How to Sleep Better: Practical Steps for Patients

On April 25, 2025August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Sleep gets a fraction of the attention we give diet and exercise, and it should not. Research from Dr. Ari Shechter at Columbia University has shown that poor sleep feeds obesity, diabetes, hypertension, and heart disease. It costs people their daily functioning, and underneath that it is quietly setting long-term disease risk. It is not a secondary problem.

When I ask patients about sleep, I keep it practical. When did this start, and is it new or has it always been like this? What is the bedroom like, too warm or too bright or too loud? Do they snore, gasp, or stop breathing, which points toward apnea? Any crawling or tingling in the legs, which points toward restless legs? I ask about weekdays versus weekends, because an irregular schedule can look exactly like insomnia. And I ask about caffeine, alcohol, nicotine, and medications, which patients rarely volunteer.

Formal tools give the conversation structure. The Epworth Sleepiness Scale is quick for daytime sleepiness. The Pittsburgh Sleep Quality Index is broader. STOP-Bang and the Berlin questionnaire flag possible apnea. The Insomnia Severity Index tracks both severity and how much it is costing someone functionally.

For objective data, in-lab polysomnography remains the standard for apnea, limb movement disorders, narcolepsy, and REM sleep behavior disorder. Wrist actigraphy at home gives a more practical picture of sleep and wake patterns over time, which is often what I actually need.

Adults should target 7 to 9 hours, and children and teenagers need more. Hours alone do not settle it. Timing, efficiency, and how someone feels the next day all matter. Patients tell me constantly that they are in bed for eight hours and wake up unrested. That is the point where efficiency and awakenings become the more useful thing to look at.

The consequences of chronic short sleep are well documented. It shifts ghrelin and leptin in the direction of more hunger and weight gain (Spiegel et al., 2004). It degrades glucose control and raises diabetes risk (Tasali et al., 2022). Hypertension, coronary disease, and stroke all track with insufficient sleep, and long-standing sleep problems are associated with cognitive decline and dementia risk (Vorster et al., 2024).

Causes are usually layered. Behavior contributes: irregular schedules, screens late, heavy meals and alcohol close to bed. So do physiologic and psychological factors: apnea, restless legs, anxiety, chronic pain.

Practical work starts with sleep hygiene. A consistent schedule resets circadian rhythm. Bedrooms should be cool, dark, and quiet. Bright light late interferes with sleep onset. Evening caffeine and alcohol come down. A wind-down routine, reading or stretching or a warm shower, makes the transition easier.

Daytime habits matter more than patients expect. Morning light anchors circadian rhythm. Even ten minutes of aerobic activity improves sleep depth. And for anyone waking in the night, what they do next shapes the rest of it: awake more than twenty minutes, get up and do something quiet in dim light rather than lie there getting frustrated.

The behavioral approach I use most is stimulus control. The principle is simple, which is rebuilding the association between the bed and sleep. Go to bed only when sleepy. Use the bed for sleep. Leave it if sleep is not coming. I have watched patients with years of insomnia retrain themselves this way. One had been scrolling his phone in bed for hours every night; once he started leaving the room when sleep would not come and only returning when he felt drowsy, his sleep onset shortened within a few weeks and the nightly frustration went with it.

Sleep is a medical necessity, and it belongs in routine care alongside everything else we screen for. Taking it seriously improves rest, and it also improves cardiometabolic health, mental health, and how people feel about their days.

Childhood Food Insecurity: What Doctors and Families Can Do

On April 11, 2025September 29, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Food insecurity means the lack of consistent access to enough food for a healthy, active life. Hunger is part of it. The rest reaches into development, school performance, behavior, and long-term health, and millions of children in this country live inside it.

In pediatrics it surfaces quietly. A child who can’t concentrate at school. A family that skips meals at the end of the month. A growth curve that looks off and doesn’t fit the usual explanations. Treating it as a clinical problem rather than a social one is where the work starts.

The scope is wide. In 2024, 13.7% of U.S. households experienced food insecurity at some point during the year, and among households with children the figure was 18.4% (1). That is up sharply from the 10.5% recorded in 2020. Children carry the heaviest burden. The literature links food insecurity to iron-deficiency anemia, delayed motor and cognitive development, poor school performance, and behavioral problems including depression and inattention (Cook et al., J Nutr, 2004; Casey et al., Pediatrics, 2006).

Food insecurity and obesity travel together, which surprises most parents. Economic pressure pushes families toward calorie-dense, low-cost food. Scarcity itself can trigger binge eating when food becomes available. Stress and parenting under pressure add another layer. Children get urged to clean their plates, or food becomes the tool for soothing. Children aged 10 to 15 in food-insecure households are more likely to carry higher BMI and adiposity (Tester et al., Curr Obes Rep, 2020).

Geography tells its own story. The Southeastern U.S. carries some of the highest rates of both food insecurity and childhood obesity. Mississippi, Arkansas, Louisiana, New Mexico, and Texas rank among the hardest hit for food insecurity. Mississippi, West Virginia, Kentucky, Alabama, and Oklahoma consistently report the highest pediatric obesity rates. The overlap is no coincidence. Rural areas, tribal lands, and parts of Appalachia function as food deserts, where grocery stores are scarce and convenience stores and fast food fill the gap. Poverty and underinvestment in health infrastructure compound it.

So how do we find it? Most pediatric settings use the Hunger Vital Sign, a two-question screener drawn from the USDA’s 18-item scale and endorsed by the American Academy of Pediatrics. Against the full scale it runs 97% sensitive and 83% specific (Hager et al., Pediatrics, 2010; AAP Council on Community Pediatrics, Pediatrics, 2015). It asks families to respond to two statements:

“We worried whether our food would run out before we got money to buy more.”

“The food we bought just didn’t last, and we didn’t have money to get more.”

An answer of “often true” or “sometimes true” to either one signals risk. It is short, it embeds cleanly in an EMR, and it has been validated across languages. Longer tools exist, including the USDA’s full 18-item module, its 6-item short form, and the 9-item youth survey, but the time cost usually rules them out.

