Diarrhea is certainly a “not so talked about” medical condition. But today, at least one kind of diarrhea is becoming quite a medical problem. It is the Clostridium Difficile colitis (colon infection and inflammation).

Physicians, nurses, clinics and hospitals as well as Public Health agencies are seeing a rise in the incidence of this C. Difficile associated diarrhea. This change in the demographics of this disease is toward a younger and healthier group of patients, and not the classic patients.

The typical patients for this “C. Diff.” diarrhea have been the elderly, those with recent antibiotic usage, and those on certain higher risk medications such as clindamycin, cephalosporins, and quinolones. Recent hospitalization and the use of gastric acid blockers, now advertised daily on television and print media are also higher risk factors.

The use of gastric acid blockers has been studied and continues to be. This arena of high use of these acid pH changing medicines in the gut may be contributing to the growth of the C. Diff. more quickly in the gut, than without the acid blocker.

The toxin in itself from the bacteria, can cause worsening symptoms such as toxic mega colon, severe sepsis, perforation of the gut, a need for colectomy (removal of the colon), and even death.

The diarrhea is many times unrelenting. It continues to be watery, sometimes mucous-like, and eventually bloody. But many patients wait to see if the diarrhea will clear. Dehydration and weight loss can be associated with such diarrhea also.

There are both blood tests for the disease and stool tests specific to the disease.

If you are on antibiotics, and develop diarrhea over 24 hours you must call your health care provider or doctor. The best treatment is to stop the antibiotic immediately with your doctor’s order if possible.

Many times two different OTHER antibiotics are used to treat the C. Diff. infection of the colon. One antibiotic for the C. Diff. is only about 80% effective now, while the backup drug is only about 90% effective. But now, resistance is starting to mount to these treatments, leaving patients in severe distress with life-threatening diarrhea and infection.

New studies are being done now using probiotics. Specifically Sacharomyces boulardii and other lactobacilli have been studied. Many are recommending the use of probiotics with the initiation of antibiotics and other antimicrobials.

There are many reasons patients get diarrhea.  But you can eliminate some high risk yourself.  So, do not use antibiotics without a reason. Do not borrow or loan antibiotics. Always talk with your doctor if you develop diarrhea while on antibiotics. When in doubt, call.

CastMD says, “You do NOT want to develop this toxic type of diarrhea.”



A month or so ago the Feds released their workplace data regarding use of drugs while on duty in various jobs and employments. These are the newest data compared to previous studies in mid-nineties.

Industries that continue to have high rates of on the job drug use and use of drugs are those industries in general that continue to have high job turnover rates.

Illicit drug usage among the 18-64 year olds working full-time was the highest in food service and accommodation industry, construction work, entertainment and arts, information services, and management support companies.

The highest rate was 16.9 percent of the food and accommodation employees used illicit drugs in the last month, in the survey.

Construction workers and miners had the highest heavy use alcohol rates at 17.8 percent. Even CEO’s rate was at 8 percent for heavy alcohol usage.

Marijuana continues to lead the pack on illicit drug use for these surveys.

Over 12 percent of the illicit drug users had three or more employers in the past year! Current drug users had twice the rate of missing one or more days in the last month.

Increased rates of illicit drug use were seen in men and lesser paid jobs.

About half of the full-time workers report that their company does pre-placement drug testing. Protective services had the highest rate (76%) of this type of testing, while legal occupations had the lowest (14%) reported in the study.

Only one-third of the workers reported random drug testing policies by their employers.

ONLY one-third of the workers reported they would be less likely to work for companies with random testing programs in place.


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



cheese-drug.jpgAs part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.




All my daughter’s friends were over for their little party.
These eight or so girls, all about 7 years old were playing crazily. You see wintertime had broken in Minnesota, and the summer was near.  But it was one of those days you live for there, vibrant blue sky, gentle breeze, and life’s passions greening up.
Well, the little girls had played on the playground equipment for quite awhile, and in the sand making “things.”   They were drawing chalk style hopscotch boards on the sidewalks, and had jumped rope without any bruises.   Such a great day, such harmony in family and friends with nature watching.
My daughter and her little friends decided it was time to play “hide n’ go seek."   No one better to hide than dad.   Their collective eyes leaked with sincerity of request.   How could any father turn such princesses and angels down for this next fun event, on such a great day, in such prime weather, in Minnesota ?
The "search and rescue" group of small girls began to count.  
Meanwhile, my scurrying about reminded me to tell them to, “Count Loud” and “NO peeking."    They, in unison, guaranteed this with giggles and laughter.
My eye scanned the topography.   Where to hide?   How long would it be to hide quickly, yet stealth like?   Scanning the local yard’s horizon, a brilliant idea now could become reality.   Ha ha ha.   Those little ones will never see me there.
Quickly, quietly, and with ease my legs jumped up into the tree.   This tree was strong.   It could hold an adult, even a hidden stealthy adult.   Lots of those huge Minnesota leaves that would cover all the color of the “hide n’ go seek” secret agent.   So covert.
Hurriedly my arms pulled my body into location, in the tree.   Knowing how to quickly judge and climb a tree was like riding a bicycle or swimming to me.   All those hours building huge tree houses in the skies of tall ash or elm trees now would pay off.   All those limb evaluations of size versus strength and caliber were emblazoned in this climber.   This was a confident spot.
As my arms lifted me into position, with my sitting spot almost prepared, the little girls were starting to rustle.   Shifting my seat gently as not to be heard by doing a pull-up on the branch above, suddenly my stealthy world changed.
As my pull-up ended, my line of sight was slightly diagonally upward.   A loud noise, a squeal.   Then heard of buffalo, a covey of quail, and a wild horse stampede came right at me! My ears were frozen on the word, “TEN” that the little princesses had yelled.   My eyes were beyond frozen to see eye to eye with it.

