poppy.gifAccording to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

meth-1.pngMETHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300


LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers. ecg_evol1.gif

This data is from the 2004 National Center for Health Statistics, the latest full database.  Prevention is the key in almost all of these killers.  With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top.  For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%





DIABETES MELLITUS……………………………..3.1%






Sometimes this medical man must make the leap from meth, cocaine, cheese heroin, disability, west nile, herpes, and death…to a topic that is close to the heart and mind.

In the blogger world and the internet world, many brilliant minds exist in a community open source manner, while many other minds (even some the same) coexist in a competitive free market manner. They so far seem to have been a symbiotic relationship at the least.

But a reminder from www.castMD.com now, as it is important. We as bloggers must pay closer attention to this “Net Neutrality” issue. This is how I understand it. Right now, internet is paid for at all levels. About 26 of them. I pay a company to provide access to the net, that company pays the next, the next pays the next…eventually to a major backbone of internet ability. These access points are not “pipes” as one Senator stated in Congress. Everyone gets paid some money along the way…

What may be happening in the telecom companies, is access restriction! Unlike other countries, especially Korea, China, Japan, access is being looked at like your cable or cellphone.

You want what, when, and how fast?

Right now, the IPhone is with AT&T I believe, after Verizon company turned it down due to strict competitive requirements. So, my contract will not allow me to get an IPhone. I cannot get a different phone with ALL the features, because some aspects of cellphones are turned off…or blocked…so the company can RESELL the access to you – EVEN though your cellphone is set for it.

My examples are real but may not be exact for the internet neutrality issue. BUT, what if my SkyNet said you can have only the internet sites that are not commerce related? What about no .com, or .biz sites? But for 100 dollars per month, I can have the .com sites? Or what if a block on all .edu sites was placed for the colleges and universities, unless a million dollars per month is paid by the college or university? Another example is whether or not your access speed would be limited? So, the telecoms give access to the “slow speeds” of uploads and downloads, yet more money for the “real” speeds.

UTube is extremely bandwidth intensive. In the beginning, without the principle of internet neutrality, the telecom ISPs most likely would have restricted bandwidth speed available to their users for viewing the site. Video traffic would slow to a crawl unless the startup business was ready to pay enormous fees to the “gatekeepers” in order to access “their subscribers.” Obviously, a startup in its infancy would not have been able to pay these fees, or would have had to grow slower or die on the vine.   The gatekeepers want to absolute control to all the access to every data pak through the internet network.  Everyone is already paying!

The meeting review on the issue might stimulate your awareness.


A review of this issue and faqs is at: SAVE THE INTERNET




Manage albums


Those darn "yellow-bellied" marmots.  Yes, my wife and I did talk with the Minister of the Blog-O-Sphere last Saturday at the Shabby sale.  I was telling him, while my wife laughed WITH me, not AT me the infamous tales of the marmot wars going on at our home.



Manage albums

We live up on a hill.  It has always been peaceful.  Then one day, while playing my guitar sitting on the deck…I see what??  This big flowered plant in my wife’s garden area is shaking back and forth.  What??  Did my eyes deceive me??  Looking around the lawn and into the aspen trees, no wind was noted.  Then suddenly, like someone had yelled, “TIMBER” in my ears, the plant fell over..crashing into the lawn.  Now one might think I was crazy.  But, I carefully placed my guitar on the stool…walked over to the now fallen beautiful comrade.  Yup…eaten flat across…sharp dissection as with a scalpel blade…less bloody in vision, but more bloody in revengeful feelings.  Let the war begin! 

Manage albums

We had been having trouble with some of our plants and flowers.  It continued randomly until more lakeside building below us happened.  These marmots, cute, furry, and cuddly, are quite the resistant critter.  What to do.  One of the local varmint guys said, “All’s you can do is shoot ‘em.”  In the neighborhood I thought?  Hardly.  Plus, they’re stealthy and quick.  They watch for you.  A squeak from a door alone will alarm their defensive dive into the ground.


We saw an ad or product about keeping the varmints away.  They were these submarine-torpedo looking aluminum rods.  Standing about 20 inches tall and 2 inches in diameter, with batteries loaded, you push them into the ground.  At random times, a signal is sent shaking the earth…maybe similar to the new movie, Ocean’s 13.  Well, anyway, we had these avenger rods throughout our garden and greenery.  Day after day…the plants were felled like a clear-cut in the woods.  What were we to do…?


We thought there was a rather large family reunion of these varmints, marmots now called of the squirrel family…near one of our home-grown rock planters.  I paid my son and his buddies years ago, a dime for every rock bigger than their hands, to build these planters.  This area became ground zero.  So, the water hose it was, "water boarding," I thought.  We waited and stalked the critters.  Flushed for hours, trying to make their life miserable.  What did I see?  I swear to the Almighty, one of them sliding down the hillside, like kids on a Slip n’ Slide®!