Screening is harder to implement than it sounds. Time, competing priorities, and plain discomfort discussing money are real barriers. Self-administered forms, EMR prompts, and universal framing all help. Telling every family “we ask everyone about food, because it’s central to health” takes the sting out of the question. When a screen comes back positive, the referral pathway has to already exist, whether that means SNAP and WIC enrollment, food pantries, or school meal programs.

Federal nutrition programs remain the strongest safety net. SNAP provides grocery support. WIC offers food vouchers, nutrition education, and breastfeeding support. The National School Lunch and School Breakfast Programs cover the school year, and the Summer Food Service Program covers the gap when school is out. The evidence doesn’t support the worry that these programs worsen obesity risk. WIC participation tracked with a decline in obesity among children aged 2 to 4 across 2010 to 2016 (Pan et al., MMWR, 2019). Stable SNAP benefits reduce the time children spend with obesity compared with non-participants (Au et al., J Nutr, 2019).

For clinicians the task splits in two: identify and connect. Screening is the first half. The impact comes from linking families to something real, which might mean a referral list built into the EMR, a relationship with a local enrollment center, or a standing partnership with a community food bank. Even asking “would it help if I connected you with resources that provide healthy food?” moves something.

Food insecurity is a health problem, and it shows up in front of us constantly. Naming it, screening for it, and acting on it protects children from consequences that reach a long way forward.

Managing Insomnia and Sleep Problems: A Physician’s Perspective

On December 26, 2024September 29, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Insomnia is one of the most common problems I deal with. A few bad nights bleed into everything: work, mood, patience, appetite. Patients usually open the visit asking about pills or supplements, and I understand why. Sleep feels like something that should have a switch. Most of the time the answer is duller than a prescription and works better, which is a hard sell at nine at night when someone has been staring at the ceiling for a week.

How Much Sleep Do We Need

Seven to nine hours suits most adults. Under six on a regular basis carries real risk, and routinely running past nine is its own signal that something else is going on. The exact number moves from person to person, and I put more weight on how someone functions at four in the afternoon than on the number they report.

What Sleep Actually Does

Sleep is repair time. It consolidates memory, sharpens focus, and steadies the emotional baseline, which is why a rested person absorbs a bad day and a chronically tired one doesn’t. It supports immune function, cardiovascular health, and metabolic balance. The long-run associations with longevity and lower rates of chronic disease are consistent enough that I treat sleep as a vital sign rather than a lifestyle detail.

The Cost of Short Nights

Chronic sleep loss shows up in obvious ways and quiet ones. Fatigue, irritability, work that slips. Those are the complaints people bring. What they usually do not connect to sleep are the things that accumulate over years: hypertension, diabetes, heart disease, obesity. Immunity weakens, which is why the poor sleepers in a household tend to be the ones who catch everything going around. Anxiety and depression travel with chronic insomnia in both directions, each making the other worse. Cognitive decline is the long-horizon concern, and it is the one patients ask about most once they hear it.

Medications for Insomnia

Short-term use can help. None of these drugs are free of risk, and I’d rather say so plainly than bury it at the end of a list.

Zolpidem (Ambien) helps with both falling asleep and staying asleep, though daytime drowsiness and the odd nighttime behaviors are well documented. Zaleplon (Sonata) is shorter acting and suits the patient whose whole problem is sleep onset. Eszopiclone (Lunesta) covers onset and maintenance, and the metallic taste is a common enough complaint that I mention it before someone calls about it. Temazepam (Restoril) is a benzodiazepine, still prescribed, and carries the most dependence risk of the group.

Shortest effective course, every time. These work best as a bridge while the behavioral changes take hold, not as the plan itself.

Supplements

Melatonin is the one everybody has already tried. It earns its place in circadian problems, delayed sleep phase and jet lag especially, and sometimes in mild insomnia. One to five milligrams is the usual range, and timing matters more than dose, which is the part most people get wrong. Magnesium is worth considering in patients who are actually deficient. Leafy greens and nuts are good sources. Supplements are gentler than prescription hypnotics, and they won’t touch the underlying driver of chronic insomnia.

Sleep Hygiene

In my opinion, the most effective and lasting treatment is better sleep hygiene. Patients who hold a consistent schedule, same bedtime and same wake time seven days a week, often notice a difference within a few weeks. Cool, dark, quiet. Screens and blue light in the last hour before bed work against the transition.

Routine matters more than people expect. Reading, stretching, meditation, anything repeated nightly trains the body to wind down on cue. Caffeine, nicotine, and alcohol all interfere and are best kept well away from evening. Daylight exercise helps; a hard workout an hour before bed usually doesn’t.

One small change that pays out more than it should: turn the clock away from the bed. Patients who wake at three and check the time start doing arithmetic about how much sleep is left, and the arithmetic keeps them up longer than the original waking would have.

Keeping a Sleep Diary

When insomnia persists, a diary earns its keep. Bedtimes, wake times, awakenings, caffeine, stress, exercise. Two weeks of honest entries usually surfaces a pattern nobody had noticed, and reviewing it together tends to point at a small, specific change rather than a large vague one.

When to Seek Help

If the problem holds after the schedule and the environment have genuinely been addressed, it needs a proper evaluation. Sleep apnea, restless leg syndrome, anxiety, and depression all hide behind a complaint of insomnia. Treating the thing underneath is what fixes the sleep.

Kratom: A New Drug Growing Popular in Washington State

On November 8, 2016August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Through 2016 I saw a growing number of patients at Urgent Care dealing with the effects of Kratom. Some came in sick; others called worried about withdrawal or side effects. Because it came up so often, I think it’s worth sharing what I’ve learned.

Kratom comes from the leaves of a tree native to Southeast Asia. People there have used it for a long time as a painkiller, for diarrhea, or recreationally. In Washington State, it’s sold in capsules filled with powdered leaf material. Some people also brew it into tea or smoke it.

