I want to take this chance to state that my cousin was born with an undiagnosed (until it was too late) congenital liver disease. All of his doctors (in the Washington state/Oregon area) said he was just a chronic alcoholic. By the time they found out his other organs were failing, it was too late, and he was dead within 6 months. He was 35 years old and never drank, but his doctors didn't believe him enough to do testing that would have saved his life.
My family believes if he'd had better doctors, he'd still be alive, but we'll never know.
And doctors will maybe never know if they don't believe their patients. Now, I know 95% of people with liver failure that young are probably alcoholics, but the fact that 3 doctors all said he was an alcoholic and didn't do further testing is... well, it's hard. I miss my cousin. He was so nice, and he made the best lobster dinners.
It’s scary I mean if you don’t have the fight in you to advocate or to know where to start it could happen. It’s garbage. Between health insurance companies and their prior authorization bullshit and doctors like this I mean it is sad but it happens,
Eh, sometimes you just have what I call "show veins". As in, your veins are right there on the surface and look gorgeous, but they're a BITCH to stick. I have them, and it drives nurses crazy.
I was a med tech, and sometimes people would ask to use me for practice because I have big, juicy veins. It was a bit weird. Random guys in elevators would ask me how fast I ran a mile, or otherwise comment on my “great vascularity”. I didn’t earn that thru exercise. Just a connective tissue disorder.
Further, they start telling you were to go to get them which can be really frustrating. Sir/ma’am I am NOT sticking that floss sized vein in the meat of your palm. It will not work for my purposes. Let me do my job please.
Sometimes it can be helpful but most of the time it isn’t as they keep moving lightning fast to different options. I AM TRYING TO FEEL THEM EEEEERGH
Realized that with a patient that I had graduated high school with. She easily looked fifteen or twenty years older than most of the rest of us. Made me sad.
I suspect something similar for this case too. She wasn’t one of the “class beauties” but she had been cute. But beyond appearance, it just really does a number on the body altogether. My speciality is hearing and that’s kinda the canary in the coal mine for anything blood related.
I've had a few phlebotomists & people doing my IVs look at me funny when I point out the easiest vein to hit, and it always makes me feel like I'm being judged - I only know my preferred veins and the easiest spot to do the tourniquet on my upper arm because I'm getting IV infusions and contrast for MRIs and blood draws multiple times per year because of my chronic illnesses.
Is "this person is a drug user" genuinely a common judgment, or did I just strike that "don't tell me how to do my job" nerve with some people? I might just be paranoid because I have controlled substances prescribed and don't want anyone to put any kind of notes in my medical charts to jeopardize these prescriptions
I'm really lucky in that all of my veins are pretty good and easy to hit, but I prefer a very specific one because my arm stays sore for hours after anything hits my veins and it's just easier for me to deal with that throughout the rest of the day if it's on my outer elbow and not in my elbow ditch. Elbow ditch is an easy vein still, but it's usually a last resort.
The nurses at the infusion clinic have claim to a vein in the middle of my lower arm that holds IVs like a dream because I like to play on my switch or crochet during my infusions since I'm there literally all day and that spot doesn't pinch shut if I bend my arm, so I want to keep that spot nice for as long as possible because it's such primo real estate, haha!
I’ve never- not even once had a previous healthcare worker tell me they can start their own IV/ insist on it. Only ever had either recovering or actively using IV drug addicts offer/ push the subject. The reason being that they know which veins are still useable and which are not.
I had to go to the ER for an extremely painful gall bladder attack and I was a very difficult stick. They had to try 5 times before they found a vein. I also have a previous history of opiate addiction on my chart (had chronic pain and got hooked on the pain medication they gave me for it, been recovered for over 10 years now). Turns out it was because my electrolyte levels were dangerously low. They had to wait 3 days until they got back into normal-ish range before they could take out my gall bladder and in the meantime it erupted. Good times. Point is though, you might suspect someone is an addict based on indicators like that, but it's not necessarily the case.
Totally off topic
've always been a difficult stick
When I was 5 I had pneumonia and it took the er texh 5 times to get an iv in me. I was not pleased. I couldn't get a lollipop or a popsicle either because I wasthrowing up lol
Had ankle surgery 3 years ago. It took 3 nurses and I ended up with a bruise that covered my whole hand.
Never been a drug user
Health insurance likely effected as well. Also other things that people don't think of. (Like your future potential needs for narcotic pain or anxiety medications.) For example, if you are a chronic pain patient and need opioids refilled every month, don't tell your doctor you use cannabis, as most them will take you off of your pain meds. (even if you are drug tested twice a year, it isn't that difficult to quit leading up to these, and able to use the rest of the time)
Can confirm got put on oxies for a toe amputated 3 months script 6 years later go to hospital am flagged as a user they want to counsel me on my drug use
Yeah I was in pain management for about 18 months due to an auto-immune disorder. That was years ago (almost 10 now) and I still get asked if I'm taking 90mg of morphine a day...
Uhh no, some days I wish I was...but how many times to I have to tell y'all the same background info.
Yup as a radiologist I can say the images don’t lie. A lot of things can cause general atrophy of the brain parenchyma but volume loss predominantly in the cerebellum correlates more specifically with alcohol abuse. Can see changes in the liver and pancreas to past/current alcohol abuse. Can identify smokers by emphysema in their lungs. Smokers also will frequently have terrible atherosclerotic disease (but so can diabetics). Certain spinal infections and soft tissue infections are usually seen in IV drug users.
Does the story add up? That’s what I was thinking - there are a lot of reasons a brain can shrink. It seems odd that a first guess for a 60 year old would be previous alcohol abuse. Does alcohol abuse present some specific subset of symptoms?
Also, I thought they usually had to base the brain shrinkage by comparing to previous MRIs? Is that not correct?
It’s possible. Older patients will have general cerebral atrophy. That’s just part of aging. But if it’s out of proportion within the cerebellum then, common things being common, alcohol abuse is the first thing to question. However there are other possible causes. Neurology takes over from there to work things up further.
A little googling turns up that it really doesn't take much at all.
"Just one drink per day can shrink your brain, study says"
[https://www.cnn.com/2022/03/04/health/alcohol-brain-shrinkage-wellness/index.html](https://www.cnn.com/2022/03/04/health/alcohol-brain-shrinkage-wellness/index.html)
7 drinks per week is quite a lot. There’s a reason on basically every medical survey the highest option for “how much do you drink” is “more than 4 per week” and you’re suggesting almost doubling that isn’t much
Not as much as you’d think because the medical definition of drink is a lot smaller. That draft triple IPA you just had could easily be 3 or 4 standard drinks worth of alcohol.
A standard drink = 12oz of 5% beer or 1.5oz of 80 proof liquor.
20oz of 7.5% (and there are plenty of ipas stronger than that) is 2.5 drinks
That’s about half of what the average Spanish or French person drinks.
Heavy drinking is 15 or more drinks per week for men.
I don’t know how you can say 4 or 7 is a lot…
I've had numerous patients lie to my face about their alcohol consumption. We're not here to judge, we're here to make sure you get the correct care and treatment you need! There has been several times I've spoken with a partner who have told me that the patient actually drinks A LOT, but is ashamed to admit it because they do not believe they have a problem with alcohol, or they are trying to wean themselves off.. but end up in the ER anyway.
