Pain pills and trauma care

People rarely die of prescription opioid medications they are prescribed. 
Well, duh. Sounds about right.

even those on high doses for chronic pain don't get "addicted": They might need to be withdrawn slowly from the medicine, but the psychological problems of addiction are not there (i.e. they take it to get rid of the pain not to get high).

The opioid crisis got bad after I left practicing medicine and moved here, but I know of two deaths in people who stole narcotic medications from cancer patients and died of an overdose. One was a known druggie, but another was a 13 year old girl at a party who was told to "drink this" and did. She was unpopular so obeyed the girl who gave it to her (probably as a joke). The source of the narcotic was the girl's grandmother, who kept liquid morphine for break through pain in her purse. Sigh.

but the dirty little secret is that the little old ladies often sell or borrow pain pills from each other because... arthritis pain.

A lot of older people just use a single mild opioid tablet at bedtime so they can sleep.


Yes, NSAIDs are just as good: indeed, for a lot of pain they are better, because they relieve inflammation: but in the elderly they have the risk of bleeding ulcer and kidney damage, so may kill more people than prescription opioids. So which are safer? It's hard to do a "clean" study, since the abuse cases and suicides confuse the statistics LINK

as for the suggestion to use Paracetamol (Tylenol), sorry: it just doesn't work as well, and it only lasts for 4 hours so you have to take a lot of pills to stay comfortable and again they do not relieve inflammation (which causes pain).

Drug abuse is a societal problem.

But of course, if you acknowledge it is Chinese fake percocet/ oxycontin /Fentanyl being smuggled in via Mexican drug cartels, you might have people actually saying yes build that wall to keep out drugs.

and my question: Where are the churches here? Isn't this a moral weakness to use drugs to get high? And how many take drugs because they were in despair, and no one was there to comfort them?

Ah, but PC churches have different priorities: Too busy worshipping Pachamama and changing Wikipedia pages for their enemies I guess...
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The Good news: from StrategyPage: Freeze dried plasma will save lives.

you give it to people suffering from blood loss. Plasma has been used since World War II (one of my professors was in charge of the blood bank using this to treat D Day casualties) but the new version is portable and doesn't require refrigeration.

The bad news: The French have been using it since 1994, and the US military has been using the French version since 2010 but is still trying to get the paperwork done to make it for the USA.

Article on the history of treatment of shock with plasma and blood transfusions and with IV fluid. LINK

A black physician, Dr. Charles Drew, developed the logistics of providing blood to the injured used in World War II.

His pioneering research and systematic developments in the use and preservation of blood plasma during World War II not only saved thousands of lives, but innovated the nation’s blood banking process and standardized procedures for long-term blood preservation and storage techniques adapted by the American Red Cross.

The Strategypage article notes other lifesaving methods devised for the military and now used in civilian life, such as hemecon and woundstat, used to stop bleeding and the abdominal belt to stop internal bleeding from the aorta.

not mentioned: Don't forget the helicopters.

The opening scene of MASH shows the helicopters bringing in the wounded, but in the last 30 years, helicopter transfer for civilians is becoming more common: Indeed, when possible they will land at your car accident site or near by (e.g. in parking lots) to take you to the Emergency room in some isolated rural communities.


the bad news: Consumer reports laments often they are used when alternative transport is available, leaving the person with a huge bill. But the problem is that when you call the ambulance, you don't often know how serious is the injury, or if the patient might die at the less equipped local hospital, or deteriorate during the long ambulance ride (when I worked in Northern Minnesota, it was 6 hours to Minneapolis and three hours to Fargo by ambulance... and in rural Pennsylvania a trip that is ten miles by map might take an hour and 30 miles by the mountain roads).

This article about a central Pennsylvania auto accident discusses how people are rescued and transported by medivac helicopter. 

I know the area.