The United Nations Office on Drugs and Crime places Kratom in a group called “New Psychoactive Substances.” That same group includes Khat from East Africa, Salvia divinorum, and certain synthetic drugs such as ketamine analogs and mephedrone. As of 2016, Kratom wasn’t illegal at the federal level in the U.S., though it was illegal in countries like Thailand, where thousands of people had been arrested for related offenses (United Nations Office on Drugs and Crime, 2013). Despite that, it could be found for sale in some recreational marijuana shops here.

Kratom’s effects show up quickly and can last about five to seven hours. People use it for both stimulation and sedation. At lower doses, it may make someone feel more energetic, talkative, or sociable. At higher doses, it often causes lethargy and a sense of euphoria. Not every user finds it pleasant, and the side effects can be significant.

Some patients report nausea and vomiting, sometimes severe enough to bring them to Urgent Care. Others describe nervousness, sweating, itching, constipation, or tremors. I’ve also seen reports of hallucinations, paranoia, and even aggressive behavior.

With longer-term use, addiction becomes a real concern. People can develop cravings, lose weight, notice skin changes on the face, and report a loss of sexual desire. When they stop, withdrawal can be difficult. Symptoms may include diarrhea, muscle pain, tremors, trouble sleeping, depression, anxiety, and sudden mood swings (Drug Enforcement Administration, 2016).

In 2016, the Drug Enforcement Administration announced plans to classify Kratom as a Schedule I drug, the same category as heroin or LSD. That decision was paused after a public comment period, and at the time of writing Kratom hadn’t been rescheduled. The DEA had called it a potential “imminent hazard to public safety” (Federal Register, 2016).

If you or someone you know is using Kratom and experiencing health problems, talk with a healthcare provider.

Low T Explained: What Is Testosterone Deficiency Exactly?

On January 15, 2013September 11, 2026 By Dr. Scott RennieIn Other Diseases and Conditions1 Comment

Editor’s note, August 2026. This post predates the TRAVERSE trial, reported in 2023, which found no increase in major cardiovascular events with testosterone therapy in men with hypogonadism and existing cardiovascular risk. The cautious framing below reflects what was known in 2013.

Low testosterone is a hot topic right now in primary care. Recent advertisements are on television discussing various testosterone treatments available to men with “Low T.” I’ve recently had quite a few patients asking me to check testosterone levels and then they usually have questions about testosterone treatments if the blood levels are abnormal. Testosterone is a hormone that is produced in both men and women, but it is usually present at higher levels in men. The consequences of low serum testosterone are not known for certain but there are several possible symptoms of low levels including (research is still being done):

Low sex drive, erectile dysfunction, poor morning erection
Fatigue
Being slow to go through puberty (if it is too low during childhood)
Decreased bone mineral density
Decreased muscle mass
Decreased muscle strength
Anemia
Decreased mood
Decreased cognitive function

Of course there are other, more common causes of low sex drive and fatigue that can affect grown men instead of low testosterone levels. Experts believe that the current trials have demonstrated weak and indirect inferences about the usefulness of testosterone for osteoporosis in men. Testosterone levels naturally decrease as men age. This normal decline in testosterone however has not had established clinical consequences. We are still studying the effect that the natural decline of testosterone levels have in the body. Elderly men often ask if they should be prescribed supplemental testosterone to keep their levels from decreasing. The answer is difficult because we currently do not entirely understand whether the changes in body generally associated with aging (decreased muscle mass, decreased energy) may be related to naturally decreasing testosterone levels or even if treatment with testosterone reverses the decreasing muscle mass and energy we see in the average person with increasing age. We’re also concerned about adverse consequences of testosterone with diseases that are testosterone dependent such as prostate cancer. Controversy regarding testosterone whether to prescribe testosterone therapy: A committee of the Institute of Medicine of the National Academy of Sciences Committee reviewed available studies and concluded that no beneficial effects of administering testosterone have been well established. The Endocrine Society however has published evidence based guidelines for testosterone therapy in adult men with deficiency of testosterone. The guidelines from the Endocrine society are:

Testosterone therapy should be prescribed only for men with low serum testosterone levels on more than one test and who have symptoms of testosterone deficiency and have no known pituitary or testicular disease.
In order to minimize the potential risk of causing testosterone-dependent diseases, the target level of testosterone level in the blood should be between 300-400 ng/dL (10.4 to 13.9 nmol/L)

The Institute of Medicine’s committee on testosterone concluded that there is insufficient evidence to conclude that testosterone treatment of elderly men has any well-established benefit thus far on improving muscle strength, physical function, vitality, sexual function, cognition and quality of life. They recommended further investigation. Potential to cause harm: High testosterone levels has the potential to cause cancer of the prostate but data are limited. The common practice in treating prostate cancer is to lower serum testosterone levels with medications. Screening for low testosterone: One approach has been the following:

If a male has symptoms of possible testosterone deficiency such as decreased sex drive, energy, mood or osteoporosis or anemia a serum testosterone level can be checked early in the morning (before 8am when normal testosterone levels are highest). If the level is low, it should be repeated for confirmation.
Free testosterone levels should only be evaluated in men who have obesity.
If testosterone levels (both times) is less than 200 ng/dL (6.9 nmol/L) evaluation for causes of hypogonadism can be performed. If there is no pituitary or testicular disease, discuss with the patient about possible treatment with supplemental testosterone (ie. Benefits vs risks).

Testosterone treatment: One approach to treatment has been the following:

If treatment is started and the symptoms that led to measuring the testosterone are not corrected (improved energy, sex drive, anemia, etc.) within a few months then discontinuing the testosterone treatment can be considered.
Before starting treatment, a digital rectal exam should be performed and a PSA (prostate specific antigen) measured. If a man has higher than normal PSA with no identifiable risk factors a urological evaluation should be performed before any testosterone therapy is started.
3 months after starting the testosterone treatment, a digital rectal exam and PSA should be repeated. If there is a prostate nodule or the PSA has increased more than 1.4ng/mL (and confirmed) urological consult should be sought. If the PSA and digital rectal exam is not considered abnormal, the digital rectal exam and PSA should be performed once a year (just as with any man).

