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bongme

Doctor Warns Brothers That The Use Of Marijuana Is Negatively Affecting Their Brains

958 posts in this topic
7 minutes ago, j.o.i.n.t said:

@The Pharm

 

Now, we could have fucked up. What law were you referring to?

Partially read the question, sorry. It's included within the mental capacity act 

Edited by The Pharm

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21 hours ago, schmoak said:

it appears that Cannabis is being used as medicine in cases of anorexia and bulimia with some success


I'd mentally blocked this out for quite a while, but talking can be therapeutic I suppose.  

When I was a full time nutritionist I had a few clients that had these conditions. Many of them had recently been hospitalised due to them. I helped them maintain a healthy weight, lifestyle or psychological relationship with food. 

One of them was a really bad drug addict (many people with these conditions had habits, it's sometimes listed as a cause due to the statistics surrounding it), or had been prior to being hospitalised. She had been suffering with both conditions for years and years. We had a couple of sessions a month where we'd just go over her food diaries, anything else that had changed and discuss things to reinforce positive behaviours. Initially she was drinking and smoking a lot of cigarettes to keep her off the harder stuff, and I encouraged her to cut down on those, slowly, if she felt up to it. Eventually she did, but then she stopped sessions for a while. Couple of months later she organises another session and her house stinks of weed. So I asked about the smell and she was pretty open about using cannabis. She said it helped her eat and made the cramps less severe but not to worry because she wasn't smoking it all day - just in the evenings. Prior to the couple of months gap, between her docs, her psych and me - we had gotten her in a relatively good place. She was a reasonably healthy weight. She was eating a reasonable amount for lunch and dinner, sometimes skipping breakfast (but often people without disorders do that). A month after the break I had enough input in her food diaries to see that there had been a change and patterns were emerging. She was more often than not skipping breakfast, eating very little for lunch and then getting about 80% of her calories in the evenings and then purging (making herself throw up). This was much worse than she was a few months prior - often clients would regress when they stopped having support.  

So, wanting her to draw her own conclusions (as that often results in more stable behaviour change), I asked her to go back through her food diaries and see if she thought that there was anything that had changed in the months that she wasn't seeing her healthcare professionals, or myself. Two weeks later, she comes back to me and says when she had finally quit smoking and drinking completely, one of her friends had suggested cannabis because it always made them eat loads and that it was completely harmless in comparison to the drugs she used to do including the cigarettes and alcohol. She said she was relying on getting the munchies to force herself to eat in the evening and often didn't feel hungry without cannabis. When she had the munchies, she said she had a compulsion to eat even if she didn't feel hungry prior to smoking and often ate a lot (and not at all healthily). She said smoking cannabis "was just easier" than seeing the doctor, her psych and me and doing the work on her diet which had previously had her eating healthily, a healthier weight and in my opinion - been much happier (though you can't measure that clinically, obviously). She recognised that she wasn't eating as much throughout the day because she was relying on cannabis to force herself to eat. She also felt that the amount she was eating when she was stoned was probably compounding the feelings of shame and regret which had led to her purging (making herself throw up) afterwards. And that the feelings often came hand in hand with anxiety attacks (that she hadn't had prior to smoking cannabis). However, she didn't care because it "was just easier". 

In the coming months, she kept arranging and missing sessions with me. I assume the same was happening with her doctors. That's about all I'm willing to share. I try not to think about what happened after that. 

Bulimia an anorexia are psychological conditions relating to a persons relationship with food. You cannot treat them by masking the problem with drugs, in the above case it actually made things much worse. 

There are more lessons to be learned from this story than any of you will be willing to see. Not just about anorexia and bulimia.  

 
 

       

Edited by Nervous
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11 minutes ago, The Pharm said:

Using force to administer emergency treatment? if someone does not have the capacity to refuse either though incapacitation, disability or age or something else, we as doctors have the right to administer that life sustaining treatment. 

 

It's bad form, but I gave you this (below). I...mate, there's a big difference. I'm not joking when I say she wrote in <10 mins (touch typer). It's what experts can do. They spot tiny mistakes in these things man, and can burrow into similar worlds quite quickly...y'know, if they work with them on occasion! This could be linked to buggery. Loads of them. I'll spare you.

 

It just flowed out, off the proverbial tip of the tongue.

 

As long as you're ok, it's fine. But... it just looks different, doesn't it, how you're putting it?

 

For comparison.

 

Quote

That's interesting, I get that in emergency health/life and death situations health staff can 'shortcut' the Mental Capacity Act (MCA).  It doesn't happen like that out in the community though!  For instance, in adult social care we have to always assume capacity (Principle 1 of the MCA) - unless a person meets both the Diagnostic and Functional questions (e.g. do they have an impairment of their mind or brain, and is it so bad, right now they can't make the decision themselves?).  Then there must also be doubts about someone's (a) ability to understand, (b) use and weigh and (c) remember the information relevant to the decision they need to make - in addition to (d) can they communicate their decision? 

If there are doubts about a, b, c or d, then MCA 2nd Principle says all practicable support must be offered to enable the person to maximise a, b, c, or d, to enable them to make their own decision.  So someone might need easy-read information, or picture reminders of why the treatment is necessary.   Just because we might not like or agree with their decision, MCA Principle 3 says we all have the right to make unwise, unsafe or even wrong decisions. 

