The Medical News Report #135

April, 2023

Dr. Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Subjects:

1. Medic Alert—Quick notes

a- 3 different companies have recalled their eye drops for fear of infection

b- Parasite in tap water causes a death from saline nasal sniffs (Ameoba)

c- Comment on the origin and responsibilities of the pandemic; other COVID news including parents rights bill, drug shortages worsen

d- Weight Watchers buys a telehealth company to sell diabetic weight loss drugs

e- Will Medicare Part D cover weight loss diabetic drugs?

f- Democrats turn their back on Parents Rights Bill! 

2.  OB/Gyn Series—Part 9—Opioid Abuse and Pregnancy; treating withdrawal in newborns and mothers

3. New target for Blood pressure; New class of blood pressure medicines

4. Gender Affirming Therapy-part B- medical and surgical therapy (also Part 4 of the series on Mental Disorders in children); Detransitioning

5. Colonoscopy and new blood tests that may as good

6. The Drug crisis in the U.S.—from marijuana to opioids, cocaine, amphetamines, and hallucinogens; crime in youth; The National Drug control Strategy--weak

Weapon of Mass Destruction!

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues.

  Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment, as it is becoming challenging.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects of therapy to look for, and plans for follow up.

  Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. Never stop one without notifying the doctor.

  The more you know about your health, the better your care will be, because your doctor will sense you are informed and expect more out of them.

  Always write down your questions before going for a visit, and accompany those who need it.

Thank you, Dr. Sam

 1. Medic Alert

     a- 3 different Eye Drop companies recalled because of infection risk

      b- Parasite (Ameoba) kills patient from sniffing salt water

      c- Comment on origin and responsibilities for the pandemic; other news including parents rights bill; drug shortages

      d- Weight Watching getting into the obesity drug business

      e. Will Medicare cover diabetic weight loss drugs?

 a- Eye drop recalls-16 states with infections

Pseudomonas aeruginosa

Now 2 more companies with eye drops are being recalled because of infection risk (pink eye—conjuctivitis).

  Pharmedica is voluntarily rcalling Purely Soothing 15% drops that soothes eye irritation. There was a concern about them causinf blindness. 

  A Florida based company Apotex, is recalling 5 lots of Brimonidine, a drop for glaucoma, 0.15%, sold from Feb. 2022-Feb. 2023. Some of the bottles have cracks in the caps.

  Recently, EzriCare Artificial Tears (sold on Amazon and stores over the counter such as Walmart) has been recalled because of one death and multiple eye infections. At least 68 people in 16 states became infected with Psuedomonas aeruginosa and 3 have died. The drops were contaminated by workers, and caused very resistant infections, one entering the blood stream causing 3 deaths. Florida is one of the 11 states.

NBC News, Medicine.net

b- Florida man dies from parasite infection thought to have come from tap water (salt water sniffs)

Amoeba

A man in Charlotte County, Florida (Punta Gorda), just north of Ft. Myers died from a parasitic infection (amoeba) thought to have come from nasal saline lavage using tap water, according to the Florida Public Health Department. Amoeba is well known to contaminate water, in streams and lakes. This patient got it in his brain (amebic encephalitis), a rare but deadly disease if the brain is infected. Normally amebiasis causes gastrointestinal infection and can invade the liver. Most infections are linked to swimming in southern states.

  2 other patients followed were found to have the parasite in their water system out of household faucets.

  Nasal saline sniffs (3X a day) are highly recommended when the nose and sinuses are congested from any type of issue, and many doctors recommended sniffing salt water to rinse COVID out their nose, the entry site.

Clearly salt water sniffs using sterile, bottled, or distilled water would be recommended. Boiling water for 1 minute will sterilize the tap water, but be sure it is cooled before using.

  I have always promoted warm salt water sniffs using a cupped hand and forcefully snorting it up one nostril while the other is closed of with a finger, while leaning over a sink. Nasal irrigating devices are commonly used but only encourage passive irrigation which is only part of getting secretions out of the nasal sinuses. Forcefully snorting the salt water siphons the secretions out of the sinuses and is very effective.

c- Comment of origin and responsibilites for the Pandemic; Other COVID news  

  I have been providing my readers information about the origin and circumstances surrounding the pandemic for about 2 years. I have also reported on the possibility that the U.S. through the NIH-Department of Allergies and Infectious Diseases, chaired by Dr. Anthony Fauci had been financing “gain of function” research on the bat coronavirus, which has never been found in any animal species. It was engineered in labs by changing the amino aids in the DNA of the virus. This was denied in front of a congressional hearing by Dr. Fauci, and lying under oath is a felony.

  I have observed congressional hearings where Dr. Fauci denied any involvement in granting funds from the NIH, or using another non-profit organization (EcoHealth) to hide the financing not only in the U.S., but when it was declared too dangerous to continue the research, it was stopped in the U.S., but continued at the Wuhan Institute of Virology with continued funding from our NIH.

  I have reported on the denials, delays, and lies not only from China but also the WHO regarding the severity of the infections. I have reported there were several scientists at the Wuhan Lab that were infected or suddenly went missing during late 2019 and early 2020. They died or were murdered.

  The Republican controlled House of Representatives will try and get to the bottom of all of us this disastrous pandemic that cost 7 million lives globally, 1 million in the U.S., and disability from long COVID for as many as 15% of those infected costing over 1 million lost jobs.

  I have reported on the tremendous unanticipated effects on the health of our country because of lockdowns, isolation, etc., and with the delays in treatment, cost thousands of unnecessary lives. The latest information from Medpage Today, March 16, 2023, found that maternal deaths surged by 40% during the second year of the pandemic, the worst in Blacks and those who could not gain access to medical care during their pregnancy. It is my impression that the results of the mismanagement of the pandemic were more severe than the virus.

  I have reported on the lack of good treatments and a vaccine that was far from adequate but did lower the hospital and death rate, even though did little to reduce the spread of the infection with multiple power grabbing maneuvers by the federal government. We were told the vaccine would prevent the disease, which was not true.

  I have reported on the contamination and mismanagement by the FDA and CDC, at the cost of trust and belief in those federal agencies, because the administration used them while promoting woke ideology, and socialism/Marxism, more interested in power and control of our citizens. And it has worked. Surely the pandemic didn’t occur on purpose!

  I do not recognize this country, but I pray that our Congress can take back some power to discover the truths about the pandemic, and prepare for the next one, as we face the possibility of another world war. Time is not on our side!!

  Also, the relationship between Big Medicine, Big Pharma, and Big Government is becoming clearer every day. Federal control of our healthcare system is at extreme risk.

Other COVID News

  Soon, the government will stop having the tax payer pay for all of the COVID management, vaccines, and medicine.

  The pandemic is over and so should we be paying for it. However, Big Pharma is planning on charging BIG PRICES for the same to the individual. Hopefully, insurance will cover these expenses, but as usual, those uninsured will be left out.

  Those who are vulnerable will still get sick and need vaccine boosters, but there is still no scientific proof multiple boosters are any better than one each year, and now they are recommending those annual boosters for those over 50 and those with medical issues. It points clearly to the necessity for them to manage their underlying diseases to the max. Unfortunately, they won’t in many cases.

  This is another play by Big Pharma in cooperation with Big Medicine and Big Government to push socialized medicine. We all want every American to have the best healthcare, but regardless of the type of healthcare system, that will never happen. But the millions coming into our country are being given a pass, and we pay for their healthcare.

  Another shocker is the entire Democratic House of Representatives voted against the Parent Rights Bill, allowing parents to have a say on school curriculum, but the bill passed and will go to the Senate.

