opioid analgesic use and abuse on the rise
types: codeine, hydrocodone, meperidine, oxycodone, propoxyphene, morphine, tramadol, methadone, hydromorphone, fentanyl, pentazocine

therapeutic opioid use reported by 2.6% of 17,449 case mothers
2.0% of 6701 control mothers
mc: codeine (34.5%), hydrocodone (34.5%), oxycodone (14.4%), meperidine (12.9%)

time window studied: 1 mo before conception to 3 mo after

2-3x risk of infant defects:
conoventricular septal defects = opening btw ventricles not assoc w/ other congenital CV defect
atrioventricular septal defects = hole in upper vent septum assoc w/ atrial septal defect, incr lung circ
hypoplastic left heart syndrome = bad prognosis, rare, incomplete development of mitral valve, left ventricle, aortic valve, and/or aorta
spina bifida = embryonic neural tube not closed
gastroschisis = abd wall defect, hole near umbilicus thru which intestines and mb other organs develop outside, aka paraomphalocele, laparoschisis, abdominoschisis, abdominal hernia

SOURCE
medscape: http://www.medscape.com/viewarticle/738236?src=mpnews&spon=12

3 stages of interview
1) relationship building, find common ground, acknowledge difficulty, give choices, touch the patient to facilitate connection
2) info gathering, open ended questions
3) education, negotiation, dx and tx, prioritize, starting place, bite sized piece
( notes on a wandering lectureCollapse )

I didn't until just now but I have a feeling this info may come up again. There are two different kinds of casein found in milk. Type A1 is associated with disease. Type A2 is not. France has mostly A2 cows and New Zealand is transitioning to A2. I wonder why? How long have people known about this distinction? "Old fashioned" Jersey and Guernsey cows as well as goats and sheep produce A2 milk. Why is the new school milk dangerous? Is genetic engineering for maximum production at the root of this? Bottom line: We want A2 milk, especially for children. I just didn't know about it until today, but my friend Mary is always good for teaching me something new. I was already switched over to goat dairy (feta and kefir), which is easy to do here in Portland. Not so easy some places.
( the info paragraph from Mary's email to meCollapse )

US Deaths from opioid overdose tripled between 1999 and 2006 according to CDC Data. The drug leading the charge for the grave was methadone.
http://www.medscape.com/viewarticle/709744?src=mpnews&spon=12&uac=89474MT
I talked to a junkie on bus#9 the other day who had been through hell but not died. He had a good idea what his protocol would be for getting people unhooked from methadone. It involved taking pts through a series of other high powered drugs, each to be given for a time period just short of the dependence/addiction-inducing timeframe. He was sure his method would work.

http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

AWESOME article. Nutshell: research has show that the biochemistry of the placebo response is due to anticipation-activated opioids and dopamine. Effects of opioids include pain relief, heart rate and breathing modulation. Effects of dopamine include improved motor function in Parkinson's. Both contribute to elevated mood, sharpened cognitive ability, decreased digestive disorders and insomnia, and lower levels of insulin and cortisol. But the whole article is well worth reading. ( Here's the text. I would take notes but I admire this guy's prose too much to chop it up. This article matters.Collapse )