The Medical Insider

Recommending marijuana not high on my list

A patient of mine said this about marijuana and his Tourette Syndrome: “The only drug that’s worked!”

I believe him.

Medical marijuana is now legal in most states, including Ohio. A physician cannot “prescribe” marijuana – it’s a federal crime. Marijuana is a Schedule 1 drug, same as heroin or ecstasy, with “high potential for abuse” and “no currently accepted medical use.” But for a patient to buy marijuana legally, the state requires a “recommendation from a certified physician.”

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Volume 9, Issue 10, Posted 9:37 AM, 05.16.2017

Statins: a simple proposal

I am the simple life.

I have but one winning formula: Set the bar low; pull the target close; paint the bull's eye big.

But I struggle to keep medicine simple. I believe, ultimately, a doctor’s decision should empower and enable you, not enslave, and sometimes it just might take a whole visit to get one simple thing straight – like cholesterol.

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Volume 9, Issue 9, Posted 9:55 AM, 05.02.2017

The vexing anti-vaccine crusade

I followed with mild curiosity the “Revolution for Truth” crowd protesting outside the White House last week. One sign read: “OUR BABIES Were Well. THEY HAVE WELL-BABY MERCURY VACCINE. NOW 1 IN 6 KIDS NEUROLOGICALLY DAMAGED.”

The first thing that popped in my head: What’s with the small letters in an all-caps message?

Then I thought: What mercury?

Aside from some flu shots and one preparation of tetanus shot, mercury (thimerosal), a preservative, has been removed from all childhood vaccines for over a decade. And vaccines for measles, mumps, rubella, chicken pox, and polio do not contain mercury – NEVER DID. The vaccines-cause-autism theory is a dead horse that’s been running wild for 19 years, defying logic, science and common sense.

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Volume 9, Issue 8, Posted 9:51 AM, 04.18.2017

What MRI can't tell you about your back pain

Who doesn’t know Miss Ruth?

At 86, she’s the reassuring voice that’s coaxed generations of Westlake toddlers to jump into the water. Recently, Ruth's sciatica acted up again. The pain starts at her buttock and radiates to her ankle. It’s been months. When she wakes up, the pain could make her cry. There’s no rhyme or reason to how the pain catches during the day.

And this pain has landed her in a crossfire between specialists.

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Volume 9, Issue 7, Posted 9:20 AM, 04.04.2017

What missing bumblebees are telling us

Months ago, the rusty patched bumblebee became the first bee species to be placed on the endangered list by the U.S. Fish and Wildlife Service. Ohio is one of its last sanctuaries.

For years, to attract bees I’ve flooded my yard with flowering plants. By June, tree-size honeysuckles choke the eaves with white, pink and yellow blossoms. Last year, I saw one or two bees inconsistently. And it’s not just bees, I rarely see butterflies and dragonflies around our neighborhood anymore. It hasn’t always been this way.

Two streets over, a neighbor keeps a beehive in his backyard, an optimist who despite losing hives two years straight is still trying. He described the day his bees came home, staggering like drunk, and died en mass.

What does science say?

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Volume 9, Issue 6, Posted 10:11 AM, 03.21.2017

The trouble with back pain

I was busily writing a beseeching piece on the health link between us and bumblebees when a news alert popped up. I dropped everything, and changed course to deliver you the newest on the oldest of health problems – back pain.

For decades, experts have pussyfooted around “pain” using language like “should, would, ought to consider” as they try to be sensible and sensitive, empowering, evidence-based and politically correct. The message was, as Tennessee Williams would have said, “all hawk, an’ no spit.”

The pain business remains murky water.

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Volume 9, Issue 5, Posted 9:26 AM, 03.07.2017

Keeping an eye on the 'silent killer'

My blood pressure shot up when I turned 41. For a year, I ran and swam, squeezed stress balls and ate low-salt coleslaw. It helped, but not all the way. Finally, I showed up at the office of my good friend, Dr. Bob Bahler.

He listened to my history, including the “everybody in my family has hypertension, but I’m too young...” line. He chuckled when he heard I’d signed up for a marathon just to scare myself into exercising more regularly. 

“How’s that working out?” he asked.

“A little too well,” I said miserably, waiting for the floodgate of testing to begin.

“Nah,” he said, “you’re just getting old.”

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Volume 9, Issue 4, Posted 9:52 AM, 02.21.2017

My favorite cancer test

No parent in their right mind will admit they have a favorite child.

But kids know. The boy says I favor his sister because the second something breaks, somebody cries or the dog barks, I always holler his name first. He gets punished more severely because he’s older, he’s bigger … he was there.

The girl says I favor her brother because – everybody knows Chinese favor their sons.

“You’re different,” I say. “I love you equally.”

But for what I do in primary care, I admit that I have my favorites, absolutely. Among the screening tests, an 80-year-old test for cervical cancer, developed by a Greek immigrant Dr. Georgios Papanikolaou, better known as the “Pap smear,” is it.

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Volume 9, Issue 3, Posted 9:51 AM, 02.07.2017

When doctors get it wrong

Medicine is a series of learning curves. Sometimes we land on our face.

