Violence

@Doobah47,

My thanks are for the above post, it just looked far more amusing on the above, above post; you speak for me Smile

.

Well I realise now that earlier in the thread how eager I was to define a social-badness causing pressure and therefore violence/unhappiness. But that same pressure- perhaps the same one that doesn't allow our heroin junkie love, is also wrongly subject to the good/bad dichotomy. It's not good now, I'm not that slow:p, it is just 'more positive'.

Dan.

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@Doobah47,

Quote:

Until you can master your immature contempt for all things rational, the access to the acquisition of understanding will escape you.

Cute. In response to my reasoning you say I have contempt for reason. Oh, if you could only make sense for a few minutes. Your diction is no substitute for thought, and does not confuse anyone. You've made a fool of yourself chopping medical definitions for your own purpose - I really shouldn't be surprised that you have no interest in an evaluation of your claims. Hollow claims that they are.

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Drugs tend to make the user peaceful; cocaine, marijuana, opiates, amphetamines all promote states of being that tend not to incur violent acts.

I agree with your point that it is not the drugs but the person who is responsible, but come on! Amphetamines promote non-violent behavior? Cocaine? This is divorced from reality. These drugs tend to elicit violent tendencies, and are terrible drugs for it.

1 Reply

@Didymos Thomas,

My only reference was myself and my own experiences.

In fact the drug I've taken that induces the worsrt of violent emotions is heroin, crack cocaine leaves the user slightly beligerent and a bit short tempered but heroin actually induces real violence (although the user probably cant stand up to hit anyone, if they could I think you'd see what I mean).

The worst drug vis a vis violence is (imo) alcohol.

Of course now I've taken to the straight and narrow, and enjoy not much more than strong cigarettes and apple juice; so I do recognize that an addiction to drugs is certainly detrimental in some ways, but I also recognize that all the hype about cocaine and heroin being difficult to give up is nonsense - the real difficulty is extracating oneself from a social circle that deals with such drugs. Giving up drugs is all about a simple cognitive development, extending a receptor or neural pathway to bypass the addiction to drugs, it's straightforward stuff - but then my addiction to 'hard' drugs (for about 1-2 years) was an endeavor centered and engaged in being by my self, if all I did was smoke crack and talk to street scum, then take heroin with prostitutes in squats I may well have found quitting a bit more difficult.

1 Reply

@Doobah47,

Quote:

My only reference was myself and my own experiences.

In fact the drug I've taken that induces the worsrt of violent emotions is heroin, crack cocaine leaves the user slightly beligerent and a bit short tempered but heroin actually induces real violence (although the user probably cant stand up to hit anyone, if they could I think you'd see what I mean).

It's all circumstantial. Addiction and withdrawal seem to be a particularly significant factors. I believe you about heroin, though.

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The worst drug vis a vis violence is (imo) alcohol.

And I would bet the statistics show it to be the most related to violence.

Quote:

Of course now I've taken to the straight and narrow, and enjoy not much more than strong cigarettes and apple juice; so I do recognize that an addiction to drugs is certainly detrimental in some ways, but I also recognize that all the hype about cocaine and heroin being difficult to give up is nonsense - the real difficulty is extracating oneself from a social circle that deals with such drugs. Giving up drugs is all about a simple cognitive development, extending a receptor or neural pathway to bypass the addiction to drugs, it's straightforward stuff - but then my addiction to 'hard' drugs (for about 1-2 years) was an endeavor centered and engaged in being by my self, if all I did was smoke crack and talk to street scum, then take heroin with prostitutes in squats I may well have found quitting a bit more difficult.

Hey, I've met people who have gone through all sorts of terrible addictions, never giving up marijuana years and years after their earlier battles. Different drugs influence people differently. But again I agree with you. The chronic use of drugs is much more than some hold the drug has over you. The real problems are social, and other more deeply rooted psychological problems, the ones that probably make people more likely to use drugs in a chronic and destructive way in the first place.

