Category: current events

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.

Snowstorm Barreling Toward Iowa!

We’re going to get about a foot of snow starting tonight according to the weather report. There are webcams about Iowa that will document the storm, which will occur across most of the state.

We’ve charged up the batteries in the Voltask electric snow shovel, which got quite a workout last winter. We took videos of using it that racked up over 5,200 views. Search my site with the term “electric snow shovel.”

Breaking News: Hands-Free Driving Law in Iowa!

Sena saw a news headline about the new hands-free driving law in Iowa that’s going to be enforced in 2026 (passed in July of this year). Guilty drivers are going to get socked with a $100 fine if they’re caught messing with their cell phones with their hands off the wheel because they might think “hands-free” means you can’t touch the steering wheel.

Drivers have been getting off with a warning for now. Hundreds of people in Iowa die every year because they fool with their cell phones while driving.

You can download a variety of free materials from the Iowa Dept. of Public Safety.

And of course, this reminds me of a Men in Black 3 quote (why not?):

Agent J: Okay! You know how you’re on a airplane and the flight attendant asks you to turn your cell-phone off. And you’re like, I ain’t turning my cell-phone off, that don’t have nothing to do with no damn airplane. Well, [Showing the crowd a crashed spaceship] this is what we get, that’s what happens. It gets up there, bounces around on the satellites, then blam! Just turn your damn cell-phone off. Now you’re gonna drive off a cliff tonight because your GPS don’t work.

The thing about GPS reminds me of a Garmin Nuvi navigator we used years ago. We could plug it into the cigarette lighter power outlet. I had to update the map data from the internet although the Garmin used satellite-based GPS signals to manage the turn-by-turn route instructions.

It worked just fine except when airplane passengers used their cell phones to play Men in Black movies after the flight attendants instructed everybody to turn them off. Most people don’t know that kind of behavior also automatically releases the frozen block of blue ice (waste) from the toilet right over Area 51 (just kidding—actually the wings just fall off!).

I’ve used my old cell phone to get directions driving once or twice but not recently. I set it in the cup holder and never took my hands off the wheel—even when I drove through the front window of Pizza Hut.

So, if you happen to be driving through Iowa in the near future, remember to abide by the new law, which doesn’t mean you can get hands for free at the discount store.

Cannabinoid Hyperemesis Syndrome in the News

I just saw a news item today that is interesting for two reasons, at least to me. It’s about people who have Cannabinoid Hyperemesis Syndrome. The physician interviewed for comments about it is Dr. Chris Buresh who used to be an emergency department physician at the University of Iowa. He’s now at the University of Washington UW Medicine and Seattle Children’s Hospital.

His comment was published in a couple of local newspapers and he pointed out that even small amounts of marijuana can make people start throwing up.

The other reason it’s interesting to me is that I gave a grand rounds on eating disorders back in 2016. I had a slide on Cannabinoid Hyperemesis Syndrome (see featured image above). There’s a reference from 2016 that probably is still useful.

  • Brewerton, T. D. and O. Anderson (2016). “Cannabinoid hyperemesis syndrome masquerading as an eating disorder.” International Journal of Eating Disorders.

Pennies from Heaven to Coin Rolls

We recently found out that pennies are being take out of circulation. In fact, the last day they stopped minting them was on our 48th wedding Anniversary this month, November 12, 2025! There may be a reason to save the 2025 pennies, according to some folks.

We have a piggy bank and I rolled up our saved coins last year. We had $55 worth. It feels fairly heavy now and we wondered if we had any 2025 pennies.

I wasn’t eager for the task, but there was another reason to tackle it again—we wondered if we had any pennies from 1977.

I forgot how tedious this chore was. I spent a long time peering at the pennies with a magnifying glass hunting for any minted in 2025 before I ever got busy rolling the coins into those pesky little sleeves.

I found one from 1969 which reminded me of the Men in Black 3 movie (what doesn’t remind me of MIB movies?). The scene is Agent J and Jeffrey Price on top of the Chrysler building when Agent J is about to do the time jump thing:

Jeffrey Price: Do not lose that time device or you will be stuck in 1969! It wasn’t the best time for your people. I’m just saying; it’s like a lot cooler now.