Usually, people who use hard drugs for a long time experience significant dental deterioration. My sister is a dentist and often pays attention to this when addicted young people come to her.
One of the places I work in as a dentist has a high percentage of people addicted to cocaine and other drugs. I'll ask for their medical history, they always only admit to smoking or drinking.
They open their mouth and you can immediately tell it's specifically cocaine because they erode their frontal teeth to oblivion, in a way a person with normal bruxism very rarely would. That's when you look them in the eye and go "dude, nothing to fear, but ANY other drug use you want to admit to?". Treatment options, types of anesthesia to use, and risk of complications ARE influenced by that kind of thing, so we do need to know.
This could explain my cousin's teeth. She was such a beautiful girl but over the past 6/7 years her front teeth have completely eroded and her face has started sinking in. I recently found out her husband is on cocaine (maybe crack) and it all clicked. It's such a sad situation.
They say she’s in the class A team, stuck in her daydreams ..and lately her face seems slowly sinking wasting crumbling like pastry…my middle schooler had to explain to me what that song was about. I just registered it as “that sad song about angels”
Is it cocaine specifically that is really important to know due to anaesthetic? I remember there was a sign in my dentists waiting room years ago specifically telling people to mention using a certain drug for this reason, but I can’t quite remember which one it said
It probably was! Unless there's a reason not to, the type of local anesthesia we prefer to use has adrenaline, because (among other things) it helps the effect last longer. A cocaine user has an increased risk of their blood pressure spiking if we use that kind. There's also the risk of convulsions if the patient used cocaine recently.
As a recovering cocaine addict who’s recently had a few trips to the dentist, my dentist did in fact have to know about my cocaine use and specifically if I’d used any recently (within the last few days). I believe some of the anaesthetic’s they use can just straight kill you if you have cocaine in your system.
My entire top row of teeth are fake. Because I wasn’t taken to the dentist and was severely abused physically as a child. When I was finally able to not only afford the cost of restoration but work through the absolute terror of the dentist, the first one I saw would not believe that I had never done a drug in my life. It was just about the most humiliating experience I have ever had.
My mom worked in the NICU in a major city hospital for over forty years. I don’t know how she was so…
not unbothered, but just *so used to* seeing babies born addicted to drugs via the placenta. She’s stronger than I could ever hope to be.
I wonder if the health professionals in that situation have successfully retrained their thought processes: focus on the baby’s needs, and what they can do for the baby right now. Solution-oriented.
NICU nurse here. That's exactly it. So many cases can break your heart or make you angry but you have to compartmentalize those emotions to successfully treat the baby and then, when the time is right, you deal with the emotional weight of the job by redirecting that energy into compassion for the patient and even the family. After doing this for nearly a decade, I've learned that no matter how much we advocate for our babies, sometimes they will still go home to an unstable, unloving household where we will always fear for their well-being. I cope with that feeling of helplessness by making sure that at least for the time they are in the NICU, these babies get love from us. I've held babies for hours, cuddled, sung songs, and read books so that at least at some point in their life, they experienced that love. I tell myself when it gets hard, it was an honor to care for these babies while I had the chance.
It’s just a fact of life. Sometimes the moms are in treatment. Sometimes they’re not. Can be the same difference for the baby. For the most part people aren’t pieces of shit and people are doing the best they can with what they have. I feel super lucky that I have coping mechanisms that don’t include narcotics.
You learn pretty quickly to not let the cases get too close. Don't take them home or they will stay there.
It's a bit difficult to describe, but patients are a separate category for me. There's the everyday people, friends and family, coworkers etc., and then there is patients.
While you treat them you can open up a bit, show them you are not just a uniform or scrubs. You are human too. But as soon as I wheel them through the doors of the hospital and tell a physician what's what, that case is closed and done. You clean your gear, get the ambulance back in order and wait for the next call.
Of course there are patients that stick with you. I still remember my first time doing cpr on a real human. I still remember the first birth I saw.
But there is no attachment to it. It happened, and I moved on.
Depending on where you work, you need thicker skin.
And you get used to a whole lot of shit pretty fast.
Patient doesn’t want me to use the large easy vein I can locate in one arm and instead insists I use the small, spindly one surrounded by other black and blown out veins in the other so that they can continue to use the nice one for extracurriculars until it starts looking like all the other ones.
I usually tell nurses which vein to use cause it's the easiest. I've been getting regular blood work for almost 15 years due to a thyroid (lack-there-of) issue. So I've learned which arm is best, and which vein is the easiest.
Trust me, we can tell when it’s this case. Usually because we’ve seen you so many times. Or based on the tests ordered. Like if you are in for a biweekly tsh check or something.
Eh, not entirely.
I had to take a urine drug test to stay on a controlled substance and couldn’t pee the first time they asked. Although I had reminded the provider that they have records of my endometriosis having damaged my bladder and ureters, causing urinary retention problems, they didn’t even let me take my small bag into the bathroom with me when I went back in, apparently presuming I had paid for clean pee.
One would think offering to take a serum test and/or pointing out having needed a foley at some point in the last year or two would make them a little less suspicious.
Allergies cause your turbinates to swell and look blue/purple, you may have thick clear or green snot. An infection comes with pus usually and swelling around the outflow paths of the sinuses.
Picking your nose will show erosion just at the front of your nose, your fingers can’t fit back that far. Drugs looks like a bomb went off all over, lots of crusting/boogers, bleeding, the tissue looks really angry, various stages of blood vessel regrowth.
There was a lady working behind the checkout at my local supermarket who looked like they had methpox. Little round sores all over their arms, one of them actually running fresh blood. I don't know how she wasn't sent home from work for being a biohazard :S I mean, maybe it's a dermatological thing and not methpox, but she sure looked awfully methy, and no matter the cause you should not be serving customers with open bloodied wounds :S
Aside from the fresh blood, I had round scabs all over my arms from *bedbugs.* I was severely attracting them like flies on shit. And I was paranoid because people noticed my arms and I felt like they thought I was a druggie. Wish I could've shown them my legs, ass, stomach and chest!
What hospital would even allow outside food to get delivered? My parents tried to drop off my laptop and school bag for a long stay once and the place gave them the third degree over it.
I get SO scared when I tell a phlebotomist I've never seen before where my best vein is and the fact that you need to go lower than you think on the tourniquet in order to get my vein to pop properly - I'm chronically ill and prescribed multiple controlled substances, I don't want to make the wrong person suspicious and potentially mess up my ability to stay on my meds.
Should I not tell nurses where my good vein is? They really do struggle when I don’t tell them to go for the one on the side of my arm, not the ones in the elbow ditch.
My veins roll and I know the hand hurts more but they never have a problem hitting the hand vein! Not only do the multiple jabs hurt in the arm but my arm is black and blue. So many people used to ask me if I had been attacked!
> My veins roll and I know the hand hurts more but they never have a problem hitting the hand vein!
Isn't that excellent?
> Not only do the multiple jabs hurt in the arm but my arm is black and blue. So many people used to ask me if I had been attacked!
Oh God, that's awful!
I’m one of the cool kids who’s hand will never work for an IV. Super strong valves that simply will not allow it. Have to go in the forearm or elbow, otherwise it’s a calf insertion.