References: Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM, Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010 Jun;95(6):2536-59. I hope that you have found this information useful. Wishing you the best of health,

What Are Today’s Trendy Drugs of Abuse? A Doctor Explains

On January 4, 2013August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Healthcare professionals across the country are seeing a new and alarming trend in drug abuse. As doctors and parents, it is important that we are aware of these substances and understand how patients who use them may present.

Dextromethorphan (“Robotripping”): Street names are DXM, CCC, High C and skittles. These are most commonly seen in boys between 10-14 years of age. Dextromethorphan is commonly found in cough syrups such as Robitussin and is ingested at about 25 times the therapeutic dose. It causes a dissociative anesthesia similar to PCP. They are often other ingredients in these common cold medications such as Tylenol and chlorpheniramine that can cause harmful effects on the body including permanent liver damage. The effects of the dextromethorphan can include decreased alertness and transient hallucinations and risk for trauma due to the dissociative effects.
Bath Salts (MDPV): These are not actual bath salts, but designer hallucinogenic amphetamines or a newer version of “ecstasy” (MDMA). Common names on the market now include “M-shine” and “hooka cleaner.” The core substance is cathinone (from the khat plant). Patients often present with increased reflexes, teeth grinding (bruxism) and involuntary muscle contractions (clonus). They can have an increased heart rate and may have seizures and can exhibit psychotic behavior or paranoia (that may last for days). Other worrisome problems associated with bath salt use include running a very high fever, forming abnormal blood clots in the legs or lungs, and liver failure.
Jimson weed (Thorn Apple): Commonly found growing in back yards, each plant contains seed pods with numerous seeds. Each seed contains a varying amount of the drugs atropine, scopolamine and hyoscyamine. Eating seeds from one plant may produce a “mild trip” while ingesting seeds from another plant may contain 10-50x the amount of these drugs and produce skin redness, dilated pupils, delirium, urinary retention, decreased gastrointestinal motility and rapid heart rate.
Psilocybin mushrooms: The spores of the parent plant are harvested and are often distributed by gluing the spores to paper and then sold as “art.” The spores themselves do not contain the hallucinogen. These are typically sold with a 10-mm syringe and a broth solution. Psilocybin mushroom spores are legal to possess in every state in the United States, except California, Georgia, and Idaho. This is because it is psilocybin and psilocin (the active chemicals in psychedelic mushrooms) which are specifically listed in Schedule I, not the mushrooms themselves.
New marijuana drugs (THC homologues): Street names include “spice” and “K2”. Often sold in combination with herbs for smoking. These are unregulated herbal substances which are often mixed with alcohol or acetone and sprayed on a plant which is then dried and sold. A single joint contains much higher doses of THC (300mg) than traditional THC. Clinical effects may include red eyes, rapid heart rate, dry mouth, and perceptual changes. Agitation, hallucinations and displaying behavior that may lead to trauma. Synthetic marijuana can also cause seizures, or acute psychotic episodes that can lead to suicidal thoughts. Other problems such as chest pain, psychological dissociation and panic attacks may occur. Sometimes the synthetic marijuana that has been sprayed on plants is also combined with formaldehyde (solvent containing PCP) that causes the user to present as acutely psychotic and violent. Most urine drug screens unfortunately do not detect these substances.
“Pharming, bowling or fruit parties”: This is a practice where teenagers get together and bring samples of medication that they get from their home (most commonly from their parents’ medicine cabinet). All samples are placed in a bowel and pills are ingested randomly. Overdoses on medications for diabetes, high blood pressure and heart problems are common in addition to possible respiratory depression and even death from narcotics, or benzodiazepines or the mixture of multiple substances.
Soma Coma: Also called “Trinity” if mixed with other drugs. Soma (carisoprodol) is a non-scheduled drug that is marketed as a muscle relaxer. It is very similar to a benzodiazepine such as Valium and heavily abused. It is a heroin substitute when combined with other drugs and its effects are very unpredictable and may predispose the individual to injuries from falls or other trauma. Many of these users have a history of heroin abuse.
Salvia divinorum: This is a mint plant common in Mexico. It is dried and concentrated before being sold, often in online tobacco shops. The salvinorin A contained in the plant is a psychoactive chemical. It is usually ingested by smoking in a water bong. Produces a trance-like high for 5-10 minutes.
Alprazolam: Abuse is on the rise as this medication is commonly used as a “downer” after cocaine use. Because of its characteristic shape, street names including “candy bars,” “coffins,” or “french fries” may be used. Pills are swallowed, crushed and snorted.
Cocaine: Because of the expense, not much cocaine sold on the street is pure. In fact up to 30-40% of some samples contain a common medication used to treat worms in veterinary animals. Highest use among those 18-25 years of age. Patients who use cocaine may present to a hospital or clinic having a high fever and have low blood cells or platelets, and have red spots on their nose or ears. Cocaine also increases the stickiness of platelets and therefore increases risk of heart attack or stroke. Look for blisters on the thumb and index finger of the dominant hand and scabs or burns around the lips.
Methamphetamines: After marijuana, it is the most widely abused drug worldwide. Approximately 5% of the US population has used methamphetamine, with an estimated 500,000 people using the drug in a given month. It may be synthesized via simple reactions using readily available chemicals and over-the-counter cold medicines, such as Sudafed. May be ingested orally, rectally, vaginally, be injected, inhaled, or sniffed. The effects are stronger and last longer than cocaine. In fact, the prolonged duration of action of methamphetamine (approximately 20 hours) helps differentiate it from cocaine (duration of action 30 minutes) and PCP (duration of action less than 8 hours). It causes rapid physical deterioration, weight loss, and poor dentition (“meth mouth”). Life-threatening intoxication is characterized by high blood pressure with rapid heart rate and severely agitated delirium, fever, metabolic acidosis and seizures. Medical providers should consider diagnosis of methamphetamine intoxication in any sweaty patient with high blood pressure, rapid heart rate, severe agitation and psychosis. Acutely intoxicated patients may become extremely agitated and pose a danger to themselves, other patients, and medical staff. Symptoms of methamphetamine withdrawal may develop within hours and typically peak within 1-2 days, and most often decrease within 2 weeks. During the acute withdrawal period (“the crash”), signs and symptoms may include restlessness, the inability to experience pleasure, fatigue, increased sleep, vivid dreams, insomnia, agitation, anxiety, drug craving and increased appetite. The prolonged withdrawal phase can last for up to 3 weeks and can include insomnia or even increased sleep, appetite changes, depression and possible suicidal thoughts.
Inhalants (poppers, snappers, rush): The use of these substances usually decreases as the individual grows older. Can cause a rapid high, drowsiness, lightheadedness, agitation as well as belligerence, impaired judgment, balance problems, and addiction. These inhalants may include halogenated hydrocarbons (butane), VCR head cleaner, whipped cream (contains nitrous oxide), colored spray paint (gold color is most popular), amyl and butyl nitrates (poppers, snappers, rush). “Sudden sniffing death syndrome” is a worrisome problem.
Opiates: These are also commonly called narcotics (heroin, Demerol, morphine, codeine, fentanyl, oxycodone, hydrocodone, and methadone). Patients who overdose are often sleepy and have a decreased respiratory rate, decreased gastrointestinal motility, urinary retention and pinpoint pupils. As a medical provider it’s important to strip an overdosed patient and look for fentanyl patches on the body, but be careful of possible uncapped needles or syringes in the pockets.