We treated syphilis with mercury.

To reduce allergy, we said no to peanuts before the age of three; now we say yes to peanuts as early as you can.

We peddled estrogen to menopausal women as some fountain-of-youth elixir until 2006 when the Women’s Health Initiative showed hormone replacement could increase the very thing we’d tried to prevent – heart attacks.

We pitched a low-fat diet for those looking to lose weight, having high cholesterol or just good health metrics. It turns out the important thing about fat isn’t how much you consume but what type. Decades of high-carbohydrate diets fueled the nation’s obesity endemic. Yet we’ve done such a good job of hammering that message that when the new 2015-2020 Dietary Guidelines called to remove restriction on dietary fat; it had fewer “likes” than Michelle Obama’s mom dance with Jimmy Fallon.

But none compares to the current crisis of prescription painkillers.

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Volume 9, Issue 2, Posted 9:39 AM, 01.24.2017

Floating a relationship

What’s the best thing that’s happened to your relationship?

Don’t say kids.

While they’re the best thing to happen to us, they can glue and unglue a relationship. 

My husband, Mark, and I used to have deep and meaningful conversations about The X-Files, the best configuration for a Star Trek tricorder (bullet-shaped), and advanced alien form (fewer legs, more evolved). Now we agonize over who has the energy to start laundry.  

Thankfully, 10 years ago, our daughter, then five, did us a huge favor by failing – three times – Level One swimming, which, apparently, was a record of sorts.

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Volume 9, Issue 1, Posted 10:13 AM, 01.10.2017

Cutting Drug Costs, Part 3: Artichokes save the day

If I had to pick the two most effective, all-purpose health interventions, I’d say: start walking and eat three artichokes each day.

Drugs, all drugs, are a game of rolling the dice against the devil. Each therapeutic benefit comes with a price – cost and side effects. Most of the time, we get away with either nothing or a rash, dizziness a mild headache. But all physicians have stories of patients whose guts turned into the Mar-a-Lago of drug-induced bugaboos after a short course of antibiotics. Or the current 78.5-billion-dollar nightmare of our “first-do-no-harm” profession: the epidemic of prescription drug and heroin abuse.  

The best way to reduce drug costs is to minimize the need for them. Let’s see if you can’t drop a drug or two with these two maneuvers.

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Volume 8, Issue 24, Posted 10:10 AM, 12.13.2016

Cutting Drug Costs, Part 2: Seeking out safe online options

Part two of a three-part series on ways to manage drug costs.

Writing this piece, on the problems and possibly a very effective solution to rising drug costs, has given me an epic, ethical headache.

The good news: Earlier this month, Bloomberg reported U.S. prosecutors are going after generic drug companies in “a sweeping criminal investigation into suspected price collusion.” They won’t name names, but I can easily guess three.

EpiPen, whose active ingredient epinephrine was isolated in 1901, went from $100 in 2007 to $609 in 2016. In 2013, a bottle of doxycycline, an antibiotic, went from $20 to $1,849 in seven months. About the same time, digoxin, a century-old heart medication derived from foxglove, went from 17 cents per pill to $1.18.

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Volume 8, Issue 23, Posted 9:38 AM, 11.29.2016

Cutting Drug Costs, Part 1: Start with your doctor

Part one of a three-part series on ways to manage drug costs.

Some facts just throw me. Here’s one: The U.S. makes up less than 5 percent of the world population, but buys more than 50 percent of its prescription drugs. Are we that sick? Wealthy? Pill-happy?

Yet, according to a 2015 Centers for Disease Control and Prevention report, almost 1 in 10 Americans don’t take their medications as prescribed because they can’t afford to. As a veteran internist, I consider myself well-schooled and informed on this issue.

Last Friday morning, I was juggling two rooms and running an hour behind, when I got a call. It was about an antibiotic I’d ordered earlier that morning. Because of the patient’s drug allergies, I’d opted for an old timer: nitrofurantoin. This little beauty has been around since the 1950s—the days of jukeboxes and poodle skirts. Just right for the job.

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Volume 8, Issue 22, Posted 9:49 AM, 11.15.2016

A closer look at 100% fruit juice

The Westlake | Bay Village Observer is excited to introduce a brand-new column, The Medical Insider. Diana Pi is a Westlake resident and board-certified general internist in practice for over 24 years. Her column will share important information on personal health from an insider's perspective – mixed with the lighter side of life.

Last month, on World Obesity Day, the World Health Organization (WHO) went ape over sugary drinks and proposed adding a 20 percent tax on soda, sports drinks and – here’s an eye popper – fruit juice.

But isn’t fruit juice healthy? Loaded with vitamin C and such?

At one time, the answer was a life-and-death yes. Back when the shape of Earth, round or flat, was still a scientific curiosity. Back when sunbeat seafarers, embarking on months-long journeys, subsisted on sea biscuits, salted meat and a mid-day ration of rum – and died in droves from scurvy, a severe form of vitamin C deficiency.

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Volume 8, Issue 21, Posted 10:07 AM, 11.01.2016