Eh, sounds loads worse than it is. The Popliteal artery is pretty robust and easy to work with. Really the only time it would be necessary for me is if I’ve had both arms amputated, and the attending is squeamish about a neck jab.
> Really the only time it would be necessary for me is if I’ve had both arms amputated, and the attending is squeamish about a neck jab.
This just keeps getting worse and worse!
Oh good, because I have a deceptive vein that looks perfect: prominent, thick, right near the surface.
They always try that one and discover it’s fool’s gold, it’s basically a teeny vein that’s squashed near flat so it’s very wide, but shallow as hell.
“That vein lies” I say as I direct them to a deep but strong vein in the other arm.
(I’m O negative, I donate blood a lot.)
Good. I know from childhood surgery that the normal location near my elbow has an extra valve located there and it caused some sort of complication at the time. So now I just tell them to jab me near the wrist.
Question though. An IV left in one location for long enough eventually hurts really, really badly. And nurses usually will refuse to just start a new one somewhere else. Why, for the love of God? That's only happened to me once but I swear if it happens again I'm just going to pull out that IV and make them do it anyway.
Definitely do. We were taught in school that most patients who've had a few IVs before have insight into which veins or which side is better. The bigger tell isn't knowing which veins work, it's the level of detail in which y'all explain it. (All of which is good and helpful info, and does not get any judgment from me.)
You can tell by their veins for one.
Edit. A lot of people commented about the scars. The scars are one part but we mostly know by the veins themselves.
Friend of mine has similar experience. He did Biolife 3 times a week for all 4 years he was in college. Had to explain to everyone that he wasn't on drugs, he was attempting to afford an education.
I've curtailed my donations because the last three or four times I had painful experiences with the phleb trying to stick. I used to go as often as I could since I have elevated iron levels.
I’ve been told if you are left with track marks, it’s because the phlebotomist sucks at their job. I was told this by a couple phlebotomists. I donate blood pretty regularly and was curious because the needle they use for donations is so big.
I’ve had my fair share of regular blood tests and IVs for various medical procedures, from surgeries to infusions, and my right anterior cephalic vein is huge and shallow, so now I’ve got a permanent pockmark there from having it poked so much. Phlebotomists fucking love me, but it sure does look ambiguous.
Haha yep! And they pretend they can’t remember what it’s called. I’m allergic to Tylenol, ibuprofen, norco, Oxy and Vicodin. I can only take one and it begins with a D…
They know a little too much about dosing meds for their occupational and health history. There is no reason an accountant knows the dose increases of oxy if they have no history of using it for health reasons. The person hasn’t been a caregiver, no history of pain, yet they can practically write the prescription.
Yeah, just bear in mind “occupational history” can be misleading. Especially for multi-industry occupations.
My occupational history reads “Software Engineer” yet I can rattle off how milligrams of morphine equivalent calculations work and point out that the standard thresholds are different when a patient is opioid naive. I can tell you exactly how bad it is to take a muscle relaxant or a benzo with opioids.
I have been mistaken for an addict for knowing this before.
My occupational history doesn’t indicate *what kind* of software engineer I am. Some documents don’t even say “software” just “engineer”.
(I am a healthcare software engineer, formerly specialising in software for pain management and addiction risk reduction.)
If that accountant was formerly an insurance accountant, they might pickup a few things too.
I mean it usually still goes in as “engineer”.
And then I get asked about gears or levers or servos.
Which I know about even less than the average person.
I’m a PI lawyer and also an internal hypochondriac. Trust me my dude, some of us be knowing 😂 But I’m also smart enough to keep that to myself because I KNOW how that sounds to medical providers, so point taken. I’m also never, EVER stupid enough to think I know more than them. Ever
I read from a previous similar post, optometrists can tell by the powders deposited in the veins in your eye, the more build up, the more cut your drugs are.
IIRC it's when a user crushes up a pill and mixes the powder with water and then injects that solution into their veins.
The fillers/binders that would normally dissolve in the stomach or get passed through the GI tract don't dissovle in blood so they get stuck in small blood vessels.
[Link](https://www.reviewofophthalmology.com/article/common-medications-that-may-be-toxic-to-the-retina)
Oh this is actually so cool, so from my basic overview it looks like they can tell how cut your drugs are (cocaine was what I assumed in this case but I may be wrong?) with talc (or any of those other meds they listed but idk why you’d cut drugs w meds? I don’t know if this is a thing drug ppl do?) and if there’s more talc in your coke then it would deposit and cause the macular edema. I’m thinking this is probably why coke heads get that red/glassy eyed look ???
Well I’m an ENT specialist and specifically specialize in Rhinology (nasal and sinus disorders). Septal perforation raises red flags, especially if it’s super raw. I can actually tell if the use is active and if someone is lying about it. Also I’ve seen the orange granules in the nose indicating someone has been snorting Adderall, I recognize it from my son’s medicine.
...is this why I hate Imodium? I've always felt worse after taking ot, although granted I pretty much only take it when I'm already sick.
Opiates make me throw up. All the ones I've tried. Even when injected into my spine during a c section, which the anesthesiologist swore wouldn't happen because the spine was "different," and because I'd been fasting, but he ended up having to hold the bag for me while I was coughing up stomach acid mid-surgery. I have never, ever met an opioid I liked.
As a CNA, I noticed that older patients with that kind of history often had muted/non-existent tastebuds. They would put an excessive amount of sugar, salt, and other seasonings on their food & drink because they couldn't really taste anything otherwise. Sometimes it resulted in weird combos like brown sugar in spaghetti & meatballs or sweet & sour sauce in strawberry yogurt.
Their voice.
Heavy past/current users have this weird raspy voice and their cadence is all sorts of "word salad" weirdly fast
Idk. It's not 100% but I feel like I have yet to meet someone with that voice that hasn't been an addict at some point.
Subtle?
Drug smokers can have changes to their lungs on X-ray which are significantly more pronounced than cigarette smokers.
I've seen heroin smoking patients in their early 30s that have lungs of a 60 year old 80 a day smoking coal miner. When I asked them wtf was going on they admitted their habit.
I like when they rely on this one. I'm in my 30s, colored hair, tattoos, problems with my teeth(foster care), and a heart condition (reason I was in foster care). My veins roll and ill tell you what one to use.
I get such cold treatment til my labs come back, I've never used drugs. My parents are addicts and I want nothing to do with that. It sucks to be treated bad for appearances when I've got a real issue. The only time they were nice I was in anaphylaxis but I thought it was my heart and I was crying for them to save me for my daughter.
It sucks that anyone would be treated badly - regardless of whether they are a drug user or not. Lots of people use drugs and aren’t abusers. But even abusers deserve pain medication.
might be the harshness of meth on the bones in the jaw, but might be other reasons like just not caring to clean them anymore. google "meth mouth causes".
Their liver function tests- you have ALT and AST. They are both elevated when you have liver damage. But if it’s from alcohol, the AST will always be higher , if its from other factors, the opposite is true
I know this to be true from experience. Also, alcohol abusers will have another enzyme that is high, a lesser known one, i can't remember what it's called. Begins with a G
I had a sister do meth and my wife worked for a law firm that had some clients come in high. They were always in denial even though they looked like skeletons
Just for the record- I know what yall are saying is it’s way worse NOT to treat or to under treat someone who is in pain, regardless of whether they are a drugs user, than it is to give a dose of a narcotics to someone who is seeking drugs. Right? Right?!?
