Category: health care

So, Is This Anything?

We used to watch David Letterman a long time ago and he had this sketch called “Is this Anything?” I can’t remember any specific example but I thought I recognized a YouTube of one segment that was originally aired years ago.

I was reminded of the “Is This Anything” sketch when Sena showed me this video of a thing called a Bionic Neck and Shoulder Massager. It looks like something out of a Svengoolie movie; a headless set of fingers. People strap it to their necks and then look like they’re being strangled by an extraterrestrial.

I thought I saw red marks on the person’s skin when the device was removed. I’m sure some people swear by their effectiveness for relaxing tight neck muscles. On the other hand, they look creepy to me.

It reminded me of a foot massager we got 3 years ago. You stuck your feet in it and it massaged your feet. It was kind of creepy.

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

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.

Working on a Simple Plan to Stay Fit?

I saw a couple of web resources about staying healthy and fit that seem to make sense to me. One of them was actually a YouTube video by a personal trainer advising people to stop doing certain kinds of workouts that could be unhealthy. He recommended avoiding certain kinds of weight lifting exercises, especially for those over 40. I’m way over 40 and I agreed with him.

The video was posted about 2 months ago and there are so far 725,000 view and well over 2,000 comments, both for and against the trainer’s advice. Many of the older commenters disagreed with slowing down after the age of 40.

I’m 70 and I’m a minimalist when it comes to exercising. I’ve slowed down from daily exercise, but I still enjoy juggling, riding an exercise bicycle, limited use of dumbbells, body weight squats, a step platform routine, planks, stretching and wrestling grizzly bears. I occasionally go for walks when the weather permits.

I remember trying to lift really old barbells in the free weight room at the YMCA when I was a kid. I dropped them once and the director directed me out of the room. After they got a weight machine, a guy bet me and a friend a dollar that he could jump over a broom handle (in another variant of this stunt you try to jump over a dollar bill, I think) while bent over and grasping his toes. He did it but we couldn’t. We didn’t pay him any money. I still can’t do that trick. Nobody recommends doing this as a regular fitness exercise.

On the other hand, patient YMCA teachers taught me how to swim and helped me get over my severe headaches related to my initial fear of the water.

The other web source is an article that actually recommends we stop focusing on working out. In fact, the title is “Stop focusing on working out”—a professor says you should follow these five science-backed steps to improve your wellness instead.”

There are so far no comments on it. The authors have five suggestions:

Make movement fun

Be socially active

Use mindfulness as a stress buster

Be kind to yourself and others

Prioritize quality sleep

The last one usually is difficult for me. Ever since kindergarten, when the teacher wanted the class to take a nap, I’ve had trouble sleeping. The teacher never understood that. I also tend to be shy. I like playing cribbage, though my wife is my only partner. I still practice mindfulness meditation. Juggling is a fun movement activity and it’s also beneficial exercise.

I think it might be a little safer to try to jump over a dollar bill while squatting and grabbing your toes than squatting with barbells if you’re 70. You’re welcome. That’ll be one dollar, please.

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?

Cribbage Could Help Preserve Your Brain Health!

I just saw an article that working on your cognitive skills might make you less susceptible to dementia. There are some websites that help you, but I think some, like BrainHQ, could cost you money.

On the other hand, there is some evidence that playing card games can help protect your brain. I think cribbage could be one of them, although it’s tough to find specific studies on it.

I checked around and found a few studies about how playing games like solitaire and hearts could help keep you sharp. On the other hand, when I was a young man, I worked on a land survey crew. We played hearts over lunch hour and when it rained. I consistently lost.

But for the last several years, Sena and I have regularly played cribbage, a card game that calls for some math skills, concentration, attentiveness, and strategy.

The one problem I see with picking cribbage as one of your main sources of cognitive stimulation is that many people see it has an old person’s game. They should try playing cribbage with someone who really knows how to play.

Cribbage players tend to be older; many tend to be over 50. The American Cribbage Congress (ACC) is the major organization for cribbage and they hold lots of tournaments, both local (called grass roots clubs) and national. They always welcome new and younger players. In general, you need to be able to play a game in 15 minutes in tournaments.