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@Didymos Thomas,

To me it seems that there are two fields of drug user -

1. Somebody who wants something akin to a comfort blanket, perhaps using the drugs as a form of escape, maybe has a routine drug ritual where they listen to music/draw/cry/dance in order to aleviate their ills.

eg - painkillers

2. Somebody who wants to enhance their performance, or feel stronger or maybe after 10 years on heroin feel 'normal'.

eg - anabolic steroids

I'd say that most drug users belong more distinctly to a specific category, but they do jump the fence or maybe transfer from one to the other (like boredom -> dependency).

We can also take this rather obtuse dichotomy and by analogy use it with violence - the escaping reactionary instinct versus the improving status/influence/etc relative to the status quo. I think if we were to talk in psychological terms we could say that the first would respond to medication, the second to counsel or a change of doctrine. Of course the pair are not alien to each other; often people are in a position of feeling peer pressure to engage in violence yet they still react with instinct when situations arise - although we can say that had they not have felt the peer pressure they might well have not reacted in a violent way.

So my feeling is that instinct should probably not be medicated (we don't know what evolutionary course might occur if we do medicate primal instincts), but doctrines and peer pressure should be counseled in order to change by societal values the reactions people make.

1 Reply

@Doobah47,

Doobah47 wrote:

To me it seems that there are two fields of drug user

There's a lot more than that. Think about 'dual diagnosis' people, who have both substance problems AND a primary psychiatric disorder. I'm not sure statistically how it breaks down, but a HUGE proportion of habitual users of drugs (whether street drugs or inappropriately used / prescribed medical drugs) are NOT normal at baseline. They have schizophrenia, depression, bipolar, PTSD, whatever.

Didymos Thomas wrote:

And I would bet the statistics show [alcohol] to be the most related to violence.

I believe you are correct, though of course there is quantitatively much greater alcohol use than cocaine. But I've seen clinically what cocaine can do to people, and it isn't pretty (and that includes but is not limited to violence).

Quote:

The chronic use of drugs is much more than some hold the drug has over you.

With tobacco being the case in point. It's EXTREMELY physically addictive, but often the habitual use is harder to break than the chemical addiction.

Quote:

The real problems are social, and other more deeply rooted psychological problems, the ones that probably make people more likely to use drugs in a chronic and destructive way in the first place.

Absolutely correct.

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@Aedes,

Aedes wrote:

There's a lot more than that. Think about 'dual diagnosis' people, who have both substance problems AND a primary psychiatric disorder. I'm not sure statistically how it breaks down, but a HUGE proportion of habitual users of drugs (whether street drugs or inappropriately used / prescribed medical drugs) are NOT normal at baseline. They have schizophrenia, depression, bipolar, PTSD, whatever.

What I said is grounded in fact, and I did make clear that people jump the fence.

My addiction to cocaine was grounded in the desire to do something, so I took cocaine and used the computer to play games/philosophy/music, but I also enjoyed the after-effects as a kind of comfort.

I have a 'psychiatric disorder' (psychosis/manic depression) and I find that both fields are applicable to me, one after the other or both at once.

Take it as an example of the uselessness of dichotomy...

Although I would say that my dichotomy is stupidious, at least it demonstrates two primary causes of drug addiction, which are grounded in experience, epistemology and language. The dichotomy is not grounded in what people say about their drug addictions, it is grounded in what they can't say - the ineffable. We don't have words to describe depression or schizophrenia beyond mere identification of obvious symptoms, perhaps we should or perhaps we shouldn't, I don't care either way; but what I do care about is the uselessness of a dichotomy.

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The real problems are social, and other more deeply rooted psychological problems, the ones that probably make people more likely to use drugs in a chronic and destructive way in the first place.

That is a point I entirely agree with, however there are many cases of people using drugs and curing societal/psychological ills; take alcohol for example, a person is incapable of talking to the person they love about real serious problems yet when drunk they can express wilfully everything that is wrong, or tell the person about their love for them etc. Apparently (so I've been told) Ketamine is a worthy cure for depression, or cocaine is a way to adjust oneself to be less susceptible to being led astray (through beligerence and self-interest combined to cause a notion of oneself and one's own style of life - knowing thyself as it were), or like I said before alcohol as a cure for shying away from expression. So I think that a major problem for the discussion of drugs/violence/psychology is the innate dichotomy found in many languages - who could determine whether a psychosis is destructive, sure there is structure in the madness but I believe that neither con- nor de- really explain the situation.

