Is this really drug abuse?

Saturday, April 21, 2007

I had the opportunity last week to visit with a journalist to provide background about drug abuse in sports. We spoke about steroids, amphetamines, erythropoietin, all the biggies. It took an encounter with a patient, though, to remind me that most of us abuse drugs as part of our daily routines.

Not uncommonly, people arrive in the ER with palpitations, occasional extra or runs of rapid heart beats. While I search for potential badness as the cause of the palpitations, most of the time I end up having the same conversation. I couch the terms to be more acceptable than drug use. I talk about small changes in lifestyle but I am really asking the patient to minimize the drugs they put in their body.

Badness can cause palpitations. Anemia, electrolyte problems, thyroid issues and electrical short circuits in the heart are the major culprits. Aside from the electrical issues, most causes are easy to find. The electrical stuff is sometimes harder because invariably the extra heart beats aren’t happening when the patient shows up in the ER. It’s like taking your car to the mechanic when it makes a funny noise and magically the noise is gone when you pull it into the service bay.

So where do the drugs come in. I want patients to minimize the irritation that things they put in their body can cause to the heart. I want them to get rid of those substances that look like adrenalin after they are metabolized.

You might be thinking cocaine or amphetamines. Good guess and while those are also bad and cause heart and blood pressure problems, they’re not a big issue with a 50 year old homemaker. Think common, think routine, think caffeine, alcohol, nicotine and over-the-counter cold medicines.

The big four span generations, cultures and geography and they keep me busy. I’m not so naïve that I expect people to change their lifestyles just because an ER doc they‘ve never met says so, but I am always hopeful that they might cut back a little and that family and friends might reinforce my message.

I’m inherently lazy and I want the message to get through so that I can be just like the Maytag repairman. Small lifestyle changes in my patient population makes my life less hectic and it’s always good to be bored in the ER.

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