current events – Go Retire Psychiatrist

Thoughts on Comebacks

I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44^th time you’ve heard that since he took the field?

So what the Colts lost? His big family was up in the stands going crazy, cheering him on.

I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.

It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.

It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).

I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.

It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).

The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.

Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”

I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.

I just can’t stay up that late nowadays.

Swearing as a Performance Improvement Method?

I read this article about swearing being a good thing to do to increase your workout performance or whatever. There’s a link to the study that a researcher says supports that conclusion. I mean this story is talking about really bad words being good for you. It reminds me of a time when I was a pre-teen kid and broke my wrist falling out of a barn loft. I don’t remember exactly how I got to the emergency room. We didn’t have a car so our next-door neighbor must have driven me with my crooked arm and my hysterical mom to the hospital.

My mom was in the emergency room with me. When I cut loose with a torrent of really bad words, nurses had to practically carry her out because she fainted. This was right after I asked the doctor if it was OK if I swore and he said “Go ahead,” injected anesthetic—and immediately started to manhandle my wrist. I don’t think I ever swore in front of my mom before that.

I don’t remember if the swearing helped me withstand the pain or not. I don’t think so.

There was my other trip to a hospital for chest surgery when I was in my early teens. I had a chest tube after the operation. My roommate had undergone some kind of abdominal surgery. We had a lot of stitches and were in a lot of pain, which was bearable if we didn’t move at all. It even hurt to breathe. But the other factor was the TV in our room. It was way across the room and there was some kind of comedy show on. It was really funny—which made us feel really terrible. We could barely move and even had to talk quietly, yet this funny show made us laugh, which expanded our chest and abdomen areas, stretching the sutures. It was excruciating.

Even swearing would have hurt, not to mention laughing out loud. We really couldn’t stand to laugh and it was too bad I can’t describe the sound of two guys trying not to even chuckle. If you e4ver watched Loony Tunes cartoons and remember how Elmer Fudd sounded with he laughed—that was how we sounded because we were trying to suppress laughing. It was funny but pitiful. My roomie finally made this desperate slow motion move out of bed, crept to the TV and shut it off. I was so grateful. Neither one of us ever swore.

The other thing this swearing for power reminds me of is the movie Signs, which starred Mel Gibson as Graham Hess. It was about an alien invasion and in one scene, some people/aliens (they don’t’ yet know what) are running around the house and Graham’s brother Merril (Joaquin Phoenix) are getting set to chase them. Merril tells Graham to yell and curse, although because Graham is a former Episcopal priest, swearing is beyond him:

All right, listen, we both go outside, move around the house in opposite directions. We act crazy, insane with anger, make them crap in their pants, force them around till we meet up on the other side.
Graham Hess: Explain “act crazy”.
Merrill: You know, curse and stuff.
Graham Hess: You want me to curse?
Merrill: You don’t mean it. It’s just for show. What?
Graham Hess: Well, it won’t be convincing. It doesn’t sound natural when I curse.
Merrill: Just make noises, then.
Graham Hess: Explain “noises”.
Merrill: Are you gonna do this or what?
Graham Hess: No, I’m not.
Merrill: All right, you want them stealing something in the house next time?
[outside light comes on]
Merrill: On the count of three. One…
Graham Hess: All right.
Merrill: two… three!
Graham Hess: Ahh! I’m insane with anger!
Merrill: We’re gonna beat your ass bitch! We’re gonna tear your head off!
Graham Hess: I’m losing my mind! It’s time for an ass-whupping!
[Merrill and Graham meet each other]
Graham Hess: I cursed.
Merrill: I heard.

Anyway, I think we have to make a distinction between cursing about something or cursing at someone before we start claiming, like the author of the study says:

“Swearing is literally a calorie-neutral, drug-free, low-cost, readily available tool at our disposal for when we need a boost in performance.”—psychology researcher Richard Stephens of Keele University in the UK.

Dr. Susan Shen University of Iowa Psychiatrist Wins Prestigious Avenir Award for Research!

This just in! University of Iowa Psychiatrist Dr. Susan Shen, MD, PhD, is an assistant professor of psychiatry at The University of Iowa Carver College of Medicine and, hold on to your hat, she’s the first female psychiatrist, the first from Iowa, and only the third psychiatrist overall to receive to win the Avenir Award (French for “future), a highly competitive grant!

The $2.3 million dollar grant will help fund her lab’s research into the underpinnings of substance use and psychiatric disorders. The grant is administered through the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health (NIH).

Give Dr. Susan Shen a big shout-out!

New Do it Yourself (more or less) Electrotherapy for Depression at Home!