Boalsburg is 30 minute drive to state StateCollege and another one hour or more drive to Altoona and in this case, the helicopter landed in a nearby parking lot.

the maps insist it is only a 45 minute drive to drive the 49 miles, but that is not true: that assumes the car accident happened near the interstate highway, that there is perfect weather, and that you can break the speed limit... 
And the dirty little secret is that it is hard to care for a critical patient in a noisy moving ambulance or in a fixed wing transport...

(I have no experience in the helicopters but these medevacs are well equipped, with experienced personnel, so things are less primitive than when I used to make ambulance runs in ambulances or in the fixed wing Cessna owned by the local undertaker that we used to borrow in the 1980s to transport people 150 miles to Rapid City from the Reservation).

My son in law is a Medevac pilot, Keep him in your prayers. 

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In World War I, those suffering mental problem from combat were said to be suffering from "Shell shock".

And the SP article cited above notes that yes, post traumatic stress syndrome is more common in those who had mild brain concussions from IED explosions.

While largely the result of being exposed to a lot of combat, it was, by the late 1990s, realized that head trauma, usually from being too close to a lot of explosions, played a part as well. Work on PTSD continues, especially now that more methods have been developed, including medicines...

more HERE. 

however PTSD also occurs in civilians who had traumatic experiences. WEBMD discusses diagnosis and treatment.

Joe Kenda (of Homicide Hunter) discusses:

Kenda knows he suffers from post-traumatic stress disorder similar to what military veterans experience, and the show is a way for him to release some of the pent-up stress that still eats away at him to this day.

“It doesn’t go away,” says Kenda, who worked his way up to commander of the Major Crimes Unit. “You can’t un-see those things, you can’t not think about them, and you can’t forget them, even though you want to...

There are certain events that will trigger a memory, and it’s startling. Imagine having a nightmare while you’re awake. That’s what it can be sometimes.”

Sigh. Been there, done that. We docs see a lot of horrors too, cases of suffering we couldn't stop, or abuse cases or accidents, or of treatment that didn't work,  and you keep busy so just put the memory in a box and carry on. But after retirement, the memories pop back suddenly, and all I can do it give the problem to the Lord...

sigh.

(cross posted from my regular blog.)

The Village of "idiots"?

Interesting BBC article discussing a small isolated hill village in India where one quarter of people are mentally or physically disabled.

Poverty and bad diet, probably...but why did it start in the 1950's?
the article suspects iodine deficiency caused by the Cassava diet.
Most rely on a diet of rice and cassava, known locally as nasi tiwul. But certain substances in cassava can inhibit the uptake of iodine, which in turn can lead to birth defects.

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Iodine deficiency

• Iodine deficiency is the most common cause of preventable brain damage

• The WHO estimates that more than 30% of the world's population have insufficient iodine intake

• Since the 1990s there have been efforts to introduce iodised salt in iodine-deficient countries

• UNICEF estimates that 50 million people worldwide live with intellectual, motor and hearing disabilities due to iodine deficiency

And the good news is that the rate of birth defects is down with some help with food and a local midwife who monitors diet.\

cases like Campret's have sharpened Mulyadi's resolve to prevent more children being born with disabilities. That's why he's taken it on himself to monitor every pregnancy in the village, especially those of women who are disabled, encouraging them to eat a healthy diet with plenty of green vegetables.
And for those who can't get to the local hospital, which is 45 minutes away, or who can't afford a scan, he will offer to take them in his car and pay.
Within the village, there is also now a health centre with a midwife and a doctor. The result is encouraging, says Mulyadi. "In the last few years there haven't been any babies born with birth defects."

you know, when I worked in rural Africa, the students got supplements in school and most of the women got prenatal care and vitamins, so most were ok in the IQ area.

But when I worked in Liberia, I was almost in despair with the local's low IQ's, including many of the staff.

They ate cassava and rice in Liberia, so maybe that was an iodine problem too. Or else because few women breast fed (leading to a very high infant mortality).

Which of course shows the problem with Eugenics (including it's newer versions of "no immigrants"): IQ in the world is going up with good nutrition.