Diarrhea is certainly a “not so talked about” medical condition. But today, at least one kind of diarrhea is becoming quite a medical problem. It is the Clostridium Difficile colitis (colon infection and inflammation).

Physicians, nurses, clinics and hospitals as well as Public Health agencies are seeing a rise in the incidence of this C. Difficile associated diarrhea. This change in the demographics of this disease is toward a younger and healthier group of patients, and not the classic patients.

The typical patients for this “C. Diff.” diarrhea have been the elderly, those with recent antibiotic usage, and those on certain higher risk medications such as clindamycin, cephalosporins, and quinolones. Recent hospitalization and the use of gastric acid blockers, now advertised daily on television and print media are also higher risk factors.

The use of gastric acid blockers has been studied and continues to be. This arena of high use of these acid pH changing medicines in the gut may be contributing to the growth of the C. Diff. more quickly in the gut, than without the acid blocker.

The toxin in itself from the bacteria, can cause worsening symptoms such as toxic mega colon, severe sepsis, perforation of the gut, a need for colectomy (removal of the colon), and even death.

The diarrhea is many times unrelenting. It continues to be watery, sometimes mucous-like, and eventually bloody. But many patients wait to see if the diarrhea will clear. Dehydration and weight loss can be associated with such diarrhea also.

There are both blood tests for the disease and stool tests specific to the disease.

If you are on antibiotics, and develop diarrhea over 24 hours you must call your health care provider or doctor. The best treatment is to stop the antibiotic immediately with your doctor’s order if possible.

Many times two different OTHER antibiotics are used to treat the C. Diff. infection of the colon. One antibiotic for the C. Diff. is only about 80% effective now, while the backup drug is only about 90% effective. But now, resistance is starting to mount to these treatments, leaving patients in severe distress with life-threatening diarrhea and infection.

New studies are being done now using probiotics. Specifically Sacharomyces boulardii and other lactobacilli have been studied. Many are recommending the use of probiotics with the initiation of antibiotics and other antimicrobials.

There are many reasons patients get diarrhea.  But you can eliminate some high risk yourself.  So, do not use antibiotics without a reason. Do not borrow or loan antibiotics. Always talk with your doctor if you develop diarrhea while on antibiotics. When in doubt, call.

CastMD says, “You do NOT want to develop this toxic type of diarrhea.”



A month or so ago the Feds released their workplace data regarding use of drugs while on duty in various jobs and employments. These are the newest data compared to previous studies in mid-nineties.

Industries that continue to have high rates of on the job drug use and use of drugs are those industries in general that continue to have high job turnover rates.

Illicit drug usage among the 18-64 year olds working full-time was the highest in food service and accommodation industry, construction work, entertainment and arts, information services, and management support companies.

The highest rate was 16.9 percent of the food and accommodation employees used illicit drugs in the last month, in the survey.

Construction workers and miners had the highest heavy use alcohol rates at 17.8 percent. Even CEO’s rate was at 8 percent for heavy alcohol usage.

Marijuana continues to lead the pack on illicit drug use for these surveys.

Over 12 percent of the illicit drug users had three or more employers in the past year! Current drug users had twice the rate of missing one or more days in the last month.

Increased rates of illicit drug use were seen in men and lesser paid jobs.

About half of the full-time workers report that their company does pre-placement drug testing. Protective services had the highest rate (76%) of this type of testing, while legal occupations had the lowest (14%) reported in the study.

Only one-third of the workers reported random drug testing policies by their employers.

ONLY one-third of the workers reported they would be less likely to work for companies with random testing programs in place.


poppy.gifAccording to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

meth-1.pngMETHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300


LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers. ecg_evol1.gif

This data is from the 2004 National Center for Health Statistics, the latest full database.  Prevention is the key in almost all of these killers.  With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top.  For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%





DIABETES MELLITUS……………………………..3.1%






cheese-drug.jpgAs part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.




