What About Medical Cannabis?
By Andrew Ellsworth, M.D.
Since ancient times, marijuana has been used for medicinal and recreational purposes in many cultures. In the United States, it became illegal during prohibition, like alcohol. Later, under the Controlled Substances Act in the 1970’s, the federal government classified marijuana a Schedule 1 drug. This classification includes heroin, LSD, and ecstasy, all deemed to have no safe, effective medical use and a high potential for abuse.
This Schedule 1 status imposes bureaucratic and legal barriers, making it difficult to conduct scientific research on the medical benefits from marijuana. Studies that have been conducted are small and limited. Thus, physicians are less confident recommending marijuana for patients. Not to mention, use or possession remains illegal federally and in many states.
The word cannabis refers to all products derived from the plant cannabis sativa. There are hundreds of compounds in this plant, called cannabinoids. Cannabidiol (CBD) is one of them, and tetrahydrocannabinol (THC) is another. The word marijuana often refers to products from the plant that contain large amounts of THC, which is psychoactive and can alter someone’s mental state.
Cannabinoids can trigger receptors in the brain to release neurotransmitters to affect mood, sleep, pain, and memory. Drugs with cannabinoids may be helpful in treating nausea and vomiting from cancer treatments, loss of appetite and weight loss from AIDS, chronic pain syndrome, multiple sclerosis symptoms, glaucoma and children suffering from seizures. There may be other medical benefits we are not yet aware of. We need more research to determine safe treatments and establish confidence.
Marijuana use can cause harm. It can do more than dull the brain and give someone the munchies. It can increase the risk of motor vehicle crashes. In some individuals it can increase the risk of developing schizophrenia or other mental illnesses. Frequent use by adults and use in adolescence can decrease attention and memory, or cause cannabis use disorder, which has symptoms of craving, withdrawal, lack of control, and negative effects on personal and professional responsibilities. Sometimes people develop recurrent severe vomiting. Vaping products with THC have resulted in severe lung injury.
Marijuana has been used as a medicine for a very long time in various cultures. Yes, it can be addictive, and it can cause problems. Although, when you consider the harms from alcohol, tobacco, narcotic pain killers, and other medications, perhaps cannabis deserves a chance to be further studied and used when medically appropriate.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Historic Impact of Public Health
By Kelly Evans-Hullinger, M.D.
Life expectancy is a measure commonly considered when it comes to the overall health of a population. In this day and age, when most of us think about which medical interventions are most important to increase life expectancy, we probably think about things like treatment of cancer, interventions to treat heart attacks, or surgeries for life threatening illnesses. While those things are all important, their overall impact on a population’s life expectancy pales in comparison to the prevention of infectious disease.
Average life expectancy around the world has doubled in the last two hundred years, from about 40 years to 80 years, with the bulk of that change occurring long before we had effective cancer treatment or cardiac catheterization. Before the 20th century, infant and childhood death was extremely common due to infections spread by contaminated water and food. It is estimated that through most of human history nearly half of children died before adulthood, almost entirely due to infections.
Armed with the new knowledge of germ theory, societies in the late 1800’s began instituting early public health interventions such as sewage management, water treatment, milk pasteurization, and garbage collection, which resulted in rapid decreases in death from food and water borne infections, and thus increased population wide life expectancy.
Later, widespread use of vaccines for many fatal diseases led to enormous improvements in the health and longevity of populations across the globe. Try to imagine a world in which almost everyone is affected by the death of children due to polio, measles, smallpox, tetanus, the list goes on. That these deaths are now extremely rare or eliminated altogether is nothing short of a modern miracle, and we ought not take it for granted.
Antibiotic use has exploded since the discovery of penicillin in 1928, and the proper use of antibiotics continues to help us prevent early death due to infections that might have been fatal left untreated. Modern science has led to effective treatments for even the most challenging infections such as tuberculosis and HIV.
Modern medicine uses abundant, wonderful technologies and treatments which help us extend lives and reduce suffering of our individual patients. But statistically, no fancy new development is likely to have the quantitative impact on human society that compares to those early public health measures. As a society, we would be careless to forget the worth of our public health institutions which have helped us thrive and double our average life expectancy.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Caring for Expectant Moms
By Debra Johnston, M.D.