  This began with the woke, CRT indoctrination and after parents started to get more active in the schools, the Dems, Teacher’s Unions, ec. have tried to shut them out. This type of racist maneuvering is doing nothing but to separate races even more, just another propaganda maneuver to promote socialism/Marxism, and if you don’t understand or believe it, get educated.

  BTW, the NCAAP just put out a warning for Blacks to stay out of Florida. Wake up Folks!! We are losing our country and our freedom. 1000 people per day move to Florida, so I guess we can handle it, but they are more than welcome.

  We still have little to offer long COVID patients, although a recent study is suggesting Paxlovid may help. I continue to see little research for better treatments, and that is where our federal money needs to be spent. COVID money continues to not be spent in the right areas of need.

  We are facing dark times unless our government gets better leadership. 

d- WeightWatchers, inc. buys company to use telehealth to sell diabetic weigh loss drugs 

  When there is a weight loss company so successful to acquire Sequence, a subscription telehealth platform to allow them to sell obesity drugs designed for diabetics.

  WeightWatchers stated that it expects the $132 million acquisition to add to its already most successful nutrition and behavior changing program to dip into a market estimated to be #50 billion in sales by 2030.

  Medicare continue to pay for telehealth visits and will for another 2 years, according to CMS.

  The telehealth physicians can prescribe Wegovy, Ozempic, Saxenda, and Mounjaro, already being sold as quick as it is produced.

  This is a follow up from the March report when I had an extensive report on diabetes and obesity drugs.

  Another note—Metformin, the most common diabetic oral drug has been found to create weight loss as well, but also if taken early for a COVID infection, it has been found that it reduces the risk of long COVID and works better if unvaccinated. Metformin has anti-immune properties, and seems to be more active in diabetics who are overweight or obese. Medpage Today, March 8, 2023

Medscape, March 7, 2023

e- Will Medicare Part D consider covering diabetic obesity drugs?

  Public pressure is mounting for insurance to cover the new diabetic obesity drugs (Ozempic, Wegovy, Maunjaro, etc.) but so far there is just discussion, and if they do cover them, expect Part D premiums to sky rocket, as it would increase up to 19% of the total cost of Part D coverage. Strict rules would only cover obese (not overweight) diabetic Medicare recipients. Some state Medicaid plans are now covering these meds. Canada does not cover these drugs, and the UK for only 2 years.

  Obesity by definition (BMI=35 or greater) plus at least one underlying medical condition is probably going to be required to qualify, and they must be diabetic (120mg/dl or greater fasting blood sugar).

  Part D provides coverage to 47 million Americans. The CDC estimates that 41.5% of people 65 and older are obese.

  So far Medicare reports the savings of health related benefits are not sufficient to spend the $billion to cover the drugs, but studies are showing as much as 15% of body weight loss, which has substantial benefit and more data will need to published before Medicare is convinced.

  Side effects are also more common in older people. Prediabetics, those not diabetic, and all who are just overweight would not qualify, which could be half the population. Some doctors are prescribing these drugs (off-label) to many of their non-diabetic, non-obese patients because of the pressure from them and little value of weight loss programs longterm. It is causing a drug shortage for diabetics, not to mention cancer drugs, breathing medications (276 drugs), according to a Senate committee, and no U.S. agency monitors manufacturers regarding shortages. Can you imagine where this situation is going when so many ingredients are made in China and India

  These weekly injectable diabetic meds cost between $1400-1800 a month. And if stopped, there will be rebound weight gain, because the stomach hormones affected would return. Bariatric surgery is looking better by the day.

  Long term studies are not available and need to be analyzed before Medicare covers these drugs, but public pressure could change that.

NEJM, March 11, 2023

f. Democrats turn back on Parental Rights Bill

  The House of Representative Republicans passed a bill to provide parental rights for school issues. The entire Democratic segment of the House voted no.

  It is so clear that the separation of parents from what is being taught in school is the mantra of all Democrats. This will allow more CRT, racism, and political separation of our country, our parents, and our kids. I can only pray it somehow passes.

  The lies about not wanting the Holocaust and slavery, etc., even being taught in school, is so ludicrous. We all want our children to know about history, good, bad, or ugly. That is how we learn. But preventing parents from having a say what is being taught their children in school is beyond my wildest imagination.

  The socialists don’t want anyone in their way when it comes to any major decisions in this country, and if the feds take over states rights, expect it. Expect a one party system that will fail. They must be stopped!!

  The Senate will vote on the bill in the next few days, but Dems have the edge, so we could be in for a painful future.

2. OB/Gyn Series—part 9—Opioid abuse in pregnancy; therapy for withdrawal in mother and child-new

  Drug addiction continues to be a serious issue with the fentanyl crisis superimposed and 110,000 deaths from them in 2020. 7% of pregnant women use opioids during pregnancy, and 1 in 5 are abusing it. The rate has risen 4X as much in the last decade.

  Unfortunately, alcohol abuse in these pregnant women is just as severe, and addressing this issue simultaneously is critical. Often, there are co-morbid psychological, social, and medical issues to deal with. Dealing with the craving for drugs and alcohol can be helped with oral Naltrexone or its injectible equivalent, Vivitrol.

  The pandemic saw a 20% spike in overdoses and excessive alcohol toxicity, all aggravated by the lockdowns and isolations.

  Drug overdose deaths for pregnant women or those who just delivered has increased 81% since 2017, while non-pregnant women of child bearing age has increased 31%. Methamphetamine, cocaine, and fentanyl were the most common causes.

  Routine pregnancy checks dropped considerably with doctor’s offices closed. Some pregnant women are not taking care of themselves, and have no primary doctor. Individual responsibility by younger patients has dropped to the point that preventative care has disappeared.

JAMA Network Dec. 6, 2022

  Sex with multiple partners, poverty, ease of access to drugs on the street, thanks to Mexican Cartels coming across the border, sex trafficking, and girls becoming pregnant even earlier, have all played a role.

  Abortions are rising greatly, but for those who choose to deliver their baby, one would think if they made that commitment, they would be more responsible during their pregnancy. As long as the government pays a woman more for every child they bare, there will be more babies born to addicted and drug abusing girls, who are more in it for the money than taking care of a baby.

  Babies exposed to drugs in utero may experience developmental consequences including impaired growth, birth defects, and altered brain development. Prenatal drug exposure may impact the child’s behavior, language development, cognition, and achievement long term, according to the NIH. The withdrawal syndrome (abstinence syndrome) is almost assured, discussed below. Autism is rising by the year, and is just one consequence of lack of prenatal care.

  The effects of addicted pregnant women or those abusing drugs has a profound effect on the fetus, not only chemically, but from neglect of the mother’s own bodies and the eventual welfare of their babies.  

Buprenorphine and Methadone in pregnancy

  Pregnant women who are addicted to opioids (mostly heroin) create serious issues for their delivered baby, because heroin and other opioids pass across the placenta to the fetus and create the abstinence syndrome with withdrawal, which cause seizures tremors, diarrhea, vomiting, and possible death. These infants must be treated with morphine tapered doses to treat withdrawal, but now can be treated with sublingual buprenorphine, resulting in a shorter duration of hospitalization, a great advance.

  Methadone and buprenorphine can reduce the percent of fetuses having to suffer. A new study found that buprenorphine reduced the suffering by 52%, whereas methadone was not as successful in helping 69%.

  These drugs can be used in the mother after naloxone (Narcan) administration if compromised. Buprenorphine is being underutilized and although more expensive reduces hospital time for both mother and baby. Hopefully the mothers  can be continued on medication, adding behavioral therapy.

  An even newer FDA approved drug, lofexidine (Lucemyra) a non-opioid medication can reduce withdrawal symptoms in detox. It blocks the release of norepinephrine, a hormone similar to adrenalin that contributes to the opioid withdrawal symptoms. It does not treat opioid addiction directly.