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@Doobah47,

Doobah47 wrote:

Take it as an example of the uselessness of dichotomy...

It's not useless clinically, because different diseases can require different treatments. Alcoholism has a life-threatening withdrawal syndrome (delirium tremens), for instance, so there MUST be a detox in heavy alcoholics -- and this is different than the therapy for say biopolar disorder (which involves both medications and cognitive-behavioral therapy in the ideal scenario). So a patient with alcoholism AND bipolar disorder needs to have both diagnoses established so that they can be treated appropriately.

On the other hand, you're correct that being a 'splitter' and not a 'lumper' forces people into diagnostic categories and can sometimes prevent them from being treated holistically. And this is why dual-diagnosis psych/substance programs are so valuable, because they treat the psychiatric diseases, the substance use, and the patient's life circumstances all with one another in mind. And the outcomes are better that way.

Quote:

We don't have words to describe depression or schizophrenia beyond mere identification of obvious symptoms, perhaps we should or perhaps we shouldn't, I don't care either way; but what I do care about is the uselessness of a dichotomy.

Well, it's a practical problem, not a semantic one. I can diagnose someone with HIV with a blood test that has a certain positive and negative predictive value. But for schizophrenia or depression we need to use diagnostic criteria based on observing and interviewing the patient to make a 'syndromic' diagnosis. This can lead to overlapping and somewhat artificial categories.

On the other hand, this practice is necessary. It's the only way we can actually study psychiatric disorders in order that we can develop or offer treatments for them. And it's ok anyway since medical therapy for psych disorders is symptomatic and not causal. So irrespective of diagnosis, we know that anxiolytics are effective for anxiety symptoms and antipsychotics are effective for paranoia and auditory hallucinations -- so eliciting these symptoms IS useful.

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@Aedes,

Fair enough one can identify dichotomies in the negative/positive outcome of an HIV test, although of course there is possibility for a mutation that is identical in practice but under the theory of a test is not identical.

But I see a problem in the dichotomy for example that drugs are either destructive or constructive, or the same for a psychosis, and other things - the inference that my example incites is that 1 is detrimental to progress and 2 is beneficial - like you said the dichotomy is unsatisfactory, yet if this is so then why should there ever be a dichotomy in such queries? We can have fairly clear distinctions in objective circumstance (there either is x or there isn't x), yet in moral/subjective circumstance we cannot have a satisfactory useful dichotomy (although there might be a use for dichotomy in counseling issues, it is not really satisfactory).

This boils down to the issue of legality of drugs/violence. The question being is drugs/violence an objective or subjective issue... the answer being that a dichotomy is unsatisfactory. A paradox.

Another question would be do you see any similarities between the swings of depression, the swings of bi-polar disorders, the swings of psychosis and the swings of an 'aggressive' person? The inference of the question is whether there is such an illness as 'aggression', or whether it is some kind of 'human condition' that does not exactly qualify as a 'disorder' as such.

1 Reply

@Doobah47,

Doobah47 wrote:

Fair enough one can identify dichotomies in the negative/positive outcome of an HIV test, although of course there is possibility for a mutation that is identical in practice but under the theory of a test is not identical.

In principle any new diagnostic test is mathematically evaluated for four basic parameters: sensitivity (ability to exclude false negatives), specificity (ability to exclude false positives), positive predictive value (ability to capture true positives), and negative predictive value (ability to capture true negatives). There are other statistics as well that need to be run, but the point is that NO test is perfect -- but we always need to know a test's limitations and evaluate that against our suspicion.

Quote:

But I see a problem in the dichotomy for example that drugs are either destructive or constructive

But public health policies always have the possibility of excluding individual benefit. Demerol (a narcotic painkiller) has been taken off the formulary at many hospitals because it has terrible side effects -- but it STILL works well for some people. It's just that we'd rather have alternatives like morphine or hydromorphone used instead 'cause they're safer. And while cocaine might be very useful for controlling nosebleeds and, and while methamphetamine may be useful for helping a tired truck driver stay awake, the public health implications of a free-for-all unregulated policy towards these drugs are such that the individual benefit is outweighed by the individual risk and the societal risk.

