It is June, 2012 at a pub in Dublin, Ireland. During a break in an international Emergency Medicine conference, and over a pint of Guinness stout (what else?), several doctors were discussing how much medical information was freely available online. Everyone in attendance agreed that the way that medical information is shared has changed radically in the last 30 years—from a few choice textbooks on the office bookshelf and subscriptions to a few medical journals to the availability of most textbooks and journals instantly, online. Not only that, but instant messaging services like Twitter make it possible to get medical help from experts almost instantly—even if the expert is on the other side of the world! In fact, the main problem now is harnessing the incredible potential of the internet to improve medical knowledge and decision-making. Where are the really good reservoirs of medical information online? How can we more easily communicate with our colleagues and friends when we need help with a vexing case? Continue reading
I am looking for a withdrawal protocol for benzos. I have patients that have been on Xanax 2mg for 3-5 years and now I need to detox them. We all know how difficult this is with people in the community let alone in the correctional setting. PLEASE HELP !!!!
Thank You, Doris
Well, Doris, you have come to the right place! I, and many other JailMedicine readers, are happy to share our strategies for dealing with benzodiazepine withdrawal. And this is a common dilemma in county jails. Believe it or not, Xanax is the single most-prescribed psychiatric drug in the United States. My experience is that Xanax is highly addictive and yet handed out like candy by some community practitioners. Some community prescribers I have talked to do not even realize that Xanax is addictive! Strange but true. Continue reading
We correctional practitioners get to see a wide range of medical practice as we review the medical histories of inmates arriving at our facilities. I myself have seen many prescribing practices that make me scratch my head. One example I have run into repeatedly is the practice at many jails of using hydroxyzine to treat alcohol withdrawal. It turns out that many jails do this. I am not talking about hydroxyzine as an adjunct or an add-on to the primary agent. I am talking about hydroxyzine being used as the primary treatment agent itself.
In my opinion, this is a mistake, and should be stopped.
Now I admit that there is room for dissention in medicine. Not all practitioners practice in the same way and there are many, many areas of medicine where there is no right answer. And it is true that hydroxyzine was used in the 1960’s to treat alcohol withdrawal. However, since then, medicine has discovered superior agents to treat this condition: the benzodiazepines. Today, hydroxyzine is the wrong agent for alcohol withdrawal. If your facility uses hydroxyzine as the primary treatment for alcohol withdrawal, you should change your protocol. There is no legitimate basis for this practice. Continue reading
I have been doing yearly wellness exams for the local fire fighters for many years now. I quite enjoy it. Many of them are in such good physical shape that I pronounce them to be “Mary Poppins” fire fighters, meaning “Practically Perfect in Every Way!” Many, however, succumb as they get older to the “weight creep” that is common in the US today. I saw one such firefighter this very week who had gained 8 pounds since I saw him last year. In such cases, I have to educate the patient about the Medical Consequences of Excess Weight. There is even a medical term for this phenomenon: “Metabolic Syndrome.” I think that just about everyone, whether a firefighter, an inmate in a prison or jail, or the medical staff that takes care of them, should understand Metabolic Syndrome. Continue reading
I ran across a couple of interesting articles about antibiotics recently.
In the first article, entitled We Will Soon Be in a Post-Antibiotic Era, CDC researchers predict that the end of the antibiotic era is coming quickly. Antibiotic resistance is developing so rapidly now, that it is only a matter of time until antibiotics just don’t work anymore. This actually is not surprising when you think about it. If we kill all of the microbes that can be killed by our antibiotics, then of course the only ones left will be those that cannot be killed by antibiotics, in other words, that are resistant. The fact that this will happen eventually is a no-brainer. Continue reading
My good friend Al Cichon in Maine writes:
As health care providers we are trained to be tolerant when patients are less than pleasant – excusing their behavior as a result of their illness / injury. Certainly there are occasions when this is appropriate. However, that tolerance can be abused in the correctional setting. Continue reading
I ran across a quite good article the other day entitled A Powerful Tool in the Doctor’s Toolkit written by Dr. Danielle Ofri. It was about how the placebo effect is underappreciated in medicine. Far from being an esoteric “Gee-Whiz!” phenomenon, the placebo effect and its counterpart, the nocebo effect, are things we can use to our advantage in almost every clinical encounter. Continue reading
Hey Jeff, like you I am an ER doc and am the Medical Director of a 550 bed jail. I would like you thoughts on body cavity searches. We had a case last week where an inmate was seen putting a baggy in his rectum. A search warrant was issued and the inmate was sent to the ER for a body cavity search. The inmate refused to let the ER personal touch him. He told the ER doc that it was a baggy of tobacco. The ER observed him for several hours and sent him back to the jail. No cavity search was done. The ER doc felt she would have to sedate the inmate to do the search and felt uncomfortable doing this against his will. The NCCHC frowns on the jail medical providers doing evidence related procedures or searches. My policy is to do the searches if the inmate will sign an informed consent and allow it to be done. If the inmate were to have a complication of sedation or the removal procedure that was done against his will, I would think a malpractice claim could be supported. How do you handle these types of situations in your jail? Thanks, BJF Continue reading
I am curious to see how other jails/prison handle fasting during Ramadan. We only KOP inhalers and creams at my facility and have no medical commissary. We do a very early medication pass for those who are fasting, but it does cause occasional problems with the management of diabetics and some other chronically ill patients. How do other facilities handle this?
Thanks, Jill McNamara Continue reading
If you have read the title of today’s blog post, you already know the answer to today’s case. The answer is “Lithium Toxicity.” I could have instead presented a “Can you figure this case out?” type of format. But I did not want to do that because, really, what was causing this particular patient’s symptoms is not obvious, especially early on. This is an introspective learning case. I want you to read the case knowing the answer. The answer is “Lithium Toxicity.” As you read this case presentation, I want you to ask yourself when the possibility of lithium toxicity would have first entered your head and when you would have stopped this patient’s lithium? Continue reading