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This is from the times magazine. They often post cases for people to try and diagnose.. I thought this on was pretty interesting.
Toxic Toking
By LISA SANDERS, M.D.
MARCH 14, 2014
“Dad, I’ve got to go to the hospital,” the young man croaked in a near whisper, which his father barely heard over the hum of the traffic outside the car. “I’m sick again.” The middle-aged man glanced over at his 25-year-old son. His face was drained of color and shiny with sweat despite the frigid winter day.
He took the next exit and headed toward Waterbury Hospital, in Waterbury, Conn.
The young man woke early that morning with the familiar feeling of weight in his stomach that always preceded an attack of vomiting. He forced himself out of bed and did a few quick push-ups. His mouth flooded with the taste of bile — a hint of what was to come. If he could just take his anti-nausea medication and get into a hot shower, he might still be able to fight it off. He worked with his father in his contracting business, and he hated disappointing him.
Kicking a Bad Habit
After he got out of the shower, he felt much better. On the way to work, his father drove him to the methadone center, where he received the daily dose that kept him from relapsing into his heroin habit. But, standing in line, waiting for the little cup of red liquid, the heaviness again settled in his stomach. He gulped the medicine and hurried back to the car.
He sat with his eyes closed as his father drove. Suddenly he was ice-cold; sweat streamed from every pore; acid burned deep in his throat. He knew he couldn’t work. Maybe he could make it to the hospital before he started vomiting. He knew from experience that once he got started, he wouldn’t stop for hours.
When the young man arrived at the E.R., he was drenched. In a small room, he pulled on a hospital gown and lay down next to a large pink basin to wait for the inevitable paroxysms to start. By the time a doctor came in, the patient had been vomiting for a while and had nothing left in his system. He told the doctor that he got these episodes of nausea fairly regularly — maybe a couple of times a month. Sometimes he could tough it out. But far too often, he ended up either here or at the hospital across town.
Inflammation
The young man looked tired and uncomfortable. His skin and lips were pale and dry. His blood pressure was high, and his belly was a little tender. The doctor wasn’t surprised. The results from the blood sample drawn earlier showed elevated levels of pancreatic enzymes, which suggested that his pancreas was inflamed — a condition known as pancreatitis. The pancreas makes the chemicals that break down food in the small intestines. But certain medications, diseases or alcohol can occasionally cause those chemicals, so beneficial in the digestion of food in the intestine, to be released inside the pancreas itself, causing the breakdown of the delicate tissues of that organ. The result is nausea, vomiting and extreme abdominal pain. All doctors can do at that point is to treat the pain and keep the patient from becoming dehydrated from all the vomiting.
Dr. Virginia Brady, the resident on call that day, hurried down to the E.R. after hearing about the young man being admitted with pancreatitis. When she entered his room, he was asleep, a slender tattooed arm slung across his face. He awakened quickly and, after wiping the sweat from his face, recounted the day’s on-again, off-again nausea and vomiting. It was frustrating, he told the young doctor, because he used to think his nausea was caused by alcohol — but he gave that up five years ago. Then he blamed drugs: heroin, cocaine, marijuana — he did them all. But a few months earlier he gave them up too. And the methadone program made sure he stayed clean, he added. But he was still getting sick just as often.
Other Drugs
Brady asked whether he took any drugs at all. The man reported that he took an antidepressant, an antihistamine to help him when he had trouble sleeping and a nausea pill that he was prescribed when this started about eight years earlier. And, he added reluctantly, there was this stuff sold under the name Spice — a so-called synthetic marijuana — that he smoked daily. But it was mostly just a bunch of dried weeds, which he bought at a little neighborhood store. It definitely wasn’t marijuana. Otherwise it would show up in the urine tests he had to take almost every week.
On exam, his blood pressure had come down and his belly was soft and no longer tender. His bowel sounds were quieter than normal but the rest of his exam was unremarkable.
Brady wondered what had made this young man so sick. The nausea, vomiting and elevated pancreatic enzymes certainly suggested pancreatitis. But an ultrasound of his belly showed a normal pancreas. Moreover, patients with pancreatitis usually have excruciating abdominal pain, and this man had none.
Was there something about Spice that could effect enzymes in such a way to suggest pancreatitis but without the abdominal pain? Brady wasn’t sure. But the nausea the patient described — starting in the early hours of the morning, causing unremitting vomiting that got better with a hot shower — sounded like a syndrome she had seen in patients who smoked pot nearly every day. Why marijuana, a drug sometimes used to fight nausea, should in some people produce cannabinoid hyperemesis (as the pot smoker’s vomiting syndrome was called) is not clear. Cannabinoids have been shown to slow down the gut. One theory is that too much cannabinoid in the system slows it down too much, leading to nausea and vomiting. Oddly, virtually all the people who experience the nausea feel much better while they are taking a hot shower. Somehow the water — as hot as they can stand it — makes the nausea disappear. It was the defining quality of the syndrome, described by a physician in South Australia in 2004, who noted that several patients with so-called psychogenic vomiting would get better just by being in the hospital, where they couldn’t smoke marijuana, and taking very hot showers. All were heavy marijuana users. The users who smoked again once more experienced the symptoms.
http://www.nytimes.com/interactive/2014/03/16/magazine/16-diagnosis.html?_r=0#/#habit
Answer
Toxic Toking
By LISA SANDERS, M.D.