There are an increasing number of patients being diagnosed with hepatitis C linked to heroin and other opioid use and that rate is expected to continue increasing.

Street Price: Vicodin (hydrocodone/Tylenol) is a prescription medication with a street value of $5/pill depending on the geographic location where it’s purchased. Percocet (oxycodone/Tylenol) or OxyContin sells for about 50 cents to $1/mg but again this varies depending on geographic location and how much is purchased. Buprenorphine/naloxone (Suboxone) which is often prescribed to patients who have a narcotic addiction sells for $5-$20/pill on the street.

Patients presenting to the medical clinic may present in the state of overdose, drug-seeking or withdrawal. Treatment of overdose may include the use of naloxone. Narcotic withdrawal symptoms may occur on the first or second day of being without the drug. Patients may present with goose bumps (where the saying “quitting cold turkey” came from), patients on the third day may be on the floor flapping about with muscle cramps or kicks (i.e. “kicking the habit”). Other symptoms include anxiety, insomnia, yawning, tearing, sweating, runny nose, all over muscle aches, nausea, vomiting, diarrhea, hot and cold flushes, muscle twitches, abdominal cramps. Onset of symptoms usually occur within 8 hours of last use with a peak in 2-3 days. Treatment of withdrawal symptoms may include clonidine, ibuprofen, Benadryl, Phenergan, or Imodium.

It is important for medical providers, parents, law enforcement and teachers to be educated about drugs of abuse that our patients are using and be able to recognize the symptoms of intoxication, drug-seeking or withdrawal and treat our patients appropriately. The first step in helping protect our patients is learning about some of the drugs of abuse, and signs and symptoms of abuse.

I hope that you have found this information useful. Wishing you the best of health,

Erectile Dysfunction and Other Sexual Problems in Men

On November 30, 2012August 30, 2026 By Dr. Scott RennieIn Other Diseases and Conditions1 Comment

Purchasing medications for erectile dysfunction: I first want to comment the issue of purchasing medication on the internet, through mail order , magazine articles or television ads that claim to sell medications such as Viagra, Cialis or Levitra or some herbal supplement for erectile dysfunction without the need for a prescription and at a low cost. I highly recommend that you do not purchase these products this way because the sources are not known to be safe or reliable. Would you purchase your blood pressure or diabetes medicine from someone you don’t know but who claims to be legit? I sure wouldn’t! It is not known if these drugs sold without prescription through ads like this are counterfeit or contain toxic chemicals which could be damaging to your health. Men often come to talk with me about medications that may help with sexual problems such as inability to acquire or maintain an erection for sexual intercourse. Since this is a popular topic in the primary care office, I thought I might discuss male sexual dysfunction, possible causes and some treatment options. Some male sexual complaints may include:

Premature ejaculation
Delayed or inhibited ejaculation
Lack of interest in sex (decreased sex drive)
Unable to become erect or maintain an erection for satisfactory sexual intercourse (we also call this impotence or erectile dysfunction)

Erectile Dysfunction (ED): Your doctor may diagnose erectile dysfunction if the man cannot acquire or maintain an erection during 75% of attempts to have sexual intercourse. If a man has only occasional inability to have an erection and this improves later, they do not have erectile dysfunction (ED) as defined by the American Urological Association. Possible causes of male sexual dysfunction:

Limited blood flow to the penis can be caused by:
1. Cigarette smoking
2. Uncontrolled diabetes (high blood sugars)
3. High blood pressure (hypertension)
4. Alcoholism
5. Illicit drug use
6. Aging
7. Depression
8. Common medications prescribed by your doctor
Psychological causes: Performance anxiety, stress or decreased mood can lead to impotence. Many patients explain that they accept a decrease in sexual function as being normal due to aging. Often times there are reasons for decreased sexual function in men that once addressed can improve sexual function and increase the satisfaction with their sexual health. One of the possible reasons such as performance anxiety is when the focus of the sexual act shifts from a romantic experience to one filled with anxiety about the ability to acquire or maintain an erection. It’s also true in some men that as they mature, their interests and concerns may expand. If he’s preoccupied with concerns about money or business matters, he may lose the sexual focus needed to maintain an erection.

