Medical aid in dying

I’ve noticed misunderstandings about medical aid in dying (MAID). Here’s the deal:

MAID has been legal in Switzerland since 1942.

In the US, MAID is allowed in 13 states. Legislation is pending in at least 16 other states. To receive MAID in the US you must be terminally ill with less than six months to live. Except for Oregon and Vermont, you must also be a resident of one of the states in which MAID is allowed.  

MAID is legal for residents of Canada. In 2021, Canada removed the requirement that a person’s death must be “reasonably foreseeable.” The central principle of Canada’s stance on euthanasia is autonomy—honoring a patient’s wishes to be in control.

As one Canadian physician wrote in a letter to the editor of The New York Times, “I agree that patients considering MAID deserve careful exploration of their suffering and access to counseling, palliative care and social support. But counseling should support patients’ decisions, not be another test they must pass before their choice is respected.…I have asked patients requesting MAID what they would need to no longer want it. Overwhelmingly, the answer is not counseling, housing or companionship. It is a cure, or a reversal of irreversible decline, something that medicine cannot offer.”

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Movement and creativity

According to Scientific American, “Movement and creativity go hand in hand.” This is news to me, but apparently creative people have found this to be true. A musician speaks of writing music while on the hiking trail; an author finds running essential to her writing practice. Apparently, Beethoven, Henry David Thoreau, Maya Angelou, and Joyce Carol Oates have also combined movement and creativity.

Scientists are finding that consistent movement helps unlock words, notes, and brushstrokes for authors, musicians, and painters. But why? One Austrian researcher, who spent years studying the link between creativity and movement, found that the more his study participants moved—in terms of step count—the greater their creative output. Other scientists have found similar effects.

One hypothesis for this effect is that our current culture of multitasking “overloads our mental workspace,” and that going outside and moving about frees up space to create. Another theory is that movement boosts mood, which allows you to create.

There’s not an optimal dose of movement that is guaranteed to boost creativity, but some researchers find that cognitive benefits appear to begin after about three sessions per week of 30 to 60 minutes of activity. According to one scientist, “You start to develop new neurons on that dosage.” Furthermore, he adds, “you think more clearly and have the mental space to support creative thinking.”

I find that I come up with my best ideas in the middle of the night. But maybe that’s because I’d been outside moving around during the day. I should keep track.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Dizziness

Recently, several people I know have been hit with bouts of dizziness. A year or so ago, I’d saved an article about dizziness that I’d seen in a medical journal. The article isn’t particularly helpful for my purposes, but it did let me know that dizziness is a common problem that affects an estimated 36.8 million people in the US every year, and accounts for nearly 2 million annual visits to the emergency room. 

Because the causes of dizziness can range from pathologic, such as stroke, to benign, such as positional vertigo, it presents a diagnostic challenge to ER clinicians.  

I can’t do justice to this complicated topic, but here are some causes of dizziness:

• Benign paroxysmal positional vertigo: Caused by the dislodging of crystals in your inner ear that help you sense gravity. You can correct it yourself by performing a series of head and body movements to move the crystals back in place. (I’ve had this vertigo. It fixed itself.)
• Vestibular migraine: Caused by abnormal electrical activity in the brain pathways that manage balance and pain. It can be brought on by stress, poor sleep, hormonal shifts, weather changes, and certain foods like aged cheese or red wine.
• Meunier's disease: A chronic inner ear disorder that causes recurring episodes of severe dizziness, ringing in the ears, fluctuating hearing loss, and a feeling of pressure or fullness in the ear. The root cause is unknown.
• Vascular vertigo: Caused by reduced blood flow or vascular problems in the brain, often linked to strokes or vertebral artery problems.
• Vestibular neuritis: Caused by an infection that inflames the main nerve of the inner ear.
• Other: Panic attacks, low blood pressure, dehydration, medication side effects and probably more.

These possibilities are positively dizzying!   

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Polypharmacy dangers

Polypharmacy means taking several medicines regularly, usually four or more. A recent issue of the Journal of the American Medical Association noted, “Between 2015 and 2025, approximately 63 serious adverse events attributed to drug-drug interactions were reported to the US Food and Drug Administration among adults aged 65 years or older, 10% of which were fatal.” (Older people have slower drug metabolism and more chronic conditions, plus they see more specialists prescribing medications and use more OTC drugs and supplements.)

Here are the drug combinations rated the most dangerous:

• Blood thinners, such as Warfarin, taken with NSAIDs (non-steroidal anti-inflammatories, such as Aspirin and Advil), can dramatically increase the risk of internal bleeding.
• Blood pressure medications, such as Lisinopril, taken with diuretics, such as hydrochlorothiazide, plus NSAIDs, is a “triple whammy” that can cause acute kidney injury.
• Opioids, such as tramadol, taken with Benzodiazepines, such as lorazepam, can slow breathing and cause respiratory depression, confusion, falls, and overdose.
•  Antidepressants, such as Zoloft, taken with supplements, such as St. John’s Wort, can trigger serotonin syndrome—a buildup of serotonin, the symptoms of which can be mild  (shivering and diarrhea) to severe (muscle rigidity, fever and seizures), to death.
• Statins, such as Lipitor, taken with certain antibiotics, such as erythromycin, can cause muscle breakdown and kidney damage.
• Diabetes medications, such as insulin, taken with beta-blockers, such as metoprolol, can hide symptoms of low blood sugar, making hypoglycemia harder to detect.
• Anticholinergics, such as Benadryl, taken with sedatives, such as sleep aids, can increase the risk of confusion, falls, memory problems, and delirium.
• Multiple OTC cold and flu products taken together can cause liver damage. Examples of risky combinations include NyQuil plus Tylenol; DayQuil plus cough syrup; anything containing acetaminophen.

The intended audience for this article is doctors. I would have hoped that they already knew about these interactions.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.