Saturday, April 28, 2012

Old Orchard RV and Campground

We came in here last night and were really enjoying the park. It's on the Harrison River at Harrison Mills, opened only a couple of years ago.  The rates are exorbitant, over $50 a night.  It's a lovely setting but we are here off season and it's a huge RV party place which hundreds of spaces and campsites packed in for maximum revenue.  This factory approach to private RV and campgrounds is often the norm making provincial campgrounds so enjoyable by comparison because they maximize the nature quality over the maximal number of units for space.  This one has a beach and open area.
There was drinking in the morning  though and by the afternoon a radio was playing loudly out the back of a truck with a bunch of guys enjoying listening to the radio. It wasn't evening but this 50's, pre earphone set negatively impacted on our enjoyment of bird song. It was loud. Really loud.  And the music as in all such cases was awful. I put on the 4 tenors in a hope of masking their poor taste but it's like spraying cologne in the room when a person is there who hasn't washed in weeks and you literally can smell their underwear.
We've been RV'ing a couple of years now and this is our first experience with the 'neighbours' and the managers who don't do anything. I suppose I could go over and talk to them.
I complained about the noise my neighbour was making in the apartment next door when I was a medical student. Just knocked on her door and asked her to turn the music down. She didn't. I went back a half hour later and knocked on the door. A pot smoking boyfriend appeared with a butcher knife.  No conversation, just stuck the knife to my throat and pushed me back against the railing over the the stairwell, tipping me precariously backwards.  I was helpless, and horrified. He said, "No one bothers my girlfriend. She can play her music as loud as she wants. Understand."  He left I staggered back to my apartment. . Called the police. They came by and I told them what had happened. They talked to him. Came back and told me I should be okay. I did my medical exams in the morning.  I moved out of the apartment later.
I don't want to put a knife in my pocket and walk over and tell the neighbours to turn down their music. Tonight if it keeps up I'll think of slashing their tires instead.  I don't want to talk to the managers. I can see them going around the grounds.  They can hear how loud it is.  I don't need to tell them. I could leave tonight too.  That's the beauty of RV's.
I 've lived on a sailboat too. In the winter a marina neighbour, after I left for work, would change his 30 amp service with my 50 amp service.  He thought he was being clever stealing that way.  The trouble was this exchange tripped my electric heater. I'd arrive home each night for weeks to my shivering siamese cat and the heater off. I told my other neighbour. She told me about the psychopath across the way. I spoke to him.   My cat had her heat back.  I have a real appreciation for what happens when children don't have good parents.
I don't think I'll ever come back to Old Orchard. It's a shame. The site is nice.  Location.  There's a lot of effort gone into this.  Just lacks management.  I know too that if I don't like something then I'm sure the guy in the $500,000 rig across the way is thinking the same. The managers don't have money or they'd appreciate what people want when they go away for a weekend.  They certainly don't want to listen to their neighbours poor taste in entertainment.  I feel sorry for the tenters too.
But they will get rich here.  Lots of yahoos and drunks like these kind of places.  My friend told me about his experience camping one night where the gangs came in and had a shoot out. It was exciting to say the least.  He and all the other rigs left at first dawn.  Makes one really appreciate finding a good safe peaceful campsight where there's not so much drugs and alcohol going on and people don't want to be 'loud'.
At least when my biker friends and I got together to party, play Steppenwolf over the gazillion watt woofers,  target practice in the back acre with all manner of hunting and non hunting guns, we chose a gravel pit in the middle of nowhere.
These people aren't nearly as socialized as my biker friends. Right now they're shouting over their music to talk to each other.

Sunday was idyllic at this location.  Waking to quiet and birds. Staff were really friendly with check out, having been most helpful with checkin.  Were it not for the lack of noise control this really would be a lovely place.  We learned that they're widening the lots to 30 feet.  Alot of the noise were limitted to a work crew.  It may be that management will be more sensitive though that remains to be seen. Given the location I'd be tempted to drop by again but fear that life is too short of another day of sound pollution when seeking peace and relaxation in the country after the hectic city work and community life.

