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12-12-2016, 01:07 PM
Wrong diagnosis of emerging marijuana disease can leave patients sick, broke<ul class="">[*]ANDREW SCHNEIDER Lee Newspapers</ul>
12/12/16
A little-known, painful reaction to heavy use of potent marijuana is popping up in emergency departments, hospitals and clinics throughout the country.
Because the disorder is often misdiagnosed, frequent users of large amounts of cannabis with high levels of the euphoria-inducing component THC find themselves in continuing agony and often receiving unneeded diagnostic testing and sometimes surgery exceeding $100,000.
The malady is called cannabinoid hyperemesis syndrome and presents endless cycles of violent vomiting and gut-wrenching abdominal pain.
Although the syndrome was first reported in medical journals in 2004, many physicians, pot sellers and users still dont know about it.
You can think of it as a new or emerging disease, said Dr. Eric Lavona, chief of emergency medicine at Denver Health Medical Center.
Lavona, who is an expert spokesman for the American College of Emergency Physicians, cautions his colleagues to be careful not to trivialize it.''
These folks are really suffering. They can get pretty sick. They vomit like crazy and make frequent emergency department visits because they just can't stop vomiting.
The average patient with the syndrome made five visits to stand-alone clinics, seven trips to emergency departments and was hospitalized three or more times, said Dr. Cecilia Sorensen, also an emergency medicine doctor at the sprawling Denver hospital. Colorado has become an epicenter for marijuana research, especially for the obscure, painful hyperemesis disorder, because it was the first in the country to legalize recreational pot.
But the cause continues to be missed by many.
Late last month, a young woman came to the emergency department at Missoulas Providence St. Patricks hospital complaining of repeated vomiting that wouldnt stop, said Dr. Douglas Melzer, who treated her. She had a Montana Medical Marijuana Card issued to control chronic pain and told him that shed been using pot for at least four or five years. But a week earlier, out of the blue, the violent, cyclical vomiting started.
Hot baths and hot showers gave her some relief, but only for the moment, Melzer said. Many victims of the syndrome have learned that the pain can be alleviated by simply bathing in hot water. But once the water turns cold, suffering returns with a vengeance.
A week earlier she went to another hospital where she was given a common anti-nauseal drug in the emergency department and sent home. Soon, she was back, still vomiting and was admitted to that hospital for two days while being treated for severe electrolyte abnormalities, which is dehydration caused by the loss of fluids from the continuous vomiting.
Doctors at the first hospital had scheduled her for a series of diagnostic tests to see what was happening, including a colonoscopy, an endoscopy, a CT-Scan and a few other studies, the woman told Melzer. But she said she had left before the procedures were begun.
Cyclic vomiting is caused by many different things, but because Melzer had seen it before and his patient willingly discussed her use of marijuana, he knew what he was dealing with.
I treated her with Haldol, which is what we think is the best anti-emetic for this, he said. The antipsychotic medication, called haloperidol, has many other off-label uses including for nausea, sedation and migraines.
This has become a very common problem for us. We see it all the time in several patients a week in our emergency department, and all the emergency departments around Denver, the physician added. It takes time for the medical community to learn about it and recognize it. But once you're familiar with the disease, you're not likely to misdiagnose it.
Emergency room personnel at San Francisco General Hospital, Georgetown University Hospital in Washington, D.C., Harborview and University of Washington Medical Center in Seattle also report routinely seeing cases of cannabinoid hyperemesis, but none could provide numbers of patients with the diagnosis for any specific period.
It should be noted that these hospitals are in states where the recreational use of marijuana is legal or widely used.In 28 states and the District of Columbia, the use of marijuana is legal for medical purposes.
Nevertheless, obtaining accurate numbers of the cases of the syndrome borders on the impossible. Jon Ebelt, a spokesman for the Montana Department of Public Health and Human Services offered an explanation: cannaboid hyperemesis syndrome does not have a specific ICD Code (International Classification of Diseases Code) which are used for billing and for disease surveillance. Therefore, there is no way to track diagnosed cases, Ebelt said.
But pot is being used everywhere.
Like everybody else, we have a lot of marijuana use in Butte, said Dr. Alan Mayer, at the towns St. James Hospital. We all know what cyclic vomiting is, but in the past we didnt recognize that a lot of these people were chronic marijuana smokers.
He said hes concerned that there are probably more patients that have it that we havent identified yet.
The difficulty in diagnosing the syndrome is due in part to its paradoxical use, meaning that while marijuana is often used for stemming nausea and vomiting caused by many ailments, with the hyperemesis patients it causes the precise symptoms it is supposed to end.
While diagnostic and surgical intervention is often ultimately the wrong choice to get to the cause of the problem, its often the most prudent course to follow to protect a patients life when the cause is unknown. Several emergency medicine specialists explained the symptoms can often be confused for life- threatening maladies that demand immediate intervention. These include bowel perforation, an ectopic pregnancy, pancreatitis, an arterial embolus, an abscess, a ruptured aortic aneurysm and a score of others.
12/12/16
A little-known, painful reaction to heavy use of potent marijuana is popping up in emergency departments, hospitals and clinics throughout the country.