Lately my teenager has been fascinated by medical dramas. Although my “doctor self” is usually rolling my eyes throughout the program, it’s often a good conversation starter.
One recent show featured a pregnant woman who experienced one medical crisis after another. Her kidneys, liver, and lungs failed in succession as the team raced to identify the underlying obstetrical problem and find a treatment. At the climax of the episode, her heart stopped. Of course, being television, the correct diagnosis was made, the experimental treatment worked, and the episode ended with a perfectly healthy mother at home, holding her perfectly healthy baby.
For all the erroneous and outrageous details that transform bad fictional medicine into good TV, they did get something right. Pregnancy is a dangerous condition. In fact, in America, pregnancy complications account for approximately two percent of all deaths among women between the ages of 20 and 44.
To put the two percent into perspective, consider that pregnancy complications can only happen in the months during and immediately following pregnancy. On average a woman in the United States will birth between one and two children. This means that between the ages of 20 and 44, the risk of pregnancy-related death isn’t spread across those 25 years as are the risks of cancer or car accidents. It is concentrated into the relatively few months during which she is pregnant. And for women younger than 20 and older than 44 the risk of pregnancy complications is even greater but, statistically speaking, women in those age groups simply don’t have enough babies to categorize pregnancy complications as a major cause of death.
Consider also that death by violence is not counted as a pregnancy complication, even though pregnancy is a significant trigger for violence.
What’s more, consider that these risks are not distributed equally between women. Socioeconomic status, education, physical location, and race all impact the likelihood of pregnancy complications, and death from those complications.
Issues that affect pregnant people affect their whole family. In medical school, I was taught “nothing is worse for a fetus than a dead mother.” It’s hard to disagree.
So, what can we do to make pregnancy safer? The answer to that question is multi-faceted. Access to quality obstetric care is one factor. However, we must also ensure women are as healthy as possible before they conceive. They need good nutrition and safe places to live and work. They need education to know what is normal, and what is not. They and their families need access to psychiatric care to address mental illness and addiction.
It may not make for good TV, but in the real world, the starting place is as basic, and as difficult, as that.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Time Heals All Wounds
By Jill Kruse, D.O.
The saying goes “time heals all wounds”, but what happens when a wound does not heal? Wounds go through many stages while healing and complications at any step can prolong the process.
The first step is stopping the bleeding. For people who are taking blood thinners like aspirin or warfarin, it may take longer for the bleeding to stop or clot.
The next step after the blood starts to clot is forming a scab. This happens when blood vessels around the wound narrow and platelets in the blood clump together to create the scab. A protein called fibrin helps hold the clot in place. After someone has had a stroke or heart attack caused by a clot, they may be placed on medications to make the platelets more slippery and less likely to clump together. Medications like Plavix and Aggrenox make platelets slide past each other rather than clumping to make a clot which can delay the scabbing process.
At this point, the body cleans the wound. Blood vessels will dilate and increase blood flow to the area. White blood cells called macrophages arrive on the scene to clear out infection and release chemicals called growth factors and cytokines that help tell the body to form new skin cells. If the infection is not cleared by the body, the wound will not heal properly.
The body also creates new blood cells to bring in nutrients and supplies to help heal the wound. Conditions like diabetes, atherosclerosis, known as hardening of the arteries, and high blood pressure, cause poor blood flow and can slow down wound healing. Smoking slows healing in many ways. Nicotine causes blood vessels to narrow and reduces the number of macrophages and fibrin in circulation. Carbon monoxide in cigarette smoke decreases the oxygen transport needed to help repair and rebuild the skin cells.
The final step of wound healing is strengthening or maturation. At this stage the wound looks closed and repaired, but the tissues below are still being strengthened. The wound may feel itchy or tight and the skin may look slightly pink and stretched. After about three months the wound should be about 80 percent healed. It can take up to two years for the scar to remodel and achieve its final appearance.
Yes, it takes time to heal all wounds, but if you have concerns don’t bide your time. Talk to your doctor to learn about options that can assist you through the healing process. We want to help your wound heal, all in good time.
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.