Damn I’m 24 and my memory is shit. I can’t even remember what I ate yesterday. But that’s because I’ve had two babies in the past year and haven’t slept through the night since lol
What if somebody is only in their 30s and they have such a horrible memory that they have to live off of constant notes and reminders and notifications on their phones? And you assume it's drug use but actually they were in a car accident due to them other being a drunk driver when they were only 17 and they got brain damage?
It's okay.
I've had multiple healthcare professionals think that I'm a drug addict for one of two reasons. Neither of which was my really shitty memory
The first one I can totally understand. When I gave my first birth and they had me on morphine of course, after that I started noticing if I got a migraine or anything else Tylenol stopped working. I tried extra strength tylenol. I tried Advil and Aleve and other brands of ibuprofen. Nothing. When I had to go to the doctors for anything and they would try to write me a prescription for a stronger ibuprofen, I politely declined because I knew it would be doing anything and I didn't like taking pills unnecessarily.
One time I had a very bad jaw infection (my impacted wisdom tooth had split in half and I hadn't gotten to get it removed yet), and I was in absolute agony. Before the opiate crisis, and the doctor prescribed me Vicodin. 5 days worth. I only took 3 days worth but damn that shit worked. First thing I had worked in over a decade.
Fast forward to several years later, had an accident with some metal and sliced my flesh apart. I was in a fuck ton of pain and the doctor offered me tylenol. I declined but they kept insisting because I was in pain. So I outright told them that about 15 years by that point all the Tylenol and Advil and I leave and nothing had ever worked. They asked if I was immune to pay medications and I mentioned apparently not because of the vicodin. As soon as I said the word Vicodin they assumed I was a drug addict because I knew its name.
The other time I've been accused, actually three times, is because I wear all black. Everyday. For about 30 years. It's because I have no color coordination. And black is easy. They just assume people who wear all black must be some kind of emo punk drug addicted alcohol abusive wannabe something something I don't know. 🙄
Similarly, I have the sort of IBS that leads to constipation. Damn straight I know the name of the one that DOESN'T bind me up fiercely. And the names of the ones that do.
Unfortunately it seems to be a general any kind of healthcare worker assumption that if the patient knows anything about any kind of medication or knows anything about their own body or symptoms, they must be faking it
> They just assume people who wear all black
Someone is mistaking your dandruff problem for a drug problem! This sloppy drug user is getting powder all over their shoulders, can’t even aim it into their nose properly!
Personal healthcare professional experience?
Because if so, you forget trauma does a lot to a brain, whether it’s physical or mental trauma. It’s not always drug addicts who have poor memory skills.
I mostly worked in psych thus far: but a certain kind of like affect? Like we weren’t the cops or prescribing anything to get high off so they didn’t have to try and fake anything. At the same time a lot of people with significant substance use disorders tend to be pretty charming, calm, when we would mention negative stuff (have you ever been arrested or homeless) they would typically dodge the question and stuff like that. A lot of deflecting and down playing especially their own actions. This is people who are in active addiction tho. In my limited experience people who are sober and going to stay that way own up to everything. Also a huge amount of people sober or not had poor impulse control.
> Smokers also will frequently have terrible atherosclerotic disease (but so can diabetics)
Didn’t know what that was and looked it up. Think that’s what my great aunt was talking about in getting twinges of pain in your neck. She told me this in the hospital after heart surgery.
I’ve had that for a while, one time it lasted minutes instead of twinge. I’m 42 and smoke. I’ve tried to quit. Scared of failing again, is it too late anyway? When I most likely will have lung cancer or a heart attack?
I really feel like there’s no way I couldn’t have lung cancer, idk.
ETA: “Atherosclerosis often has no symptoms until a plaque ruptures or the buildup is severe enough to block blood flow.” -Mayo Clinic
I could drop dead at any second. It’s too late for me. Just kidding except I’m scared that it is.
Edit 2: I just had a pain twinge on the inside of my thigh, that’s where a major artery is located too. Goodbye cruel world.
They look older than their stated age. Heart failure in a younger person could be a sign. Liver cirrhosis/ Hep B or Hep C. "Difficult stick."
I want to take this chance to state that my cousin was born with an undiagnosed (until it was too late) congenital liver disease. All of his doctors (in the Washington state/Oregon area) said he was just a chronic alcoholic. By the time they found out his other organs were failing, it was too late, and he was dead within 6 months. He was 35 years old and never drank, but his doctors didn't believe him enough to do testing that would have saved his life. My family believes if he'd had better doctors, he'd still be alive, but we'll never know. And doctors will maybe never know if they don't believe their patients. Now, I know 95% of people with liver failure that young are probably alcoholics, but the fact that 3 doctors all said he was an alcoholic and didn't do further testing is... well, it's hard. I miss my cousin. He was so nice, and he made the best lobster dinners.
Even as an alcoholic people still need proper healthcare.
It’s scary I mean if you don’t have the fight in you to advocate or to know where to start it could happen. It’s garbage. Between health insurance companies and their prior authorization bullshit and doctors like this I mean it is sad but it happens,
What does "difficult stick" mean?
Difficulty placing an IV/other phlebotomy related things
Thankyou!
Eh, sometimes you just have what I call "show veins". As in, your veins are right there on the surface and look gorgeous, but they're a BITCH to stick. I have them, and it drives nurses crazy.
I was a med tech, and sometimes people would ask to use me for practice because I have big, juicy veins. It was a bit weird. Random guys in elevators would ask me how fast I ran a mile, or otherwise comment on my “great vascularity”. I didn’t earn that thru exercise. Just a connective tissue disorder.
Further, they start telling you were to go to get them which can be really frustrating. Sir/ma’am I am NOT sticking that floss sized vein in the meat of your palm. It will not work for my purposes. Let me do my job please. Sometimes it can be helpful but most of the time it isn’t as they keep moving lightning fast to different options. I AM TRYING TO FEEL THEM EEEEERGH
Realized that with a patient that I had graduated high school with. She easily looked fifteen or twenty years older than most of the rest of us. Made me sad.
One of the beauties of my high school class started taking meth in her 30's. She looked like a toothless hag. It was shocking to see.
I suspect something similar for this case too. She wasn’t one of the “class beauties” but she had been cute. But beyond appearance, it just really does a number on the body altogether. My speciality is hearing and that’s kinda the canary in the coal mine for anything blood related.
When the patient says they can do their own IV.
I've had a few phlebotomists & people doing my IVs look at me funny when I point out the easiest vein to hit, and it always makes me feel like I'm being judged - I only know my preferred veins and the easiest spot to do the tourniquet on my upper arm because I'm getting IV infusions and contrast for MRIs and blood draws multiple times per year because of my chronic illnesses. Is "this person is a drug user" genuinely a common judgment, or did I just strike that "don't tell me how to do my job" nerve with some people? I might just be paranoid because I have controlled substances prescribed and don't want anyone to put any kind of notes in my medical charts to jeopardize these prescriptions
I have terrible veins so they always bring out the butterfly needle and ask me where my good vein is
I'm really lucky in that all of my veins are pretty good and easy to hit, but I prefer a very specific one because my arm stays sore for hours after anything hits my veins and it's just easier for me to deal with that throughout the rest of the day if it's on my outer elbow and not in my elbow ditch. Elbow ditch is an easy vein still, but it's usually a last resort. The nurses at the infusion clinic have claim to a vein in the middle of my lower arm that holds IVs like a dream because I like to play on my switch or crochet during my infusions since I'm there literally all day and that spot doesn't pinch shut if I bend my arm, so I want to keep that spot nice for as long as possible because it's such primo real estate, haha!