How to determine the cause of male sexual dysfunction: When a man expresses concern about sexual dysfunction, I usually start off by trying to determine the cause by asking some questions, performing an exam and then ordering some laboratory tests. If you will be visiting your doctor and have concerns about sexual dysfunction, I recommend that you think about the following and be ready to discuss these items with your doctor:

Do you get erections at night or in the morning when you first wake up?
Are you having any personal problems with your sexual partner?
Did the sexual dysfunction come on gradually or all the sudden?
Do you have medical problems such as diabetes, high blood pressure, tobacco use, alcohol or illicit drug use or other psychological factors that could contribute to the dysfunction?

What to expect during a physical examination: Some men may be resistant to come to their doctor to discuss sexual dysfunction because they’re not sure what to expect during the physical exam. Your doctor may do the following:

Check your blood pressure – it’s very important to get your blood pressure at goal
Examine the penis, testicles and blood vessels in the groin
Examine the chest for signs of abnormal breast swelling in men

Laboratory testing: Your medical provider will often check several lab tests that can influence a man’s sexual ability.

Testosterone (hormone) level – hormone
Blood sugar tests – a fasting blood glucose or an A1c
Thyroid hormone test (TSH)
Prolactin (hormone) level
Home nocturnal penile tumescence (NPT) is a test that measures how many erections the man is getting during the night when sleeping. Men who have damage to the blood vessels or nerves involving the sexual organs usually have decreased nocturnal erections and we call this “organic” impotence. Men with normal night-time erections are more likely to have psychologically related impotence although there may be a combination of the two factors involved.
If the nocturnal penile tumescence test is abnormal, your doctor may ask you to have some special tests such as a ultrasound test to examine the deep arteries of the penis and groin to make sure they are getting enough blood flow.

Treatments for male sexual dysfunction: Men often come in to the clinic and ask for medication without understanding that medication may not help if the cause of the problem is not discovered. It’s very important to determine the cause of the sexual dysfunction because the improper use of medications can have serious side effects and may not actually cure or help the problem. Medications to treat erectile dysfunction: Testosterone therapy: If your testosterone level is too low, correcting this by taking testosterone medication can improve sex drive, erectile dysfunction, increase muscle mass and reduce the risk of osteoporosis. Men who do not have low testosterone levels do not benefit from additional testosterone and may actually have unhealthy side effects if they take testosterone inappropriately. Treatment options may include testosterone injections that may be given every 1-2 weeks, testosterone gels (Androgel is a commonly prescribed example), a testosterone skin patch (Andoderm is a popular example) or a testosterone lozenge that remains in the mouth for 12 hours are the most common treatment options for low testosterone. Counseling: We realize that depression, anxiety and increased social stresses can cause erectile dysfunction. Sexual therapy is often helpful in these cases. The great thing about counseling is that there are no medical side effects because this does not involve taking a medication. Counseling can actually fix the problem which is often more desirable than relying on a medication which must be used repeatedly. Some examples of where psychotherapy can be useful are:

Performance anxiety, when a man suddenly experiences one or more failures during sex. Often this is not due to the inability to perform but more related to anxiety about failure.
Men who have depression or anxiety often have a lowered sex drive. Counseling can help improve both while improving sex drive and function without the need for medication.
Couples where one partner has a serious medical condition might be worried about possible the safety of sexual activity. It is often helpful to discuss this with a medical professional or counselor who can help with these concerns.

Phosphodiesterase-5 inhibitors (PDE-5) – Viagra, Levitra and Cialis: These medications work by increasing the natural chemicals in the body that allow the penis to become erect. The do not increase sexual desire. These medications are effective in restoring the ability to have an erection in about 70% of men and work best in men with psychological erectile dysfunction problems (in combination with treating the underlying psychological component). In men with damage to the blood vessels or nerves of the pelvis/penis due to high blood pressure or diabetes, these medications help about 55-60% of the time. For men who have sexual dysfunction after prostate surgery, these medications help in only 25%. The main difference between Viagra, Levitra and Cialis is the cost of the medication and amount of time that the medication takes to begin working and how long the effects last. Some people may find the one particular medication works better for them than another but all three work in a medically similar way. Possible side effects: PDE-5 medications such as Viagra can cause headache, dizziness, indigestion and flushed (red colored) skin or blurred vision. Most side effects only last a short time, but because Cialis has a longer duration than the others, the side effects may also last longer. There is also a possibility of drug interaction with nitroglycerin if a patient uses that for chest pain or blood pressure. Using PDE-5 medications and nitroglycerin can cause dangerously low blood pressure. If a man is taking nitrate medications we generally do not recommend Viagra, Levitra or Cialis. Drug interactions: In addition to nitroglycerin, patients who take doxazosin or terazosin (which are used to treat enlarged prostate and hypertension) should not take PDE-5 medications because the combination can cause a dangerously low blood pressure. Other medications such as erythromycin, ketoconazole, rifampin, phenytoin and grapefruit juice can alter the time that these erectile dysfunction drugs remain in the body and subsequently can cause more side effects. Safety: We are unsure if Viagra is safe for patients who have had a heart attack, stroke or life-threatening heartbeats (arrhythmia) within 6 months. We are also not sure if it is safe for men who have had untreated high or low blood pressure or a condition called retinitis pigmentosa which is a medical condition of the eye that can lead to blindness. Penile self-injection: Patients may inject a medication into an area of the penis called the corpora cavernosa and this causes an erection by allowing the blood vessels within the penis to expand. No sexual stimulation is needed to create the erection. The common medications used are alprostadil or papaverine. Possible side effects: many men stop doing penile self-injections because of pain at the injection site. There is also a risk that the penis may remain erect after intercourse. Prolonged erection is called priapism. If it lasts longer than 4-6 hours it may be a medical emergency and those patients should be seen in an emergency room. If blood stays inside the penis for more than 48 hours permant scarring of the tissue inside of the penis may result. Insertion of a pellet into the urethra: MUSE (Intraurethral alprostadil): The same medication used for penile self-injection can be inserted into the urethra (opening where the urine comes out) and the medicine is absorbed and causes an erection. Possible side effects: There can be some pain in the penis as the blood vessels enlarge to create the erection. There is less chance of prolonged erection with this than with self-injection. Vacuum-assisted erection devices: A rigid ring is placed at the base of the penis (near the body) to hold the blood in the penis and then vacuum pressure is used to draw blood into the penis to create an erection. About 67% of patients are able to achieve and erection with a vacuum assisted device but only about 25-50% of people who use them are satisfied with them. Possible side effects: Although the man will be able to have an orgasm, he is usually not able to ejaculate with a vacuum-assisted device because the ring that holds blood in the penis also compresses the urethra and that prevents semen from exiting. Inflatable implant: With an inflatable implant, an erection is produced by squeezing a small pump that has been implanted surgically in the scrotum. The pump causes fluid to flow from a reservoir (also implanted surgically) in the lower pelvis to two cylinders residing inside the penis. The cylinders expand to create the erection. As you can see, there any many possible reasons that can lead to male sexual dysfunction and multiple treatment options. For more information, you may check out the web resources below: American Urological Association The Hormone Foundation I hope that you have found this information useful. Wishing you the best of health,