Because the disorder is often misdiagnosed, frequent users of large amounts of cannabis with high levels of the euphoria-inducing component THC find themselves in continuing agony and often receiving unneeded diagnostic testing and sometimes surgery exceeding $100,000.
The malady is called cannabinoid hyperemesis syndrome and presents endless cycles of violent vomiting and gut-wrenching abdominal pain.
Although the syndrome was first reported in medical journals in 2004, many physicians, pot sellers and users still dont know about it.
You can think of it as a new or emerging disease, said Dr. Eric Lavona, chief of emergency medicine at Denver Health Medical Center.
Lavona, who is an expert spokesman for the American College of Emergency Physicians, cautions his colleagues to be careful not to trivialize it.''
These folks are really suffering. They can get pretty sick. They vomit like crazy and make frequent emergency department visits because they just can't stop vomiting.
The average patient with the syndrome made five visits to stand-alone clinics, seven trips to emergency departments and was hospitalized three or more times, said Dr. Cecilia Sorensen, also an emergency medicine doctor at the sprawling Denver hospital. Colorado has become an epicenter for marijuana research, especially for the obscure, painful hyperemesis disorder, because it was the first in the country to legalize recreational pot.
But the cause continues to be missed by many.
Late last month, a young woman came to the emergency department at Missoulas Providence St. Patricks hospital complaining of repeated vomiting that wouldnt stop, said Dr. Douglas Melzer, who treated her. She had a Montana Medical Marijuana Card issued to control chronic pain and told him that shed been using pot for at least four or five years. But a week earlier, out of the blue, the violent, cyclical vomiting started.
Hot baths and hot showers gave her some relief, but only for the moment, Melzer said. Many victims of the syndrome have learned that the pain can be alleviated by simply bathing in hot water. But once the water turns cold, suffering returns with a vengeance.
A week earlier she went to another hospital where she was given a common anti-nauseal drug in the emergency department and sent home. Soon, she was back, still vomiting and was admitted to that hospital for two days while being treated for severe electrolyte abnormalities, which is dehydration caused by the loss of fluids from the continuous vomiting.
Doctors at the first hospital had scheduled her for a series of diagnostic tests to see what was happening, including a colonoscopy, an endoscopy, a CT-Scan and a few other studies, the woman told Melzer. But she said she had left before the procedures were begun.
Cyclic vomiting is caused by many different things, but because Melzer had seen it before and his patient willingly discussed her use of marijuana, he knew what he was dealing with.
I treated her with Haldol, which is what we think is the best anti-emetic for this, he said. The antipsychotic medication, called haloperidol, has many other off-label uses including for nausea, sedation and migraines.
Popping up everywhere
In Denver, Lavona said he knows of 50 or so people at any given time who suffer from the reaction.
This has become a very common problem for us. We see it all the time in several patients a week in our emergency department, and all the emergency departments around Denver, the physician added. It takes time for the medical community to learn about it and recognize it. But once you're familiar with the disease, you're not likely to misdiagnose it.
Emergency room personnel at San Francisco General Hospital, Georgetown University Hospital in Washington, D.C., Harborview and University of Washington Medical Center in Seattle also report routinely seeing cases of cannabinoid hyperemesis, but none could provide numbers of patients with the diagnosis for any specific period.
It should be noted that these hospitals are in states where the recreational use of marijuana is legal or widely used.In 28 states and the District of Columbia, the use of marijuana is legal for medical purposes.
Nevertheless, obtaining accurate numbers of the cases of the syndrome borders on the impossible. Jon Ebelt, a spokesman for the Montana Department of Public Health and Human Services offered an explanation: cannaboid hyperemesis syndrome does not have a specific ICD Code (International Classification of Diseases Code) which are used for billing and for disease surveillance. Therefore, there is no way to track diagnosed cases, Ebelt said.
But pot is being used everywhere.
Like everybody else, we have a lot of marijuana use in Butte, said Dr. Alan Mayer, at the towns St. James Hospital. We all know what cyclic vomiting is, but in the past we didnt recognize that a lot of these people were chronic marijuana smokers.
He said hes concerned that there are probably more patients that have it that we havent identified yet.
The difficulty in diagnosing the syndrome is due in part to its paradoxical use, meaning that while marijuana is often used for stemming nausea and vomiting caused by many ailments, with the hyperemesis patients it causes the precise symptoms it is supposed to end.
While diagnostic and surgical intervention is often ultimately the wrong choice to get to the cause of the problem, its often the most prudent course to follow to protect a patients life when the cause is unknown. Several emergency medicine specialists explained the symptoms can often be confused for life- threatening maladies that demand immediate intervention. These include bowel perforation, an ectopic pregnancy, pancreatitis, an arterial embolus, an abscess, a ruptured aortic aneurysm and a score of others.
Risk from wrong guesses
Lavonas and other emergency medicine practitioners said the greatest risk to the patient is from unnecessary diagnostic testing.,.....
<a data-ipb="nomediaparse" href="http://missoulian.com/wrong-diagnosis-of-emerging-marijuana-disease-can-leave-patients-sick/article_e9bbc2ae-1f0c-5e2a-9309-30e0f160762d.html">http://missoulian.com/wrong-diagnosis-of-emerging-marijuana-disease-can-leave-patients-sick/article_e9bbc2ae-1f0c-5e2a-9309-30e0f160762d.html</a>