As if in confirmation, I found a few from the mid-late 20th century and beyond as well as a few marking other important historical events:

Source: Historydotcom; A Year in History series

1959: Alaska becomes the 49th state; Hawaii becomes the 50th state

1960: Greensboro sit-in by 4 black college students at a whites-only lunch counter in Greensboro, North Carolina, starting a nationwide civil rights movement

1964: President Johnson signs Civil Rights Act; Martin Luther King Jr. wins the Nobel Peace Prize

1975: Microsoft founded by Bill Gates and Paul Allen; Arthur Ashe becomes the first black man to win at Wimbledon tennis championship

1976: First women inducted into the United States Naval Academy at Annapolis and at the U.S. Military Academy at West Point

2001: 9/11 attack on America

I found one from 1985 when I graduated from Iowa State University with a Bachelor’s Degree in 1985. I found another from 1988; the year I started medical school in Iowa City. I accidentally broke the arm of our cadaver in gross anatomy. I also found one from 1996, when I graduated from the psychiatry residency program at University of Iowa. Dr. George Winokur had just stepped down from being department of psychiatry chair and he encouraged me to apply for a position at Iowa.

But the best penny find was the one from 1977, when Sena and I got married. What a coincidence that the U.S. Mint stopped making pennies on November 12, 1977—the anniversary day of our wedding.

I rolled $16.50 in coins this time, but there was plenty left over (including pennies) that wouldn’t fill the sleeves.

Penny for your thoughts?

This is World Kindness Day 2025!

Sena saw something on the web about World Kindness Day this morning and alerted me to it right away. World Kindness Day is an international movement which started in 1998 by the World Kindness Movement. It’s observed on November 13th annually.

This made me look through my blog posts and I found a short announcement about the event from a couple of years ago. Wouldn’t it be great if this were more than an annual event? What if this were a way of life, a way of being?

There are many ways to observe World Kindness Day, limited only by imagination.There are many ways to observe World Kindness Day. Sena suggested we donate to one of Iowa City’s local food pantries.

So, she headed over to the grocery store and bought several bags of non-perishable items and delivered them to the CommUnity Crisis Services Food Bank.

Iowa City Food Bank Items for World Kindness Day

More Calvinball Cribbage Games

This just in; we found a Crib Wars game on Amazon for only $20! I’ll have a lot more to say about Crib Wars/Cribbage Wars tomorrow.

We’ve been thinking about taking this game out for a spin for a while.

Sena also ordered something called Wicked Cribbage. I don’t know anything about it except it’s a deck of special cards which gives you a chance to cheat during a regular cribbage game. It’s yet another Calvinball cribbage item similar in nature to games like Crib Wars.

This reminds me of another variant we used to have: Chicago Cribbage. We don’t have it anymore, but it’s pretty complicated and the rules are on the web. In fact, I just found out that our demonstration of it is posted on BoardGameGeek. It also comes with a special card deck which has cards that allow you to essentially penalize your opponent.

Another Calvinball crib variant we messed around with was Zombie Cribbage about 3 years ago. It comes with a rickety 61-hole folding plastic board that often got stuck closed and the pegs were plastic zombie figurines!

One of the Zombie Cribbage variants involved using jokers although the rules for using them was tough to figure out. There were two female and two male zombies. One of the guys had a big hole in his chest and was missing an arm, which is actually normal for zombies. The cards are decorated with zombies.

We also considered trying to invent a mashup of Zombie and Chicago cribbage that we could call Chicago Zombie Cribbage. If you played your reverse counting card, you could tell your opponent, “Walk like a zombie, only backwards!” That never got off the ground, or should I say out of the grave?

Our zombie cribbage game YouTube video is at the top of a google search, but only because there are no similar videos made, apparently! There are plenty of mistakes in it, but it didn’t really matter. It got over 300 views. We don’t have the game anymore.

And the other news is even more absorbing. I’m not sure how it happened, but a squirrel got in the house and took a few bites from my pumpkin spice cake. And it brought a cribbage board, but forgot a deck of cards!

And another thing! We just found out that the Michaud Toys company has again today replaced the message (missing in the last couple of days) that U.S. orders are subject to a 35% tariff and a 25% UPS brokerage fee paid before delivery!

When Tariffs and Cribbage Boards Collide

I’m going to take a chance and mention tariffs in this post because it figures importantly in our cribbage game pastime. We have several cribbage boards we’ve bought over the years and one of them is from Ontario, Canada.