  Also the FDA has approved naltrexone (Vivitrol) for the prevention and treatment of relapse to opioids.   

NEJM, Dec. 1,2022

Cannabis and pregnancy

  Frequent use of cannabis in early pregnsncy has recently been studied regarding its effects on the fetus.

  There was a significant increase in (25%) low birth babies, whether preterm or full term, compared to 18% in women who did not partake in the study.

  There is evidence that cannabis has influence on placental growth with direct regulation by the endocannibinoid system, a neuromodulatory system that plays an important role in CNS development.

  Hypertensive disorders during pregnancy (pre-eclampsia) were another obvious influence with regular cannabis use. Stillbirths were more common as well.

  Recreational use has risen with 21 states now legally allowing it.

  Counseling for not using cannabis should include smoking cigarette cessation, another negative influence on the fetus. These women were also were more likely to be non-Hispanic blacks, single, and never married.

Medpage Today, Feb. 10, 2023

3. Guidelines for a good blood pressure; New class of blood pressure medication; Treating resistant hypertension

  Blood pressure levels have changed over the last few years. In 2014, the target BP was 140/90 if under 60, and 150/90 if over 60. In 2017, the American Heart Association recommended a blood pressure of 130/80 for everyone.

  The American Academy of Family Practice has updated their recommendations recently to a level of 140/90. Their reasoning is that lower blood pressures do not statistically lower mortality rates. In fact, the rate of syncope and falls rises by 3%. The AHA rose the blood pressure target, because cardiovascular disease was rising, and the academicians always feel they must respond with some action.

Medscape-Family Practice, Feb. 2, 2023

  Often hypertension requires an additional blood pressure medication to keep the levels lower than this, and that is where trouble can occur. That second BP med correlates with higher side effects of falls, syncope, and injury.

  This double meds had controversy, and is especially on the high side for those older than 65. Why? Because, older people taking blood pressure medication often drop their pressure especially when standing (postural hypotension), and it is a common reason for dizziness, falls, and injuries.

  Most people don’t take their blood pressure often enough and should, but for those older, who are likely to have some postural blood pressure issues anyway, it is better to be on the high side of BP readings than the low.

  Of course, this is an issue that everyone should discuss with their doctor, and monitor their BPs at home in the sitting and standing position. Doctors need to press patients to be more proactive in monitoring.

  Blood pressure varies with medication, and doctors need this added home BP levels to make decisions about the proper meds and dosage. 140/90 makes total sense for most people, bu follow your doctor’s recommendations and watch your

pressure often.

Resistant hypertension and a new class of antihypertensive meds

 There are about 10% of hypertensive patients who are resistant to the current classes of antihypertensive medications.

  Hypertension is the leading global factor in cardiovascular diseases. The definition of a resistant hypertension patient is one that with 3 diffrerent medications combined, they still can’t normalize blood pressure.

  The new class of medication is baxtrostat, which inhibits a hormone called aldosterone. There have been other aldosterone inhibitors but have lost favor because they cross reacted with an enzyme that also produces cortisol, and that is not good.

  The new medication inhibits aldosterone 100X more than potently than cortisol, and 2 mg of baxtrostat orally once a day lowered the blood pressure on average of 11mm of pressure in the resistant hypertension group.

  It does potentially raise the blood potassium levels, which is the opposite that other classes of antihypertensives can do.

  Adjusting the diet usually remedies the levels, but some had to stop it temporarily. The patients also continue on their other 3 antihypertensives.

  This medication is still in clinical trials, but looks very promising. I will follow its progress.

Medpage Today, November 19, 2022

4. Gender Affirming Care—Part B (and part 4 of the series on mental disorders in children); Detransitioning; New stats on mental disorders in youth from social media)

  1.6 million in the U.S. identify as transgender (??), so this issue is not going away, and the promotion of going trans has been quite politicized and weaponized, so regardless of personal opinions, this movement is increasing.

  Because, of the consequences of taking hormones and having multiple surgeries, it has become a significant healthcare issue, and even though the medical journals are extremely biased for transitioning (revenue), it is my place to report what is known and more importantly what is not reported in U.S medical journals. We are dealing with a health issue that has been poorly studied, and the studies available are short and far from longterm. They are observational only, which is the weakest data published.

  Changing nature has its risks and benefits, and until it is better understood, it is hard to support. However, it is worth a reader’s time to understand what it known. And if a child sincerely wants to transition, it is still a free country. Of course, we pay for it, as the military already pays for it with our tax dollars.

  And without a question, interfering with women’s sports is a travesty, and should be stopped. Sharing showers and bathrooms is disgusting, in my humble opinion. As usual, some red states have already forbidden it before age 18, since at least until the Parental Rights Bill gets pushed through (I pray it doesn’t), parents still have the right and responsibility of knowing what is best for their child, but this issue, as many others, has polarized our country.

Mental Disorders rising very fast!

  Before I begin reporting on gender issues, I found a report that 57% of high school girls experience sadness and hopelessness (was 36% in 2011), whereas 29% of boys experience the same compared to 21% in 2011. This is a 60% increase in girls and 38% in boys, according to the CDC in the past few years. And now the media is pushing Climate Anxiety…..OMG!! As I have pointed out the iphone is a weapon of mass destruction of our way of life and promoting a socialistic/Marxist society, and 1/3 of the Gen Z are on board, with that number rising rapidly.

  There is a movement to raise the age to access social media to 16 to combat this crisis. Kids will get their media regardless of such a law. Besides they are more internet savy than adults are anyway. Think they are going to drop Tic Tok? Adults spend 1 hour a day on this slop, and kids several hours. They don’t care we are handing our country to China.   

  Parents must be taking much more responsibility spending more time with their children, and limiting their exposure to social media with such venomous material. 1 in 3 girls have contemplated suicide. Wake up parents!! This was not the case before i-phones.

  The transgender movement has escalated these mental disorders!!

  Before discussing transgender affirming therapy, it is important that this transition has the other side of the coin, because these clinics popping in most universities sure don’t address the issue equally. Remember, it is no longer equalty….it is equity…the mantra of socialism. A certain percentage decide for several reasons, they made a mistake, and I will report on this excellent publication.

De-transitioning gender

  Since last month, a new publication came out from Doctor Kinnon MacKinnon, a 37 year old transgender man and Assistant Professor in Sociology at New York University. “He” found that it was offensive to talk about people who transitioned and later regretted their decision, and detransitioned.

  With an academic career focusing on sexual and gender minority health, “he” assumed that nearly everyone who detransitioned did so because they did so because they lacked family support or couldn’t bear the discrimination, bullying, and hostility they encountered—nothing to do with their own regret. There is no question thes youngster are being discriminated on.

  A few wanted to transition to a male because they were abused as a child as a girl, and wanted to transition, so that abuse would stop as a male, something not mentioned in any article I have read.

  He and his researchers questioned in depth 40 people who detransitioned across the globe. Most had gender affirming medical treatment in their 20s or earlier. Their answers upended his assumptions.

  Many have said their gender identity remained fluid well after their treatment started, and 1/3 expressed regret about their decision to transition.

  Some were embarrassed to tell their doctors they wanted to stop the transition. They also stated that their doctors were ill-equipped to help them detransition. They also talked about transitioning not helping their mental health problems. Obviously, mental disorders are at the bottom of many of these kids for a variety of reasons. One stated it was more acceptable to be fat as a male than a female!

  Online abuse for those detransitioners was overt and painful, on TikTok, etc. They had many transgender people tell them to “shut up” about their decisions, and even sending them death threats. There goes freedom of speech for those who are looking for support for their decisions, and created more mental problems.