Kidney Stones: Pain That Can Rival Childbirth, Explained

On July 8, 2012August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

I’ve had quite a few female patients who’ve told me that the pain of having a kidney stone is similar to the intensity of pain during childbirth. A patient came in the other night with intense abdominal/side pain associated with nausea and vomiting. At first I thought he might have had appendicitis but after we were able to give him enough fluid by IV to rehydrate him and get a urine sample I saw he had blood in his urine and the CT scan showed a 3mm stone in his kidney. Kidney stones (also called nephrolithiasis or urolithiasis) are small solid fragments or crystals with sharp barbs on them that form within the urinary tract. They can be made up of calcium, oxalate, cysteine, uric acid or a combination of these and other substances. When these crystals form within the kidney or urinary tract they can become anchored or stuck and get larger. Sometimes additional kidney stones are also formed while one is already lodged within the kidney or ureter. The ureter is a small tube that drains the urine from the kidney down to the bladder. When a kidney stone travels down the ureter it can cause pain that radiates from the kidney all the way down the side and abdomen to the urinary bladder. Risks for Developing Kidney Stones: Certain factors can increase your chances of developing a kidney stone including: 1) Dehydration 2) Diet with high level of sugars 3) High sodium diet 4) Low calcium in your diet 5) Diet with lots of animal protein 6) Diet with low levels of phytate (phosphorus that we get mostly from plants) 7) Patients with gout 8) Obesity 9) Crohn’s disease 10) History of bariatric surgery such as gastric or intestinal bypass surgery 11) Diabetes 12) Hyperparathyroidism Symptoms: 1) Pain – most patients complain of pain either in the back, flank or abdomen. The pain seems to come on in waves (called renal colic) and sometimes it may be barely noticeable and then become so intense that it requires treatment in the hospital. 2) Bloody urine 3) Pass small stones in the urine 4) Nausea 5) Vomiting 6) Pain with urination Diagnosis: Sometimes the patient’s symptoms and history can be very suggestive of kidney stones and making the diagnosis is easy. Other times it can be more challenging to diagnose kidney stones and imaging studies such as a CT scan or ultrasound. Plain x-rays can also sometimes show kidney stones. Treatment: For patients who come to the medical clinic we try to ensure that they are well hydrated to prevent the formation of more stones and help the current stones to pass. Some patients need IV fluids to help with the hydration process, especially if they have been vomiting and aren’t keeping fluids down. Depending on the size of the stone and location, the patient may be able to treat their symptoms at home with over the counter pain medications such as Advil or Aleve. In addition, we may prescribe medications that help the stone to pass more easily. If the pain becomes severe, the patient may need to be treated with stronger pain medications and sometimes hospitalization is necessary. If the stones are larger than 5mm, they don’t pass on their own very easily and generally require a procedure to break them up or remove them. Some treatments to remove the stones may include: 1) Shock wave lithotripsy (SWL): Ultrasonic energy is used to break up the larger stone so that it can be passed more easily 2) Percutaneous nephrolithotomy (PNL): A surgical procedure that is minimally invasive may be required to remove a stone that is extremely large or complex, especially if SWL is not effective. Small instruments are inserted through the skin in the operating room to remove the stone. 3) Ureteroscopy: A small scope is passed through the urethra up into the bladder and then up into the ureter. This scope has a small camera and instruments that are used to remove the stone or break it up into small pieces. This procedure is used more often if a stone is blocking the ureter and causing swelling of the kidney. I hope that you have found this information useful. Wishing you the best of health,

What Really Causes a Hangover? The Truth Explained

On July 4, 2012August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

It’s the 4^th of July and it is a big night for parties for many people. People often drink on holidays so I thought it was important to discuss hangovers. A hangover is the unpleasant set of symptoms that come with drinking too much alcohol too quickly. The particular set of symptoms experienced and their intensity may vary from person to person and depend on the occasion. The characteristics may also depend on the type of alcohol consumed and the amount that a person drinks. Typically, a hangover begins within several hours after the individual stops drinking. Many people are probably familiar with these, but here is a list of some of the symptoms that may be present with hangover: 1) Headache 2) Dizziness 3) Nausea & Vomiting 4) Fatigue 5) Disrupted sleep – it may be easy to fall asleep but as the alcohol wears off, people often wake up frequently and complain of feeling tired the next day. 6) Increased thirst 7) Sensitivity to light and sound 8) Muscle aches 9) Rapid heart rate 10) Tremor 11) Sweating Dehydration is common because alcohol causes the body to increase urination. Increased sweating, vomiting and diarrhea are also common during a hangover and that can lead to dehydration and increase and the symptoms of hangover. Here are several tips to prevent a hangover: 1) Have something to eat before you drink alcohol – fat slows your body’s absorption of alcohol – eat steak, sausage, fried foods or pizza before going to the party 2) Drink slowly 3) Drink in moderation – The National Institute on Alcohol Abuse and Alcoholism recommend that women have no more than 1 drink per day and men no more than 2 drinks per day. Definition of one drink: 12 ounces of beer, 5 ounces of wine or 1 ½ ounces of 80 proof liquor 4) Drink a glass of water between alcoholic drinks 5) Avoid alcohol completely if you want to be sure to prevent a hangover Home treatment tips for hangover: 1) Dehydration is common with a hangover, so replace fluids by drinking sports drinks such as Gatorade. I suggest making a mixture of ½ sports drink and ½ water. 2) Eat a meal as soon as you are able to. 3) Rest. Most hangovers are gone within 24 hours. 4) Remember that even if you feel well the morning after drinking alcohol, the lasting effects of alcohol will reduce your ability to perform at your best. 5) Ibuprofen or aspirin may be helpful for headache or muscle aches A Few Facts About Hangover Myths: 1) A wake-up cocktail will only delay, not prevent your hangover. 2) The order in which you drink alcoholic drinks does not determine the magnitude of the hangover, it’s the amount of alcohol that you drink 3) Diet drinks will not help with hangovers Hangover pills don’t do much to help with hangovers and may actually make your symptoms worse I hope that you have found this information useful. Wishing you the best of health,