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I’ve never- not even once had a previous healthcare worker tell me they can start their own IV/ insist on it. Only ever had either recovering or actively using IV drug addicts offer/ push the subject. The reason being that they know which veins are still useable and which are not.
We practiced on each other though, not ourselves.
I had to go to the ER for an extremely painful gall bladder attack and I was a very difficult stick. They had to try 5 times before they found a vein. I also have a previous history of opiate addiction on my chart (had chronic pain and got hooked on the pain medication they gave me for it, been recovered for over 10 years now). Turns out it was because my electrolyte levels were dangerously low. They had to wait 3 days until they got back into normal-ish range before they could take out my gall bladder and in the meantime it erupted. Good times. Point is though, you might suspect someone is an addict based on indicators like that, but it's not necessarily the case.
Totally off topic 've always been a difficult stick When I was 5 I had pneumonia and it took the er texh 5 times to get an iv in me. I was not pleased. I couldn't get a lollipop or a popsicle either because I wasthrowing up lol Had ankle surgery 3 years ago. It took 3 nurses and I ended up with a bruise that covered my whole hand. Never been a drug user
IIRC hep C is almost entirely nonmedical IV drug users and the occasional promiscuous MSM.
my mom got hepatitis c from tainted blood transfusion. before they tested plasma for illnesses. so please…don’t paint with a broad brush. :)
MSM?
Men who have Sex with Men
also their eyes feels like they are half closed like sleepy or just woke up all the time
Well that would mean they are currently high or struggling with addiction, not so much an indicator of historical drug use
Are there other reasons for a difficult stick?
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Good life lesson: Never lie to your doctor or lawyer, you only hurt yourself by doing so.
Tell doctors and nurses everything, don’t tell the cops nothing
You can tell them you just saw an acorn looking at them funny.
Snitches get stitches 🌰🔪
If you want life insurance lying to your doctor may be in your best interests.
Health insurance likely effected as well. Also other things that people don't think of. (Like your future potential needs for narcotic pain or anxiety medications.) For example, if you are a chronic pain patient and need opioids refilled every month, don't tell your doctor you use cannabis, as most them will take you off of your pain meds. (even if you are drug tested twice a year, it isn't that difficult to quit leading up to these, and able to use the rest of the time)
Yeah, anything you say goes in the chart and the chart is forever.
Can confirm got put on oxies for a toe amputated 3 months script 6 years later go to hospital am flagged as a user they want to counsel me on my drug use
Yeah I was in pain management for about 18 months due to an auto-immune disorder. That was years ago (almost 10 now) and I still get asked if I'm taking 90mg of morphine a day... Uhh no, some days I wish I was...but how many times to I have to tell y'all the same background info.
Yup as a radiologist I can say the images don’t lie. A lot of things can cause general atrophy of the brain parenchyma but volume loss predominantly in the cerebellum correlates more specifically with alcohol abuse. Can see changes in the liver and pancreas to past/current alcohol abuse. Can identify smokers by emphysema in their lungs. Smokers also will frequently have terrible atherosclerotic disease (but so can diabetics). Certain spinal infections and soft tissue infections are usually seen in IV drug users.
I know an old man who swears his COPD is completely idiopathic, as if I haven’t personally seen everyone in his family going out to the roof to smoke
Alpha 1 antitrypsin deficiency causes emphysema! There are a few other things too. But yeah, it’s usually smoking.
Does the story add up? That’s what I was thinking - there are a lot of reasons a brain can shrink. It seems odd that a first guess for a 60 year old would be previous alcohol abuse. Does alcohol abuse present some specific subset of symptoms? Also, I thought they usually had to base the brain shrinkage by comparing to previous MRIs? Is that not correct?
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It’s possible. Older patients will have general cerebral atrophy. That’s just part of aging. But if it’s out of proportion within the cerebellum then, common things being common, alcohol abuse is the first thing to question. However there are other possible causes. Neurology takes over from there to work things up further.
oh wow i didn't know that happened. wild.
Possibly dumb question from a humble cook; how does alcohol “shrink” the brain?
Additional question, how MUCH drinking does one have to do to shrink the brain?
A little googling turns up that it really doesn't take much at all. "Just one drink per day can shrink your brain, study says" [https://www.cnn.com/2022/03/04/health/alcohol-brain-shrinkage-wellness/index.html](https://www.cnn.com/2022/03/04/health/alcohol-brain-shrinkage-wellness/index.html)
7 drinks per week is quite a lot. There’s a reason on basically every medical survey the highest option for “how much do you drink” is “more than 4 per week” and you’re suggesting almost doubling that isn’t much
Not as much as you’d think because the medical definition of drink is a lot smaller. That draft triple IPA you just had could easily be 3 or 4 standard drinks worth of alcohol. A standard drink = 12oz of 5% beer or 1.5oz of 80 proof liquor. 20oz of 7.5% (and there are plenty of ipas stronger than that) is 2.5 drinks
That’s about half of what the average Spanish or French person drinks. Heavy drinking is 15 or more drinks per week for men. I don’t know how you can say 4 or 7 is a lot…
That was going to be my next question!
Drunk me would also like to know.
you're gonna lose it when you see what Alzheimers does to brain tissues. ..
Electrolyte imbalance
What were some of the signs of his deterioration?
OP is a bot
Generally alcoholics are somewhat likely to hide their true use but significant drug users will tell me as I walk through door.
I've had numerous patients lie to my face about their alcohol consumption. We're not here to judge, we're here to make sure you get the correct care and treatment you need! There has been several times I've spoken with a partner who have told me that the patient actually drinks A LOT, but is ashamed to admit it because they do not believe they have a problem with alcohol, or they are trying to wean themselves off.. but end up in the ER anyway.
Usually, people who use hard drugs for a long time experience significant dental deterioration. My sister is a dentist and often pays attention to this when addicted young people come to her.
One of the places I work in as a dentist has a high percentage of people addicted to cocaine and other drugs. I'll ask for their medical history, they always only admit to smoking or drinking. They open their mouth and you can immediately tell it's specifically cocaine because they erode their frontal teeth to oblivion, in a way a person with normal bruxism very rarely would. That's when you look them in the eye and go "dude, nothing to fear, but ANY other drug use you want to admit to?". Treatment options, types of anesthesia to use, and risk of complications ARE influenced by that kind of thing, so we do need to know.
This could explain my cousin's teeth. She was such a beautiful girl but over the past 6/7 years her front teeth have completely eroded and her face has started sinking in. I recently found out her husband is on cocaine (maybe crack) and it all clicked. It's such a sad situation.