OK, so the title is a little provocative; on the other hand, this is my take on a legitimate treatment for depression that was just approved by the FDA only last week. A company called Flow Neuroscience is marketing the newly approved FL-100 device for treatment of depression and their website definitely has their marketing skills down. And I definitely was reminded of a TV commercial about removing your own appendix.

That’s my smartass joke, but hang on, there’s more to it than jokes. I had to search around a while to find actual FDA web evidence that they actually did approve the FL-100, but I was saved by the reliable and trustworthy Psychiatric Times article about the FL-100 with references that I could verified the FDA’s approval.

So, I’m a retired psychiatrist and I was a clinician educator type doctor, not a neuroscientist, but I can read the FDA approval document section XV. Conclusions Drawn from Preclinical and Clinical Studies (starts on page 12). It boils down to, yeah, this device’s probable benefits outweigh its probable risks.

The Effectiveness Conclusions subsection on effectiveness outcomes at Week 10 contains what sounds like realistic answers: “The medical literature lacks consensus regarding what constitutes a clinically significant or meaningful between-group difference in HDRS-17 scores. As such, the clinical significance or meaningfulness of the between-group difference of -2.3 points on the HDRS-17 scale has not been established. Nevertheless, the 2.3 point between-group difference helps support the view that FL-100 provides probable benefit.”

I’m not familiar with the EQ-5D-3L scale of health-related quality of life but the summary says:

“The EQ-5D-3L measures a person’s health-related quality of life by assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was no between-group statistical difference in EQ5D-3L scores at Week 10. The EQ-5D-3L frequently fails to detect mild depressive symptoms, as individuals with subclinical depression often select “no problems” on the anxiety/depression dimension. The insensitivity of EQ-5D-3L is documented in the literature.”

I happen to think that comparison of medical treatments with psychotherapy is a good idea but: “Data were not provided regarding FL-100 used adjunctively with psychotherapy or with psychotherapy and antidepressants.”

The device has no recommendation for use with patients with treatment-resistant depression:

“Patients who previously had an inadequate clinical response to two or more antidepressants at an adequate dose and duration were excluded from the study, limiting the evidence for use of the FL-100 in a more treatment resistant population.”

The potential risks are first degree skin burns if you’re not careful with the electrodes, headaches, and scalp pain. The benefit is modest but outweighs the risk.

You can use the device at home under the supervision of a clinician—they don’t do house calls so you’d presumably do this by zoom call. You can also get advice through an app on your device, which may or may not be a monotonal AI. You pay $500-800 and there won’t be any answers to questions about insurance coverage until at least next spring. But it’s being used by tens of thousands of people in Europe and beyond.

So go ahead, take your own appendix out (just kidding; put that jack knife away!). Did you know that at least one guy actually did that? A Russian surgeon, Dr. Leonid Rogozov managed it in 1961 while he was stranded in Antarctica.

It’s just my opinion, but the headset could be more stylish.

American Flags Flying at Half-Staff Today in Honor of Iowa Soldiers Killed in Enemy Attack in Syria

Iowa Governor Kim Reynolds ordered all public buildings in Iowa to fly all flags at half-staff until sundown today in honor of two Iowa Army National Guard soldiers and an American civilian interpreter killed in an enemy attack in Palmyra, Syria on December 13, 2025.

Florida Man News!

We saw the news story about the Florida Man who recently got busted by the cops in Ormond, Florida after he stole a BMW and when he was stopped for going 130 mph (about 5 mph over the local speed limit), he thanked the police for saving him from the extraterrestrials who evidently had teleported him into the BMW. Well, that explains everything!

This is just further evidence on top of what has already been thoroughly documented by Dave Barry in his 2016 documentary book, “Best State Ever; A Florida Man Defends His Homeland.”

Did you hear about the blackout in Florida?

People were stuck on the escalators for 4 hours.

I used to have a ton of Dave Barry books. I got hooked on his humor shortly after I graduated from Iowa State University back in the 1980s. I was in a post graduate program in Medical Technology in a Des Moines hospital and back then you could always find a newspaper on some tables in the cafeteria.

Over the years, I lost many of his books during moves. Sena would ask me something like “Do you really still want all these Dave Barry books?” I knew better than to say “These are very important examples of timeless prose exemplifying humor literature that will be excavated in the distant future by archaeologists who will preserve them in hermetically sealed glass bookcases so people can admire the covers.”

I just threw them out. Please don’t tell Dave.

Anyway, I have managed to preserve a photo of Florida Woman, taken in Miami many years ago. Let this be a lesson to you: never call your wife “Florida Woman” unless you want to live the rest of your life in a refrigerator packing box—although you can use duct tape to seal off those cracks to keep the wind and snow out.

