Showing posts with label precaution. Show all posts
Showing posts with label precaution. Show all posts

Sunday, 14 July 2019

LSD - Between Good and Bad Trip


Few years back, I got a frantic phone call from a friend. It was 4 AM so between my annoyance being woken up before dawn, I asked him what the hell happened. He told me he was on this party and they did some drugs. At that moment, I just knew this wouldn’t be a nice phone call. He said he took some ‘acid’ and now he didn’t feel well. Everything around him seemed distorted. He was ‘seeing sounds’ and ‘hearing colours’. When I told him to go to the hospital, he fearfully told me he couldn’t because the medics would turn him in.

He had a good point, though ... the laws concerning narcotics in Indonesia is pretty strict. So out of desperation, I told him to find himself a green coconut water somewhere. What else could I do? His friends left him when he got too ‘high’. They just dumped him back at his place and left. So much for good friends.

Some of you might heard about LSD or ‘Acid’. They usually looked like stamps and people put them on their tongue. It was known as drugs used by hippies, besides marijuana. There is even a song about it, ‘Lucy in the Sky with Diamonds’. There are several positive ‘reviews’ on how LSD influence arts and society. Many said it was an enlightning experience, getting high on acid. However, I’m going to write a little bit about LSD and its effect.

Hasil gambar untuk LSD

Lysergic acid diethylamide (LSD) is a classic hallucinogen drug. It worked by binding to the serotonin receptors in human brain, that mediates the hallucinogenic effect by activating the frontal cortex glutamate transmission. It mimics the effect of the chemicals on your brain called ‘glutamate’, causing an increasing activity of the part of your brain – the sensory and cognitive processing. LSD also binds the adrenergic and dopaminergic receptions, which is not the case for other classic serotogenic hallucinogens.

On a studies using validated psychometric scale on 2017, the subjective effects of LSD were predominantly positive in controlled settings. However at the dose of 200 μg negative effects also reported. LSD at this dose also used in LSD-assisted psychotherapy in Switzerland.

 

The picture showed us which part of the brain activity is increasing after LSD exposure (right). This lasts for about eight hours. The hallucination or ‘psychadelic’ effect, was said to be a result of the increasing visual cortex communication with the other areas of the brain. This was similar to the psilocybin or ‘magic mushroom’. There was also a reduce in blood flow, so the neurons that normally act together lost its synchronization. Some volunteers in the experiment said that they feel themselves ‘becoming less a singular entity and melded with people and things around them’. However, the ‘good’ effects are vary. Some reported effects include : flashbacks, euphoria, anxiety and paranoid. 

LSD is relatively safe when used in medical settings and according to safety guidelines. However in unsupervised settings LSD could causes harm to the users. Acute adverse effects up to 10–24 hours after LSD administration included difficulty concentrating, headache, dizziness, lack of appetite, dry mouth, nausea, imbalance, and feeling exhausted. Headaches and exhaustion may last up to 72 hours. In my friend’s case, he said he’s not feeling well for good three days afterwards.

A case report on 2015 wrote that the user of LSD experience feelings of ‘trapped’, increasing heart rate, hallucinations and the subject was driven to the point of attempted suicide. The LSD was ‘25I-NBOMe’ a hallucinogen synthesized for research purposes. It has even higher affinity in the receptor. Thus, the ffects are also stronger. Most common adverse reaction is an acute episode of anxiety or panic (“bad trip”) that resolves with reassurance and the use of benzodiazepines. This NBOMes also caused tachycardia, palpitations, clonus, pyrexia, elevated creatine kinase, severe agitation, delirium, tonic-clonic seizures, renal failure, fatal overdoses and traumatic deaths.

There isn’t any ‘directions’ on the drugs one get form the street. The risks of overdose are pretty high, because one cannot measure the dose alone. We also can never tell which one is the real LSD and which one is not, as well as when will we get the good or the bad ‘trip’. The NBOMes is one of the drugs that difficult to detect, due to the high potency and small dose ingested. In conclusion, when one wishes to get high or hallucinating using the ‘acid’ they get from the street, they must remember that (1) the careless way the maker might use to make it and (2) one should not use it alone without a sober ‘friend’ and last but not least (3) the narcotics law.

Further reading : 
Cormier, Z., 2016. Nature.com. [Online]
Available at: https://www.nature.com/news/brain-scans-reveal-how-lsd-affects-consciousness-1.19727 [Diakses 14 July 2019].


Liechti, M. E., 2017. Modern clinical research on LSD. Neuropsychopharmacology, XLII(11).
Suzuki, J., Poklis, J. L. & Poklis, A., 2015. My friend said it was good LSD : a suicide attempt following analytically confirmed 25l-NBOMe I

Thursday, 27 June 2019

DIY (??) Invasive Medical Treatment


Hasil gambar untuk illegal whitening injection

One of the social media influencer in Indonesia, who is also a beauty and trend icon had gotten herself into trouble few months ago. The problem was, she’s endorsing a breast enhancer product that required self-injection on the breast. Yes, you read that right. She was promoting some kind of crazy DIY invasive medical treatment and wihtout any hestation said, "This is a safe and risk-free product!" 