  The obvious conclusions he came to was a lack of supportive care when those transitioning were flooded with support from political and other groups. It was clear if these gender clinics don’t provide the same degree of support to those who are transitioning, and decide to stop transitioning or want to detransition, these clinics need to shape up!

  When this trans community is indoctrinating children at their prepubertal age and older, they don’t give them alternative support who want to detransition, which I suspect is true. This has become another proactive movement by the LBGTQ community, and it is not fair.

  This doctor held a symposium regarding these issues and faced great criticism from the Canadian Health Providers, and LBGTQ groups refused to promote his event, citing   threats to hospitals who were offering youth gender transitioning care.

  Transgenders denounced his event as “transphobia” (what’s new with the liberal radicals). He found that anger abounded when the word “detransitioning” was brought up.

  The 7-8% cited (and trans groups cite only 1.5%) who wanted to detransition would have little support from their communities and were being denounced, obviously shedding important light on the controversy of the subject, and putting “a fly in the ointment” of this movement, which has become totally political, once again separating our country. They lie that it is often regret for transitioning rather than living in a society where transphobia exists.

  The trans groups don’t want any negatives out there while they are fighting hard to gain wide acceptance (sports, showers, bathrooms, etc.). They reject any opposition, rather than accepting the fact that both sides of the “coin” need equal time before a young person takes drastic steps to transition. This is the same group that don’t use the word equality, only equity. Same with racism!

  The bottom line, long term data is still not available about the risks and benefits, and until it is, I am very concerned that major medical centers are more interested in pushing woke ideology and making a “buck”. Until there is, I can not support gender affirming care until age 18, which is the conclusion that some states have already reached. Even finding research dollars to follow these patients to find out what happens to them is lacking for fear of politicization and weaponization of the subject.

  Some stop treatment when the effects of the hormone therapy become undesirable such as male pattern baldness, weight gain, acne, bone density loss, and the emotional transitions (1 in 3 girls contemplate suicide) as well. Some spend thousands of dollars undoing what the transitioning surgery causes (loss of breasts and lactation, fat distributon, infertility, etc.), having facial hair, loss of genitalia, and certainly those who have complications from these types of surgery with bad scarring, disappointment with results, and more regret.

  Later in life, added cardiovascular events (high cholesterol in transwomen will also lower HDL cholesterol, and the effects of obesity and diabetes occur more frequently. Some after trans-surgery, initially were happy but became depressed and developed anxiety, suicidal ideation, and eating disorders. And the confusion of what sex they were attracted to has become a bigger issue than expected, many of whom wind up bisexual.

  Pondering one’s own sexuality, the advantages and disadvantages of being a male or female are all issues that need to be addressed. A third of these patients had reservations about transitioning, but proceeded with excessive  trans friends encouraging them.

Medscape, from Reuters, January 4, 2023

  Reuters spoke to 17 people who began medical transition as minors, and all regretted it. Many said they realized only after transitioning that they were homosexual. Some thought that transitioning was safer or more desirable to transition to a gender that made them heterosexual. Some said that sexual abuse or assault made them want to leave that gender that was associated with that trauma. Many said they had autism, bipolar disorder, etc. that complicated their search for identity as a teenager. McKinnon found the same in his research.

  Many also wish the doctors had spent more time talking about the pros and cons of transition, a true breach of a doctor’s primary responsibility. Doctors who get into this field are obviously very biased and have no intention of talking any child out of transitioning.

  Until there are large scale studies performed, I am very concerned for the kids and parents who go to these clinics, which are popping up across the country. It is also why most physicians don’t even want to discuss the issue and immediately refer them. Evidence based medicine should have been better clarified before allowing these clinics to open (revenue), and obviously that is the main reason, some state legislatures have outlawed gender affirming care before age 18.

  Better decision making for the kids and their parents is a must. Regardless, counseling and great support for those who detransition are mandatory. There are no protocols for detransitioning, which is a red flag in itself. Coping with denouncement from the LBGTQ community, friends, other trans friends, and even negative experiences with their doctors, has been a serious social issue.

  Are children able to make such life long decision making before 18?? If a child has gender dysphoria, time and patience in this issue must be taken and not be referred to a clinic which is one sided. The Endocrine Society’s guidelines for gender affirming care don’t even address the issue of detransitioning. What a mess!

Pubertal blockers (Gender affirming medical care)

  Taking medications (hormones) to block the normal occurrence of puberty is a big step and potentially with negative consequences, and has caused the most controversy. Endocrinologists and or pediatric doctors, who work in these gender clinics need that are in charge of such a major medical issue for a child likely 8-9, must be carefully monitored with intensive record keeping with regarding these children’s behavior, stress levels, counseling, and making sure they want to continue the transitioning. THEY ARE NOT!

  Unfortunately, it is just before puberty that these drugs need to be given to prevent the natural, normal transformation puberty provides, and are kids that young able to be making major decisions without proper education, parental assistance, psychological support, etc.?

  Trying to exclude any part of this care should disqualify a child being able to consider gender interference. Parents are in charge and any political, or ideological group trying to interfere with that, deserves prosecution.

  Some small observational studies are reporting relief of dysphoria, anxiety, depression, and improvement in mental well-being, social interaction and integration with other kids in the children wanting the change, but certainly not the other kids.

  Blocking puberty may eliminate the need for future surgeries like mastectomies (although creating a different sexual organ would still be later in life). That is a factor, if a child and parent can accept the child’s wishes.

  The gonadotropin analogues (the meds to block puberty) suppress the body’s release of sex hormones, including testosterone and estrogen. Not going through puberty, however, may create self esteem issues when being compared to their peers.

  There are primary and secondary sex characteristics for all humans. Primary includes the genitalia, and secondary include breast development and growth of facial and body hair, deepening of the voice, etc.

  If a biological male takes these medications, the puberty blockers will decrease hair growth on the face and body, prevent voice deepening, and limit genital growth and erections.

  If a biological female takes these medications, puberty blockers limit or stops breast development, and stops menstruation, ovulation, and fertility.

  These puberty blockers are taken for a few years (injections monthly or every 3 months, although an implant can be placed under the skin of the arm replaced every year).

  Later, with medical supervision, the youngster may decide to further hormonal treatments to continue feminization or masculinization.

  Side effects of puberty blockers include weight gain, hot flashes, headaches, and injection site swelling, and over time there will be growth spurts, bone growth and density, and future fertility that will be affeced when the puberty blocker is started. Ultimately, cardiovascular disease increases occur. Messing with nature has a cost!

 Height, bone density, and blood tests are routinely followed.

  If for biological males, puberty blockers may prevent enough penile and scrotal skin growth to create future female genitalia surgery (penile inversion vaginoplasty).

  If a child decides to stop taking puberty blockers, puberty will return, although delayed, and there is not much data about how this eventually turns out.

  Puberty usually begins at age 10-11, although it can occur earlier. The timing of starting puberty blockers should be in the hands of a specialist.

  If breasts are present in these genetic females, they may want mastectomies, as the number of cases have skyrocketed with approximately 300,000 adolescents between 13-17 who identify as transgender and want these surgeries. Most are masculinizing procedures (mastectomy) with a very small number having breast implants for those transitioning to females. Parental consent is necessary for any procedure or treatment, under law.

  61% of transgender surgery has been covered by insurance with costs averaging $30,000. Most were white. Imagine what socialized medicine will do to that number! JAMA Pediatrics in Medpage, Oct. 17, 2022.

  Transgender crosses all races, color, creed, and socioeconomic status. Access to care is an issue!