Thursday, April 26, 2012

Buprenophine and BuTrans Patches

Last night I attended a superb dinner presenation by Dr. Owen Williamson arranged by Chris Szado, the pharmacological representative for Bu Trans.  Buprenorphine is a partial agonist opioid that has been extremely successful as an alternative to methadone in select populations for addiction therapy. It's also been used for moderate pain control with less concern for addiction. .One of the main advantages of patch technology like Bu Trans is that it can't be diverted. Pills like oxycontin were being crushed and injected by heroin users but this is not the case with Bu Trans.  Indeed Oxycontin , dubbed Hillybilly Heroin, has been removed and replaced by OxyNeo, the exact same drug but in a formulation that does not allow the pill to be crushed and used for injection.  Oxyneo in contrast to Oxycontin turns into an insoluble gel with crushing and heating so is a breakthrough development we can all be thankful to the pharmacology company for developing.
Bu Trans  advantage pharmacologically especially for pain is that it results in slow steady release  through skin absorption - and less fluctuations in dosage than oral preparation.  Patches can be worn for a week at a time so the whole problem of missing dosage or taking too many pills at once is simply bypassed.
Dr. Owen Williamson is an Orthopedic Surgeon from Australia who specialized in spinal surgery then became a leader in pain medicine in Australia. He'd used buprenorphine there years and had 7 years experience with the buprenophine patches before coming to Canada where he works specifically as a Pain Specialist.  Canada doesn't have a subspeciality of pain medicine yet so most of us there tonight were indeed Addiction Medicine specialists who were pain specialists as a consequence of our work with addiction.
Appropriate narcotic treatment of pain doesn't  lead to addicition however addicts commonly had pain and presented with pain to address their addiction issues.. Indeed many of us were there tonight to ask Dr. Williamson's advise on how best to manage pain in our addicted patients.  Often despite being on methadone and having their addiction controlled with methadone patients have pain and this needs to be addressed.
After the presentation during a lovely meal provided by the excellent Market Restaurant on Georgia we had ample time to discuss not just individual clinical strategies but community medicine and community psychiatry in general.
There is extensive evidence based scientific research in clinical management of addiction and the appropriate treatment of pain yet authorities with distinctly different agendas and apparently often political short sighted personal aims commonly intervene with such old saws  as the 'war on drugs'.  To date the only success in that multi billion dollar tax payer kerfuffle has been the recognition of the success of the socalled 'drug courts'.  These divert addicts who committ crimes to support their addiction from jails into treatment.
All the efforts to 'police borders' or invade other countries has to date only escalated drug abuse. Filling jails with addicts has also demonstrably harmed society and created more criminality.  Miami Vice as a television show probably did more to make cocaine sexy to kids than act as a deterrent to drug abuse. The glamor is in the 'context' and it's easy to get into the 'glamour' as a user than a cop.
Of course it's extremely difficult to unhorse the white knights who have a license to kill, often come from elite families,and get to ride roughshod over all civil rights and human rights claiming to protect a child who is likely to learn about addiction from his school mates and family especially if his family were jailed rather than treated for addiction. . Thanks to scientific research there are studies that seriously question use of the Hollywood cowboy police chase because police chases have caused more  damage, maiming and  killing.  Thanks to better surveillance technology today than yesterday police can save themselves car damage and collect their suspects reasonably a day later. It's equally effective today but decidedly less glamorous. Treatment of addiction today is the gold standard.  The hope is for as many options in the treatment of addicition as we as doctors have in the treatment of diabetes.  Buprenorphine and Bu Trans are certainly welcome addictions.  My psychiatrist and addiction medicine friends in the US who have had these tools swear by them.
Dr. Gary Horvath, the Addiction Medicine specialist, whose clinic Doc Side is in  Downtown Eastside Vancouver is presently using buprenorphine on selected patients where he can assure clinical safety and is having significant success.  
So it was enjoyable to learn of how buprenorphine can be used alone for addiction and/or pain or how to switch a person from other narcotics to buprenorphine and how it is used for tapering people off narcotics whether they are being used for pain or addiction management.  There's real advantage to the Bu Trans patch being used when people are tapering off methadone and their dose is below 40 mg a day.  This assists them in going through the final withdrawal phase.
Dr. Owen Williamson is a very bright and accomplished young man who has extensive experience in this field as well as being decidedly witty.  I am only giving a taste of the presentation. I took notes and am including these here, just as more of a jist. I was eating the very fine Market Restaurant food while listening too the talk so will only apologise for any mistakes or mispelling.  I would indeed suggest contacting either Chris Szado with Bu Trans or Dr. Owen Williamson directly for the 'facts'.   My purpose in sharing this here is to save a reminder for  myself  and to essentially raise consciousness about advances in the incredibly rapidly developing speciality fields of addiction and pain management.
iphone 2 finger notes on notepad while eating scrumptuous food at end of long work day
Owen D Williamson
Originally orthopedic surgery then spine surgery then public health
Melbourne 3 years later pain - biggest predictor mental health 
Chronic pain and addiction
National Pain Summit yesterday
Addiction - 10%
Chronic Pain - 30%
OxyContin attraction was predictability - cost of 1 80 mg oxycontin on street same cost as 2 days heroin
67% high school students get their opioids of abuse from home
Need for use of "drug safe"1 in 5' Canadians have chronic pain
Diverters - industrial dosages of pain medicine - street value of example patients -$650,000 a year
Inquest into death of Donna Marie Bertrand
- suicide - antidepressants
- jury 32/48 recommendations related to opioids
- pharmanet - "every patient I see I get pharmanet"
BC - suboxone very good for pain and addiction
Suboxone can be used in BC if methadone contraindication
Detox and maintenance
Detox maintenance and taper
- slow
If you taper over 12 weeks twice as good as any faster regarding relapse and least relapse if taper over year
Transdermal buprenorphine - transition people from methadone to buprenorphine
Maintenance alone on heroin - Naomi study 
Cochrane reviews - more relapse on buprenorphine
30% Persisting pain after trauma
Butrans - persisting pain 
Max recommended dose 20 mcg/hr every 7 days 
In aust dose is 40
In Europe dose is 70
U receptor partial agonist
K receptor antagonist
Chronic pain doubles risk of suicide
Binds to alpha and b globulins not albumin
Hepatic not renal metabolism
Side effects of patch
Don't confuse fetanyl or durogesic patch with bu-trans patches - can lead to death 
Opioid induced hyperalgesia - this is done because of effect on glial cells
Allodynia - painful response to something not normally painful
Pain Medicine
- opioid rotation - webster
Meth to TDB conversion
- reduce meth to 40 
- apply patch 12 hr later - 35 mcg/hr
- hospital
- nosyk b et al Addiction 2012 (ePub)

