidiarrheal such as Imodium and withdrawal symptoms with Librium and Clonidine, a blood pressure medication with anxiolytic properties.  In some cases, we will actually use a taper benzo schedule so that patients do not seize.  Following medical stabilization inpatient detox and rehabilitation programs guide the patient through out the rehab process but that is only if this is an option for the patient due to expense.  Outpatient programs are great options too, but again they can be costly and NA and AA are available free of charge and in my personal opinion offer great hope to all addicts.
  2. Alcohol Last, but by no means least, along with Heroin abuse this drug is one of the most abused on the planet. Many of the alcoholics we see in psych facilities are there because they have been Baker Acted in the ED.  Many of the patients we see in the ED are there due to traumatic injury, because they have been found passed out or because they are suicidal (therefore they are Baker Acted).
    1. Class: Alcohol
    2. Common Names: Beer, Liquor, Wine, Hand Sanitizer, Mouth Wash
    3. How is it Used: Ingested?
    4. Signs/Symptoms: Slurred Speech, lack of coordination, poor judgment, loss of memory, loss of consciousness
    5. Additional Problems: Liver toxicity, Seizures, end organ damage.
    6. Treatment:  Our main concern is medical stabilization of the patient.  As stated in the ED we see a lot of alcoholics as trauma patients who have been hit by a car while walking in traffic, head injuries, assaults on the street.  Also alcohol withdrawal related seizures are probably the most violent seizures I have ever had to treat, usually occurring 6-72 hours after drinking has stopped.  We will treat all medical problems and in addition try and make the patient more comfortable throughout the detox process.  Nausea and vomiting will be treated with anti-emetics such as Zofran.  Persistent Diarrhea with antidiarrheal such as Imodium and withdrawal symptoms with Librium and Clonidine, a blood pressure medication with anxiolytic properties.  In some cases, we will actually use a taper Librium schedule so that patients do not seize.  Following medical stabilization inpatient detox and rehabilitation programs guide the patient through out the rehab process but that is only if this is an option for the patient due to expense.  Outpatient programs are great options too, but again they can be costly and NA and AA are available free of charge and in my personal opinion offer great hope to all addicts.

Picture of a Drug Addict  This could be your brother, sister, mother, father, friend.  It’s the banker, the nurse, the student, the teacher, the rich socialite, the impoverished homeless person.

Treatment  

  1. Recognition
  2. Intervention
  3. Stabilization

Treatment facilities with Inpatient, PHP (Partial Hospitalization Program) or IOP (Intensive Outpatient Program), Half Way House.  The draw back with these programs, especially in the US is expense and in other areas of the world sheer lack of availability.

AA:  Alcoholics Anonymous – Free Program with like minded members addicted to Alcohol.  http://www.aa.org  find meetings here.

NA:  Narcotics Anonymous – Free Program with like minded members addicted to Narcotics.  https://www.na.org find meetings here.

Outlook:

From a personal stand point, we are losing the “war on drugs”.  Is our current strategy working? Are we seeing less patients?   With a continued lack of connection to each other this problem is only going to persist. For a different perspective on the war on drugs http://chasingthescream.com.

For more confidential help or if you have a topic you would like discussed – you can call me at 561-866-1211.  Thanks Dolores

Synergy Health and Wellness   Dolores@synergyhealthandwellness.net

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5 Signs You may have Obstructive Sleep Apnea (OSA)

5 Signs You May Have Sleep Apnea

At the beginning of the week we discussed the importance of sleep and one of the sleep disorders that severely disrupts sleep is Sleep Apnea. Sleep Apnea is experienced by nearly 42 Million Americans with 1 in 5 having mild Obstructive Sleep Apnea (OSA) and 1 in 15 having moderate to severe OSA There are three types of Sleep Apnea; the most common OSA which is caused when throat muscles relax and two less common types, Central Sleep Apnea and Complex Sleep Apnea Syndrome. In this article we will discuss the more common OSA.

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The following are some signs and symptoms:

1. Snoring – Often loud snoring followed by gasping, stops in breathing or choking are usually reported by significant others
2. Morning Headaches – Sleep apnea usually causes an increase in carbon dioxide and reduction in oxygen levels in the blood both of which can cause morning headaches which are usually resolved within 30 minutes of waking (as oxygen levels increase and carbon dioxide is expelled). Increasing carbon dioxide levels cause blood vessels to dilate resulting in throbbing and pounding headaches. If you get morning headaches as a result of sleep apnea it usually means that the sleep apnea is moderate to severe.
3. Inability to Concentrate – Due to the lack of restful and restorative sleep. Patients who suffer from sleep apnea often wake up more than 6 times per hour therefore they do not obtain enough restorative sleep leading to brain fog and lack of concentration
4. Fatigue Again, like number 3 patients do not get restorative sleep, wake multiple times per hour and spend many hours with decreased oxygen levels and increased carbon dioxide levels, all lend to fatigue.
5. Dry Mouth or Sore Throat when Waking – due to sleeping with mouth open and dehydration of mucus membranes
6. Irritability, Depression, Mood Swings Due to fatigue, lack of sleep, decreased oxygenation and increased carbon dioxide