 

Only after all supported decision-making fails, can we move into completing a paper capacity assessment - and we have to involve family and friends wishes and health professionals opinions too - and also the best interests decision (MCA Principle 4) includes taking into account what is least restrictive (MCA Principle 5). 

 

This all takes much longer than asking 'can you tell me what you want?'

 

We don't use the term 'force' (that'd be a Deprivation of Liberty - to be renamed Liberty Protection Safeguards next year, and then a further 6 assessments would be required!) - the example I'd give is if someone in the community stops taking their tablet medication, (it's common to find a stash of tablets wrapped in tissues 'hidden' down the side of their chair cushions!) maybe all's needed is for a care worker to prompt and remind, or proffer their tablets in a plastic cup - but if they continued to refuse we'd have to follow all five statutory principles of the MCA. 

 

We'd ask why they haven't taken them and if they know what they're for - and respond according to their answer.  If someone says they can't swallow the tablets anymore we'd arrange for liquid medication (costs more though) or if they can't explain then we might be able to get agreement from GP to hide the tablets in food.  It's much harder when someone says they don't like the side-effects and it's their choice... (Principle 3 again).

 

Even after a capacity assessment deems them to be lacking in capacity it must then deemed to be in their best interests to take their tablets, and we'd have to also consider what the least restrictive option would be.  I doubt it'd ever be deemed 'least restrictive' to rugby tackle the person down into a chair, hold them down and strap their arms/hands to the arm rests, force open their mouth and throw the tablets into the back of their mouth! If just placing a comforting hand on the person's arm helps reduce anxiety so they agree to take their tablets, then that'd be both best interests and least restrictive - but sadly, it very rarely works in the community. 

 

 

Edited by j.o.i.n.t
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@The Pharm

'

Mate, big love. I was subject to the laws which mention force in my 20's, twice... I am not attacking.

 

 

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3 minutes ago, j.o.i.n.t said:

 

It's bad form, but I gave you this (below). I...mate, there's a big difference. I'm not joking when I say she wrote in <10 mins (touch typer). It's what experts can do. They spot tiny mistakes in these things man, and can burrow into similar worlds quite quickly...y'know, if they work with them on occasion!

 

It just flowed out, off the proverbial tip of the tongue.

 

As long as you're ok, it's fine. But... it just looks different, doesn't it, how you're putting it?

 

For comparison.

 

 

 

 

I understand, however the first thing I would attempt would be comforting, supportive initiatives to try to enable them to understand, thought that I would be assessing and calculating my next course of action try carefully. When I transitioned to emergency care, decisions have to be made very quickly and indefinitely, there have been times when I have had to administer care onto a patient in a forceful manner but its not how it sounds, depending on the situation we can offer sedation, or calm-inducing drugs so that we can care for them, its not an everyday occurrence but it does happen. Using the term 'force' is what we use amongst staff, to the patient, its known as emergency intervention (if they ask). I'll provide a scenario.

A patient presented to the department with a head injury and a suspected spinal cord injury, they were immediately assessed and the necessary imaging was taken. Images shows a T5 spinal cord injury and required urgent surgical treatment, as well as a cerebral oedema (swelling on the brain) which also required urgent care. Subsequent of such, the patient was vomiting, in and out of consciousness and seizures and was unable to consent to any medical treatment. As his symptoms were critical, and he was over the age of 18, we administered the emergency care. He made a full recovery. Hadn't we of administered that care, he would have died from the fatal injuries he suffered.

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Wrong

 

ETA

(I'm not talking about A&E, this post timed badly)

 

It's the word 'force'

Edited by j.o.i.n.t

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2 minutes ago, j.o.i.n.t said:

@The Pharm

'

Mate, big love. I was subject to the laws which mention force in my 20's, twice... I am not attacking.

 

 

I could tell, I hope my answer suffices.

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Just now, j.o.i.n.t said:

Wrong

I'm not wrong at all, I'm 100% correct.

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Just now, The Pharm said:

I could tell, I hope my answer suffices.

 

We see you.

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1 minute ago, j.o.i.n.t said:

 

We see you.

If I am wrong please correct me. 

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2 hours ago, Comrade Stoker said:

Does anybody know if Dr Dre is a proper doctor, and the doctor from Dr and the Medics :unsure: 

what about dr feelgood ?

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3 minutes ago, The Pharm said:

If I am wrong please correct me. 

 

The only time force is mentioned in medical law is mental health related.

 

If I'm wrong, correct me. Or I could put back on the MCA geek there which has it all.

 

 

Edited by j.o.i.n.t

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Just now, j.o.i.n.t said:

 

The only time force is mentioned in medical law is mental health related.

 

 

disability and capacity. Keep searching 

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10 minutes ago, The Pharm said:

disability and capacity. Keep searching 

 

:D

 

I'll put her on tomorrow.

 

Edit, actually, she'll be working... When she can be arsed :D

 

 

 

 

 

USERS.

 

Be careful with this one. There... it's...not right. The bits she knows about have triggered...concerns.

Edited by j.o.i.n.t

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Quote

The only thing that hasn't evolved with modern times is education, although I was a very capable student who later got a career in chemical development but it's no free ride, these companies ensure their biochemists meet a high standard and they do this with annual internal training, assessments and routine monitoring, each month I am randomly assessed for a whole shift, they are watching my every single move and one critical mistake would make or break me.

 

Chemical development in this thread.

 

We think we know what those mmitigating circumstances are.

 

We could be wrong.

 

 

Edited by j.o.i.n.t
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