Quote:

Another question would be do you see any similarities between the swings of depression, the swings of bi-polar disorders, the swings of psychosis and the swings of an 'aggressive' person?

I'm not a psychiatrist, so I can only answer this so well. But there are such things as schizophrenia with manic features, bipolar type schizoaffective disorder, and bipolar disorder with psychotic features. And something like 25% of people with major depression actually have undiagnosed bipolar disorder (don't quote me on that percent, but it rings a bell). A psychiatrist would have to tease them out, of course. But I think someone who stays up all night writing philosophical treatises or doing math equations and is restless and energetic and grandiose has pretty typical manic features; whereas someone who is doing all this stuff but the newspaper is talking to him or who is paranoid or who hears voices has psychotic features. It's not as simple as 'aggression' -- because you need to put it in the right context. But hey, there are schizophrenics on mood stabilizers and there are bipolar patients on antipsychotics -- it just depends which features predominate.

Quote:

The inference of the question is whether there is such an illness as 'aggression', or whether it is some kind of 'human condition' that does not exactly qualify as a 'disorder' as such.

Well, also remember that something isn't a psychiatric disorder until it interferes with normal functioning in life (loosely defined though that may be). We ALL get depressed or bereaved from time to time, but we DON'T all have major depressive disorder. Humans can be aggressive in sports, war, arguments, whatever. But normal human behavior restricts aggression to a reasonable context. So excessive aggression that interferes with life may indeed be the result of an underlying psych disorder, or substance-induced disinhibition, or whatever, rather than being simply a variant of normal.

There's a point at which normal transitions to eccentric and at which eccentric transitions to disordered. It's not always clear, but our object is to help people, so we make diagnostic categories that are most likely to capture the right people.

1 Reply

@Aedes,

Aedes wrote:

Well, also remember that something isn't a psychiatric disorder until it interferes with normal functioning in life (loosely defined though that may be). We ALL get depressed or bereaved from time to time, but we DON'T all have major depressive disorder. Humans can be aggressive in sports, war, arguments, whatever. But normal human behavior restricts aggression to a reasonable context. So excessive aggression that interferes with life may indeed be the result of an underlying psych disorder, or substance-induced disinhibition, or whatever, rather than being simply a variant of normal.

So would you say that an ordinary, mentally 'stable', sane boxer does not suffer from any particular disorder? That their passion for violence is well within the moral and medical codes of what is 'good'/'healthy'? I would say most certainly NO! I think that this passion for violence that so many people adore, profit from and admire is very detrimental to our lives in this society. Remember that there are words - such as 'sporting' - that identify a morally acceptable level of effort, and I believe (through interpretation of the word 'sporting') that aggressive behaviour is outside the limits of said word; one can try incredibly hard, and make abstracted aggression part of the game (attacking shots in squash for example), yet this is not the kind of aggression which I talk of - I'm talking about the arguing with the referee, or the spiteful use of language to harm other players performances; the kind of simplistic aggressive bodily behaviour and not the type of shots or plays one makes.

It is actually an idea of mine that politics be an entirely linguistic affair, based on the internet and word processors in order to extinguish the kind of aggressive, socialite leadership qualities that many politicians profit from - the bullying by influence and sly secrets would be no more if the politicians could only be identified by a name on a computer screen, and not by their race/class/winking eyes/sly taps on the nose; as well as this it would be their policies and not their demagogue that were known to the audience/citizens.

1 Reply

@Doobah47,

Doobah47 wrote:

So would you say that an ordinary, mentally 'stable', sane boxer does not suffer from any particular disorder? That their passion for violence is well within the moral and medical codes of what is 'good'/'healthy'? I would say most certainly NO! I think that this passion for violence that so many people adore, profit from and admire is very detrimental to our lives in this society.