Now knowing that my enemy was strong and well fortressed, it was time to talk with more professionals.  Well, my attention was directed to the smoke bombs.  These things are more powerful than Superman, more web entangling than Spiderman, and more dangerous than CatWoman.  So I purchased a sleeve of these poisonous smoke producing rods.  Well, off to the planning stage again, securing a savagely strategic plot against those critters.  No more buying flowers and plants redundantly.  Think of the money to be saved.  Early retirement I thought.


So, I carefully inspected the hillside.  Monitoring each and every move by these unwelcome visitors, THIS plan would become the "Mission Accomplished.” 


While holding my breath literally, I lit one of these smoke bombs and slid it into the hole.  Then number two into another, then number three, and lastly number four…like torpedoes being called from the master.


I thought this will be it.  Victory so close to grasp. 


After about three to four minutes, happily watching from my perched binocular position, an amazing universal, near existential experience was witnessed.  My whole hillside now smoked, not the four holes…but hundreds.  Like the exhausting sulfur gas fields of Yellowstone and Glacier, the property was steaming with this poisonous smoke. 


Within a few minutes, I thought, someone is going to call the Fire Department due to all the smoke.  Outlet after outlet, the rising smoke then diminished.  It was over.  The offensive was over.  My observation keen.  Success.


Call me crazy, but thinking back, I swear the smell of cigar smoke was amongst the gas-smoke smell.  Could those little furry varmints have been sittin’ back with a cold one, smokin’ a cigar in their cozy dens, watching the doctor’s next strategic play? 


The next morning, about three more plants had been felled…But soon, new construction left huge rocks and boulders about a block away.         

It seemed they found a new territory.

Manage albums





A recent article in the AARP Bulletin highlighted an email of a drug company's inside commentary on drug representatives and their impact on physicians' practices.  Congress was on this subject of how doctors obtain information years ago, and rather than mandating legislation, the Pharma Industry limited themselves.  Now the irony here is that, all the Pharma Industry now advertises the millions and millions of dollars for their new drugs on television, cable and non-cable, radio, and the print media.  How many ads of erectile dysfunction have you seen or watched in the last few years?  What about allergy drugs?  Those ads seem to be everywhere also.

Meanwhile, most doctors get some of their information from drug company representatives.  The doctors of yesteryear were wined and dined – alot.  But all that has changed.  Company meetings for continuing medical information and education are sponsored for cost.  However, the rules are tight.  No trips to Hawaii have ever been offered to me, in 25 years or so.

Now the medical appliance industry, like the artificial hips, pacemakers, etc., are not included in the Pharma SELF-imposed rules.  This industry works like many others.  Recently my awareness was stretched when a person told me ALL hundreds of employees of a beer industry were wined and dined, golfed, and brought to a city with alot of casinos!  All on the company.  And recently a marketing company took hundreds of employees to another city for 3-4 days, for their needs.

Now, most doctors do like to see drug representatives.  We do get good and current information from the reps.  If the doctor has a brain, he or she will and can challenge the drug rep with his product, his information, and his competition.  This is good information.

Literally, thousands of patients through the years have asked for "Any free samples?" Many times we can accomodate some starter paks of medicines that have been given to us by the pharmaceutical representatives.  Most clinics get some samples for patients.  According to a recent study over 75% of clinics get free samples.  Many times the reps will sponsor quick to the point luncheons.  Some doctors join company panels to discuss the highlights and controversies of new therapy.  So, what is the big deal?

Most pharmaceutical reps are good people.  Most earn their living by providing information currently and timely.  Most doctors are good people.  Most earn their living by providing good patient care.  Most patients are good people.  Most enjoy and sincerely appreciate a "few samples" to start their drug regimen.

Now, with the costs of drugs so high, and the pressure on the drug companies to limit free samples or starter paks, it would seem to be soon – a policy that will be forced out.  This will be a loss for the underinsured, uninsured, family of four parents, and others that look at the costs in general of healthcare and delay or eliminate their prescription all together.

The billions of dollars spent on "direct-consumer-advertising" that is endorsed by the FDA and other federal, state, and societal organizations is the first place to cut drug costs.  Those ads drive the physician by patient requests.  Get rid of direct to consumer advertising.  Next, get rid of the massive class action suits against all the companies.  The U.S. has driven the vaccine industry out of the U.S. and the drug making is not far behind.  If the vaccine shortage concerns did not awaken some fear in you, this should.

So, soon, patients will say good bye to free samples, free starter cost reduction cards, and reduced up to date physician information.