(generic photos from tufts.edu and generic medicines)
The Herald – Everett, Wash. – www.HeraldNet.com

Published: Saturday, April 28, 2007

Toxic drug at Portland clinic causes three deaths

Associated Press


PORTLAND, Ore. – Three people in the Pacific Northwest have died after receiving a drug that was erroneously made 10 times more potent than intended, the Oregon State Medical Examiner’s Office said Friday.

ApotheCure Inc., a drug-compounding pharmacy company in Texas, said an employee made a weighing error in the creation of the drug colchicine, which lead to the deaths. Colchicine is commonly used to treat gout, but in these cases it was being given intravenously to treat back pain.

The drug was sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch of the drug this spring. All three people, two from Portland and one from Yakima, died between the end of March and beginning of April from the toxic levels of the drug.

The defective doses were sent only to the Portland clinic, ApotheCure said.

The Food and Drug Administration said it is investigating the case but believes the problem has been contained.

The Center for Integrative Medicine has since closed, and representatives from the organization could not be reached.

Colchicine works by stopping cells from dividing, which reduces inflammation in conditions such as gout, said Dr. Rob Hendrickson, associate medical director for the Oregon Poison Center. But in excess doses, the drug stops all cells from dividing – eventually leading to organ failure and death.

The medication is not commonly used anymore and the use as a back pain treatment is less common than for gout.

Gary Osborn, a pharmacist and certified clinical nutritionist for ApotheCure, said the situation could have been contained earlier, but the clinic did not contact ApotheCure until nearly two weeks after the first death. He said the second death occurred before the company was able to complete recalling the batch and sending them a new lot. He said this is ApotheCure’s first incident of this sort.

“We are kind of the leaders in the industry,” Osborn said. “But you know what people say, stuff happens.


Copyright ©1996-2007.
The Daily Herald Co.



This is the time of year when lawn chemicals, yard cleanups, and neighborhood events start to be exposed and available to little hands.  Certainly many chemicals, including pesticides, herbicides, fuels, and cleaning agents are ubiquitous in homes and garages.  But beware.  Many of these chemicals are poisonous and dangerous with regard to flammability, explosiveness, and chemical burns.

Each dollar invested in poison centers saves about seven dollars in expenses not needed if the patients go into their doctor, their clinics, or their hospitals.  This is a great public health service.

Over the years since the early 60's, the poison centers have become an integral part of the healthcare network.  Now with the terrorism issues, the poison centers have become an integral monitoring source of information, as many times calls come to the poison centers early and often, thereby making a grid of what is happening and where it is happening.

For instance, when the bad botulism toxin product that was being used by spas and clinics that were trying to save money by not buying and using the approved botulinum toxin brand, the poison centers were seeing a problem early.  Patients across the country, in pockets, were being paralyzed – not just the muscles of the eyebrow, forehead, and other smaller muscles.

The poison centers across the USA now have a single number.  Depending on your area code, your call will be forwarded to the center in your area, or the one contracted by your state officials.  For instance, Idaho calls go to Denver's poison center.  Alaska's poison calls go to Oregon.  Washington's poison center gets all of Washington State's calls.  This year that number will be around 150,000 calls!   Poison calls are answered by an expert group of pharmacists, nurses, Pharm Ds and have backup by physicians specializing in toxicology and poisonings.  It is the number that the experts in all fields, from dermatologists to kidney specialists, call when the patient has been poisoned, or is toxic from unknown sources, or when the patient doesn't act or change based upon "normal" disease states.

The goal of Poison Prevention Week is to reduce illnesses, injuries, and deaths due to poisonings; build safer communities; and reduce unnecessary health care costs for everyone.


Here are some ways to be poison cautious:

Obtain syrup of ipecac and keep it in your home – but use it ONLY if instructed to do so by a poison center or physician

Use child-resistant containers and remember, they are not childproof

Keep products in their original containers

Never call medicine candy or take it in the dark

Return products to storage areas immediately after use

Teach children about Mr. Yuk

Put Mr. Yuk stickers on all poisonous products  

Call the Poison Center for a free information packet and Mr. Yuk stickers  

Keep emergency numbers next to your phone:



What is National Poison Prevention Week?