Did you know there’s a song titled “Florida Man”? Believe it or not I heard it a couple of years ago on the Big Mo Blues Show on KCCK radio. It’s by Selwyn Birchwood who is from—that’s right, Tampa, Florida. The song was released by—you guessed it, Alligator Records.

And here’s Iowa Man:

Jim with 48 inch pusher plow shovel and new coveralls

Pearl Harbor Day Today

Today is Pearl Harbor Day and it reminds me of the time we made a trip to Hawaii in 1997 and visited the USS Arizona Memorial. There was a guy named Norm in our tour group and he and his wife Lee (Leota) made friends with me and Sena. They were in their seventies at the time. Norm wept openly when we stood inside the memorial and viewed the names of those killed in the attack. I don’t think he served in WWII. He would have been only 16 years old at the time. I think he was just very affected by the loss of so many lives. Standing in the place where so many died can make us want to cry. You could call it normal—and it is sad. We exchanged Christmas cards with Norm and Lee for years afterward until they passed.

Men in Black 5 a Thing Now?

I just saw something on the web which look like Men in Black 5 could be for real. Supposedly, maybe, I dunno—but I hope so.

It may be more than a rumor, but there are doubts about whether Will Smith and Tommy Lee Jones will reprise their roles as Agents K & J respectively. Sony Pictures may or may not be confirming this depending on what article you read. Maybe somebody is drafting a script but I’m not sure.

I can’t confirm whether Frank the talking pug will be in it, but I doubt it because I think he passed away. Agent K will get around pretty well in a plutonium powered mobility scooter and Agent J will take Serutan (remember, that’s Natures spelled backward!) just before pressing the little red button.

Serleena will not stick her 3-foot-long green tongue into Agent K’s ear. I can never stand to watch that part.

Yours truly might be involved—but I really can’t say at this time because I’m still negotiating my contract.

Thank you for your time.

Cannabinoid Hyperemesis Syndrome in the News Lately

I’ve seen a few articles about Cannabinoid Hyperemesis Syndrome (CHS) and because my funny bone is sensitive to provocative titles, I first read the one with the title that starts off with “I still partly think this is bullshit…” My reference list resulting from a quick search is below.

Of course, I don’t think CHS is “bullshit” (quote from an emergency room patient in the Collins et al paper). I agree it’s hard to diagnose and the news media tends to sensationalize it by promoting popular terminology like “scromiting,” which my spell checker doesn’t recognize. This is a vogue portmanteau word combining screaming and vomiting. It makes me wonder why someone didn’t try harder to come up with a portmanteau that might be more descriptive of the complex triad of vomiting, belly aches, hot baths, and screaming. Why not barfinbawlinbellyachinbathingbadness?

But it’s not funny and attempts to attach funny words like scromiting to the condition by the press (or whoever) is misguided.

I found one systematic review and treatment algorithm (Hsu et al) written to guide consultation-liaison psychiatrists who are likely to get called when CHS patients are admitted to emergency departments. However, I think the place to start would be the StatPearls review by Cue et al. One thing I found out from that paper is that the interesting ACCENT study ((Achieving Cannabis Cessation: Evaluating N-Acetylcysteine Treatment) the authors cite does not yet have results available, although it was started way back in 2014.

Just a couple of comments about the treatment algorithm by Hsu et al: haloperidol can cause dystonic reactions and akathisia as well as cardiac conduction problems like QTc prolongation and more. One episode of neck dystonia or akathisia or both can lead to mistrust of physicians who administer the causative agents, especially if there were no explanations of side effects as well as potential benefits. Benzodiazepines, while they may work, may also lead to some patients with substance use disorders becoming attached to them. Less commonly, patients with somatoform, factitious, or eating disorders will complicate the diagnostic picture.

Reference List:

Alexandra B. Collins, Francesca L. Beaudoin, Jane Metrik, Rachel S. Wightman,

“I still partly think this is bullshit”: A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting,

Drug and Alcohol Dependence,

Volume 246,

2023,

109853,

ISSN 0376-8716,

(https://www.sciencedirect.com/science/article/pii/S0376871623000911)

Abstract: Background

Cannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS.

Methods

Semi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo.

Findings

Participants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have.