Michaud Toys is a company in Ontario which makes very nice wooden toys, many of them board games. It’s a small, family-owned craft shop in Ontario not far from the Niagara area. They are well-known for making excellent wooden toys, games, and puzzle boxes. A little over 6 years ago, we bought a jumbo cribbage board from them at a reasonable price. I think it was about $70.

It came with a nice storage bag, some metal pegs (2 inches long), a deck of cards, and a set of very accurate rules. It’s 27 ½” long and 8” wide. It’s great fun to play on. We feature it in several of our cribbage game YouTube videos.

It has a handy little cubby on the board which can hold the card deck, pegs, and rule booklet. This is covered by a cap which fits snugly over the hole and is secured by “powerful rare earth magnets.” They work. I can turn the board upside down and shake it—nothing pops out.

We were looking for a new cribbage board and checked what’s new at the on-line Michaud Toy store.

This is a novelty board which is sold as Cribbage Rumble although the web link has “cribbage wars” in it. That should ring a bell to anyone who has heard of the game with the name “Cribbage Wars.” We’ve never played Cribbage Wars but Cribbage Rumble resembles it. Cribbage War sells for about $20 or so. Cribbage Rumble is prettier—but it costs a lot more.

We’ve been playing several cribbage game variants lately. We were looking for yet another one, checked out the price of Cribbage Rumble and found out it includes a high tariff, which the company tells you about in bold red type with exclamation marks after it. It doesn’t use the word “tariff.”

I don’t know much about tariffs except that they’re taxes. The last time I interviewed President Trump, he was pretty enthusiastic about them (satire).

Tariffs work both ways. I don’t really know anything else about them. But they’re going to delay our purchase of Cribbage Rumble.

I wonder if a Cribbage Rumble match could be arranged between President Trump and Prime Minister of Canada Mark Carney to settle this tariff business? I won the Cribbage Pro match with President Trump (satire). If President Trump wins, I get the Cribbage Rumble game free. If Prime Minister Carney wins—it stays on the shelf at Michaud Toys.

Jim vs Donald Trump on Cribbage Pro

When it Comes to AI, What Are We Really Talking About?

I’ve been reading about artificial intelligence (AI) in general and its healthcare applications. I tried searching the web in general about it and got the message: “An AI Overview is not available for this search.”

I’m ambivalent about that message. There are a couple of web articles, one of which I read twice in its entirety, “Are we living in a golden age of stupidity?” The other, “AI, Health, and Health Care Today and Tomorrow: The JAMA Summit Report on Artificial Intelligence”was so long and diffuse I got impatient and tried to skip to the bottom line—but the article was a bottomless pit. The conflict-of-interest disclosures section was overwhelmingly massive. Was that part of the reason I felt like I had fallen down the rabbit hole?

I recently signed an addendum to my book contract for my consult psychiatry handbook (published in 2010, for heaven’s sake) which I hope will ultimately protect the work from AI plagiarism. I have no idea whether it can. I delayed signing it for months, probably because I didn’t want to have anything to do with AI at all. I couldn’t discuss the contract addendum with my co-editor Dr. Robert G. Robinson MD about the contract addendum because he died on December 25, 2024.

I found out today the book is old enough to find on the Internet Archive as of a couple of years ago. One notice about it says “Borrow Unavailable” and another notice says “Book available to patrons with print disabilities.”

All I know is that an “archivist” uploaded it. The introduction and first chapter “The consultation process” is available for free on line in pdf format. I didn’t know that until today either.

Way back in 2010 we didn’t use anything you could call AI when we wrote the chapters for the book. I didn’t even dictate my chapters because the only thing available to use would have been a voice dictation software called Dragon Naturally Speaking. It was notorious for transcribing my dictations for clinic notes and inserting so many errors in them that some clinicians added an addendum warning the reader that notes were transcribed using voice dictation software—implying the author was less than fully responsible for the contents. That was because the mistakes often appeared after we signed off on them as finished, which sent them to the patient’s medical record.

Sometimes I think that was the forerunner of the confabulations of modern-day AI, which are often called hallucinations.

Now AI is creating the clinic notes. It cuts down on the pajama time contributing to clinician burnout although it’s not always clear who’s ultimately responsible for quality control. Who’s in charge of regulatory oversight of AI? What are we talking about?