December 2013
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December 2013 posts

What parents and teens should know about marijuana

In 2012, Washington passed legislation to legalize marijuana use for people 21 and over.  While still illegal for those under 21, it is important to understand how this might affect adolescents and children.

Facts about marijuana and teens:

  • In a 2009 national study, 32.8% of 12th graders had used marijuana in the last year, and 20.6% within the last month.
  • One in eight adolescents who start using marijuana by age 14 become dependent.
  • When prolonged marijuana use starts in the teen years it is linked to a significant drop in IQ points - and the decrease is irreparable.
  • Marijuana can affect memory and concentration, cause or exacerbate depression/anxiety/hallucinations, and negatively affect asthma and other chronic lung diseases.
  • Marijuana is much more potent now than in the past.  In 2012 the average concentration of THC in marijuana was 15% (compared to just 4% in the 1980s).
  • Harmful effects occur whether marijuana is smoked, ingested, or vaporized.  “Edibles” are becoming more popular, and present unique risks.  It may take longer to feel the effects when ingested rather than smoked - this often leads to users consuming more than intended and experiencing severe side effects.
  • Adults cannot “share” with teens - it is felony to provide marijuana to a minor.

What you can do as a parent:

  • Start the conversation early - begin talking to your child about marijuana and other substances by about age 10.
  • Set clear expectations that marijuana is like any other drug, and is illegal for anyone under 21.  For example ...

Happy Holidays - Not

I will never forget my first holiday season as an internal medicine resident in Spokane, WA. I learned that the holidays are a nightmare for the medicine service, especially the GI service. Many people don't take their medication during the holidays. The GI service is the worst in that patients with liver disease often drink more and develop major bleeding in their gut. People are depressed and the stress of the holidays puts them over the edge.

We had a resident’s clinic once a week. One of my favorite patients was an 80 year-old gentleman who was as nice of a person as you could meet. He had some moderate lung disease but otherwise was fairly healthy. He was admitted to the hospital on Christmas Eve with respiratory failure. It did not make sense to any of us, as his lung disease was not that severe. We had a whole team working intensely to solve the puzzle. It did not matter. He died two days later. During the course of the hospitalization I found out that his son who lived in Seattle had not invited him over for Christmas and he had become despondent.  I have since learned that the will to die is as strong as the will to live.

My descent into loneliness

I could not figure this increase in illness and depression over the holidays for many years – until I descended into my own anxiety-driven depression and chronic pain. There were many ...

Why you should care about fatty liver disease

The liver is a vital organ necessary for survival.  It performs crucial functions including protein synthesis and detoxification.  When excessive amounts of fat and lipids accumulate in the liver cells, this can lead to liver injury and cause a disease called fatty liver disease.  Fatty liver disease is a serious diagnosis that has become one of the most common causes of abnormal liver function tests in the United States.   Fatty liver disease is also referred to as Non Alcoholic Fatty Liver Disease or NAFLD.  NAFLD is associated with other diseases which influence fat metabolism, such as type 2 diabetes.

Why is fatty liver disease important?

NAFLD is a single disease seen in both alcoholics and non-alcoholics, especially in those who are overweight.  When a biopsy is taken of a fatty liver, features of liver injury and fat deposit in the liver may be seen.  These findings are of crucial importance as fat accumulation may cause progressive inflammation of the liver over time.  This is called steatohepatitis.  Unfortunately, NAFLD may progress to cirrhosis. Cirrhosis is scarring of the liver, which may mean someone would later need ....

Swedish Notifies Patients of Omitted Step in Infection Control Process

On Dec. 20, Swedish notified 27 patients treated in the same day surgery unit of its First Hill hospital that one of the four steps in an infection prevention protocol for a piece of equipment used in a prostate-related procedure was omitted. Infection control has determined the omission occurred over a three-month period. Because the other steps in the protocol were properly followed, Swedish believes the risk of infection is extremely low. Out of an abundance of caution for our patients, we have directly notified each of them and recommended they receive appropriate testing and evaluation services.