Conclusions

Although cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Keywords: Cannabinoid hyperemesis syndrome; Cyclic vomiting; Cannabis use; Qualitative

Cue L, Chu F, Cascella M. Cannabinoid Hyperemesis Syndrome. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549915/

Jennifer Hsu, Saurabh Kashyap, Cheryl Hurd, Lauren McCormack, Zachary Herrmann, Ann C. Schwartz, Joshua Jackson, Dustin DeMoss,

Treatment of cannabinoid hyperemesis syndrome: A systematic review and treatment algorithm for consultation-liaison psychiatrists,

General Hospital Psychiatry,

Volume 97,

2025,

Pages 185-191,

ISSN 0163-8343,

(https://www.sciencedirect.com/science/article/pii/S0163834325002038)

Abstract: Background

Cannabinoid Hyperemesis Syndrome (CHS) is a cyclical vomiting syndrome associated with chronic cannabis use and is often resistant to anti-emetics. Despite increasing incidence of suspected CHS, literature regarding its treatment is limited, and there are no established treatment guidelines.

Objectives

With the goal of establishing treatment guidelines for consultation-liaison (C-L) psychiatrists managing CHS, the authors systematically reviewed existing literature for pharmacologic treatment strategies using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. With the results of the review, the authors propose a treatment algorithm for CHS.

Methods

We searched PubMed, PyschINFO & PsychARTICLES, Embase, and Web of Science from inception to July 2021 to identify literature describing treatment of CHS. We included cases of CHS where patient-level data describing the treatment of CHS was available. Pharmacologic treatments were considered beneficial if the patient’s nausea, hyperemesis, and urge to take hot showers resolved. Non-independent review of exclusion criteria assisted in reducing individual bias of the literature.

Results

The authors identified 34 eligible articles, consisting of 63 individual cases. Among these articles and cases, capsaicin cream, antipsychotics, and benzodiazepines were reported to improve CHS more effectively than other, more frequently used anti-emetics, such as promethazine, ondansetron, and metoclopramide.

Conclusion

An examination of treatment strategies for CHS can allow for more effective care while providing a foundation for further research in treatment. This proposed algorithm is designed to aid in establishing treatment strategies for C-L psychiatrists who assist with managing CHS for patients in general medical settings. The goal of this research is to establish evidence-based treatment guidelines for C-L psychiatrists who are managing patients with CHS in general medical settings. Recognizing the limitations of this algorithm being based on case reports adds to the necessity of further research in this area.

Registration

PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42021254888) registration number CRD42021254888.

Keywords: Cannabinoid hyperemesis syndrome; Treatment strategies; Systematic review; Pharmacologic treatment

Loganathan, P.; Gajendran, M.; Goyal, H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals 2024, 17, 1549. https://doi.org/10.3390/ph17111549

Bigfoot Snow Removal Service!

We got about 9 inches of snow over the weekend and we’re set to get a few more inches today. People have to work pretty hard to get the snow off their sidewalks because Iowa City has some pretty strict rules about it. If you don’t get that snow removed from your sidewalk “down to the concrete” the city will do it for you—for a stiff price.

You got 24 hours’ notice for your first violation. If you don’t get it done in 24 hours, the city will fine you a penalty of however much it costs to remove the snow plus a $100 administrative fee.

You’ll be glad to know there’s a way to prevent this from happening to you. All you need to do is contact Bigfoot Snow Removal Service. They don’t have a phone number because they don’t technically exist, but that’s only what the city will tell you.

Bigfoot Snow Removal does not have a telephone connection nor a website but there’s a way to get around that. All you need to do is find a big stick and knock really hard on a nearby tree. You have to knock 3 times just like Tony Orlando and Dawn sang the song and do it like you mean it.

Then grab a big bucket and fill it up with a lot of meat. Beef jerky is good but if you don’t have it, use anything you got on hand, even Wagyu beef. I can’t help it if you paid a lot of money for it, just be glad you can get it in America. Even though 10 pounds of it can set you back over $1000, just keep thinking about how much the city will charge you to clear your sidewalk.

Set the bucket of Wagyu or whatever out in your front yard. You can set up a critter cam if you want to make sure it’s Bigfoot fetching it and not your neighbor. However, it’s only fair to warn you that because Bigfoot is an interdimensional creature (that’s why nobody’s ever found fossils or seen baby Bigfoots) you’ll never capture any footage of Bigfoot. Oh, people pass off amateur videos claiming Bigfoot posed for them and you’ll see them on TV shows, but that’s just a government plot to distract you from the price of Wagyu beef.

The nice thing about Bigfoot Snow Removal is that they bring their own snow shovels. None of them have snow blowers because they would have to go to the hardware store and buy them. That would just cause a panic because people would faint and have to go to the emergency room and then Bigfoot hunters would start setting traps, looking for tracks and making plaster casts of them which invariably turn out to be bear or collecting animal poop that is always from raccoons, playing practical jokes and whatnot.

Just shovel your walks.