This is hardly black and white, though, and it's both culturally determined and an individual judgement. My father thinks football and hockey are needlessly brutal and violent. Most Americans think that's not the case, and the violence (and risk of injury) just goes with the territory. I completely abhor sport hunting -- but I'd bet Americans are quite split on this one (certainly regionally). I'm sure nearly all Americans think that ****fighting, dogfighting, dueling with pistols, and deathmatches (like in Bloodsport) are horribly cruel and unnecessarily violent.

As for disorder among the participants? It certainly takes a certain type to want to punch and be punched, or tackle and be tackled. And I'm sure there's a spectrum of those who are globally aggressive and that's one of several outlets, versus people who channel ALL aggression into a socially acceptable outlet (like playing hockey or perhaps boxing). So for a culturally acceptable thing, I'm not sure a disorder can be readily diagnosed. For someone who likes to torture animals, you might not be able to make a diagnosis but there is certainly high likelihood that this person is not mentally healthy.

Quote:

It is actually an idea of mine that politics be an entirely linguistic affair, based on the internet and word processors in order to extinguish the kind of aggressive, socialite leadership qualities that many politicians profit from - the bullying by influence and sly secrets would be no more if the politicians could only be identified by a name on a computer screen, and not by their race/class/winking eyes/sly taps on the nose; as well as this it would be their policies and not their demagogue that were known to the audience/citizens.

Food for a different thread.

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@Aedes,

Aedes wrote:

For god's sake, here is the FDA-approved package insert and full prescribing information for phenytoin. Take a brief look at "indications and usage":

http://media.pfizer.com/files/products/uspi_dilantin.pdf

Being one of the oldest drugs still in use (first marketed around 1960), phenytoin has been tried for a lot of things, both off-label and in clinical trials. But we're talking about a generation ago. Phenytoin is a notoriously toxic drug that has a very limited set of uses these days.

Distal phalanges is only word salad when used in the sentence "Phenytoin is used to treat most types of distal phalanges", which is what you wrote. A phalanx (the singular of phalanges) is an anatomic word and "distal" refers to the end farther away from the body (it's the opposite of "proximal"). So what you wrote is like writing "Tylenol is used to treat most types of heads."

Yes, osteoarthritis affects the interphalangeal joints (arthritis refers to joints, not bones which the phalanges are). However, antiinflammatories in clinical trials are marginally effective for osteoarthritis, with little difference between antiinflammatories (like ibuprofen) and non-antiinflammatory analgesics (like acetominphen).

Phenytoin is not an effective antiinflammatory, it is not used therapeutically for osteoarthritis, and in fact it is known to worsen osteoarthritis in rare cases (Eur J Intern Med. 2001 Sep;12(5):448-450). It has been studied for rheumatoid arthritis which is a completely different disease than osteoarthritis, and it has had some efficacy in those few studies, but it is not in clinical use because there are numerous better, safer drugs for RA. It's a very toxic drug that has limited use, almost exclusively for acute and chronic seizure management (it's probably used off-label for some refractory psychiatric disorders and severe neuropathic pain disorders as well, but that's not my specialty so I'm not sure). Phenytoin has a LOT of toxicities, including drug interactions, hepatotoxicity, and drug rashes, so its use is pretty limited.

As for my medical training, Harvard Medical School and the University of Connecticut School of Medicine have been kind enough to be my homes for the last 11 years of my medical career, and I've just taken a faculty position as one of the core teachers in the internal medicine and med-peds residencies at Duke Medical School. I hold three board certifications, two licenses, DEA certification, and a number of publications and awards. But hey, you were close.

Why are we fighting about this, by the way? Oh, because you called it a cardiac drug and I said that it wasn't. Can we just get back to the topic now?

Could you kindly provide research-able evidence with regards to your credentialing claims, basically provide information that a potential patient might request in evaluating the academic criteria of a potential Physician(doctors do it everyday). If you can follow through with the request, I will certainly apologize to you with regards to the evaluation process of prescription drugs, as your education and profession provides you with the expertise to provide more credible counsel, as mine is woefully inadequate in comparison, but I am 98.50% confident based on your style of responses that you are just another Internet Hack indulging in fantastical misrepresentations.