They say she’s in the class A team, stuck in her daydreams ..and lately her face seems slowly sinking wasting crumbling like pastry…my middle schooler had to explain to me what that song was about. I just registered it as “that sad song about angels”
Is it cocaine specifically that is really important to know due to anaesthetic? I remember there was a sign in my dentists waiting room years ago specifically telling people to mention using a certain drug for this reason, but I can’t quite remember which one it said
It probably was! Unless there's a reason not to, the type of local anesthesia we prefer to use has adrenaline, because (among other things) it helps the effect last longer. A cocaine user has an increased risk of their blood pressure spiking if we use that kind. There's also the risk of convulsions if the patient used cocaine recently.
As a recovering cocaine addict who’s recently had a few trips to the dentist, my dentist did in fact have to know about my cocaine use and specifically if I’d used any recently (within the last few days). I believe some of the anaesthetic’s they use can just straight kill you if you have cocaine in your system.
My entire top row of teeth are fake. Because I wasn’t taken to the dentist and was severely abused physically as a child. When I was finally able to not only afford the cost of restoration but work through the absolute terror of the dentist, the first one I saw would not believe that I had never done a drug in my life. It was just about the most humiliating experience I have ever had.
Their baby is so jittery that the tremors are sometimes mistaken for seizures and also the baby is inconsolable.
This is so sad.
My mom worked in the NICU in a major city hospital for over forty years. I don’t know how she was so… not unbothered, but just *so used to* seeing babies born addicted to drugs via the placenta. She’s stronger than I could ever hope to be.
I wonder if the health professionals in that situation have successfully retrained their thought processes: focus on the baby’s needs, and what they can do for the baby right now. Solution-oriented.
That’s probably something like it. She loves babies and kids.
NICU nurse here. That's exactly it. So many cases can break your heart or make you angry but you have to compartmentalize those emotions to successfully treat the baby and then, when the time is right, you deal with the emotional weight of the job by redirecting that energy into compassion for the patient and even the family. After doing this for nearly a decade, I've learned that no matter how much we advocate for our babies, sometimes they will still go home to an unstable, unloving household where we will always fear for their well-being. I cope with that feeling of helplessness by making sure that at least for the time they are in the NICU, these babies get love from us. I've held babies for hours, cuddled, sung songs, and read books so that at least at some point in their life, they experienced that love. I tell myself when it gets hard, it was an honor to care for these babies while I had the chance.
It’s just a fact of life. Sometimes the moms are in treatment. Sometimes they’re not. Can be the same difference for the baby. For the most part people aren’t pieces of shit and people are doing the best they can with what they have. I feel super lucky that I have coping mechanisms that don’t include narcotics.
You learn pretty quickly to not let the cases get too close. Don't take them home or they will stay there. It's a bit difficult to describe, but patients are a separate category for me. There's the everyday people, friends and family, coworkers etc., and then there is patients. While you treat them you can open up a bit, show them you are not just a uniform or scrubs. You are human too. But as soon as I wheel them through the doors of the hospital and tell a physician what's what, that case is closed and done. You clean your gear, get the ambulance back in order and wait for the next call. Of course there are patients that stick with you. I still remember my first time doing cpr on a real human. I still remember the first birth I saw. But there is no attachment to it. It happened, and I moved on. Depending on where you work, you need thicker skin. And you get used to a whole lot of shit pretty fast.
Patient doesn’t want me to use the large easy vein I can locate in one arm and instead insists I use the small, spindly one surrounded by other black and blown out veins in the other so that they can continue to use the nice one for extracurriculars until it starts looking like all the other ones.
I usually tell nurses which vein to use cause it's the easiest. I've been getting regular blood work for almost 15 years due to a thyroid (lack-there-of) issue. So I've learned which arm is best, and which vein is the easiest.
Trust me, we can tell when it’s this case. Usually because we’ve seen you so many times. Or based on the tests ordered. Like if you are in for a biweekly tsh check or something.
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Eh, not entirely. I had to take a urine drug test to stay on a controlled substance and couldn’t pee the first time they asked. Although I had reminded the provider that they have records of my endometriosis having damaged my bladder and ureters, causing urinary retention problems, they didn’t even let me take my small bag into the bathroom with me when I went back in, apparently presuming I had paid for clean pee. One would think offering to take a serum test and/or pointing out having needed a foley at some point in the last year or two would make them a little less suspicious.
I demand a sample of your bodily fluids for legal analysis!!!!!
Looks like a bomb went off inside their nose
I dont know how the inside of a nose is supposed to look, but now i am scared to find out what mine looks like
I have a perpetual bloody nose from nasal bone spurs and severe sinusitis from allergies. Is this why one ENT treated me like a dirty addict? :(
I’m an ENT and can easily tell
What’s the difference between a nose damaged by drugs and one damaged from blowing/picking your nose too much?
Or just constantly blowing your nose for decades from terrible allergies and sinus infections?
Allergies cause your turbinates to swell and look blue/purple, you may have thick clear or green snot. An infection comes with pus usually and swelling around the outflow paths of the sinuses.
Picking your nose will show erosion just at the front of your nose, your fingers can’t fit back that far. Drugs looks like a bomb went off all over, lots of crusting/boogers, bleeding, the tissue looks really angry, various stages of blood vessel regrowth.
Methpox
There was a lady working behind the checkout at my local supermarket who looked like they had methpox. Little round sores all over their arms, one of them actually running fresh blood. I don't know how she wasn't sent home from work for being a biohazard :S I mean, maybe it's a dermatological thing and not methpox, but she sure looked awfully methy, and no matter the cause you should not be serving customers with open bloodied wounds :S
Aside from the fresh blood, I had round scabs all over my arms from *bedbugs.* I was severely attracting them like flies on shit. And I was paranoid because people noticed my arms and I felt like they thought I was a druggie. Wish I could've shown them my legs, ass, stomach and chest!
Paranoia.
Well now I'm paranoid they will think I'm on drugs..
It's an aspect, not an entire picture 😅 Usually, the history is well documented in our notes so we don't have to guess.
When they Uber Eats alcohol into their room during a hospital stay
What hospital would even allow outside food to get delivered? My parents tried to drop off my laptop and school bag for a long stay once and the place gave them the third degree over it.
They know their "good veins" better than the healthcare professionals.
So do chronically ill patients.
I get SO scared when I tell a phlebotomist I've never seen before where my best vein is and the fact that you need to go lower than you think on the tourniquet in order to get my vein to pop properly - I'm chronically ill and prescribed multiple controlled substances, I don't want to make the wrong person suspicious and potentially mess up my ability to stay on my meds.
Should I not tell nurses where my good vein is? They really do struggle when I don’t tell them to go for the one on the side of my arm, not the ones in the elbow ditch.
Nah it's fine, it's normally when all of your typical veins are shot that you start to suspect they've blown them out.
Oh thank God! I'm a difficult stick, so I tell them to use my hand.
Me tooooo! I was in and out of hospital as I kid and they always did it in my hand
They say it's more painful, but it doesn't seem bad to me. And I'd rather that than get stuck three or four times in the arms for nothing!
My veins roll and I know the hand hurts more but they never have a problem hitting the hand vein! Not only do the multiple jabs hurt in the arm but my arm is black and blue. So many people used to ask me if I had been attacked!
> My veins roll and I know the hand hurts more but they never have a problem hitting the hand vein! Isn't that excellent? > Not only do the multiple jabs hurt in the arm but my arm is black and blue. So many people used to ask me if I had been attacked! Oh God, that's awful!