Picture of Sleep Apnea Unfortunately the following are increased risk factors for OSA. Male, overweight, BMI >30, Waist Circumference >40, Alcohol, Smoking, Hypertension, Metabolic Syndrome

Treatment
To definitively diagnose OSA patients will need Polysomnography testing. This may not be available to many populations. In the absence of testing a good clinical history, physical and assessment can be completed. Patients are encouraged to :

A. Lose weight (if appropriate)
B. Encourage to sleep on side
C. Refrain from Alcohol and Smoking
D. Exercise
E. Allergy Medications to decrease inflammation and mucus production which may help open airway passages

For those who do have a PSG, CPAP or a Mandibular Repositioning device may be recommended or Tonsillectomy/Adenoidectomy.

Outlook:
Left untreated OSA is debilitating and can lead to depression, anxiety, decreased libido, increased accidents. Patients who employ positive lifestyle changes often see improvement in energy levels and mood. In addition there are interventions such as CPap and Mandible Repositioning Devices that will help the patient obtain better more restorative sleep.

For more confidential help or if you have a topic you would like discussed – you can call me at 561-866-1211.
Thanks Dolores
Synergy Health and Wellness
Dolores@synergyhealthandwellness.net
http://www.synergyhealthandwellness.net


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The Importance of Sleep – Sleep is that golden chain that ties health and our bodies together – Thomas Dekker

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The Importance of Sleep

A lot of people don’t realize the importance of sleep, and good quality sleep,  until they are deprived of it.  Lack of sleep increases moodiness, grumpiness and depression, it is essential for an individual’s ability to function and causes problems in decision making, concentration and just the ability to function.  Poor sleep quality has been associated with a reduction in productivity, increase in weight and increase in accidental behavior.

  1. How Much do I need – This is a tough question and it varies for everyone but the consensus is that most individuals need between 6-10 hours with 8 hours being the average.  Having said that some people can function on 6 hours high quality sleep while babies to 12 year olds often need more sleep.

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  1. What about Quality – Some people get 8-10 hours of sleep yet they awaken tired and fatigued and unable to function at peak performance throughout the day this is because they are not getting enough deep, restorative sleep. For these patients I ask them to keep a diary that notes food, alcohol consumption, exercise and more throughout the day and prior to going to bed.  In addition, patients are asked to rate their day in terms of level of stress and anxiety, the time they go to bed and the time they wake up.   We often find that individuals are drinking caffeinated beverages or alcohol close to bed time and it’s a matter of educating the individual to reduce stimulating drinks and behaviors (exercise) prior to bedtime.  Also patients are going to bed too late, while having to get up early and their sleep quality is interrupted by noise, lights and electronics.  By evaluating sleep environment and patterns we can often easily improve sleep quality.
  1. Alcohol and Drugs, Stimulants Big No No – Sorry!  Alcohol, drugs, caffeine, heavy meals all affect the ability to sleep and are best limited before bedtime.  Also limit excessive exercise before bedtime and try to decompress from job requirements as much before bedtime as possible
  1. Improving Sleep – Create a sleep ritual. Designate a time to go to bed and start preparing about 30 minutes before that time.  A warm bath or shower can relax you, add lavender and even drink cherry juice (high in melatonin) or Sleepy Time tea with Chamomile.  Make sure your room is cool and dark and that your bed is comfortable.  Switch off all electronics or at least place them on vibrate (for all of you that have to take call).  Meditate before bedtime if this helps to relax you.  Studies have also shown that if you mentally think of one thing to be grateful for it can improve your sleep quality.
  1. Environment and Sleep Disruptors:   TV’s, Computers, Tablets all have no place in the bedroom so switch them off or keep them out of the bedroom.  Also make sure that your room is dark, cool and quiet; particularly important for those people who work shift work such as nurses, pilots, doctors etc.
  1. Sleep Testing and Sleep Disorders       True insomnia and sleep apnea are two sleep disorders that need to be throurogly evaluated by a medical professional and because they are so important they will actually be evaluated separately this week.  Patients who complain of fatigue should also be evaluated for psychiatric disorders such as depression, anxiety, seasonal affective disorder (SAD) and bipolar.  Most major medical centers in the US have sleep study clinics and patients can be referred for testing (polysomnography) by Nurse Practitioners, PA’s and Doctors.  Locally Broward Health has a sleep study clinic that can be contacted.  http://app.browardhealth.org/bhmcsleep

Sleep Apps    Sleep Cycle     iPhone and Android Usability: Sleep Cycle is rated number one in the United States and around the world. Easy-to-read graphs help you make sense of your sleep patterns. The alarms and snooze functions are also very user-friendly.