  Gender Affirming Surgery

Bruce “Caitlyn” Jenner—He has now had a California Supreme Court Judge rule that he is now legally a female, which allows “her” to have all identification, applications, and legal documents designated as a female. She had genital surgical reassignment in 2020, according to the tabloids. Breast implants are easy to perform after a few years of taking estrogen.

Caitlyn has taken years to completely transition her identity, and now at 65 feels completely female, especially after the trans-sexual surgery.

  Examples of Adam’s Apple shaving, rhinoplasty (nose), and breast augmentation in transgender patients are below:

Mastectomy in a trans man above right. Hair, makeup, and good looking clothing are all part of the transitioning for these men and women.

  Christine Jorgensen made news regarding this subject in 1952. Renee’ Richards, the professional tennis player, did in the early 80s, but  it has exploded with Bruce Jenner’s notoriety with the infamous Kardashians.

Penis reconstruction takes a free muscle skin flap from the forearm and transplants it with nerves and vessels to an opening in the labia, suturing nerves and vessels and turning the arm muscle skin to create a penis. This is enormously difficult, and often unsuccessful or needs revisions. This photo would be a top of the line result below. These surgeries have not been perfected!

Creating a vaginoplasty is easier by taking the penis and scrotal skin and invaginating them into a pocket created between the pubic bone and anus. 
  Whether sensation can be attained is another story, although, some feeling is expected. Orgasms are not near as successful.

  If the skin of the newly reconstructed penis is not sufficient to create some type of a erectile tissue, a penile implant can be implanted, but still may not produce orgasm. Only the best and most experienced surgeons are successful, and complications and revisions are frequent.

  The fact that the trans has the appearance of the sex they aspire to be is very valuable psychologically and visually for most, and the 20% that eventually have the sex organ changed does improve their satisfaction in being a trans, but must be delayed several years to be the most successful. In other words, these surgeries must be delayed into their late teens or later.

  Genital surgery is much less commonly done than chest surgery (mastectomy or breast implants). Only about 1/3 of transgender patients have genital surgery (25-50% for trans-men and 5-10% for transwomen). It is obviously easier to remove the penis rather than create one.

21  U.S. states are considering gender affirming care for minors (including Florida), and 1 state government has declared it child abuse, so you can see this issue is a hot potato that will receive much more attention ahead. 16 state Medicaid programs are not covering the care.

  There is concern by some that this type of care is fostering pedophilia, and will become another hotbed of political discussion.

Other Surgical considerations

  Otoplasty needs to be delayed until the ear cartilage has started to stiffen, usually around 6 or 7. These kids are most anxious to have their “Dumbo” ears fixed, and it is a relatively simple procedure.

  I preferred not considering cosmetic nasal surgery on kids before age 12- 13, and it depended on how mature their facial features were for a rhinoplasty. The cartilages of the nose don’t mature enough until then.

  Chin and cheek implants (with fillers or actual implants) could be performed at that time (see below). If the jaw is too small or large, oral surgery consultation is recommended if the dental arch is a problem or the temporomandibular joints are causing pain.

I preferred not considering cosmetic nasal surgery on kids before age 12- 13, and it depended on how mature their facial features were for a rhinoplasty. The cartilages of the nose don’t mature enough until then.

  Chin and cheek implants (with fillers or actual implants) could be performed at that time (see below). If the jaw is too small or large, oral surgery consultation is recommended if the dental arch is a problem or the temporomandibular joints are causing pain.

Nose and chin

Buttock implants

Surgical Voice change

  Shaving a larynx (tracheal shave) in front (prominent Adam’s Apple is very masculine) is not an uncommon procedure for trans patients to remove the masculine appearance of an Adam’s apple, but when the voice is altered, half of the patients experienced complications according to a study presented at the annual meeting of the Academy of Otolaryngology and Head and Neck Surgery.

  Adam’s apple shave is much more easy, as shown in the right photo.

Men transitioning to a woman who want more feminine voices must have the leading anterior 1/3 of the vocal cords stretched with sutures caused scarring of the vocal cords potentially creating voice difficulty and inability for the vocal cords to close totally, causing cough and aspiration. Injections of fillers can help. Over time, many of these patients can improve with speech pathology therapy, but the risks and benefits, as always, must be discussed, and an experienced surgeon is mandatory.

Medscape Medical News, Sept. 15, 2022

  Transgender identity and LBGTQ issues will continue to expand as we progress with such a liberal society we are experiencing, like it or not.

  Regardless of the reader’s opinion, religious beliefs, etc. about this whole issue, it is the right of Americans to choose what they want to be “when they grow up”, but who pays for it will continue to be controversial, and trying to exclude parents will never be acceptable for most conservatives.  

  It is critical that proper extensive research be performed by the clinics who are treating these children, to provide the latest information on the risks and benefits of such undertaking over not just years but decades.

  Because there are definitely positive and negative consequences changing one’s biologic gender, and making sure those children who want to transition are allowed to become trans requires major analysis, education, counseling, and support, and data is a must.

  I hope I have given the reader a look at the pros and cons of this most political but yet medical issue.

5. Colonoscopy and other diagnostic tests including blood tests for cancer

Cologuard

Colonoscopy and Cologuard

  Colonoscopy and stool specimen tests have been the standard to detect colon cancer. Some tests are good at detecting DNA from the cancer cells or polyps, and others detect blood or proteins that may be secreted by polyps or cancer.

  Cologuard and FIT (fecal immunochemical test) tests are most accurate using stool specimens, but Cologuard is more accurate than FIT (92% vs 74%). However, there are more false positives with Cologuard (13%) and they increase with age.

  Anyone should be tested for cancer with abdominal symptoms, pain, bloating, chronic constipation or diarrhea. Any change in bowel habits are very important to evaluate. Blood or darker stools require evaluation.

New Blood test good for diagnosing colon cancer

  A blood test (Guardant Health) is an assay of DNA circulating in the blood from a colon cancer. The study was performed in Spain, and the paper was presented at a digestive disease seminar in San Diego. It has 90% sensitivity (detects cancer) and 88% specificity (only detects colon cancer) making it as accurate as stool tests, and certainly a more desirable test as a simple blood test compared to collecting and mailing a stool specimen would be so helpful.

  The study was performed on higher risk people and that means is not a test that is ready for the general population, but hopefully with repeat studies will find its way into being recommended for general population screening. For now, colonoscopy and Cologuard are the best we have.

  Also, realize if there is a positive test, colonoscopy should be performed.

  Sadly, a new study reported that only half the people who have a positive stool test get a potentially life saving colonoscopy. Reasons included concern for pain from the procedure (most are given IV sedation), cost, insurance coverage, copays, and just being lazy. Doctors should be following up on these patients better to encourage a colonoscopy. With early detection od colon cancer, there is a 90% 5 year survival rate. WebMD, January 30, 2023

  Routine screening testing should begin a 45.

Medscape Medical News, May 21, 2022

Does colonoscopy reduce death rates in colon cancer?

A study from Vienna, Austria, continues to demonstrate that screening colonoscopy reduces the risk of developing and dying from a colon cancer, should there be one found at the time of the screening.

  Every 10 years, starting in the 40s is recommended for the general population. Obviously, for those with a family history of colon cancer, those who are followed for colon polyps, and those who rarely have a familial polyposis disorder, should have screenings as often as every 3 years.

  Having a screening colonoscopy every 10 years reduces the risk of an advanced cancer by 40-50% in individuals studied younger than 75. Actual numbers were 6-7% in men and 4-5% in women with fewer advanced cancers and more significant in younger patients.

  It is clear getting screening colonoscopies every 10 years if asymptomatic is very important. This study was for asymptomatic patients with no history of colon cancer in the family or previous polyps in the colonoscopies.