View the KING 5 news story, including an interview with Swedish Chief Medical Officer Dr. John Vassall, here.

Grieving and the holidays

A cancer doctor is very familiar with the anxious and fearful grief that accompanies a diagnosis of cancer. We are less acquainted with the lonely and empty grief that is experienced by those left behind when our patients die. However, when I wear my hospice medical director hat, I am privy to those struggles, and knowing that the loss of someone close is particularly difficult during the holidays, I have chosen to divert from subjects I am more familiar with and rely on the experts at hospice to help me present a meaningful discourse on grief during the holiday season.

For the bereaved, the joyous holidays trigger emotions of great conflict. Every act of preparing for the holidays, once a time of cheer and anticipation, becomes another stabbing reminder of ones loss. The demands of family and friends, always a bit stressful around Thanksgiving, Hanukkah, Christmas, and New Year, now are overwhelming, both physically and emotionally. Traditions, designed to create love and family unity, now seem empty and may even create divisions among the grieving. Even successful celebration may bring on a deep surge of guilt for enjoying the holiday alone. And those who have no physical or emotional reserves left for thanksgiving or joy making, may feel great pressure to “get on with their life, and join in the fun.”

It has been suggested that the key word in grief is “permission.” The bereaved need permission from themselves, and from family and friends, to grieve as long as necessary and in any way that works, remembering that what works may not always be the same. It means permission to only do what you can. A turkey and all the trimmings may just be too much this year. Eating out may be perfect. Having someone else do dinner may be better yet. 

Permission may also be needed to change some timeworn traditions. It must be recognized that ...

New options for genetic testing in pregancy

Congratulations!  You just found out you are pregnant and so many things start going through your mind.  When you’re not dry heaving or completely exhausted you start planning for your exciting future but in the back of your mind you wonder… how do I know everything is okay with my baby?

We are entering an exciting time in the field of obstetrics that involves less invasive and more accurate options for genetic testing in pregnancy.  ACOG, the American College of Obstetrics and Gynecology, recommends that all women, regardless of maternal age, be offered prenatal testing for chromosomal abnormalities. 

For quite sometime our options for this testing have been somewhat stagnant.  We have offered noninvasive risk profiling that involves a mixture of blood tests and ultrasounds at various times in the first and second trimesters to help evaluate the baby’s risk for Down syndrome or other lethal chromosomal abnormalities.  Depending on how these tests are processed, the sensitivity ranges from 80-95% with about a 5% false positive rate.  They are fairly accurate at identifying babies at higher risk, but can have false positive results (meaning an abnormal result followed by more invasive testing that shows normal results but of course this causes a lot of worry for the patient). 

Obviously we want to be able to offer testing that has a high rate of detection and a low rate of false positives.  More invasive testing is often offered also.  This testing involves removing a sample of placental cells called chorionic villus sampling, or removing a sample of fetal cells from the amniotic fluid called amniocentesis.  These cells are then analyzed for chromosomal abnormalities.  Although these invasive tests are the most accurate, they do carry a small risk of miscarriage or fetal loss. 

Fortunately, new testing has come out on the market called cell free fetal DNA testing.  This is ....

Am I Operating on Your Pain or Anxiety?

I have noticed this year that many patients with significant structural anatomic problems will improve or resolve their symptoms without surgery after engaging in a self-directed structured approach.  It appears that as the nervous system calms down that the pain threshold rises.

Surgical decision-making

The barometer I use before I help patients make the final decision about whether to have surgery is whether they are sleeping well and their anxiety levels have dropped under a 5 on a scale of 10. My experience with performing surgery on a patient with a “fired up” nervous system has consistently been less than satisfactory. Pain control is difficult and even the longer-term results are marginal. There is often still a significant amount of residual pain.

I recently saw ....

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