2 Replies

@Ruthless Logic,

Ruthless Logic wrote:

Could you kindly provide research-able evidence with regards to your credentialing claims, basically provide information that a potential patient might request in evaluating the academic criteria of a potential Physician(doctors do it everyday). If you can follow through with the request, I will certainly apologize to you with regards to the evaluation process of prescription drugs, as your education and profession provides you with the expertise to provide more credible counsel, as mine is woefully inadequate in comparison, but I am 98.50% confident based on your style of responses that you are just another Internet Hack indulging in fantastical misrepresentations.

Well even if you did apologies on those grounds it would be a lousy apology. Reminds me of the bully who apologizes when he realizes his victim has a 24 y.o brother with a car and real muscles. :p

1 Reply

@Ruthless Logic,

Did you get your honey moon in the end?

1 Reply

@de budding,

de_budding wrote:

Did you get your honey moon in the end?

Yeah, it was on the way home. Ironically we had been stuck in Maui an extra 3 days because of a huge snowstorm in Chicago and an ice storm in Dallas, so it was serendipitous that we were on that particular flight.

We were in Hawaii for a meeting earlier this year and on the flight home we discovered by pure luck that one of my med school classmates was on the same plane (he wasn't at the meeting). He's a cardiology fellow at Mass General, so that meant HE could deal with the heart attacks. I'm much happier dealing with meningitis or tuberculosis than with a heart attack :rolleyes:

1 Reply

@Aedes,

Why are we fighting about this, by the way? Oh, because you called it a cardiac drug and I said that it wasn't. Can we just get back to the topic now?

The claim that Phenytoin is NOT a cardiac drug is carelessly inaccurate. Phenytoin is used for certain Cardiac Arrhythmias (irregular rhythms). The link will directed you to ACCURATE information.

Dilantin - Phenytoin, Phenytoin sodium - Cancer Drug=

Do you know what distal phalanges are? They're the tips of your fingers and toes. That's it -- fingertips. So phenytoin is used to treat fingertips -- last I checked fingertips aren't a disease.

I also find it disconcerting that a health care professional could possibly think that Distal Phalanges are immune to any disease processes.

1 Reply

@Ruthless Logic,

*Edit -- I spoke earlier this morning with a PharmD who is the head of our hospital pharmacy, and I also spoke with one of the senior cardiologists in our practice who has been in practice for about 30 or 40 years, and neither one has ever heard of phenytoin being used as an antiarrhythmic*

Getting accurate medical information as a layperson is very tricky, especially on the internet, because there isn't an easy way to know which sites are reputable and there isn't a peer-review process. You have had a difficult time differentiating the actual clinical use of phenytoin from a potential use that has been investigated but was never commonly used clinically. We spend a lot of time with patients trying to inform them and provide resources online and elsewhere with accurate information.

OUR main resource for accurate information is the National Library of Medicine, which has online access to the medical literature going back to around 1963. You can use various search engines like PubMed or Ovid to access it. We also use textbooks that have good referenced reviews. For drug information the FDA requires that all package inserts include information about approved uses, toxicities, and other information. Phenytoin is NOT FDA approved for arrhythmias, as you will find by looking at the package insert that I linked. Its antiarrhythmic activity is class IB, and there are only a few class I antiarrhythmics in use anymore (like lidocaine, procainamide, a couple others) because better and safer drugs are out..

Ruthless Logic wrote:

The claim that Phenytoin is NOT a cardiac drug is carelessly inaccurate. Phenytoin is used for certain Cardiac Arrhythmias (irregular rhythms). The link will directed you to ACCURATE information.

If you want accurate information, check MicroMedex, check PubMed, or call a cardiologist.

Phenytoin works on the brain by modulating ion channels. Turns out the heart has ion channels as well, and other antiarrhythmics work on the same site. Because of this there were early trials of phenytoin as an antiarrhythmic but as far as I can tell in PubMed, which catalogs all medical journal articles back to 1963 I can find NO evidence of it ever being used clinically as an antiarrhythmic. The LAST published clinical trial of it for arrhythmias was published in 1988. It is not FDA approved for this indication and probably has not been even used off label for it for a generation. I've seen a lot of people with bad, refractory arrhythmias who are on multiple antiarrhythmics, and who have implanted defibrillators and pacemakers, and never once has phenytoin been part of the cardiologists' repertoire.