JAMA, Jan. 17, 2023

  However, closer analysis of how effective it really is for finding early cancers, this study found that there would have to be 455 colonoscopies performed to diagnose 1 cancer. These findings were published in the New England Journal of Medicine, Oct. 9, 2022

  One limitation in this study is important….only 42% of those asked to have a colonoscopy agreed and were only followed for 10 years. Had all agreed, the chance of finding more cancers may have increased, and the risk of having a cancer undetected would have dropped from 8.4% to 1.22%.

  It would be advisable to have an initial colonoscopy to see if there are any precancerous polyps present, the precursor for cancer. If there are polyps present, then based on their type, repeat screenings might be more or less important (every 3-5 years).

  Polyps also tend to develop with age, so if in a person’s 40s, they do not have polyps, by no means does that imply there won’t be polyps in the future.

  Some studies have shown a 50% reduction in missing an early cancer with colonoscopy. In other studies using sigmoidoscopy alone reduces the risk of cancer by 33-40%, and in fact, the author states that sigmoidoscopy is almost as good as colonoscopy, which finds most colon cancers in the lower left colon and rectal part of the colon (which is by far the most common place for colon cancer to occur).

  Flexible colonoscopy can allow the entire colon to the  small intestine and appendix can be visualized, but requires anesthesia and is more invasive. It usually requires a gastroenterologist, where sigmoidoscopy is usually performed with a stainless steel tube and can be performed without anesthesia in most cases by internists.

  What does the reader take away from this study? Since 12% of colon cancers occur before the age of 50, performing this procedure in the 40s is recommended. Colon cancer increases with age. See chart!

  If a colon cancer is not caught when it is still present as a precancerous polyps, or when cancer hasn’t invaded the wall of the colon, the 5 year survival rate is 90%. The overall 5 year survival rate for all colorectal cancers is 64% according to the American Cancer Society, therefore don’t ignore screenings.

  As always, a discussion with your doctor, about the wisdom of doing yearly stool tests vs having a colonoscopy every 10 years, is in order. Also the timing for the first screening is important and if there is any family history, screenings are critical and even earlier.

  It is the third most common cancer diagnosed in the U.S. with lung and breast more common with 1 in 20 people being diagnosed in the U.S.

  7 in 10 people in the U.S. are up to date on their colon cancer screenings age 50-75. When a person ceases having screenings is another discussion with their doctor.

Blood test can help determine who should receive chemo after colon cancer surgery (stage 2)

  A new blood test that detects DNA in the circulating blood after surgery to remove colon cancer (stage 2), has been successful in this study to prevent as many as half of patients from being administered chemotherapy in Melbourne, Australia. This dropped the rate from 28% to 15% receiving chemo. If the DNA test is positive, chemo must be performed, as there is an 80% risk of recurrence.

  92% of patients were cancer free 3 years later, but admittedly most want to know the 5 year survival rate.

NEJM, June 4, 2022

6. The Drug crisis—part 2—marijuana, alcohol, opioid and non-opioid pain control and abuse, methamphetamine, and cocaine; The National Drug Control Strategy--weak

46 million people 12 and older in the U.S. fit the clinical criteria for a substance abuse disorder, and 1 in 4 adults report a mental disorder, according to a 2021 National Survey of Drug Use and Health, conducted by the federal government.

  I am still reporting on the Mental Disorders of the Youth in my series, and it certainly overlaps with this report.

  Crime, mental health, and substance abuse are the weapons of Mass Destruction, all accentuated by the iphone!!

  At the end of this report, I will describe what the 2022 National Drug control Strategy is proposing and has yet to make any impact on the unbelievable epidemic of drugs in the U.S. I will also point out several areas totally missing. Maybe a few words, but little action!!!

  A significant percentage of mental disorders (80%) involve drugs in some way, and many prescription painkillers are easily abused. People today are asking for help for their mental disorders in the face of staffing shortages. Appointments are not easy to get.

  Many in crisis will look for outlets and unfortunately drugs can be an easy answer and escape from reality rather than seeking counseling and proper treatment. There continues to be a stigma when admitting a person has a mental disorder. Unfortunately, the pandemic magnified these issues greatly.

Don’t forget Cocaine, Heroin, Crystal Meth, and hallucinogens are still killing!!

  Snorting and smoking cocaine is still very prevalent, and is a common drug smuggled over the border, not to mention other means (air, freight, etc.). Cocaine and methamphetamine are also incredibly addicting drugs, often added to other drugs, especially synthetic opioids.

  I used to see patients with nosebleeds from cocaine use (and often found perforations in the nasal septal cartilage just inside the nose—see photo below). Crystal meth rots the teeth as does cocaine, as seen in the lower photo. Yet, with all the isolation of humans from the pandemic, increased use was widespread.

Crack cocaine is much stronger and much more addicting. The effects are stimulating and make a person happy, confident, energetic, but more use causes anxiety, paranoia, irritability, dry mouth, teeth grinding, high blood pressure, insomnia, and even aggressiveness with violent and unpredictable behavior.

  Cocaine psychosis can occur with an overdose, and if someone experiences these symptoms, someone needs to call TRIPLE 000, according to the Drug and Advice line 1-300-85-85-84. This can call an ambulance and not involve the police.

  Heroin must be injected, although it can be added to other drugs and snorted or smoked. It is the most pure form of the poppy plant, whereas fentanyl, morphine, Demerol, hydrocodones, tramadol, etc. are all synthetic drugs.

  China is the culprit growing ingredients for manufacturing fentanyl, and yet our administration, and yet Biden has not even talked to Xi Jinping ( can you say compromised??). He hasn’t even addressed our enormous drug trafficking over the southern border, and the over 110,000 overdose deaths from mostly fentanyl laced drugs (80%). Come on America, how can we stand for this intended avoidance of crises in our country.

  Amphetamines are the second most abused illicit drug in the world, and causing increasing numbers of hospitalizations in our country from overdoses.

  There is an increased risk of infections and mental disorders associated with amphetamines with higher mortality from overdose, suicide, injuries, and cardiovascular disease. The aggressive behavior created by this drug makes criminals very dangerous. The death rate has doubled over the past decade from amphetamines.

  These drugs are abused to lose weight, stay awake, and get high. These type of stimulants are used in narcolepsy, ADHD, etc. because these people respond in an opposite way than normal people by relaxing them (paradoxical reaction).

  Adderall, Ritalin, Dexedrine, are amphetamines are very good medications properly prescribed, but now they are on the street too, often laced with fentanyl to enhance the high, and killing children and adults who unknowingly overdose because of it.

In a crystal form, methamphetamine, it is smoked in a pipe, as it melts and creates smoke to enhale. It causes similar symptoms as cocaine, since both are stimulants, but much more powerful and addicting.

  Mixing with other illegal drugs, increases the risk of heart irregularities and seizures.

  Kicking the habit of any of these drugs is challenging, and usually requires professional help. There are no approved pharmacological interventions available. However, there is a inactive form of dextroamphetamine, called lisdexamethamphetamine, and trying to switch abusers to this form in studies have been promising in reducing the death rate and hospitalizations.

  Using tranquilizers (benzodiazepines) to come down on a high was associated with higher risk. This drug can be prescribed for those with ADHD and binge eating disorders in those not abusing the drugs. These medications are often prescribed for short term anxiety, muscle spasms, and even vertigo (Valium).

  More studies using this inactive form of amphetamine is ongoing.

JAMA Network-Psychiatry, November 16, 2022

Drug info and Advice Line 1-300-85-84   

NIH website

Doctors now have an easier time to prescribe treatments for opioid addiction finally

  Doctors previoisly have had to obtain a waiver to prescribe buprenorphine, which curbs the desire to take opioids, and it was a barrier keeping many doctors from taking those added steps. Some of these doctors were discriminated by other medical professionals. The lack of adequate number of treating doctors has created a serious issue when clearly this is now the drug of choice to help addicted patients begin to quit.