As for me, trips, rock n' roll collections, and tennis racquets have not crossed my desk….And to say they do is just crazy by a biased author.  And some of the doctors will stay "chummy" with professional colleagues in the pharmaceutical representative business.  Some might call that professional interaction and ethical education…


Stroke and other cardiovascular diseases are linked closely to high blood pressure.  In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked.  Most of these studies have been a type of case control showing high probable causal relationship.  Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue.  In the study, persons were given about 2.6 gms or 2.0 gms of salt daily.   Another group of placebo was a control also.  The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period.  This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group. 

We have long known this concern of salt and high blood pressure and other cardiovascular diseases.  Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day. 

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %.  In many developing countries however, the personal use is the burden of salt.  Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation.  More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it.  Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products?  Dear ol' Mom probably had it right when she said, "Not so much salt!" 

So next time you pick up the product, do a salt survey.  Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk.  The debate appears to be over.  Salt can take a toll.  Be a wise shopper and a wiser eater. 

Salty popcorn with butter anyone?  Remember, more fiber, less salt, less trans-fats….Yuk!

Mature Older 55+ Crowd and the Internet

Saw a recent article in a magazine on the over 55 crowd.  Besides still listening to crooners, rock n' roll, and elvis (sightings often), the crowd is internet savvy.  In the game category, over 55 in the slotsites are 2/3 of the internet seekers.  Surprisingly, obituaries at one site are logged onto by the over 55 about the same amount of time.  Puzzles, investments, genealogy all run about half of the logged on are in the over 55 crowd. 

This is opposed to the 25-35 crowd that find the parenting sites, over 55 %, while family issues, shopping are frequented in the mid forty percents.  News, sports, and other items run in the 30s percent on those type of websites.

So, if you are in the over 50 crowd, now you know where your colleagues are and your kids!   Wink

DVT – DEEP VEIN THROMBOSIS – POTENTIAL SILENT KILLER – planes, trains, and surgeries


My grandfather had been in the hospital after a minor surgery.  Remember years ago, even small procedures were done in the hospital by the general practitioners or early surgeons and patients were held in the hospital for days.  Just shortly after my father returned from seeing his father, our telephone rang.  I remember seeing his face change and his voice quiver slightly.  But dad was a strong man.  He said to all of us, a big family, and my mother, that grandpa had "some trouble" and that he needed to go to the hospital right away.  Only, not just dad went, but mom went hurriedly along also.  Grandpa died that few moments between my dad seeing him, and returning home, about 5-10 minutes.  Grandpa died of a pulmonary embolism, a clot in the lungs that travelled from his leg, after that small procedure.  Certainly a sudden and quick death, a reality that still exists these days.

Deep vein clot (thrombosis) is a relatively common, and a very serious potential disease.  We see those patients in the emergency room, immediate care, and certainly worry about many more.  The mortality and further injury (morbidity) from clots in the legs is not in the leg!  The risk occurs from associated lung clots (pulmonary embolism) and a rare condition of post-clot syndrom (post-thrombotic syndrome). 

There is not one specific symptom or sign that clinches the diagnosis.  The elderly have rates of DVTs in the 200/100,000 range while younger people have rates of about 50 per 100K.  The clots occur in the higher deep veins of the legs, or from extension of clots in the lower legs – even though this risk is lesser.  When clots in the lower leg veins extend, the risk of lung clots goes up.  The problem with DVTs creating the lung clot (PE) is that symptoms can range from sudden death to minimal at all symptoms.

In a doctor I knew, his clot formed during a long airplane ride and he lived.  In my grandpa's case as told by my father, it was sudden death.

Risks for developing DVTs in the leg veins are:

conditions:  cancer, pregnancy, blood disorders, kidney disorders, estrogens, and smoking

stagnant movement:  surgery, immobility, paralysis, obesity, extended travel

other:  previous DVT or PE increases risk, and trauma increases risk.

If patients have any two or more of these, they really become at risk.  Symptoms that patients can feel or see are: swelling of the leg compared to the other side, calf swelling, localized tenderness of the calf or leg, new pain or numbness in the leg.  There are other causes of these same symptoms, therefore you should see a doctor without hesitation.

Your doctor will most likely go through the above lists with you.  But your doctor will be concerned.  Lab tests will be drawn most likely and an ultrasound of your leg will be ordered stat.  Usually if both of these are negative, the cause is not a clot.  If the ultrasound is positive, you will begin treatment.  If the blood test is positive and the ultrasound is negative, you will probably have a repeat ultrasound in about a week.