If you do a PubMed search, you'll find that nearly all the literature about phenytoin for arrhythmias comes from the late 1960s and early 1970s, with the most recent trial of nine patients being in 1988. Why do I underline nine? Because most cardiology trials have tens of thousands of patients. There is a national registry of clinical trials that you can check to see if someone is actually studying it. I believe you access it throug the NIH website.

Phenytoin is quite toxic and there are tons of safer alternatives. I've been certified in ACLS, PALS, and NALS/NRP several times each, I've worked in adult and pediatric ICUs, I've run resuscitations for people in cardiac arrest from arrhythmias, I am constantly consulting cardiologists, and never in my career has ANYONE ever regarded phenytoin as a viable therapeutic antiarrhythmic. So if it's actually used as an antiarrhythmic anywhere, it's either investigational or for extreme, refractory cases.

If you want independent corroboration of this, get away from Google and go ask someone else. Go find the chief of cardiology at your local hospital or a professor of cardiology at a local medical school. See how often they've used phenytoin to treat arrhythmias.

I'll do the same for you. I'll probably run across 5 to 10 cardiologists over the course of today at work. I'll ask them all.

Quote:

I also find it disconcerting that a health care professional could possibly think that Distal Phalanges are immune to any disease processes.

Where pray tell did I say that? I didn't. In fact I have a patient right now with a Staph infection of his middle and distal phalanges of one finger, I recently had a patient with sickle cell disease who had sequestration in the distal phalanges, I've got a patient with RA with disease of the phalanges, and I've had a recent patient with endocarditis who had septic embolization to the distal phalanges.

I was responding to your aphasic dribble "Phenytoin is used to treat most types of distal phalanges". You didn't say used to treat most types of diseases of the distal phalanges (which would be ludicrous unto itself, because we think of diseases as PROCESSES, not PLACES). You said "most types of distal phalanges". Turns out that there are 20 types of distal phalanges -- one for each finger and toe. We also have middle phalanges and proximal phalanges.

Now which disease of the distal phalanges are you referring to? Are you referring to osteomyelitis? Onychomycosis? Sickle cell bone infarcts? Traumatic amputation? Frostbite? Osteosarcoma? Animal bites? Burn injuries? Osteoporosis? Osteogenesis imperfecta? Polydactyly? Diabetic ulcers?

These are hardly MOST types of diseases of your digits, but it should illustrate why you can't just speak of "most types of distal phalanges" as if its a disease that any doctor would recognize as such.

Like I said, you didn't refer to treating disease. You referred to treating anatomy.

Oh, and I'm still looking for a disease of the distal phalanges other than neuropathic pain that is routinely treated with phenytoin.

If you don't believe me, that's fine. I don't care. Everyone here has had a chance to see our respective credibility on this topic, decide for themselves, and then get on with their lives.

Now I'm going to lock this thread if this digression keeps going on, and that is a shame because it's a good philosophy topic. If you want to have a chat about pharmacotherapy, feel free to start a topic in the Lounge. Otherwise, let's get back on track.

2 Replies

@Aedes,

I'd like to retract my statement that cocaine and violence aren't related. I've recently discovered that a small dose of cocaine leaves the user disgruntled and prone to loss of temper; large doses leave the user calm and tranquil though... ah well, it should be cheaper is all I'll say.

As for violence in society, I think it is probably more closely relevant to indoctrination than to carnal, primal instincts...

Any thought?

1 Reply

@Doobah47,

Doobah47 wrote:

I've recently discovered that a small dose of cocaine leaves the user disgruntled and prone to loss of temper; large doses leave the user calm and tranquil though...

In the patients I've seen, the higher the dose the higher the level of agitation and belligerence. I don't know if the dose-response relationship has been formally studied, but I don't think your impression of it is accurate.

1 Reply

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