  We are also closer to having Narcan, over the counter . This is a must. Below is buprenorphine and the brand name Sublocade.

Sublocade time release buprenorphine

Now, the waiver for doctors has been deleted in the latest Mainstreaming Addiction Treatment Act to address the drug crisis. Doctors can get their DEA license now by applying for it without having to take an 8 hour course to qualify.

  This is a small but important step to take the stigma of treating those with drug addiction, and get more doctors to prescribe this very important treatment step. The drug includes naloxone (Narcan) to reverse the effects of opioids yet does not block the  value of pain relief from buprenorphine, an opioid without much less cravings.

  Patients taking opioids and are feared to overdose are great candidates for this combination drug, as a sublingual pill.

Medpage Today, January 5, 2023

  It should be clear that treating opioid addiction is not just about taking buprenorphine. They must seek counseling, AA, and other support groups to “kick their habit”.

Children’s fatal poisonings are rising because of opioids

  Irresponsible people are still leaving opioids around their house and children are dying from accidentally taking them, which was reported in a publication in the Journal of Pediatrics, March 8, 2023. 41% of the poisonings for children 5 years and younger are now from opioids, and 18% were deliberate. OMG!! 65% are happening at home.

Buprenorphine and Methadone in pregnancy

  Pregnant women who are addicted to opioids (mostly heroin) create serious issues for their delivered baby, because heroin and other opioids pass across the placental to the fetus and create the abstinence syndrome with withdrawal, which cause seizures tremors, diarrhea, vomiting, and possible death. These infants must be treated with morphine tapered doses to treat withdrawal, but now can be treated with sublingual buprenorphine and resulted in a shorter duration of hospitalization, which is a great advance.

  Methadone and buprenorphine can reduce the percent of fetuses having to suffer. A new study found that buprenorphine reduced the percent to 52% whereas 69% of patients were not successfully treated with methadone compared to those without treatment.

  These drugs can be used in the mother after naloxone (Narcan) administration if compromised. Buprenorphine is being underutilized and although more expensive reduces hospital time for both mother and baby. Hopefully they can be continued adding behavioral therapy.

  An even newere FDA approved drug, lofexidine (Lucemyra) a non-opioid medication can reduce withdrawal symptoms in detox. Also the FDA has approved naltrexone (Vivitrol) for the prevention and treatment of relapse to opioids. Administered once a month may improve compliance by eliminating the need for daily dosing.    

NEJM, Dec. 1,2022

 (this information will also appear under the OB/Gyn Series in the near future).

Non-opioids for pain

  With expansion of the use of marijuana, NSAIDs, medicines used for nerve pain, acupuncture, and antidepressants has shown hope for some in chronic pain if patients will try these meds and treatments.

  These medications do have side effects such as irritation of the stomach, increased reflux, bleeding issues (you can’t take NSAIDs if a person is on a blood thinner), blood abnormalities including liver dysfunction, and even neuropsychiatric issues with the drugs normally used for neuropathic pain (gabapentin, Lyrica, pregabalin, oxycarbazepine, etc.). We are in incredible need of new non-addicting pain meds, but who is doing the research????

  95% of prescriptions for gabapentin are for off-label pain management, despite gabapentin’s questionable benefit for chronic pain. Most of these prescriptions were written by pain specialists!!

JAMA, Nov. 21, 2022

  Patients are programmed to receive opioids for pain, and there have been many a doctor patient relationship destroyed over physicians refusing to refill pain medicine, refusing to see patients for pain, with bullying, and physical harm including death to doctors and their staff.

  Non-opioids (NSAIDs), exercise, physical therapy, meditation, epidurals, nerve ablations, acupuncture, THC and CBD oils in gummies or smoked, yoga, topical preparations (lidocaine, capsaicin, Voltaren-an ibuprofen) etc. have been studied widely, compared to the benefit of opioids and found that for chronic pain they may be as effective in selected cases. The whole field of pain management needs revamping!! But these doctors need better medications to prescribe. The feds need to fund this research insead of putting illegals up in hotels!!

   The critical thing to note is that pain rarely stays the same each day, and most patients have to learn what will help for different levels of pain.

  Unfortunately, most doctors do not work with patients on a day to day basis, and those seeking a “high” with their pain medicine, will never be satisfied with most non-opioids.

  Street drugs for pain are also available since some are considered plants and not FDA regulated, such a Kratom (an herbal tea), and has been used to treat opioid withdrawal, and according to many who drink these teas get pain relief.

Hallucinogenics

  Mushroom containing psilocybin have been around forever. Recently, this drug, PCP (a dissociative drug) and even LSD have been studied to help resistant cases of depression, and psilocybin seems to be effective in controlled cases, under careful supervision, as well as ketamine. Special clinincs are usng these chemicals under very controlled circumstances.

  However, these hallucinogens will continue to be available on the streets and can be very dangerous especially if behind the wheel of an automobile, including those laced with other drugs. They can last for hours, and create situations leaving the person out of control or disconnected from their bodies and environment.

  Peyote (mescaline) from the cactus, can create some of these symptoms, and some Indian tribes used to use them in their rituals.

  An Amazonian plant DMT can be ingested as a tea called Ayahuasca, another hallucinogen that can be natural or synthesized.

  251-NBOMe is similar to LSD or MDMA, called N Bomb or 251 can be purchased illegally. PCP (phencycline) developed in the the 1950s as a general anesthetic is no longer used but now can be found illegally.

  Ketamine, a veterinarian drug use for anesthesia (and I used in it at the VA while in training to do local surgeries and in animal research) has become a popular special treatment for depression, and has been added to the date rape drug list. But it causes hallucinations and increases wild dreaming similar to LSD.

  Ketamine poisonings are up 81% since 2019, as recreational use of this chemical. In this study, 40% of callers asking for help, reported intentional use or abuse, and 20% were involved in suicide attempts. 1/3 of these people were also taking tranquilizers, opioids, and alcohol.

J Pharmacologicology, December 7, 2022

  Plants such as these have been found to stimulate some of the brain neuroreceptors as opioids in a known system called the endocannabinoid system.

  Most of the claims about their benefit are anecdotal, but I have known people who have found great benefit, but got addicted to them, and fortunately got off of these herbs. So if a plant can help pain, it can still addict!!! Where is the legitimate research? And yet, it can be purchased in certain bars and vaping facilities right here in Florida.

  This is where the FDA is shamefully not studying Kratom, and others like it, to expand the field of regulated approved chemicals that may be safer than opioids. Why aren’t they?? If not federally approved, the law says there are no funds allowed to study these street drugs, herbals, and plants. OMG!! So sad!!

The truth about the danger of fentanyl

  It is a lie that just touching a pill with fentanyl will kill you!! There are always groups trying to not tell the truth about issues potentially fatal. The sad thing is those Mexican Cartels are lacing pills for children (rainbow pills) and adults from adderall to opioids and can be purchased on the streets in any state and even online. Ignoring these issues is beyond comprehension. Fentanyl has been confiscated just this year crossing out southern borders that can kill 3 million people.

  Emergency departments are seeing people shooting up fentanyl which has been added to an animal tranzquilizer, xylazine, which makes fentanyl’s high last longer. Fentanyl is very strong, but short acting, so adding a drug to,  prolong the high, was bound to happen.

  Xylazine found its way from Puerto Rico the U.S. and now being seen in the Southern U.S. This drug is commercially made as Xylamed, a sedative for horses, and deer. It prolongs the effects of opioids.