Public Law 87-319 authorizes the President to designate annually the third week in March as National Poison Prevention Week. This act of Congress was signed into law on September 16, 1961, by President Kennedy, after which the Poison Prevention Week Council was organized to coordinate this annual event. Congress intended this event as a means for local communities to raise awareness of the dangers of unintentional poisonings and to take such preventive measures as the dangers warrant.

(PC week and listing adapted from WAPC.org website with commentary from castMD.com)


What if Sally told Damian who told Susie who said Bob heard from Tony that someone was told that somebody knew about what was supposed to have happened !

What matters is:

Does your family need every kid to be “on call?”  Does the kid deserve some privacy, alone time, reflection time…

Does your family need every kid to be “on call?”  Does the kid deserve not to be in everyone’s quick pick cellphone five to stay alive?  What if no reply is sent?

It seems that the number of anxiety disorders is rising, as is the number of children with attention deficit disorder, attention deficiti hyperactivity disorder and eating disorders.  Many other illnesses such as diabetes, joint disorders, heart disease, ocd, and high cholesterol are sneakingly and alarmingly rising in our youth.

Many of the reasons that cell phones’ basic safety issues have been put to the back burner, is to train the trend setting addiction downloads and uploads to happen.   Addicted to cell?  Crazy?

The problem is – with all the uploads, downloads, text messages, pix interchanges, and annoying ringtones or games that your youth has to endure….when does the quiet moment come, when does the kid get to relax?  Flop on the couch? Jump in the lake?  Take the cell with…

Processing of information is good.  Processing of steps is good  – as in chess.  All this does come from being able to program a cell phone, take a picture, record a intro, text the message…then send the entire file to a friend or foe in record milliseconds. 

But while doing all of this, reading books, doing homework, writing poetry or music, or practicing basketball or bass guitar…even eating ice cream does NOT happen relaxed.

When people are constantly interrupted from thought, the complexity of the thought process drops.  Like in hitting baseballs or golfballs, the follow through is critical.  I say slow the burn, cell phone OFF turn !

Torture is being interrupted from a thought process over and over and over and over.  Sleep patterns, napping, resting, watching the clouds go by, day-dreaming, and wishing upon a star…are all interrupted.  It just makes for high anxiety.

Slow down, even the turkeys obey the speed limit.

Many of my colleagues would forever give up their beepers, cellphones, and pagers…for less anxiety.  What is crazy is we are creating and feeding the mental anxiety monster in youth worldwide…….

Oh, excuse me, my cell phone is vibrating………. 


Fire victims, EMS providers, methlab remediation teams, and firefighters will be greatly served by this medical advancement in the United States.  This cyanide antidote replaces the "lilly kit" that had been used for years, which used early, was lifesaving but medically cumbersome at best.  Three medicines quickly had to be given to these severely critical patients – and the antidote itself had poisoning problems itself.  This new antidote uses an extremely novel idea.  Vitamin B12, hydroxycobalamin, likes cyanide.  With a little molecular twist, the new antidote drug, hydroxocobalamin, simply exchanges a part of the drug and binds the cyanide with impressive results.  Dr. Steve Borron, well know to some of us, and definitely an international leader in this arena, has done significant and life changing research on this new antidote to get the approval through the FDA.  This antidote has been used in Europe for over a decade with great success.  Others like Dr. Hall in Denver has done work on the FDA project years ago.  Many have contributed to this landmark success of getting this drug in a workable form into the United States.  Congrats to all of them!


FDA News

December 15, 2006

Media Inquiries:
Press Office, 301-827-6242
Consumer Inquiries:

FDA Approves Drug to Treat Cyanide Poisoning

The Food and Drug Administration (FDA) today approved Cyanokit (containing the drug hydroxocobalamin, intravenous tubing and a sterile spike for reconstituting the drug product with saline) for the treatment of known or suspected cyanide poisoning.  The approval, which is based on evidence of the drug's effectiveness when tested in animals, improves the nation's ability to respond to emergencies, including a potential attack by terrorists.

