A case of abdominal pain in the ER. And a surprising cause. (marijuana)

[Sgent]

http://www.kevinmd.com/blog/2016/07/case-abdominal-pain-er-surprising-cause.html?utm_content=buffer0a389&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

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I introduce myself, and tell him that Dr. Cluff has told me his story, but that I’d like to hear it again. The illness has been ongoing for two days, almost three now. The pain has been across his abdomen, but is most severe at his stomach. I palpate, and he clutches my wrist when I push below his sternum. His bowel sounds are normal and his belly his soft. His heart and lungs are clear. His history is just as I’d heard from my colleague — a little reflux, and an appendectomy in his teens. I apologize, and tell him that there is nothing abnormal on his CT scan. I go back to the story.

“When I asked if you’ve had this before,” I say, “you said ‘not like this.’ Does that mean you’ve had something similar to this before?”

He sits up. “It’s been over a year now,” he says. “Every couple of weeks I start vomiting, and sometimes there’s pain, but it’s never lasted this long. I’ve seen my family doctor. I’ve had ultrasounds, blood tests, and even a camera in my gut, but there’s nothing.”

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“What if I told you that it’s likely the marijuana?”

[OKNancy]

1. never post anything bad about weed

or you will get jumped on. To some it is the most important thing in the world. The most important political stance too.

[nolabear]

9. That's a terrible way to cut off legitimate concerns from being expressed.

And yes, I have some.

[Warren DeMontague]

13. Ever seen what chronic alcoholism does to the human body?

That is, for the ones who surivive.

Well, I guess we better outlaw it and throw everyone caught with a bottle of jack daniels in prison, too, since prohibition is such a peachy fuckin' idea.

[nolabear]

17. What? I don't understand.

[Warren DeMontague]

18. What "legitimate concerns" do you have, here?

You say you're being discouraged from expressing them. On the contrary, I'm asking what specifically they are.

[nolabear]

21. Oh. You misunderstand.

I hate it when people here talk about third parties in a dismissive way. People need to be able to ask questions, raise concerns, provide info and not just stay away from a conversation because they're being cut off automatically.

I'm all for legalization. I live where it's legal. I smoke it casually and use high CBD products for pain management. It's pretty darn good for it. It hasn't brought down society one iota. Downthread I talk about my son having problems with doctors having read those studies and assuming something that has caused him a whole lot of pain.

But the comment I replied to seemed to be just preemptive snark and I'm not good with that.

[Warren DeMontague]

22. Gotcha.

Yes, I agree. I'm where it's legal, too, and at my age most of the people I know who indulge are more about cbd/pain relief than getting couchlocked on Saturn.

Another benefit of legalization, because in the old days weed was weed was weed.

[nolabear]

25. And prison is insane.

[Warren DeMontague]

14. Yeah, well, prohibition is a fucking failure and is long overdue to be ended. Period.

There is no objective rationale by which anyone could argue that cannabis is anywhere near as dangerous as a whole long list of totally legal substances.

One thing noted by this article is, doctors would miss this often because patients wouldnt want to discuss their cannabis use - because of stigma and illegality, largely. Seems to me that's another argument for legalization.

[Rex]

16. Seems some are obsessed with others obsessions.

What an odd obsession. IMO.

[Warren DeMontague]

19. I dont know how anyone who claims to be progressive can defend the drug war, at this point.

Seriously.

[Rex]

20. They can't.

At all.

[Egnever]

2. If he told me that I would laugh in his face

This clown goes on for two paragraphs on how little he knows then wants to pretend he knows it is the marijuana based on nothing..

[JNelson6563]

5. Same here.

What an idiot.

[bravenak]

3. My doctor said that shit too. It was actually H pylori

[brush]

4. Good info about cannabinoid hyperemesis syndrome (abdominal pains from smoking marijuana)?

Who knew weed would cause this. It's been researched though and there might be something to it.

I, I mean a friend, smokes because of being diagnosed with slight glaucoma development. Every time he smoked before his doctor's appointment he would get stomach pains at night. Once he stopped the pain stopped so he cut down on the amount.

Hard to convince most smokers of this though as weed has always been viewed as a feel-good panacea for many maladies and certainly not the cause of one.

The doctor told patients suffering from CHS to stop smoking weed and the pains would go away.

Logical advice from a doctor's stand point but if I may, from years of past experience and some recent contact experience with today's marijuana, the stuff out today is exponentially stronger than the average pot from back in the day so there's no need to smoke as much of it to get high. A couple of deep tokes do the trick, or so I'm told.

IMO, the doc should've told his patients to just cut back on the amount used.

The stuff today will keep you high for hours, the equivalent of acid back in the day, as I'm told.

[nolabear]

6. Funny story about that.

My son, who's in his late 20s, has cyclic vomiting syndrome. He goes into the hospital once or twice a year throwing up so badly that he tears muscles and pukes blood. It began when he was two.

Until about two years ago they'd look at his chart and start an IV with every sedative and anti nausea drug they've got. He usually ended up overnight but released the next day and went on. Then everyone started this "he's a young man it must be marijuana" thing. To be honest he does smoke some, but he's also very much into health and is in no way a stoner. But now we have to fight them to get them to accept a diagnosis he got when he was a child, and when he was two he certainly wasn't smoking pot.

I suppose it's a thing, but it's not always a thing and it's horrible to see them give him the "do you smoke a lot of pot?" questionnaire every damn time. It's on the chart. We tell them (and his dad and I are generally there because he literally cannot speak). They can't get that bee out of their bonnets.