Medpage Today, Feb. 2, 2023

  A vaccine has been developed to prevent the “high” created in taking fentanyl by a Houston research team, which if FDA approved, could be commenrcially available by 2025.

Effects of Marijuana, and Medical Marijuana    

  Medical marijuana has its place, and if a person desires a medical card, it can be obtained online in telehealth visits, and doctors who have been licensed to give these cards to their patients, but more need to help their addicted patients or those with pain.

  Pot is being used by 8% of the population as of 2019. It is still federally illegal although legal in many states, and those states have paid the price especially with younger people abusing it. 39 states (and D.C.) have authorized medical use of cannabis, and 21 states (and D.C.) have legalized recreational use of cannabis.

  The strength of cannabis plants today is much more potent than in the past (as much as 10% and higher), and the oil can be concentrated to extremely high concentrations that cause seizure and psychosis.

  Cannabis should never be used outside the home and away from motor vehicles. Cannabis has increased the number of auto accidents by 6%, but I would double that at least. Fatal crashes have increased by 4%.

  THC psychotic behavior has led to many emergency department visits including many young children, having consume potent gummies. This drug is serious and now cannabis is being laced with fentanyl, killing young people.

  Those in accidents have tested positive for cannabis in a range of 7-32%. One study found that 9.7% admitted to being high from cannabis while driving. That is higher than opioids, cocaine, and tranquilizers combined.

  Recent research from Canada where it is legal have reported that pot smoking is causing serious lung damage (emphysema) while the public perception is that marijuana is safe.

  Their studies of CT scans are finding more emphysema (93%) in pot smokers as compared to cigarette smokers (67%).  Sadly most of the pot smokers were under 50 while the cigarette smokers were all over 50. Most of the pot smokers were also cigarette smokers, so it is difficult to separate the damage from each other. It is obvious what COVID, flu, and other respiratoy viruses can do to their lungs. It is time for physicians to ask about pot smoking, because as the legalization continues, we are facing more public health trouble.

  The largest study ever has begun in the UK regarding the effects of cannabis on the brain. 6000 subjects 18-35, half who use marijuana and half who don’t, filled out a questionnaire regarding possible neuropsychiatric issues, and will be followed over years. We need this research.

Medscape UK, September 5, 2022

Chronic use of marijuana and its brain effects

  It is known that chronic use of marijuana creates anxiety, depression, memory issues, difficulty thinking, learning issues, impulsivity, and attention deficits, and problems with school and social life. As pointed out in the mental disorders report above, the potency of drugs today are causing psychotic behavior in all ages including children. That includes high potency marijuana.

  Regular use in adolescence have shown altered connectivity, impulse control, and learning capability, even decreases in IQ. Nih.gov

  In 2019, 4 in 10 high schoolers reported using marijuana, and the 125% increase in the last decade is primarily edibles. 3 in 10 teens who use pot regularly have marijuana use disorder.

  Most school kids are smoking pot and or tobacco mostly in a vaping apparatus, and most prefer menthol flavor, and yet our administration hasn’t stopped production of mentholated cigarettes and vaping tools.

Medical marijuana

  There are many neurological disorders that respond to cannabis, and should be legalized for specific neuromuscular diseases, AIDS, GI diseases (Crohns), etc. It also relaxes people when in pain, and lets them sleep. It also stimulates appetites in those in an anorexic state, from chemo and disorders that create weight loss.

  Those physicians should not be criticized for becoming a “cannabis doc”, like they are now.

  Gummies are becoming the “thing”, but must be understood they take hours to work, so be advised. Be very careful consuming more than 1 gummie until the hour or so has passed to feel the benefit, as it takes the stomach time to absorb.

Medscape, November 10, 2022

  The other concern, as has been the case for sometime, is that marijuana and vaping are the gateway to becoming a cigarette smoker. Not all people who use marijuana proceed to other illegal drugs, but most people who use other drugs started with marijuana, as has been reported in many studies.

  This crisis is hitting all classes of people, but the poorer communities are especially being hit the hardest. Where are the feds when they constantly preach equity, racism, continue to divide our country and when the people of color and those who are poor are hit harder, where is there outrage. A stoned person isn’t looking for a job!!

Alcohol and substance abuse in young people; youth and crime

  Alcohol will always be the most abused substance, because it is legal at 21 and accepted socially. If the Democrats have their way, marijuana will be legal and it will be present where ever smoking is allowed.

  1 in 8 deaths is attributable to alcohol consumption, accounting for 20% of all deaths age 20-49. There are 58 causes of death that attribute alcohol as a factor, according to the CDC. It is one of the leading causes of death that are preventable. It is almost always the entry substance that begins abuse of many other drugs. 66% of those who die from alcohol related issues are men, and 38% are women.

  Sadly the incidence of alcohol abuse is rising in seniors (60 and over), and the isolation suffered during the pandemic, was the big factor in the rise of alcohol use and abuse along with other substances.

  Binge drinking continues to rise as well, especially in younger people. Look at the Spring Breakers!!

  Here is a list of the diseases caused by alcohol abuse: hypertension, heart disease, liver disease, digestive problems, pancreatitis, cancer of the breast, esophagus, throat and voice box, liver, colon, and rectum. Many neurological diseases are caused by alcohol including Wernicke Korsakoff Syndrome, alcohol neuropathy, alcohol withdrawal syndrome, cerbellar degeneration, myopathies, and fetal alcohol syndrome.

  As soon as kids can get their hands on booze, they are going to experiment, and when parties are attended, alcohol is always a factor, and often abused to the point of drunkenness, resulting in incidents in relationships, vehicle accidents, and the beginning of diseases affected by alcohol.

  The recommendation for adult women is one drink per day and 2 for men.

CDC, Healthline

Youth violence, and crime

  Crime in the young is rising rapidly, with attacks on teachers, fellow students, wholesale theft in bodegas, and gang escalation. The judges are so woke, they won’t even keep them in jail. No bail in NYC?????

  These kids will not go to school, and will sentence themselves to low paying jobs and more crime as they mature.

  Homicide is the 3^rd leading cause of death in ages 10-25, and the leading cause of death in black youth. Emergency departments report over 1,000 physical assault related injuries a day in the U.S., and many are drug and alcohol related.

  Youth violence and crime lead to many mental and physical consequences as they age. A 13 year old was beaten by 3 bigger kids, and 2 days later, from the beating and bullying, she committed suicide. OMG!

  The number of young girls being bullied, forced into unwanted sex, and injured by other kids is also rising, and the school leaders are doing nothing to address this issue.

   Loss of schooling leads to impaired learning, bad decision making, decreased connections with their peers and adults, and trouble coping with stress, according to the CDC. Our country is being dumbed down by the year!! And the school leaders and teachers are part of it.

  As police departments have been devastated with so much negativity, defunding, worsening of the public-police connection, there is no way these young people will have a deterrent to stop them, and will be denied positive neighborhood connectivity with youth centers and positive police experiences.

  Sexual abuse is rising as the southern border human trafficking continues. These kids are forced to live on the streets, comit crimes, sell their bodies for food and shelter, and become drug addicts.

  Parents have become very frustrated trying to make an impact on their children. It is magnified in fatherless homes.

  Gen Z is in big trouble without direct attention to this rising problem, or our future is very weak and vulnerable.

CDC

JAMA, March 7, 2023

This ends the April, 2023 report;

The May report will include:

1. Bipolar Disorders—Kanye (Ye) West

2. Child Abuse and its consequences for life-part 4 of the Mental disorders Series

3. The FDA; more information on immunity and vacccines

4. Eldercare crisis

5. Celebrities with unusual conditions—part 1—Terry Bradshaw, Celine Dion, Alan Jackson, and Bruce Willis

Enjoy the spring and stay healthy and well, my friends, Dr. Sam