Favorite thing: While you sleep, Sleep Cycle rests under your pillow and works to gather data. The app then uses that information to wake you up when you’ll feel the least groggy

Pandora:  Dean Evenson but also you can select restful music and program your own play list.

Bonus Vanilla, Chai, Almond Milk and Chamomile tea – Warm almond milk add tsp vanilla and chai concentrate with chamomile tea.

Later this week – Insomnia and Sleep Apnea – Signs, Symptoms, Treatment and more !

For more confidential help or if you have a topic you would like discussed – you can call me at 561-866-1211.  Thanks Dolores

Synergy Health and Wellness   Dolores@synergyhealthandwellness.net

http://www.Synergyehealthandwellness.net

 

 

 


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5 Benefits of Turmeric: Anti-Inflammatory, anti-bacterial and fights depression !

 

5 Benefits of Turmeric!

Turmeric a beautiful vibrant orange Indian and middle eastern spice has long been used in Ayurvedic and Chinese medicines for its healing properties and health benefits.  Treating everything from infections to inflammation to calming and stabilizing mood its no wonder that western medicine is now paying attention. Here are 5 benefits to using turmeric and why we should be incorporating this spice into our daily nutrition routine.

Turmeric

  1. Blocks Cancer Cells– Some research has shown that curcumin (Turmeric) can help decrease cancer cells with best results seen in breast, colon, stomach and skin cancer. In studies chemo and curcumin combined worked more effectively in killing cancer cells than chemo alone and curcumin stopped the spread of cancer from cancer cells to other parts of the body.  More research is needed but if we also look at lower rates of cancer occurrence in those countries where between 100-200 mg of Turmeric is consumed there is validity to the argument.
  2. Anti-Oxidant – Curcumin is a powerful antioxidant. Antioxidants seek out and eat up molecules in the body known as free radicals, that cause to damage cell membranes, alter DNA, and even cause cell death. Antioxidants can fight free radicals and may reduce or even help prevent some of the damage they cause.  In addition, curcumin lowers the levels of two enzymes in the body that cause inflammation. It also stops platelets from clumping together to form blood clots.
  1. Anti- Inflammatory & Pain Relief Turmeric and its most potent active ingredient Curcumin contain more than two dozen anti-inflammatory compounds, including six different COX-2-inhibitors (the COX-2 enzyme promotes pain, swelling and inflammation; inhibitors selectively block that enzyme) Dr. Weil. Turmeric research has shown positive results in the treatment of arthritis showing better pain relief when compared to NSAIDS such as Diclofenac (Voltaren) without the dangerous side effects we often see with conventional medicine.  Other studies have also show good results in conditions influenced by inflammation such as fibromyalgia, Crohns and IBS
  2. Diabetes – Great news for pre-diabetics (those with HGBA1C between 5.7 and 6.4 and blood glucose levels between 100 -125). In one 9-month study use of curcumin significantly lowered the number of individuals who would go on to become diabetics.  Additional curcumin seemed to improve overall β-cells performance.  Curcumin is a good adjunct to prediabetes treatment.
  3. Antibacterial: In a March, 2015 Study against 4 common bacteria Gram-positive (S. aureus and E. faecalis) and Gram-negative (E. coli and P. aeruginosa). It was found that Curcumin worked effective as a  broad-spectrum antibacterial by damaging cell membranes so that bacteria could not proliferate.  In these days of increasing antibiotic resistance it we need to find additional antimicrobials with low cytotoxicity (poison threat) and turmeric’s membrane damaging property may work either by itself or synergistically with other antibiotics to treat more resistant bacterial strains and super infections.
  4. Bonus Tip : Fights depression – Some studies have shown that Turmeric worked more effectively than Prozac in tests. Chronic inflammation can decrease serotonin and dopamine levels.  Turmeric is a powerful anti inflammatory and antioxidant agent which can help restore these neurotransmitters and protect the brain, eventually leading to improvements in mood.

 

Turmeric is a Spice:  Add it to chicken, meat or fish along with curry powder, make tea with it, and add to vegetables

Bonus Recipe:

Turmeric Tea – Blend Turmeric Root, Ginger, Lemon Juice into a Paste (I make enough for 1 week and store in Fridge).  Add Cayenne pepper to the paste and add boiling water and natural white honey.  Steep and then strain.

Recommended Dose:  1.5 – 3 Gm of Root Daily

Contraindications:  As with all medications please consult with your doctor before using and especially if you take anticoagulants such as Warfarin as Turmeric may increase the effects, with diabetic medications as Turmeric may increase events of hypoglycemia and if taking acid reflux medications.

For more confidential help or if you have a topic you would like discussed – you can call me at 561-866-1211.  Thanks Dolores

Synergy Health and Wellness   Dolores@synergyhealthandwellness.net or go to my website http://www.synergyhealthandwellness.net