"Cyanide is a potent poison and one of the substances that could be used in a chemical attack," said Dr. Steven Galson, Director of FDA's Center for Drug Evaluation and Research.  "Today's approval is yet another measure to counter the threat of terrorism, which is a critical component of FDA's public health mission."

Cyanokit received a priority review and was approved under the Animal Efficacy Rule, which  allows use of animal data for evidence of a drug's effectiveness for certain conditions when the drug cannot be ethically or feasibly tested in humans. 

In a controlled study in cyanide-poisoned adult dogs, the use of Cyanokit reduced whole blood cyanide concentration by approximately 55% by the end of the infusion, and significantly improved survival of the Cyanokit-treated dogs compared with dogs receiving placebo.

The safety, metabolism and excretion of Cyanokit were evaluated in 136 healthy adult humans.  At the proposed starting dose of 5 grams, the drug was found to be generally well tolerated with side effects that were mild to moderate.  The drug exits the body unchanged in the urine.  In the presence of cyanide, Cyanokit's active drug takes up the cyanide and becomes a form of vitamin B12.

The most frequently reported adverse reactions in the trial were red urine, skin redness (both from the drug's coloration itself), a temporary increase in blood pressure, headache, nausea and injection site reactions.  Allergic reactions were observed in a small number of individuals but were relatively mild and responded quickly to treatment.

Cyanokit is manufactured for EMD Pharmaceuticals, Inc by Merck Sante s.a.s. in Semoy, France and packaged by Dey Laboratories of Napa, California.

More information about FDA's efforts to counteract bioterrorism is available on FDA's website at http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html.


(photos courtesy: google images)



Methlabs continue to plague society. Costs continue to rise.  New laws embedded.  New techniques on how to get the drugs to help make meth continue, for example:

Typical mechanisms that the non-cartel methlab cooks get pseudoephedrine are: smurfing and shelf sweeping.  Individuals that “smurf” go to a large number of stores and buy amounts at each retailer of pseudoephedrine that are under the legal limit but in the aggregate are much more.  A less sophisticated version of smurfing involves sending many individuals into the same store to buy amounts of pseudoephedrine just below the legal limit.  “Shelf sweeping” occurs when an individual or a group goes into a store and remove all the pseudoephedrine on the shelf and then exit without paying.



photo courtesy srhd



Recently, radio listening to a report of the "significant" risks to persons entering into methlab areas that already have been cleaned up or decontaminated or remediated.  The report left me believing that any site with any amount of meth activity is the same.  Not true.

The report said after the cleanup process has occurred, the persons are still able to be "poisoned" and become "toxic" from being in the decontaminated room.  Not probable either.

The epidemic of methlabs across the country have spawned the entire "cleanup industry" making many companies extremely wealthy in the "abatement industry."  One operator told me, "If I just turn on the truck, the fee is $2500 dollars, then the bill goes up depending on what we do."

Most ingredients of methlabs are dangerous.  Some can be flammable.  Some have bombs or incindary devices. However, after the cleanup has occurred, risk is minimal, probably non-existent.

Do you clean out your garage or shed as a methlab decon project – the spaces that have been storage for such contaminants of lawn mower gasoline, oil, garden chemicals, camping or cooking supplies, glass cleaner, carburator fluids, drain cleaners, windshield washer fluids, antifreeze, and other highly toxic day to day chemicals of household use?

The risk of financial collapse for cleanup is hard hitting for any owner that needs to hire a "cleanup" company.  It is estimated that a methlab cleanup can cost from $1000 to hundreds of thousands, depending on cartel activity or the mom-pop variety.

Google "methlab cleanup companies" (remediation) and nearly 60,000 hits arrive at the "deal or no deal" option.

Searching and searching, little is found on "risk of after-cleanup toxicity."   Colleagues in this area have been surveyed.  An anwer is in waiting.  Thus far, experience has not shown me one person ill, sick, contaminated, physically harmed, toxic from a space declared "clean."