Go Retire Psychiatrist

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

Starlings and More!

Sena got a video of a large flock of birds flying around in the outlot beyond our backyard. We thought they were all starlings, but I couldn’t focus enough on individual birds to tell for sure if there were other species mixed in with them. I couldn’t even confidently identify a starling although I’m pretty sure that’s what many of them were.

I think it’s not unusual for other small nondescript blackbirds to mingle with starlings. While we can’t make a case for the smallish flock being a murmuration, there was an impressive number of them. Trying to identify specific species by repeated attempts to focus and magnify using video editing software mostly led to my murmuring under my breath—mainly curses.

Starlings are often called pests and web sources say they are among several species of birds that spread disease. The Iowa State University Extension calls them “nuisance birds.”

My usual resource, Birds of Iowa Field Guide (2023 edition) by Stan Tekiela is a little more generous in the description of the European Starling, calling it a songbird which can mimic the songs of up to 20 species and can even imitate the sound of the human voice. Other web resources compare them to mockingbirds. Large flocks of starlings commonly mix with other blackbirds in the fall. Starlings were introduced to New York City in 1890-91 from Europe.

See if you can pick out the starlings in our video and other birds. I got mostly eyestrain from the effort.

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.

Svengoolie Movie: “Devil Doll”

Svengoolie Intro: “Calling all stations! Clear the air lanes! Clear all air lanes for the big broadcast!”

Well, I watched the Svengoolie movie, “Devil Doll” last night and was that creepy! It’s a British 1964 film directed and produced by Lindsay Shonteff (although I don’t know him from Adam. What do you take me for, a legit movie reviewer?).

Anyway, I noticed right away that I recognized one of the stars, William Sylvester (Mark English) who played a reporter trying to figure out what gives with the Great Vorelli (Bryant Halliday) a really sleazy ventriloquist and hypnotist whose stage act includes stealing Mark’s girlfriend Marianne (Yvonne Romain) and humiliating his dummy Hugo in front of an audience full of well-to-do people who smoke unfiltered cigarettes like they were going out of style.

Anyway, William Sylvester starred as Dr. Heywood Floyd in the 1968 blockbuster film 2001: A Space Odyssey. Who can forget the scene of him puzzling over the long sheet of instructions for using the Zero Gravity Toilet! I don’t think there’s a free copy of it, so it’ll set you back at least twelve bucks.

But what a contrast between the elegantly cryptic Heywood Floyd and Mark English, who is a hard-nosed, cynical journalist trying to figure out whether there’s a little guy inside the Great Vorelli’s wooden dummy Hugo, mainly because Hugo can get up and walk, even sing and dance a few show tunes like Puttin on the Ritz better than Frankenstein’s monster in you-know-which movie! Mark even gets an opportunity to examine Hugo using a set of Stanley tools, x-rays, and X-Acto knives but doesn’t get any reaction from the dummy unless you count a little sawdust.

But the tough-minded Mark gets a surprise visit from Hugo who gives him a few tips on woodworking and a hint that there’s more to him than sawdust.

The Great Vorelli has a master plan and hypnotizes Marianne which leads to a pretty complicated plot twist which involves the hypnotist learning ancient techniques for messing around with peoples’ souls which Dr. Heller (Karel Stepanek) dismisses in favor of a clinical diagnosis of catalepsy (although he didn’t directly imply Marianne was cataleptic) when Mark tries to convince him that Marianne’s personality change and delirious appearance was brought about by Vorelli.

You can check the catalepsy comment on a 16mm film of the full movie at about 1:05:40.

This catalepsy reference fascinated me because I’m a retired psychiatrist and I’ve seen patients with the syndrome. I guess there were no expert consultants available to the director.

There is a fight scene between Hugo and the Great Vorelli, full of switchblade knives, a hybrid chess boxing match, and tag team with Chuck Norris although the roundhouse kick was ineffective.

You didn’t think there’d be spoilers, did you? There were a lot of ventriloquist dummy jokes during the Svengoolie show and my featured image is my stab at it. Anyway, the ending is surprising.

I think the movie is pretty creepy and dark enough that it might not be a good flick for children. I give it a 3/5 Shrilling chicken rating.

The Snow Looked Gentle This Morning

The snowfall this morning looked pretty gentle out in our backyard—and then the storm hit the gas. Around 7:30 a.m. the wind was barely blowing and the first snow looked slow.

A half hour later, it was blowing sideways and the plow had just plugged our driveway (Thank you so much!).

Across the street, kids came out to play while the snow was blowing. The neighborhood is still pretty new and pretty much under construction, so not much of a place to play yet.

Sena and I remember going to an outdoor skating area at East Park in Mason City when we were kids. It was really just a pond. Park staff pushed the snow away when the ice was thick enough to skate on. Lots of kids skated there and it was free.

It’s not like nowadays. The ice skating rink at the mall not far from us charges you just to fall down on the ice. I think they charge $7 admission and $3 to rent skates. Skating coaches charge $6—I don’t know if that’s an hourly rate or flat fee.

Anyway, at East Park back in the day you could fall down on the ice for free.

Snow Storm vs Electric Snow Shovel: The Rematch!

Well, now that we’re getting this big snowstorm, this will be the second season Sena breaks out the Voltask battery-powered 48V 16-inch snow shovel! It’s up to the task! I manned the snow plow shovel as usual-but Sena deserves all the glory.

We got outside around 8:00 a.m. and finished up at 10:00 a.m. It’s still snowing, but we’ll tackle the rest of it tomorrow. We’re pooped.

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. You can watch it’s progress on the University of Iowa webcam.

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.”

Thanksgiving Day 2025 Tabloid News!

Today is the day for the 2025 Thanksgiving Day Tabloid News and you better believe this paper’s got issues. Eat turkey, watch football, take a nap from all that turkey.

This post’s title was inspired by (what else?) lines from the first Men in Black movie:

Agent K: [at newsstand] We’ll check the hot sheets.

Agent J: *These* are the hot sheets?

Agent K: Best investigative reporting on the planet. Read the New York Times if you want, they get lucky sometimes.

Agent J: I cannot believe you’re looking for tips in the supermarket tabloids.

Agent K: [front-age article about farmer’s stolen skin] Not looking for. Found.

Anyway, today is a special day because we’re waiting for some new items: a premium Cribbage Wars board from Ebonwood with resin inlays. We’re also waiting for extra pegs. These acrylic and brass pegs just shipped from the United Kingdom, which doesn’t charge tariffs. Michaud Toys makes a game board they call Cribbage Rumble (actually the same game as Cribbage Wars), but they’re currently not shipping to the U.S. because of the tariff situation.

We’re still playing Cribbage Wars on our economical little board with tiny peg holes. We’re finding out we like it so much we’d prefer a larger board so we can at least see what we’re pegging without a magnifying glass.

Sena still wins most of the games. I’m working on my strategy.

Happy Thanksgiving!