Treatment consists of starting the pill, warfarin, for "thinning the blood."  But this takes days for the body to change.  Therefore, almost all patients will need to use injections of a heparin substance that "thins" the blood quickly.  Usually, patients will need to be on heparin medicine for 5 days or so, or at least until the pill warfarin reaches a therapeutic level in your bloodstream. 

Patients will need to use compression stockings during this time and after the event to minimize risk of recurrence of DVT.  These stockings also help prevent the post-thrombotic syndrome of pain, swelling, inflammation that can become a chronic condition. 

Risk of recurrence never goes away.  That is why proper treatment and post-event planning is so important.  Expect to be on medicine for 3-12 months after a DVT or PE.  Risk reduction knowledge goes a long way. 



After yesterday, castMD must speak out again.

The Emergency Departments are at a break point. A year or so ago, almost 3/4 of all medical directors said their ER has inadequate specialist on-call backup! There are fewer specialists in general surgery being trained, and neurosurgeons are at a standstill in training numbers. Many of the ortho, neuro, and plastic surgeons are older and not being replaced in numbers.

Yet the numbers of ER patients is exploding in numbers. Many patients are uninsured, underinsured, and have serious illnesses and injuries. ERs must see, triage, treat, and plan for each one without asking for a dime upfront. Declining reimbursement with increasing costs is a martial arts contest in the ERs. EMTALA dictates ERs must see everyone! The on-call specialist to the emergency doctors have high liability with these patients. Some specialty groups have stated one third of their groups have been sued by patients that they have responded to in the ER patient's time of greatest need.

Many ERs have closed, and more will. Many hospitals cannot continue to absorb the see all and sue all patients under the mandated-free care system. It is broken, and yesterdays marches reminded me. No one should be turned away in a critical time of health-need, but the system is critical now.

Washington State did not pass tort reform. Why work there? Why be on call to an ER that will lead the doctor to critical patients with high malpractice risk? You wonder why doctors quit being "on-call" to trial attorneys. Oh, did the drycleaners mistake settle for the 60+ million yet?


This is the time of year when lawn chemicals, yard cleanups, and neighborhood events start to be exposed and available to little hands.  Certainly many chemicals, including pesticides, herbicides, fuels, and cleaning agents are ubiquitous in homes and garages.  But beware.  Many of these chemicals are poisonous and dangerous with regard to flammability, explosiveness, and chemical burns.

Each dollar invested in poison centers saves about seven dollars in expenses not needed if the patients go into their doctor, their clinics, or their hospitals.  This is a great public health service.

Over the years since the early 60's, the poison centers have become an integral part of the healthcare network.  Now with the terrorism issues, the poison centers have become an integral monitoring source of information, as many times calls come to the poison centers early and often, thereby making a grid of what is happening and where it is happening.

For instance, when the bad botulism toxin product that was being used by spas and clinics that were trying to save money by not buying and using the approved botulinum toxin brand, the poison centers were seeing a problem early.  Patients across the country, in pockets, were being paralyzed – not just the muscles of the eyebrow, forehead, and other smaller muscles.

The poison centers across the USA now have a single number.  Depending on your area code, your call will be forwarded to the center in your area, or the one contracted by your state officials.  For instance, Idaho calls go to Denver's poison center.  Alaska's poison calls go to Oregon.  Washington's poison center gets all of Washington State's calls.  This year that number will be around 150,000 calls!   Poison calls are answered by an expert group of pharmacists, nurses, Pharm Ds and have backup by physicians specializing in toxicology and poisonings.  It is the number that the experts in all fields, from dermatologists to kidney specialists, call when the patient has been poisoned, or is toxic from unknown sources, or when the patient doesn't act or change based upon "normal" disease states.

The goal of Poison Prevention Week is to reduce illnesses, injuries, and deaths due to poisonings; build safer communities; and reduce unnecessary health care costs for everyone.


Here are some ways to be poison cautious:

Obtain syrup of ipecac and keep it in your home – but use it ONLY if instructed to do so by a poison center or physician

Use child-resistant containers and remember, they are not childproof

Keep products in their original containers

Never call medicine candy or take it in the dark

Return products to storage areas immediately after use

Teach children about Mr. Yuk

Put Mr. Yuk stickers on all poisonous products  

Call the Poison Center for a free information packet and Mr. Yuk stickers  

Keep emergency numbers next to your phone:



What is National Poison Prevention Week?

Public Law 87-319 authorizes the President to designate annually the third week in March as National Poison Prevention Week. This act of Congress was signed into law on September 16, 1961, by President Kennedy, after which the Poison Prevention Week Council was organized to coordinate this annual event. Congress intended this event as a means for local communities to raise awareness of the dangers of unintentional poisonings and to take such preventive measures as the dangers warrant.

(PC week and listing adapted from WAPC.org website with commentary from castMD.com)