As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen) or Tylenol (acetaminophen) to bring down the temperature daily. This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions. Mainly, it is not necessary to treat the number ...

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We have embarked upon a unique strategy to assess and manage pain. "Opioids Rarely Help Bodily Pain" is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first ...

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The FDA has given official approval to market eskatamine as a treatment for depression. As expected, there has been great fanfare (press releases, morning TV talk show guests, NPR segments and so on). The news leaves me salty. The esketamine story reveals so much of what is wrong about how we get useful medical science findings into clinical practice. Esketamine is not a new drug Esketamine is being promoted as a new ...

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In my clinical practice, I have encountered patient aggression typically with narcotic medications, in particular with the refusal of a refill due to evidence of concerning behavior, like a positive drug screen for drugs not prescribed. Aggressive behavior can include yelling, threatening physical violence or intimidation. I have had less trouble with narcotic-related aggression nowadays especially with media coverage of the dangers of narcotic abuse and especially since a lot ...

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Life experience gives one an intimate appreciation for the meaning behind the saying “just the tip of the iceberg.” Everyone’s encountered something that turned out to be much larger and more complex than was initially understood. In my experience, medicine has yet to submerge its head underwater to discover the true depths of the sordid underside of what I’m calling the “iatrogenic benzodiazepine iceberg.” My own boat capsized on that ...

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In hindsight, I should have never accepted a Xanax prescription from my doctor. What followed was catastrophic — rapidly developing tolerance and physical dependence on the drug and a prolonged illness. Three-and-a-half years later, I am still slowly tapering off Valium (having transitioned to a longer-acting benzodiazepine to aid in tapering) and experiencing debilitating symptoms daily. I was unprepared for what happened ...

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“I feel like a caged animal” — My patient offered me this lens through which to view his life seeped in chronic pain. For him, pain dictated his entire sense of being — it was something that simply could not be distilled down to a single value on a 10-point scale. The cage represented the restriction of life and the boundaries within which he was allowed to experience, let alone ...

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Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock. It happened to be on a Tuesday night with my Suboxone group starting at 5 o’clock. The patient had been there since 4; his ...

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Advocates for the legalization of medical and retail marijuana are quick to point out all the possible benefits that a community might see from such a venture. These include increased jobs, increased tax revenue, possible medical benefits and they advertise it as “safe” and “healthy” and “organic.” Many people who have voted for legalization thought they were talking about the marijuana of the 1960s to 1980s when the THC content ...

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Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden. Fortunately, many expensive cancer drugs are going ...

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