11 Fourth of July Safety Tips to Know Before You Celebrate

On July 3, 2012August 30, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

I thought this article had some particularly great tips for people regarding being safe during the July 4th holiday. Medical Author: Melissa Conrad Stöppler, MD Medical Editor: William C. Shiel Jr., MD, FACP, FACR 1) Be a safe swimmer. Water sports and fireworks are two of the biggest pastimes for Fourth of July celebrations, and these are both linked to numerous deaths and injuries each year. Never swim alone, and make sure that kids’ water play is adequately supervised at all times. Many drownings occur when parents and other adults are nearby, so always have a designated chaperone for water play and don’t assume that others are watching the kids. Statistics show that most young children who drown in pools have been out of sight for less than five minutes. 2) If fireworks are legal in your community and are a part of your celebration, be sure to store and use them safely. Keep the kids away from the fireworks at all times, and keep spectators at a safe distance. Attending fireworks displays organized by professionals is always safer than trying to put on your own show. 3) Use alcohol responsibly. Alcohol and fireworks can be a hazardous and dangerous combination. Also, have a designated driver to bring partygoers home from the festivities. Remember also that alcohol and swimming can be as dangerous as drinking and driving. 4) Lakes, waterways, and seas will be crowded with boats. Review safe boating practices, and don’t drink and drive your boat. Alcohol consumption while operating boats or other motorized water vessels is illegal, and you can be arrested for a BWI (boating under the influence!). Be sure that you have an adequate number of life preservers on hand for extra guests. Become familiar with the boating laws in your area. 5) Cover food and beverages outdoors to discourage bees and wasps from attending your party. If someone is allergic to insect stings, you should have an emergency anaphylaxis kit on hand. Wearing shoes, long sleeves, and long pants outdoors and avoiding fragranced body products, bright colors, and sugary drinks can also help prevent bee stings. 6) Apply sunscreen both before and during an outdoor party. Ultraviolet rays from the sun can cause both premature aging and skin cancer in the long term, and a painful burn the next day. Even those with darker skin should use a sunscreen with a minimum sun protection factor (SPF) of 15, according to recommendations from the American Academy of Dermatology. 7) Check prescription medications you are taking to assure you will not have a sun-sensitizing drug reaction to the medication. Check prescription medications you are taking to assure you will not have a sun-sensitizing drug reaction to the medication. 8) If you’ll be hiking or camping in an area where ticks are abundant, wear long-sleeved, light-colored shirts and long pants tucked into socks or boots to protect yourself from tick-borne diseases. For your skin, you can use a tick repellent with no more than 30% DEET according to the manufacturer’s instructions. Products containing DEET should not be used on children less than 2 months of age and should not be applied to the hands or face of young children. Check yourself (and your pets) for ticks at the end of the day. 9) Spend adequate time indoors or in the shade and drink plenty of fluids to avoid heat illness in extremely hot climates. The risk of heat illness is increased when participating in strenuous activity or sports, and those with chronic medical conditions and the elderly are also at an increased risk of heat exhaustion and/or heat stroke. Alcohol consumption can also promote dehydration and increase the risk. 10) Keep children away from campfires and grills. Gas leaks, blocked tubes, and overfilled propane tanks can be a cause of grill fires and explosions. 11) Don’t leave the picnic spread out all day. Allowing food to sit in outdoor temperatures can invite foodborne illness. The U.S. FDA suggests never leaving food out for more than one hour when the temperature is above 90 F and not more than two hours at other times. Foods that need to be kept cold should be placed in a cooler with plenty of ice or freezing packs and held at a maximum temperature of 40 F. While mayonnaise and other egg dishes are often associated with food poisoning, any food can potentially become contaminated. Adequate hand washing and food preparation can also help prevent food poisoning.

Dr. Scott Rennie

Category: Other Diseases and Conditions

How to Sleep Better: Practical Steps for Patients

Related Reading

Managing Insomnia and Sleep Problems: A Physician’s Perspective

How Much Sleep Do We Need

What Sleep Actually Does

The Cost of Short Nights

Medications for Insomnia

Supplements

Sleep Hygiene

Keeping a Sleep Diary

When to Seek Help

Related Reading

Sources

Kratom: A New Drug Growing Popular in Washington State

Related Reading

Low T Explained: What Is Testosterone Deficiency Exactly?

Related Reading

What Are Today’s Trendy Drugs of Abuse? A Doctor Explains

Related Reading

Erectile Dysfunction and Other Sexual Problems in Men

Related Reading

Kidney Stones: Pain That Can Rival Childbirth, Explained

Related Reading

What Really Causes a Hangover? The Truth Explained

Related Reading

11 Fourth of July Safety Tips to Know Before You Celebrate

Related Reading