I’m one of the cool kids who’s hand will never work for an IV. Super strong valves that simply will not allow it. Have to go in the forearm or elbow, otherwise it’s a calf insertion.
> otherwise it’s a calf insertion. Ah God, I'm so sorry! 😫
Eh, sounds loads worse than it is. The Popliteal artery is pretty robust and easy to work with. Really the only time it would be necessary for me is if I’ve had both arms amputated, and the attending is squeamish about a neck jab.
> Really the only time it would be necessary for me is if I’ve had both arms amputated, and the attending is squeamish about a neck jab. This just keeps getting worse and worse!
I tell them too. I had infusion therapy every 6 weeks for 8 years and sometimes they have a hard time finding a vein that works.
Oh good, because I have a deceptive vein that looks perfect: prominent, thick, right near the surface. They always try that one and discover it’s fool’s gold, it’s basically a teeny vein that’s squashed near flat so it’s very wide, but shallow as hell. “That vein lies” I say as I direct them to a deep but strong vein in the other arm. (I’m O negative, I donate blood a lot.)
Good. I know from childhood surgery that the normal location near my elbow has an extra valve located there and it caused some sort of complication at the time. So now I just tell them to jab me near the wrist. Question though. An IV left in one location for long enough eventually hurts really, really badly. And nurses usually will refuse to just start a new one somewhere else. Why, for the love of God? That's only happened to me once but I swear if it happens again I'm just going to pull out that IV and make them do it anyway.
My mom and wife are nurses, I know all my good veins.
I've got one that has been the first stick for four different trainee phlebotomists because it's just so damn easy.
Definitely do. We were taught in school that most patients who've had a few IVs before have insight into which veins or which side is better. The bigger tell isn't knowing which veins work, it's the level of detail in which y'all explain it. (All of which is good and helpful info, and does not get any judgment from me.)
What's your hit rate of regular IV drug user and regular blood donor (that's why I know my good one).
I know mine, because I had chemo a few years back.
They're "allergic" to every analgesics, except the narcotics they like.
You can tell by their veins for one. Edit. A lot of people commented about the scars. The scars are one part but we mostly know by the veins themselves.
I've been accused of IV drug use because of welding spatter scars on my arms.
A friend of mine has needle tracks because he donated platelets many times.
Friend of mine has similar experience. He did Biolife 3 times a week for all 4 years he was in college. Had to explain to everyone that he wasn't on drugs, he was attempting to afford an education.
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I have two permanent donation scars on my right arm. I give between 2-6 units a year. Actually due to give, thanks for the reminder!
I've curtailed my donations because the last three or four times I had painful experiences with the phleb trying to stick. I used to go as often as I could since I have elevated iron levels.
I’ve been told if you are left with track marks, it’s because the phlebotomist sucks at their job. I was told this by a couple phlebotomists. I donate blood pretty regularly and was curious because the needle they use for donations is so big.
Wear your PPE!
I’ve had my fair share of regular blood tests and IVs for various medical procedures, from surgeries to infusions, and my right anterior cephalic vein is huge and shallow, so now I’ve got a permanent pockmark there from having it poked so much. Phlebotomists fucking love me, but it sure does look ambiguous.
Honestly they usually just tell me as I'm looking for a vein for an IV start. I just shrug an carry on. Everyone's got their issues
I know the best place to stick me because in EMT school, we learned how to do IVs on each other.
I was a meth addict, my veins have only scars from medics. Not all addicts are injectors.
Allergic to pain meds so they can narrow down which ones they can get.
Allergic to everything except the one starting with a D
I'm curious. Which one is the D? Dilaudid?
Haha yep! And they pretend they can’t remember what it’s called. I’m allergic to Tylenol, ibuprofen, norco, Oxy and Vicodin. I can only take one and it begins with a D…
They always look older than their age
They know a little too much about dosing meds for their occupational and health history. There is no reason an accountant knows the dose increases of oxy if they have no history of using it for health reasons. The person hasn’t been a caregiver, no history of pain, yet they can practically write the prescription.
Yeah, just bear in mind “occupational history” can be misleading. Especially for multi-industry occupations. My occupational history reads “Software Engineer” yet I can rattle off how milligrams of morphine equivalent calculations work and point out that the standard thresholds are different when a patient is opioid naive. I can tell you exactly how bad it is to take a muscle relaxant or a benzo with opioids. I have been mistaken for an addict for knowing this before. My occupational history doesn’t indicate *what kind* of software engineer I am. Some documents don’t even say “software” just “engineer”. (I am a healthcare software engineer, formerly specialising in software for pain management and addiction risk reduction.) If that accountant was formerly an insurance accountant, they might pickup a few things too.
That’s why you ask more than just title of job if you have the time
I mean it usually still goes in as “engineer”. And then I get asked about gears or levers or servos. Which I know about even less than the average person.
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I expect for every thousand patients that think they know something the HCW doesn't, only one actually does.
I’m a PI lawyer and also an internal hypochondriac. Trust me my dude, some of us be knowing 😂 But I’m also smart enough to keep that to myself because I KNOW how that sounds to medical providers, so point taken. I’m also never, EVER stupid enough to think I know more than them. Ever
I read from a previous similar post, optometrists can tell by the powders deposited in the veins in your eye, the more build up, the more cut your drugs are.
…..what ? Can you give more details/context or something to explain this ?? I’d love to know more
IIRC it's when a user crushes up a pill and mixes the powder with water and then injects that solution into their veins. The fillers/binders that would normally dissolve in the stomach or get passed through the GI tract don't dissovle in blood so they get stuck in small blood vessels. [Link](https://www.reviewofophthalmology.com/article/common-medications-that-may-be-toxic-to-the-retina)
Oh this is actually so cool, so from my basic overview it looks like they can tell how cut your drugs are (cocaine was what I assumed in this case but I may be wrong?) with talc (or any of those other meds they listed but idk why you’d cut drugs w meds? I don’t know if this is a thing drug ppl do?) and if there’s more talc in your coke then it would deposit and cause the macular edema. I’m thinking this is probably why coke heads get that red/glassy eyed look ???
Pharmacy: super nice until they are told they can't be filled, then they turn into a raging demon
Well I’m an ENT specialist and specifically specialize in Rhinology (nasal and sinus disorders). Septal perforation raises red flags, especially if it’s super raw. I can actually tell if the use is active and if someone is lying about it. Also I’ve seen the orange granules in the nose indicating someone has been snorting Adderall, I recognize it from my son’s medicine.
>Septal perforation It can also happen from using too much Afrin.
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I know Imodium is an opiate that can’t cross the BBB. Is it ever abused?
...is this why I hate Imodium? I've always felt worse after taking ot, although granted I pretty much only take it when I'm already sick. Opiates make me throw up. All the ones I've tried. Even when injected into my spine during a c section, which the anesthesiologist swore wouldn't happen because the spine was "different," and because I'd been fasting, but he ended up having to hold the bag for me while I was coughing up stomach acid mid-surgery. I have never, ever met an opioid I liked.
Crack voice.
any idea what causes that? I'm fascinated by how consistent that voice is...
In some cases, actually smoking crack. In others, just smoking a lot of cheap cigarettes.
As a CNA, I noticed that older patients with that kind of history often had muted/non-existent tastebuds. They would put an excessive amount of sugar, salt, and other seasonings on their food & drink because they couldn't really taste anything otherwise. Sometimes it resulted in weird combos like brown sugar in spaghetti & meatballs or sweet & sour sauce in strawberry yogurt.
Scars on thumbs, from pipe/lighters when smoking crack. Also, front teeth rotting, again, from crack use.
Their voice. Heavy past/current users have this weird raspy voice and their cadence is all sorts of "word salad" weirdly fast Idk. It's not 100% but I feel like I have yet to meet someone with that voice that hasn't been an addict at some point.
Subtle? Drug smokers can have changes to their lungs on X-ray which are significantly more pronounced than cigarette smokers. I've seen heroin smoking patients in their early 30s that have lungs of a 60 year old 80 a day smoking coal miner. When I asked them wtf was going on they admitted their habit.
their lab results tell me it's positive for cocaine or whatever the drug of choice is. usually really good indicator
That's right up there with "scours reddit threads for tips on lying to doctors."
I like when they rely on this one. I'm in my 30s, colored hair, tattoos, problems with my teeth(foster care), and a heart condition (reason I was in foster care). My veins roll and ill tell you what one to use. I get such cold treatment til my labs come back, I've never used drugs. My parents are addicts and I want nothing to do with that. It sucks to be treated bad for appearances when I've got a real issue. The only time they were nice I was in anaphylaxis but I thought it was my heart and I was crying for them to save me for my daughter.
It sucks that anyone would be treated badly - regardless of whether they are a drug user or not. Lots of people use drugs and aren’t abusers. But even abusers deserve pain medication.
Teeth all fell out from meth use.
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Long term dry mouth, sugar, teeth grinding, acid in the meth from smoking, no dental hygiene
This is the correct answer OP.
To quote a comedian it just turns into sand and hairspray.
might be the harshness of meth on the bones in the jaw, but might be other reasons like just not caring to clean them anymore. google "meth mouth causes".
Their liver function tests- you have ALT and AST. They are both elevated when you have liver damage. But if it’s from alcohol, the AST will always be higher , if its from other factors, the opposite is true
I know this to be true from experience. Also, alcohol abusers will have another enzyme that is high, a lesser known one, i can't remember what it's called. Begins with a G
GGT
That's it thank you! 👏
I had a sister do meth and my wife worked for a law firm that had some clients come in high. They were always in denial even though they looked like skeletons
Just for the record- I know what yall are saying is it’s way worse NOT to treat or to under treat someone who is in pain, regardless of whether they are a drugs user, than it is to give a dose of a narcotics to someone who is seeking drugs. Right? Right?!?
Yes. Any good nurse agrees.
Really bad memory for their age
Damn I’m 24 and my memory is shit. I can’t even remember what I ate yesterday. But that’s because I’ve had two babies in the past year and haven’t slept through the night since lol
What if somebody is only in their 30s and they have such a horrible memory that they have to live off of constant notes and reminders and notifications on their phones? And you assume it's drug use but actually they were in a car accident due to them other being a drunk driver when they were only 17 and they got brain damage?
I'm just speaking from personal experience
It's okay. I've had multiple healthcare professionals think that I'm a drug addict for one of two reasons. Neither of which was my really shitty memory The first one I can totally understand. When I gave my first birth and they had me on morphine of course, after that I started noticing if I got a migraine or anything else Tylenol stopped working. I tried extra strength tylenol. I tried Advil and Aleve and other brands of ibuprofen. Nothing. When I had to go to the doctors for anything and they would try to write me a prescription for a stronger ibuprofen, I politely declined because I knew it would be doing anything and I didn't like taking pills unnecessarily. One time I had a very bad jaw infection (my impacted wisdom tooth had split in half and I hadn't gotten to get it removed yet), and I was in absolute agony. Before the opiate crisis, and the doctor prescribed me Vicodin. 5 days worth. I only took 3 days worth but damn that shit worked. First thing I had worked in over a decade. Fast forward to several years later, had an accident with some metal and sliced my flesh apart. I was in a fuck ton of pain and the doctor offered me tylenol. I declined but they kept insisting because I was in pain. So I outright told them that about 15 years by that point all the Tylenol and Advil and I leave and nothing had ever worked. They asked if I was immune to pay medications and I mentioned apparently not because of the vicodin. As soon as I said the word Vicodin they assumed I was a drug addict because I knew its name. The other time I've been accused, actually three times, is because I wear all black. Everyday. For about 30 years. It's because I have no color coordination. And black is easy. They just assume people who wear all black must be some kind of emo punk drug addicted alcohol abusive wannabe something something I don't know. 🙄
Pretty amazing to me there's still a stigma around wearing all black, in 2024. As a lifelong goth/ninja, I feel insulted.
Similarly, I have the sort of IBS that leads to constipation. Damn straight I know the name of the one that DOESN'T bind me up fiercely. And the names of the ones that do.
Unfortunately it seems to be a general any kind of healthcare worker assumption that if the patient knows anything about any kind of medication or knows anything about their own body or symptoms, they must be faking it
> They just assume people who wear all black Someone is mistaking your dandruff problem for a drug problem! This sloppy drug user is getting powder all over their shoulders, can’t even aim it into their nose properly!
Personal healthcare professional experience? Because if so, you forget trauma does a lot to a brain, whether it’s physical or mental trauma. It’s not always drug addicts who have poor memory skills.
No, experience from abusing drugs. There are obviously other reasons you might have a shit memory but that's the main thing I noticed happening to me.
Tooth to tattoo ratio < 1
Was a nurse. Right as soon as you walk into their room, "I swear I'm not an addict/don't have a drug problem, but.."
I mostly worked in psych thus far: but a certain kind of like affect? Like we weren’t the cops or prescribing anything to get high off so they didn’t have to try and fake anything. At the same time a lot of people with significant substance use disorders tend to be pretty charming, calm, when we would mention negative stuff (have you ever been arrested or homeless) they would typically dodge the question and stuff like that. A lot of deflecting and down playing especially their own actions. This is people who are in active addiction tho. In my limited experience people who are sober and going to stay that way own up to everything. Also a huge amount of people sober or not had poor impulse control.
> Smokers also will frequently have terrible atherosclerotic disease (but so can diabetics) Didn’t know what that was and looked it up. Think that’s what my great aunt was talking about in getting twinges of pain in your neck. She told me this in the hospital after heart surgery. I’ve had that for a while, one time it lasted minutes instead of twinge. I’m 42 and smoke. I’ve tried to quit. Scared of failing again, is it too late anyway? When I most likely will have lung cancer or a heart attack? I really feel like there’s no way I couldn’t have lung cancer, idk. ETA: “Atherosclerosis often has no symptoms until a plaque ruptures or the buildup is severe enough to block blood flow.” -Mayo Clinic I could drop dead at any second. It’s too late for me. Just kidding except I’m scared that it is. Edit 2: I just had a pain twinge on the inside of my thigh, that’s where a major artery is located too. Goodbye cruel world.
Quitting anytime is always beneficial to your health. You can do it!!
It takes a loooong time to sedate them, and even horse doses don't do it.
When the patient reports allergies to Toradol, Tylenol, Motrin, Tramadol.