We have tried to finish a cribbage game in 15 minutes, but we can’t seem to do it in less than 20 minutes. I always know when Sena wants to play. She like to use the automatic card shuffler (I like to shuffle manually) and whenever I hear the card shuffling machine (which is loud enough to hear from all over the house), I know it’s time for a game!

Walking the Clear Creek Trail Today

Took a quick hike on the Clear Creek Trail this afternoon. Last week, my step counter logged about 5 miles or so when I walked out to the mall. I paid dearly for that; I could barely limp around the house for a day and a half. Today, I got about 7,500 steps which now gives me an average of about 10,850 steps over the last week. But I burned only 30 calories per day over the last month. Walking 10,000 steps usually burns 300-500 calories.

Not good if I’m going to get rid of a belly which could threaten to qualify me to play Santa Claus at the mall—eventually (I’m exaggerating—a little). The web tells me I have to burn 3,500 calories by exercise to lose a pound or 500 calories per day over a week.

One incentive to walk more frequently (at least until the snow flies) is to walk where I can see interesting scenes in nature, like today. I’m pretty sure I saw a downy woodpecker because it was pretty small, which distinguishes it from a hairy woodpecker—otherwise they look a lot alike. And I caught a chipmunk trying to hide from me.

downy woodpecker
chipmunk

On the other hand, I saw an article indicating that you could get good results from working out 2 days a week. They always quote a study, which in this case was published in the open access journal Obesity. It says that a weekend warrior can get the same results at losing belly fat as those slogging away every day. Maybe.

I’m not a weekend warrior. In fact, lately I’m a peacenik when it comes to exercise. I’d rather sit on a bench than bench press.

CDC ACIP Highlights on Covid 19 Vaccine

There was a lot to digest in today’s CDC ACIP meeting on Covid-19 vaccines. I missed the morning sessions but managed to see a few of the afternoon presentations.

The presentation by Dr. Retsef Levi, PhD, MIT, ACIP Work Group Chair, the Covid -19 Vaccine Discussion Framing Work Group (WG) was basically pretty critical of the Covid-19 vaccines in general.

The opposing reply to this (favorable to vaccines) was put together by University of Iowa’s Dr. Stanley Perlman, Dr. H. Bernstein, and Dr. M. Miglis, Additional Workgroup Considerations in Covid-19 Vaccination Policy and Practice.

For a change, I listened to the Public Comment section. I usually have not paid attention to them because most of the speakers were opposed to vaccines. Today was different. All of them were strongly supportive of vaccines.

There is a bottom line to this. I watched the voting session, which was very interesting. There were 4 voting questions. I had to take pictures of them because they were not included in the on-line schedule. It was easily the most interesting session of the afternoon, at least for me.

Voting question 1: all but one member voted “yes,” the committee chair Kulldorff voted “no.”

Voting question 2: one member suggested striking this one, but they voted anyway. What’s worrisome is that it was split between the yes and no votes; only the chair, Kulldorff, could break it and he voted “no.” Looks like common sense won; otherwise it would have made access very difficult.

Voting question 3: The video lost audio for a long time, but eventually it turned out that the votes were “yes” unanimously on the assumption that pharmacists counted as “health care providers.”

Voting question 4: The votes were all “yes,” mainly because they decided that pharmacists could make this work. One member questioned the wording which suggested that you needed to talk to your doctor about getting the vaccine because of the wording “shared clinical decision-making.” They glossed over it.

It looks like access to the Covid-19 vaccine will remain mostly open for now.

Public Comments on Upcoming CDC ACIP Meeting Posted

I have just noticed that there are over 5,000 comments posted on the comments section of regulations.gov in the section entitled Meeting of the Advisory Committee on Immunization Practices-September 2025.

The link to the comment section is on the CDC ACIP meeting announcement web page, “Written Public Comments.”

This is the first time I’ve seen a written comment section like this for the meetings. I think it gives people a sense of what health care professionals and others think about how things are going with the current approach to preventive medicine at the CDC.