[NCTraveler]

10. CVS is what I thought.

So many don't get it even in the medical field. I'm not necessarily knocking them as it isn't common. I haven't been big on the marijuana connection. I will say that there are often personality similarities in those afflicted that lead them as a group to have higher rates of marijuana use than the population as a whole.

[jalan48]

7. It's real-I have two friends who came down with CHS shortly after weed was legalized here in Oregon

Then again, they were eating RSO.

[ananda]

8. Color me skeptical and very suspicious.

I have never heard of pot having this effect on anybody .. till now.

So my big question: how is the money flowing and who has a vested
interest in tainting or destroying the legalization of marijuana?

???

[GWC58]

32. Don't worry!

Kevin Sabet and Patrick Kennedy will spread this like wildfire. Sabet is almost giddy with Trumps pick for Atty Gen!

[Barack_America]

11. Hmm, sounds like porphyria, which was my first thought.

Off to see if there's a connection.

[lame54]

12. Mis-diagnosis are way too common

[Calculating]

23. I've never known anyone to suffer from this

Sounds like a pretty rare disorder. I don't like seeing it used to bash on cannabis any more than food allergies being used to bash on foods. It's basically just a rare allergy/disorder that a small amount of people might experience if they use cannabis, and the easy solution is to just stop using it.

[Nevernose]

24. I'm allergic to cannabis

If (and who am I kidding: when) I smoke, it's usually asthma and always nose closing up, eyes swelling. Similar, but not as bad, as when I eat shrimp or pet a cat.

I've got a close friend who smokes daily, but eating anything containing more than a milligram or two of THC will throw her into hours long vomiting.

So although I've never heard of it (and apparently none of us have), I suppose it's possible to have a rare endocannabinoid-related disorder.

[Warpy]

26. All drugs have side effects

and cannabis has been poorly studied, thanks to the WOD.

This is a new one on me to add to what I already knew, cannabis related supraventricular tachycardia.

I keep reminding people cannabis is no panacea, a few people will always react badly to it. However, it shouldn't be illegal, either.

[tenderfoot]

27. I understand these abdominal pains can lead to opiate abuse. Like Oxy or Vicodin.

Proving further that marijuana is a gateway drug.

[Sunlei]

28. something he easily could stop using, to see if he stops becoming sick. maybe he's a codeine addict?

closet codeine addicts have withdrawal intestinal 'pain' all the time. RX, codeine drugs are used as analgesic drug for gut pain.

[lunasun]

29. Sounds like it would be from high CBD strains from the research published

Over abundance of Cbd can activate the nausea . May be its more common now with some of the perfected strains seeking to be higher in cbd .
The cbd strains are used more in some of the medical applications of marijuana I believe. The patients in the article all seemed to just be using it as a high though.

[ALBliberal]

30. My 19 year old son has suffered from abdominal pain for a few years

Not so much throwing up but many of the other symptoms in this article. Thanks so much for posting this it may help us.

[hollowdweller]

31. I have a friend with Cannabanoid induced hyperemesis syndrome

VERY heavy smoker...or was.

Initially when he'd come back from visiting a friend or a vacation without his wife, who sort of discourages his smoking he came down with it.

The first time he thought it was food poisoning.

Then he has diabetes so they made a provisional diagnosis of gastroparesis which nerve damage due to diabetes can cause.

Finally they diagnosed cyclical vomiting syndrome.

He eventually wound up at a fairly upscale hospital and asked him if he smoked pot.

He basically smoked pot almost like cigarettes.

Well he cut back and I was under the impression that he hadn't had any more episodes but he had.

So he went backpacking with us after spending the weekend with a friend who smokes a lot.

When we got to camp he got sick and we had to have him airlifted out the next morning. He was really dehydrated and in intensive care for like a week.

So he pretty much took it seriously. He will still do a bong hit or two at a party or something but if he's telling me accurately he hasn't had any more episodes.

Apparently it affects extremely heavy smokers more often. I've always been very sensitive to MJ and a hit or two and I'm fine. When I was around him or some of my other pals that were heavy smokers they would smoke me under the table. They smoked so much they had an incredible tolerance where I was too blasted.

As much as my friend likes to smoke i was glad he could still enjoy, but after the incident with the airlift it always makes me real nervous when he's smoking around me.

[MindPilot]

33. My doctor says the same thing.

Over the past five or six years I have been hospitalized three times. There is absolutely excruciating abdominal pain and vomiting so painful and violent, it literally makes me scream. This is coupled with a constant feeling like I'm falling. A little morphine with some fluids, and in a couple hours, I'm fine.

Every test comes back textbook normal.

Doc tells me it is "cannabis induced hyperemesis". I tell him, with all due respect. I think he's full of shit. Working for a big HMO, I know he has to toe the company line, but I explain that I have been fed so much bullshit about weed for the past forty some-odd years I've been using cannabis, and none of it is real. People have been using cannibis for thousands of years, and only just now, modern medicine--i.e. big pharma--comes up with a brand new horrible malady attributed to the demon weed just in time for legalization. What a coincidence!!

(I recall in high school being told that weed would kill all my sperm and make me grow breasts. I still had to get a vasectomy, and I don't even have a decent set of man-boobs.)

So Doc put me on Efexor, and I'm coming up on two years since I've had an "episode".

My decidedly un-medical conclusion...if you're sick and all the test are negative, it's stress.