MARCH 14, 2014
“Dad, I’ve got to go to the hospital,” the young man croaked in a near whisper, which his father barely heard over the hum of the traffic outside the car. “I’m sick again.” The middle-aged man glanced over at his 25-year-old son. His face was drained of color and shiny with sweat despite the frigid winter day.
He took the next exit and headed toward Waterbury Hospital, in Waterbury, Conn.
The young man woke early that morning with the familiar feeling of weight in his stomach that always preceded an attack of vomiting. He forced himself out of bed and did a few quick push-ups. His mouth flooded with the taste of bile — a hint of what was to come. If he could just take his anti-nausea medication and get into a hot shower, he might still be able to fight it off. He worked with his father in his contracting business, and he hated disappointing him.
Kicking a Bad Habit
After he got out of the shower, he felt much better. On the way to work, his father drove him to the methadone center, where he received the daily dose that kept him from relapsing into his heroin habit. But, standing in line, waiting for the little cup of red liquid, the heaviness again settled in his stomach. He gulped the medicine and hurried back to the car.
He sat with his eyes closed as his father drove. Suddenly he was ice-cold; sweat streamed from every pore; acid burned deep in his throat. He knew he couldn’t work. Maybe he could make it to the hospital before he started vomiting. He knew from experience that once he got started, he wouldn’t stop for hours.
When the young man arrived at the E.R., he was drenched. In a small room, he pulled on a hospital gown and lay down next to a large pink basin to wait for the inevitable paroxysms to start. By the time a doctor came in, the patient had been vomiting for a while and had nothing left in his system. He told the doctor that he got these episodes of nausea fairly regularly — maybe a couple of times a month. Sometimes he could tough it out. But far too often, he ended up either here or at the hospital across town.
Inflammation
The young man looked tired and uncomfortable. His skin and lips were pale and dry. His blood pressure was high, and his belly was a little tender. The doctor wasn’t surprised. The results from the blood sample drawn earlier showed elevated levels of pancreatic enzymes, which suggested that his pancreas was inflamed — a condition known as pancreatitis. The pancreas makes the chemicals that break down food in the small intestines. But certain medications, diseases or alcohol can occasionally cause those chemicals, so beneficial in the digestion of food in the intestine, to be released inside the pancreas itself, causing the breakdown of the delicate tissues of that organ. The result is nausea, vomiting and extreme abdominal pain. All doctors can do at that point is to treat the pain and keep the patient from becoming dehydrated from all the vomiting.
Dr. Virginia Brady, the resident on call that day, hurried down to the E.R. after hearing about the young man being admitted with pancreatitis. When she entered his room, he was asleep, a slender tattooed arm slung across his face. He awakened quickly and, after wiping the sweat from his face, recounted the day’s on-again, off-again nausea and vomiting. It was frustrating, he told the young doctor, because he used to think his nausea was caused by alcohol — but he gave that up five years ago. Then he blamed drugs: heroin, cocaine, marijuana — he did them all. But a few months earlier he gave them up too. And the methadone program made sure he stayed clean, he added. But he was still getting sick just as often.
Other Drugs
Brady asked whether he took any drugs at all. The man reported that he took an antidepressant, an antihistamine to help him when he had trouble sleeping and a nausea pill that he was prescribed when this started about eight years earlier. And, he added reluctantly, there was this stuff sold under the name Spice — a so-called synthetic marijuana — that he smoked daily. But it was mostly just a bunch of dried weeds, which he bought at a little neighborhood store. It definitely wasn’t marijuana. Otherwise it would show up in the urine tests he had to take almost every week.
On exam, his blood pressure had come down and his belly was soft and no longer tender. His bowel sounds were quieter than normal but the rest of his exam was unremarkable.
Brady wondered what had made this young man so sick. The nausea, vomiting and elevated pancreatic enzymes certainly suggested pancreatitis. But an ultrasound of his belly showed a normal pancreas. Moreover, patients with pancreatitis usually have excruciating abdominal pain, and this man had none.
Was there something about Spice that could effect enzymes in such a way to suggest pancreatitis but without the abdominal pain? Brady wasn’t sure. But the nausea the patient described — starting in the early hours of the morning, causing unremitting vomiting that got better with a hot shower — sounded like a syndrome she had seen in patients who smoked pot nearly every day. Why marijuana, a drug sometimes used to fight nausea, should in some people produce cannabinoid hyperemesis (as the pot smoker’s vomiting syndrome was called) is not clear. Cannabinoids have been shown to slow down the gut. One theory is that too much cannabinoid in the system slows it down too much, leading to nausea and vomiting. Oddly, virtually all the people who experience the nausea feel much better while they are taking a hot shower. Somehow the water — as hot as they can stand it — makes the nausea disappear. It was the defining quality of the syndrome, described by a physician in South Australia in 2004, who noted that several patients with so-called psychogenic vomiting would get better just by being in the hospital, where they couldn’t smoke marijuana, and taking very hot showers. All were heavy marijuana users. The users who smoked again once more experienced the symptoms.
http://www.nytimes.com/interactive/2014/03/16/magazine/16-diagnosis.html?_r=0#/#habit
Answer
NSFW:
