Trendy Drugs of Abuse

shutterstock_10131886Healthcare professionals across the country are seeing a new and alarming trend in drug abuse.  As doctors and parents, it is important that we are aware of these substances and understand how patients who use them may present.

1)   Dextromethorphan (“Robotripping”):  Street names are DXM, CCC, High C and skittles.  These are most commonly seen in boys between 10-14 years of age.  Dextromethorphan is commonly found in cough syrups such as Robitussin and is ingested at about 25 times the therapeutic dose. It causes a dissociative anesthesia similar to PCP.  They are often other ingredients in these common cold medications such as Tylenol and chlorpheniramine that can cause harmful effects on the body including permanent liver damage.  The effects of the dextromethorphan can include decreased alertness and transient hallucinations and risk for trauma due to the dissociative effects.

2)   Bath Salts (MDPV):  These are not actual bath salts, but designer hallucinogenic amphetamines or a newer version of “ecstasy” (MDMA).  Common names on the market now include “M-shine” and “hooka cleaner.”   The core substance is cathinone (from the khat plant).  Patients often present with increased reflexes, teeth grinding (bruxism) and involuntary muscle contractions (clonus).  They can have an increased heart rate and may have seizures and can exhibit psychotic behavior or paranoia (that may last for days).  Other worrisome problems associated with bath salt use include running a very high fever, forming abnormal blood clots in the legs or lungs, and liver failure.

3)   Jimson weed (Thorn Apple):  Commonly found growing in back yards, each plant contains seed pods with numerous seeds. Each seed contains a varying amount of the drugs atropine, scopolamine and hyoscyamine.  Eating seeds from one plant may produce a “mild trip” while ingesting seeds from another plant may contain 10-50x the amount of these drugs and produce skin redness, dilated pupils, delirium, urinary retention, decreased gastrointestinal motility and rapid heart rate.

4)   Psilocybin mushrooms:  The spores of the parent plant are harvested and are often distributed by gluing the spores to paper and then sold as “art.” The spores themselves do not contain the hallucinogen.  These are typically sold with a 10-mm syringe and a broth solution. Psilocybin mushroom spores are legal to possess in every state in the United States, except California, Georgia, and Idaho. This is because it is psilocybin and psilocin (the active chemicals in psychedelic mushrooms) which are specifically listed in Schedule I, not the mushrooms themselves.

5)   New marijuana drugs (THC homologues):  Street names include “spice” and “K2”.  Often sold in combination with herbs for smoking.  These are unregulated herbal substances which are often mixed with alcohol or acetone and sprayed on a plant which is then dried and sold.  A single joint contains much higher doses of THC (300mg) than traditional THC.  Clinical effects may include red eyes, rapid heart rate, dry mouth, and perceptual changes.  Agitation, hallucinations and displaying behavior that may lead to trauma.  Synthetic marijuana can also cause seizures, or acute psychotic episodes that can lead to suicidal thoughts.  Other problems such as chest pain, psychological dissociation and panic attacks may occur.  Sometimes the synthetic marijuana that has been sprayed on plants is also combined with formaldehyde (solvent containing PCP) that causes the user to present as acutely psychotic and violent.  Most urine drug screens unfortunately do not detect these substances.

6)   “Pharming, bowling or fruit parties”:  This is a practice where teenagers get together and bring samples of medication that they get from their home (most commonly from their parents’ medicine cabinet).  All samples are placed in a bowl and pills are ingested randomly.  Overdoses on medications for diabetes, high blood pressure and heart problems are common in addition to possible respiratory depression and even death from narcotics, or benzodiazepines or the mixture of multiple substances.

7)   Soma Coma:  Also called “Trinity” if mixed with other drugs.  Soma (carisoprodol) is a non-scheduled drug that is marketed as a muscle relaxer.  It is very similar to a benzodiazepine such as Valium and heavily abused.  It is a heroin substitute when combined with other drugs and its effects are very unpredictable and may predispose the individual to injuries from falls or other trauma.  Many of these users have a history of heroin abuse.

8)   Salvia divinorum:  This is a mint plant common in Mexico.  It is dried and concentrated before being sold, often in online tobacco shops. The salvinorin A contained in the plant is a psychoactive chemical.  It is usually ingested by smoking in a water bong.  Produces a trance-like high for 5-10 minutes.

9)   Alprazolam:  Abuse is on the rise as this medication is commonly used as a “downer” after cocaine use.  Because of its characteristic shape, street names including “candy bars,” “coffins,” or “french fries” may be used.  Pills are swallowed, crushed and snorted.

10)  Cocaine:  Because of the expense, not much cocaine sold on the street is pure. In fact up to 30-40% of some samples contain a common medication used to treat worms in veterinary animals. Highest use among those 18-25 years of age.  Patients who use cocaine may present to a hospital or clinic having a high fever and have low blood cells or platelets, and have red spots on their nose or ears. Cocaine also increases the stickiness of platelets and therefore increases risk of heart attack or stroke. Look for blisters on the thumb and index finger of the dominant hand and scabs or burns around the lips.

11)  Methamphetamines:  After marijuana, it is the most widely abused drug worldwide.  Approximately 5% of the US population has used methamphetamine, with an estimated 500,000 people using the drug in a given month.  It may be synthesized via simple reactions using readily available chemicals and over-the-counter cold medicines, such as Sudafed.   May be ingested orally, rectally, vaginally, be injected, inhaled, or sniffed.  The effects are stronger and last longer than cocaine.  In fact, the prolonged duration of action of methamphetamine (approximately 20 hours) helps differentiate it from cocaine (duration of action 30 minutes) and PCP (duration of action less than 8 hours).  It causes rapid physical deterioration, weight loss, and poor dentition (“meth mouth”).  Life-threatening intoxication is characterized by high blood pressure with rapid heart rate and severely agitated delirium, fever, metabolic acidosis and seizures.  Medical providers should consider diagnosis of methamphetamine intoxication in any sweaty patient with high blood pressure, rapid heart rate, severe agitation and psychosis.  Acutely intoxicated patients may become extremely agitated and pose a danger to themselves, other patients, and medical staff.  Symptoms of methamphetamine withdrawal may develop within hours and typically peak within 1-2 days, and most often decrease within 2 weeks.  During the acute withdrawal period (“the crash”), signs and symptoms may include restlessness, the inability to experience pleasure, fatigue, increased sleep, vivid dreams, insomnia, agitation, anxiety, drug craving and increased appetite.  The prolonged withdrawal phase can last for up to 3 weeks and can include insomnia or even increased sleep, appetite changes, depression and possible suicidal thoughts.

12)  Inhalants (poppers, snappers, rush):  The use of these substances usually decreases as the individual grows older.  Can cause a rapid high, drowsiness, lightheadedness, agitation as well as belligerence, impaired judgment, balance problems, and addiction.   These inhalants may include halogenated hydrocarbons (butane), VCR head cleaner, whipped cream (contains nitrous oxide), colored spray paint (gold color is most popular), amyl and butyl nitrates (poppers, snappers, rush).  “Sudden sniffing death syndrome” is a worrisome problem.

13)  Opiates:  These are also commonly called narcotics (heroin, Demerol, morphine, codeine, fentanyl, oxycodone, hydrocodone, and methadone).  Patients who overdose are often sleepy and have a decreased respiratory rate, decreased gastrointestinal motility, urinary retention and pinpoint pupils.  As a medical provider it’s important to strip an overdosed patient and look for fentanyl patches on the body, but be careful of possible uncapped needles or syringes in the pockets.

There are an increasing number of patients being diagnosed with hepatitis C linked to heroin and other opioid use and that rate is expected to continue increasing.

Street Price:  Vicodin (hydrocodone/Tylenol) is a prescription medication with a street value of $5/pill depending on the geographic location where it’s purchased.  Percocet (oxycodone/Tylenol) or OxyContin sells for about 50 cents to $1/mg but again this varies depending on geographic location and how much is purchased. Buprenorphine/naloxone (Suboxone) which is often prescribed to patients who have a narcotic addiction sells for $5-$20/pill on the street.

Patients presenting to the medical clinic may present in the state of overdose, drug-seeking or withdrawal.  Treatment of overdose may include the use of naloxone.  Narcotic withdrawal symptoms may occur on the first or second day of being without the drug.  Patients may present with goose bumps (where the saying “quitting cold turkey” came from), patients on the third day may be on the floor flapping about with muscle cramps or kicks (i.e. “kicking the habit”).  Other symptoms include anxiety, insomnia, yawning, tearing, sweating, runny nose, all over muscle aches, nausea, vomiting, diarrhea, hot and cold flushes, muscle twitches, abdominal cramps.  Onset of symptoms usually occur within 8 hours of last use with a peak in 2-3 days.  Treatment of withdrawal symptoms may include clonidine, ibuprofen, Benadryl, Phenergan, or Imodium.

It is important for medical providers, parents, law enforcement and teachers to be educated about drugs of abuse that our patients are using and be able to recognize the symptoms of intoxication, drug-seeking or withdrawal and treat our patients appropriately.  The first step in helping protect our patients is learning about some of the drugs of abuse, and signs and symptoms of abuse.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO




Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States, Clin Toxicol (Phila), 2011 Jul; 49(6):499-505

Severe toxicity following synthetic cannabinoid ingestion. Clin Toxicol (Phila), 2011 Oct;49(8):760-4

White, Suzanne R  (2011, November) Current Trends in Drug Abuse, Lecture Detroit Trauma Symposium, Detroit, MI.

Kloss, Brian T (2011, June) Drugs of Abuse Seen in the ED, Lecture – Impact 2011 AAPA Annual Conference


What to do about Anxiety

shutterstock_86293354Today a patient came in because she’s been feeling anxious because she’s had some heart palpitations.  She’s seen a cardiologist (heart specialist) and learned that the abnormal heart rhythm is intermittent atrial fibrillation (a usually non-dangerous rhythm) that has likely been brought on by the increased stress and lack of sleep lately.  When she gets the heart palpitations, she becomes more anxious, and the more anxiety that she experiences,  the more heart palpitations she has.  To her, it feels like an endless cycle that will never end.

This patient’s anxiety is understandable.  We all experience stressful or potentially anxiety provoking details that occur in our lives.  How we deal with these thoughts and events is critically important because it often determines how we function from day to day.

Feeling anxious can be a normal response to a stressful situation.  The adrenaline rush after we learn that a bear is in our campsite might help us escape the dangerous situation.  Feeling anxious for most of the day for long periods of time however is not normal.

Symptoms:  Excessive worry or feelings of dread or being “on edge” may contribute to daily fatigue, and muscle tension.  Other common symptoms may include headaches, hives, heart burn, constipation, diarrhea, abdominal pain, chest tightness, difficulty sleeping, memory problems and an increase or decrease in appetite.  Sometimes a patient might have depression along with anxiety.

Often patients come in to talk with me about treatment for their anxiety with medications.  I understand that feeling anxious is not particularly desirable, however in many circumstances, it’s normal.  Treating the anxiety is often most effective by addressing the anxiety provoking situation rather than masking the symptoms with medication.  Once the medications wear off, the anxiety returns and the cycle repeats itself.

I think it’s important to distinguish the difference between anxiety and an anxiety disorder.  People who have “normal” anxiety may have worries from time to time, but these feelings do not interfere with daily life.  An example might be a parent worried about their child who is late coming home from a date.  I’m sure you can think of many other examples.  People with an anxiety disorder are often worried or anxious about a number of events or activities and these worries are out of proportion to the situation.  A parent might worry excessively about their child’s safety even when the child is at home with the family.  An anxiety disorder can make routine activities difficult to complete.  There are certain criteria that need to be met in order to make a diagnosis of an anxiety disorder and it’s my opinion that only a qualified health mental professional with training in anxiety disorders such a psychologist should make this diagnosis.

Treatment:  Usually we tailor the treatment to the individual patient and what is causing the anxiety.  If the anxiety is caused by a certain life event, then learning how to address the feelings and concerns related to the event is often the most helpful way to decrease the anxiety.  Individuals who suffer from an anxiety disorder often require more treatment than those who have anxiety from stressful life events.  Some possible treatments for anxiety might include:

1)   Cognitive Behavioral Therapy (CBT): CBT focuses on the person’s behavior and patterns of thinking.  The therapist helps teach you how your thoughts contribute to your anxiety and how to decrease these negative or unpleasant thoughts when they occur.

2)   Eye Movement desensitization and reprocessing (EMDR): A particularly effective technique being used by psychologists who have had specialized training.  One of the procedural elements is “dual stimulation” using either bilateral eye movements, tones or taps. During the reprocessing phases the patient attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.

3)   Medications: If medication is used to treat anxiety, you will need to see a primary care provider or psychiatrist.  If a patient has an anxiety disorder however, my opinion is that the patient should also be treated by a mental health provider such as a psychologist and/or psychiatrist.  Medications used to treat anxiety may include:

  1. Antidepressant medications such as SSRI or SNRI.  Examples of these medications include Fluoxetine, Citalopram, Paroxetine, Fluvoxamine, Sertraline, Escitalopram, Venlafaxine, Duloxetine, Desvenlafaxine, and Milnacipran.
  2. Buspirone is an antianxiety medication used to treat anxiety disorders
  3. Herbal medications such as kava kava and valerian have been used.  Kava Kava however has been linked to liver failure and is not recommended.  There is not enough evidence to show whether herbal medications are effective or safe for treating anxiety disorders.  Make sure to tell your medical provider if you are taking herbal medications
  4. Benzodiazepines such as Alprazolam, Chlordiazepoxide, Clonazepam, Clorazepate, Diazepam, Flurazepam, Halazepam, Lorazepam, Oxazepam or Prazepam are sometimes prescribed for short-term use only.  Because of the addictive nature of these medications, and because of safety concerns, I generally do not prescribe these medications frequently

If you or someone you know is suffering from an anxiety disorder (in contrast to experiencing anxiety as part of a life event), I strongly recommend that you seek help from a qualified mental health professional. Sometimes it can be challenging to know whether the anxiety you experience is the result of a “life event” or an actual disorder.  Most primary care providers can help you determine this or refer you to a mental health professional if further diagnosis is needed.

To find a Psychologist in your area, you may use the American Psychological Association Psychologist Locator website:

Helpful links for additional reliable anxiety related mental health information:

National Library of Medicine (

National Institute of Mental Health (

National Mental Health Association (

Anxiety Disorders Association of America (

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Finger/Hand Pain – Is it Carpal Tunnel Syndrome?

shutterstock_86604217Many patients come to the Urgent or their primary care office with complaints of hand/wrist pain, numbness, tingling or a combination of these symptoms.  They often wonder if it could be due to carpal tunnel syndrome.

Carpal Tunnel Syndrome:  characterized by pain and numbness in the fingers and hands, and sometimes in the arms.  It happens when the median nerve in the wrist becomes pinched or squeezed.  The median nerve travels through a small “tunnel” in the wrist that is formed by bones and a ligament.  It’s a setup for this nerve to become pinched due to our normal anatomy, but may be worse in some people or due to certain conditions.  There is some thought that the nerve gets pinched possibly due to one or more of the following:

1)   Tissues that surround the surrounding tends in the tunnel harden

2)   Tendons that go through the tunnel get swollen

3)   People hold their hands in a position that causes the tunnel to get smaller.

Parts of the hand affected by the median nerve:

1)   Thumb

2)   Index finger

3)   Middle finger

4)   Half of the ring finger

5)   The parts of the palm closest to the thumb

Symptoms:  Pain, and tingling in the thumb, index, middle and ring fingers.  These symptoms may be present in one or both hands.  Rarely, the pain can travel up the wrist and forearm and even cause tingling past the elbow to the shoulder.

The symptoms are usually worse at night.  Activities that may trigger carpal tunnel syndrome include:

1)   Typing

2)   Reading

3)   Driving

4)   Holding a phone

5)   Sleeping at night – many people bend their wrist while sleeping

Testing:  Nerve conduction studies or Electromyography can measure the speed of the electrical nerve conduction of the median nerve or show whether muscles of the hand and wrist are responding appropriately to the electrical signals.  Most of the time the surgeons want these tests to be performed before they will consider surgical treatments for carpal tunnel syndrome.

Treatment:  they are tailored to the individual patient and may include:

1)   Wrist splints keep the hands in a neutral position, where the wrists are not bent forward to backward

2)   Surgery is offered to patients who have severe symptoms and that involves cutting the ligament that stretches across the wrist to form the carpal tunnel.

3)   Steroid shots or pills:  The steroid medications that we use short-term are a group of medications that control inflammation and swelling.  Sometimes we will inject a steroid directly into the carpal tunnel, but this is usually done by a hand specialist because of the risks of getting the steroid directly into the median nerve.

4)   Osteopathic manipulation: There are techniques that an Osteopathic Physician (D.O.) may perform that can actually help increase the space inside the carpal tunnel ie. “carpal bone mobilization.”

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Pet Therapy: How Animals And Humans Heal Each Other

Article from NPR:
Ryan Shank-Rowe, 9, takes part in a therapeutic riding program at Little Full Cry Farm in Clifton, Va., last month.

Maggie Starbard/NPRRyan Shank-Rowe, 9, takes part in a therapeutic riding program at Little Full Cry Farm in Clifton, Va., last month.

Those of us who own pets know they make us happy. But a growing body of scientific research is showing that our pets can also make us healthy, or healthier.

That helps explain the increasing use of animals — dogs and cats mostly, but also birds, fish, and even horses — in settings ranging from hospitals and nursing homes to schools, jails and mental institutions.

Take Viola, or Vi for short. The retired guide dog is the resident canine at theChildren’s Inn on the campus of the National Institutes of Health in Bethesda, Maryland. The Inn is where families stay when their children are undergoing experimental therapies at NIH.

Vi, a chunky yellow Labrador retriever with a perpetually wagging tail, greets families as they come downstairs in the morning, as they return from treatment in the afternoon, and can even be “checked out” for a walk around the bucolic NIH grounds.

 Thelma Balmaceda, age, 4, pets Viola, the resident canine at the Children's Inn on the campus of the National Institutes of Health in Bethesda, Md. Families stay at the inn when their children are undergoing experimental therapies at NIH.

Melissa Forsyth/NPRThelma Balmaceda, age, 4, pets Viola, the resident canine at the Children’s Inn on the campus of the National Institutes of Health in Bethesda, Md. Families stay at the inn when their children are undergoing experimental therapies at NIH.

“There really isn’t a day when she doesn’t brighten the spirits of a kid at the Inn. And an adult. And a staff member,” says Meredith Daly, the Inn’s spokeswoman.

But Vi may well be doing more than just bringing smiles to the faces of stressed out parents and children. Dogs like Vi have helped launch an entirely new field of medical research over the past three decades or so.

The use of pets in medical settings actually dates back more than 150 years, says Aubrey Fine, a clinical psychologist and professor at California State Polytechnic University. “One could even look at Florence Nightingale recognizing that animals provided a level of social support in the institutional care of the mentally ill,” says Fine, who has written several books on the human-animal bond.

But it was only in the late 1970s that researchers started to uncover the scientific underpinnings for that bond.

One of the earliest studies, published in 1980, found that heart attack patients who owned pets lived longer than those who didn’t. Another early study found that petting one’s own dog could reduce blood pressure.

More recently, says Rebecca Johnson, a nurse who heads the Research Center for Human/Animal Interaction at the University of Missouri College of Veterinary Medicine, studies have been focusing on the fact that interacting with animals can increase people’s level of the hormone oxytocin.

“That is very beneficial for us,” says Johnson. “Oxytocin helps us feel happy and trusting.” Which, Johnson says, may be one of the ways that humans bond with their animals over time.

But Johnson says it may also have longer-term human health benefits. “Oxytocin has some powerful effects for us in the body’s ability to be in a state of readiness to heal, and also to grow new cells, so it predisposes us to an environment in our own bodies where we can be healthier.”

Animals can also act as therapists themselves or facilitate therapy – even when they’re not dogs or cats.

For example, psychologist Aubrey Fine, who works with troubled children, uses dogs in his practice but also a cockatoo and even a bearded dragon named Tweedle.

“One of the things that’s always been known is that the animals help a clinician go under the radar of a child’s consciousness, because the child is much more at ease and seems to be much more willing to reveal,” he says.

Horses have also become popular therapists for people with disabilities.

“The beauty of the horse is that it can be therapeutic in so many different ways,” says Breeanna Bornhorst, executive director of the Northern Virginia Therapeutic Riding Program in Clifton, Va. “Some of our riders might benefit from the connection and the relationship-building with the horse and with their environment. Other riders maybe will benefit physically, from the movements, and build that core strength, and body awareness and muscle memory.”

On a recent day, one of the therapeutic riding program’s instructors – speech therapist Cathy Coleman – works one-on-one with 9-year-old Ryan Shank-Rowe, who has autism.

Well, not really one-on-one. The co-therapist in this session is a speckled pony named Happy.

Cathy Coleman is a speech pathologist for the Northern Virginia Therapeutic Riding Program. She uses a horse named Happy in her therapy sessions with 9-year-old Ryan Rowe, who has autism.

Maggie Starbard/NPRCathy Coleman is a speech pathologist for the Northern Virginia Therapeutic Riding Program. She uses a horse named Happy in her therapy sessions with 9-year-old Ryan Rowe, who has autism.

“Walk on” says Ryan, and Happy obediently does. “Excellent,” Coleman replies.

As the session progresses, Ryan makes Happy trot, weave in and out of poles, and even rides bareback, all the while answering Coleman’s questions and keeping up a continual back-and-forth chatter.

Coleman says she used to see Ryan in a more formal office environment. But since he’s started horseback riding, his speech has actually improved.

“I get greater engagement, greater alertness, more language, more processing, all those things,” she says. “Plus, he’s just really good at it.”

And Ryan’s mother, Donna Shank, says the riding has helped with more than just his speech.

“It’s helped his following directions, some really core life skills about getting dressed and balance — which really translate to a lot of safety issues, too.”

But not all the research is focused on the humans. “We want to know how the animals are benefitting from the exchange,” says Rebecca Johnson of the University of Missouri.

Much of Johnson’s research, for example, has focused on the value of dog-walking by studying volunteers who walk dogs at animal shelters. She even wrote a book, Walk a Hound, Lose a Pound.

Those programs have clearly helped people get healthier, she says. Not only do they increase their exercise while they’re walking the dogs, “but it increases their awareness, so that they exercise more during the week.”

But it turns out the program was also helping the dogs.

“What we found was that they were significantly more likely to be adopted if they were in the dogwalking group,” she says, thanks to the additional exercise and socialization they were getting.

Johnson’s now working on a new project with likely benefits for dogs and humans. Military veterans returning from Iraq and Afghanistan are providing shelter dogs with basic obedience training.

And while it’s still early in the research, she says, one thing seems pretty clear: “Helping the animals is helping the veterans to readjust to being at home.”

Now the research is getting an even bigger scientific boost.

The National Institutes of Health, with funding from pet food giant Mars, Inc., recently created a federal research program to study human-animal interaction. The program, operated through the National Institute for Child Health and Human Development, offers scientists research grants to study the impact of animals on child development; in physical and psychological therapeutic treatments, and on the effects of animals on public health, including their ability to reduce or prevent disease.

Johnson says it’s critical to establish the scientific foundation for the premise that animals are good for people, even if that seems obvious.

“The last thing we want is for an entire field to be based on warm fuzzy feelings and not on scientific data,” she says. “So it’s very important that now the NIH is focused on this … and it is helping scientists across the country like myself to be able to do our research.”

Fall back to sleep: Some tips to help with the time change

shutterstock_165363764It’s that time of the year again for most of us in the United States to change our clocks back one hour to standard time (except Alaska and Arizona).  For most of us means gaining an extra hour of sleep on Sunday morning. The problem is that even this one hour time change can affect our “internal clock.”  The good news is however, that this time shift in the autumn is better tolerated for most, than the change in the spring.  If you find that you have trouble with your sleep however,  here are some hints.

1.  Don’t try to force yourself to go to sleep as this can cause frustration.  If you go to bed and find that you cannot fall asleep within a reasonable amount of time – say 15-30 minutes, get up out of bed and do something else until you start to fall sleepy.  Then go back to the bedroom and try sleeping again.

2.  Don’t read or use your computer in the bed.  If you do these other non-sleep related activities in bed, your brain actually begins to associate the bed with activities other than sleep.

3.  Decrease the amount of light you are exposed to an hour or so before bedtime.  Melatonin, a hormone released in the brain is affected by light exposure.  As the amount of light entering your eyes decreases, the level of melatonin in the brain increases and stimulates sleepiness.

4.  Don’t sleep in or take naps.  Get up at your normal time, even if you don’t have any obligations that you need to attend to.  Establishing a sleep pattern in important, and if you sleep in or take a nap, you may find it harder to sleep later on.

5.  Adjust the temperature of the room.  Usually decreasing the temperature  slightly at the night is helpful, because the natural circadian rhythm during sleep decreases our temperature slightly.

6.  Participate in some relaxing activity before bed rather than exercising, reading an adrenaline raising story, or watching a horror film.  It may seem obvious, but even watching the nightly news before going to bed can make getting to sleep more challenging.

7.  Decrease the noise in your environment.  Wear ear plugs if you cannot change to a location that is quiet.

8.  Don’t go to bed on an empty stomach, or when your stomach is over-full.  Too much fluid intake may also cause unwanted trips to the toilet.  Pay special attention to caffeine, nicotine and alcohol intake which can all negatively impact sleep.  Alcohol may make you feel sleepy at first, but as it wears off it may disrupt sleep later in the night.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


What are the signs of dementia in your pet?

As we become more and more educated on the signs of Alzheimer’s Disease in people, it’s worth asking  — what about animals? Can anything be done to prevent it?

This article by Steve Dale in USA Today Weekend discusses both the signs and ideas on how to keep cognitive dysfunction (CD) at bay. CD is diagnosed by excluding everything else medically relevant first, but there are signs to identify it.

“It’s always been there,” says veterinary behaviorist Gary Landsberg of Thornhill, Ontario, director of veterinary affairs at Cancog Technologies. “Our pets are living longer, and we’re learning much more about identifying cognitive dysfunction.” Landsberg is now researching the disorder in cats.

The acronym for pet owners to identify CD is referred to as DISH:

D — Disorientation and confusion, such as attempting to walk through the wrong side of a doggie door.

I — Changes in interactions, such as an outgoing pet becoming withdrawn.

S — Sleep disturbances: cats yowling or dogs pacing overnight for no apparent reason.

H — House soiling, having “accidents.”

So what can be done to prevent CD? The best wisdom points to one thing  –  exercise.Professor Carl Cotman, Director of University California, Irvine,  Institute for Brain Aging and Dementia, says that dementia in people and in animals respond the same.