Squirrel attack !!!   

Yes, man to female animal, face to face, and eye to eye there it was.  No time for a counterattack.   It was cold.   It was heartless.   The attack of the mother squirrel was like no other.   Brutally shown teeth, larger than a shark – claws drawn, sharper than the griz.   Lightening speed, out of no where.   An ICBM loaded and launched at the intruder.   No early warning system for the unprepared “hide n’ go seeker.”   BAM.   The war was on.   Knowing my face had been hit, a cover was needed.  No where to hide now.   Too far up to jump, as a youth might attempt.   Age and wisdom prevented that action quickly.   Swiping away the blood, my fight was limitless but so ill directed.   Not once was there a hit on the enemy despite readjusting my coordinates while in the leaves.   Retreat was the only option.   Cut the losses.   Sooner, not later.   This mother wasn’t retreating from the nest she had so preciously prepared for the family.

The gaggle of girls was coming down the sidewalk.   They too had heard the noisy breach of the stealthy sacred safe place.   It was over…almost.

The “hide n’ go seeker” now did what all attacked, retreating, and severely mentally and physically injured “hide n’ go seekers” do.   Swing out of the tree.   With two great leaps of caliber-calculating swings, my feet hit terra firma.   Solid.   Looking around quickly, the attack was over.  

All the faithful players of the “hide n’ go seek” family game came running. My position was still of a prepared martial arts stance, ready to counter strike as if a secondary push might occur.

“We see you,” they all yelled.   The girls approached quickly to prove they had seen me.   But as they received their victory in game, they realized what was different.   Suddenly, they all began screaming at the top of their choral lungs, high pitched in fear, yelling and running away faster and faster.  My daughter said, "Daddy, you have blood,” and she ran away too, to the safety of the flock.   Reaching up to my face, it was warm, and slippery.   Looking at my hand, realizing my sweat from the environmental battle was not red – it was blood.   Wiping away the blood from my hand to my pants, the flow of blood continued.   A painted warrior of sorts.

My wife came outside to see how things were going with the “hide n’ go seek” game.   She had come around a corner just as the girls were approaching. “My goodness,” she said, “Why did you fly out of that tree…to scare the girls…They were yelling so loud…And YOU looked like a gorilla flying out of the tree… AND you are bleeding!”   “What happened?”  
Re-living it…worse….

As my eyes close yet to this day, that mother squirrel is in my view forever.   Everyone survived. A family moment. A father-daughter memory forever.  And now you know why my 20 something daughter sends reminders once in a while, and why she sent me a shirt with a squirrel on it that states the rules:  “ADVICE FROM A SQUIRREL.”  


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!

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. 



(generic photos from tufts.edu and generic medicines)
The Herald – Everett, Wash. – www.HeraldNet.com

Published: Saturday, April 28, 2007

Toxic drug at Portland clinic causes three deaths

Associated Press


PORTLAND, Ore. – Three people in the Pacific Northwest have died after receiving a drug that was erroneously made 10 times more potent than intended, the Oregon State Medical Examiner’s Office said Friday.

ApotheCure Inc., a drug-compounding pharmacy company in Texas, said an employee made a weighing error in the creation of the drug colchicine, which lead to the deaths. Colchicine is commonly used to treat gout, but in these cases it was being given intravenously to treat back pain.

The drug was sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch of the drug this spring. All three people, two from Portland and one from Yakima, died between the end of March and beginning of April from the toxic levels of the drug.

The defective doses were sent only to the Portland clinic, ApotheCure said.

The Food and Drug Administration said it is investigating the case but believes the problem has been contained.

The Center for Integrative Medicine has since closed, and representatives from the organization could not be reached.

Colchicine works by stopping cells from dividing, which reduces inflammation in conditions such as gout, said Dr. Rob Hendrickson, associate medical director for the Oregon Poison Center. But in excess doses, the drug stops all cells from dividing – eventually leading to organ failure and death.

The medication is not commonly used anymore and the use as a back pain treatment is less common than for gout.

Gary Osborn, a pharmacist and certified clinical nutritionist for ApotheCure, said the situation could have been contained earlier, but the clinic did not contact ApotheCure until nearly two weeks after the first death. He said the second death occurred before the company was able to complete recalling the batch and sending them a new lot. He said this is ApotheCure’s first incident of this sort.

“We are kind of the leaders in the industry,” Osborn said. “But you know what people say, stuff happens.


Copyright ©1996-2007.
The Daily Herald Co.



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)