Jul 09, 2017 Chris Foley

The new opiate…but it’s not a controlled substance…

The substance above is commonly used to treat “nerve pain” but is also prescribed and used for just about every kind of pain — muscle, joint, headaches, you name it — is the new “companion” drug for opiate users to gain a better “high”.  Gabapentin, aka, Neurontin, is the de rigueur new designer drug to go into your opiate sandwich.  In fact adding some gabapentin — or it’s much advertised cousin, Lyrica — to the treatment mix is frequently the quickest way to end a visit with a chronic pain sufferer whose diagnosis continues to be frustratingly ambiguous.  Hmm.


Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is neither an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.  (Internal Medicine News 7.6.17)


Just like the laws of thermodynamics, for every action there is an equal an opposite re-action.  Here, my detective nose is once again going down that road that begins with asking the question, “What is REALLY happening here?”  So often I see patients who have been bounced around from clinic to clinic, specialist to specialist, Mayo to Mayo.  Dust to dust, ashes to ashes.  We live in a medical world increasingly dominated and frustrated by ill-defined, chronic, painful, and dysfunctional conditions for which we have seemingly continued to add one Band-Aid drug after another. Very little gets resolved. Did I mention Lyme disease? Now, we have created a new Pharnkenstein, and there will be more. Until the medical system begins to honestly address underlying causes and reasons for these chronic conditions, the drug industry will continue to spawn new black market epidemics.

So, what could be the harm in this seemingly innocuous add-on medication?   There is strong evidence that gabapentin and its cousin, pregabalin (Lyrica), actually inhibit dendritic plasticity and may also adversely affect reproductive functions. In other words long-term use of these two drugs will create infertility and inhibit one’s ability to learn. One might even say that it would accelerate brain aging and limit cognitive function.  The apparent benefit of these drugs in their use for chronic pain seems to largely come from limiting new “pain synapses”. That is certainly not a bad thing. However, unless the underlying reason for the pain is more aggressively sought, the patient is left to a future of simply covering it all up. Eventually, the brain is affected adversely. But also, eventually, novel and abusive uses of these drugs are discovered. This seems to be just the beginning.




Jan 12, 2017 Chris Foley

The next generation of medications for your mood…


…will likely have something to do with a fellow I studied with a while ago.  His name is Joe Moskal, and he has been a neuroscientist ever since I knew him as an undergrad at Notre Dame. Among the many areas of study to which he has applied his considerable intellect is that of the “NMDA receptor (N methyl D aspartate)”, a particular protein in and on our nerve cells that plays an in depth role in how nerve cells talk to each other. It would not be helpful to try to explain the finer dimensions of this science (as I do not understand them all that well myself). But the impact that is just around the corner could be profound.  The molecule pictured above is glutamate, the major neuroexcitatory substance in our brains, and its target is the NMDA receptor.


Dec 16, 2016 Chris Foley

Those darn, useless supplements…



…that we recently highlighted here after the JAMA editorialized about the stupid American public’s ongoing use of them. The scholarly publication — with absolutely NO ties to the drug industry — again warned us about the dangers and waste in their use a few weeks ago very likely because the pharmaceutical folks would love to get their hands on the money from their sales. So let’s demonize them first, regulate them, then take them over when hundreds of small supplement companies cannot possibly afford to deal with the newly created regulatory environment.


Dec 03, 2016 Chris Foley

Medical freakout…


The only thing more self righteous than the Archbishop of Seville during the Spanish Inquisition is the modern day oncologist when confronted with a curious patient who might have a suggestion or two in the management of their cancer.  Any physician who has had experience with managing the cancer patient — especially childhood cancer where “treats” are used as a reward for the administration of chemotherapy and many of the other treatments used in modern day oncology — diet is usually casually dismissed with a “eat whatever you want comment” by the oncologist.  This has been the case for years and unfortunately continues despite a growing body of evidence that diet indeed does matter…


Nov 27, 2016 Chris Foley

A simple element…



Selenium.  Brazil nuts (though not really “nuts” but rather more of a fruit) contain unusually rich amounts of selenium.  Simple supplementation with this key mineral can turn what might otherwise be a deadly case of coxsackie virus-induced myocarditis (with heart failure, the need for a heart transplant, etc) into a nuisance respiratory infection to which your immune system successfully responds with lifelong immunity. I read today a fear-mongering story in the LA Times about the devastation wrought by the West Nile virus in the case of a 55 year old woman who is now wheelchair bound.  What could have prevented this?  Oh, I know… »

Nov 19, 2016 Chris Foley

The Legend of Domperidone…


Occasionally something comes around in the world of medicine that creates such a universal value that it is welcomed and praised for the misery it spares and the lives that it saves. How about a drug that enhances the rather common problem of a sluggish bowel, speeds gastric emptying (a common variable in reflux), and even helps women safely produce breast milk when it is not forthcoming? Even relieves nausea and vomiting! This med is not even new, actually, but rather has been around for quite some time — long enough for any proprietary rights to have long expired. It’s generic is rather inexpensive. So why can’t physicians today prescribe it?


Oct 28, 2016 Chris Foley

The American Medical Association declares war (again) on supplements…


Yes, the AMA — that organization consisting now of < 12% of licensed MDs or DOs in this country — has sought to go after that life and death question in one of their latest editorials:  The Supplement Paradox — Negligible Benefits, Robust Consumption (JAMA. 2016;316(14):1453-1454. doi:10.1001/jama.2016.14252).  Why, we Americans must be downright stupid, no?


Oct 16, 2016 Chris Foley

Thank you Dr Zhang

One would think that a full professor of Molecular Microbiology and Immunology at the Johns Hopkins University would be a credible source of validation to the seeming endless numbers of infectious disease specialists, neurologists, rheumatologists, and other tone deaf physicians in the Twin Cities, Minnesota, the upper midwest, and nation who continue to tell patients that “chronic Lyme disease does not exist”. Yet, today he effectively said that it not only exists but that it is imperative to understand its complex nature in order to begin to prescribe appropriate treatment plans.  Here he is interviewed at a Vector Disease conference in 2015 in Norway.  This should be required reading for the aforementioned Luddites we find in every clinic in the country right now.