The latest Discover magazine contained one of the most startling Vital Signs columns I can recall. (That's my favorite recurring department of the magazine, where doctors describe how they figured out what was making someone sick.)
In this case, a 50ish white male civil engineer was nauseated and puking. It wasn't controllable with IV antiemetics, which almost always work for food poisoning and the usual causes of those symptoms. He had been seen in the ER 10 days earlier for the same exact problem, and they had run a gamut of tests that showed everything was normal. After a couple of days in the hospital that time, his symptoms had subsided and he had gone home. But a week later, the nausea and puking were back.
The doctor considers that it might be one of many "zebra" causes (porphyria is mentioned, for instance), but before going down that rabbit hole, he thinks of a different possiblity:
I stared at him, then asked as neutrally as I could: "Have you ever smoked marijuana?"
"Every day," he answered matter-of-factly, "for years."
"Ten years? More?"
"Since my 20s, doc. Never gave me any trouble."
The patient points out that pot is used to suppress nausea in chemo patients, and the doctor admits it's a paradox. But the article gives a good hypothesis of why it might still make sense:
... cannabis hypermesis syndrome [was first] described in 2004.... Striking at random, it cycles as discrete episodes every few weeks or months. Daily marijuana use over a number of years is the common thread.
With legalization cresting throughout the U.S., and marijuana more abundant and more potent, cases...have spiked. About 10 percent of the adult population used marijuana last year, double the rate of a decade ago. Beyond that, the average THC content in marijuana tripled from 1995 to 2014 [while] the CBD content...has been halved, so the THC-to-CBD ratio has soared sixfold. In Colorado, visits to emergency departments for hyperemesis syndrome doubled after legalization in 2009. Some estimates put the number of those with hyperemesis in the U.S. between 2 and 3 million each year.
The cannabis plant contains some 100 different cannabinoids...so touting its effects as predictable is a triumph of head-shop marketing over biochemical reality. Cannabinoid receptors abound in the central nervous system. One theory of hyperemesis holds that chronic stimulation of anti-vomiting receptors in the brainstem causes a rebound effect.
All of that is followed by this slap-in-the-face pair of sentences:
None of that was of much immediate use to [the patient]. My urgent worry was that all this retching would rip his esophagus and he'd bleed out.
And that was a pretty major fact I never knew. Between 2 and 3 million people a year! That's close to 1 percent of the U.S. population.
2 comments:
Yep, I talked about it with a nurse friend a while ago. Hot baths/showers tend to help with the nausea at first, but once you get it, the only real solution is to stop smoking pot. Apparently it will come back pretty easily if you keep it up.
I'm surprised that this was a surprise diagnosis to the doctor; but then I live in California. It's my understanding that ERs are pretty familiar with it by now, but maybe that's mostly in states where it's legal.
The doctor is in New York City, so not near anywhere with completely legalized or decriminalized marijuana (I think that's still true). He probably wasn't as surprised as he wrote it to sound... though maybe he was a bit because the guy was a so "straight" seeming? But I was!
He does give details in the article about hot baths, and also that Valium-family medications help. But that, yes, the only real solution is to stop smoking pot.
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