The product was sold online and the seller would give you the syringe as well as the ‘serum’ once you order it. As terrifying as it might be, many of her followers attracted to this kind of ‘beauty product’. I didn’t know about this until a doctor angrily post her disagreement on social media. She wrote ‘What on earth is wrong with this socmed influencer?? Doing this kind of ‘endorse’!! There’s a limit for endorsing, not selling the drug as well as the syringe!! Please help me report her. This is dangerous!’ Yes, as a doctor I can understand her anger. It’s like looking at a little kid running with a pair of scissors. When I saw the post I also thought “Safe and risk-free breast enchancer?? Now wait the hell a minute!” 

From what I heard, the ‘serum’ contains estradiol – synthetic hormones they used for hormone replacement therapy ... okay now hormone replacement therapy isn't a simple procedure. It needs several examinations before it even start, in order to avoid long-term risks such as cancer. Second of all, even though they claimed that it contains 'estradiol', how could we be sure that it's real?

Many people agreed with the doctor, because they also knew the danger. However, some of the social media influencer's devoted follower got angry at the doctor. "If you don't like what she promote, then simply don't buy the product! You're just jealous because nobody wants to endorse you!" is one of the backlash posted.  



Injecting questionable substance into one’s body has a lot of risks. The method itself isn’t something DIY. Without knowing anatomy, a mistake such as hitting a major artery or vein might happen.


You see that’s the anatomy of the breast I got from my Netter Atlas of Anatomy. If the substance enters the blood vessel, it could cause complications such as embolism (blockade of blood vessel) on the lung or the heart also there’s risks for infections entering your blood vessels directly. If the process isn’t sterile. If the infection was localized and formed an abscess (swelling area filled with puss) for me that is considered ‘light’ if the treatment ‘only’ required puss drainage. 

Hasil gambar untuk abscess drainage

The infection could also go through the blood vessel and reach the heart, thus creating infections on the heart called endocarditis. It’s not a ‘light’ problem, to put it mildly. If one did not realize the symptoms, untreated endocarditis could cause death within weeks and even days. The treatment of endocarditis required intra-venous antibiotic and sometimes surgery if the heart structure (mostly the valves) damaged due to the infections. If the valves could not be saved, a replacement valves might be used because of damages as seen below :

 Hasil gambar untuk endocarditis
Anaphylactic shock is one of the direct-fatal risks that could happen. It’s a severe alergic reaction, when your body doesn’t agree with the susbtance enters your body and releasing susbtance to fight it. The susbtance causes fatal symptoms such as dilatation of the blood vessels (that leads to blood vessel drop), increase of heart rate, spasm in coronary (heart) blod vessels,  swelling of throat/tongue/lips (causing airway blockade), confusion (makes you can’t think of what to do) and loss of consicousness. This reaction happens within minutes and need immediate emergency treatment otherwise the various organ system in your body will fail within short time.

Epinephrine injection – an emergency injection that could be used during anaphylactic episodes – could be bought with official prescription from a doctor, proper indication as well as clear instruction on how to use it. The ‘online clinic/shop/etc’ who sell the ‘beauty injection’ obviously doesn’t consider it because the seller might not be aware of the risks.

There are plenty of reports on unofficial beauty treatment gone wrong ... but that’s just the tip of the iceberg. Many people do not report such incident because they still think that having body modification is a ‘guilty pleasure’, something they do to feel good but it’s a shame if anyone knows about it. So if something goes wrong, the shame beats the willing to get better. Thus, the unreported incidents. 

Sadly, this is not the first time I heard questionable ‘beauty therapy’. When I just graduated, I work at some clinics and once I encountered a patient who wanted me to inject this ‘skin whitening serum’. When I refused, she was told me ‘The person from other clinic injected this before to me, doc! And it’s safe!’ I told explained to her that we could not inject susbtance the patients got by themselves, without any official referal letters from the hospital (I explained about patients with Hepatitis B and AIDS who sometimes got their injection medication at the clinic) as well as the safety guarantee of the substance (And ‘I bought this at official online clinic from Thailand’ is not what I meant). She finally left the clinic,looking upset.

What most people don’t understand is, we doctors are taking a lot of precautions when it comes to invasive treatments. We do not enjoy ‘making things harder’ for our patients and no, we’re not ‘jealous of the social media influencer because they got endorsement and we’re not’. Trust me, if a (sane) medical care giver were offered endorsement on ‘DIY invasive medical treatment’ they will immediately say ‘no’ as well as reporting the dangerous offer to the authority. 

Ambis

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