Pray for your enemies

When I heard this after a particularly poor time in my life, I was extremely resentful. As a Christian I had promised to return evil with good yet all my being wanted to lash out and lash back at these people who had hurt me individually and as a group.  I knew that they themselves being pagans and bullies would have never tolerated any such abuse themselves. They were cowards and hypocrites and hid in the shadows waiting to lash out and steal from travellers journeying peacefully along in life.  I was a a fool and unaware. Innoscent and too trusting.  But mostly I'd not prayed and not stayed close to my fellow Christians living a life in Christ but rather wandering off alone in my own pride.
Now having been with animals I wanted to do as animals do.  Instead like a prodigal son I returned from the pig sty and begged forgiveness of my father and set about to make amends.  That's when I heard Pray for your Enemies. my first thought was that "It would keep the list fresh".
Yet I appreciated this wisdom more and more with time.  Resentment is poison we take hoping another person will die.  Thinking of my enemies with anger in my heart I couldn't appreciate the good in my life and see the light of God because I was focussing on the darkness of the devil.  Further, God is in the present and by thinking of my enemies I was dwelling on my past and losing my future.  If I'm not present now I'll not be present when my future comes. My ingratitude in life was my biggest problem. I needed to be more grateful and have more faith.
So I prayed for my enemies and continue to pray for my enemies.  There's good in the worst of us and bad in the best of us. It's what makes us human.  I am not here to judge either.  By praying for my enemies I truthfully avoid thinking of them because the fact is I don't like praying for them.  As  I pray for them I see their cowardice and fear and realize that all bullies and especially those most ignorant, cruel and insensitive are just the least developped, most paranoid and most immature.
When I met them they were fearful, inadequate, envious and retaliatory.  I was naive.  I was also likely insensitive because I didn't see the betrayal coming or realize that they lacked the capacity for love, empathy and learning.  Working in groups they even tried to avoid responsibility for their nefarious acts. The fact remains, as even Nuremberg taught us in this world, we are all individually accountable and ultimately can't hide in committees or organizations. Instead they hurt me and indeed would have killed me were it not for God's grace.
Praying for them I realize that they too are children of God.  Even today as I hear of the failures in their lives I want to gloat but must recognise that in gloating and in gossipping "see I told you so", I'm showing I am still immature and wrapped up in pride.
My journey has been made more difficult by my pride because in truth I wouldn't have recognised gloating as pride years past. I didn't even realize then that my fear and self pity were a product of my lack of faith and not so much a product of my enemies' terrorism.
Each day I realize I have to focus more on my own short comings , seeing them now and changing these behaviours this day rather than dwelling on the past and focussing on the evil of my enemies. In praying for them I make amends for implicitly accusing them wholly of fault and holding a resentment which would maintain I was wholly innoscent.  In the subjective objective world of misunderstanding and miscommunication there is a gray zone where I'd like to attribute the fault to others when this marginal area of mystery is as likely to involve my lapses as their.  I need to take my fair share of responsibility.
And as to fighting bullies. I need to fight those I meet today or go around them and simply leave a sign pointing at the obstacles in the path.  Maybe God's job then is to send in a mine sweeper or to instruct these wayward souls as he no doubt instructs me in this kindergarden of life.  It's not my job to judge but rather to forgive, accept, let go, pray and move on.
Thank you Jesus for your example and your presence.

Wednesday, April 25, 2012


Thank you for this day, Lord. Thank you for my family. Thank you for my friends. Thank you for my works. Thank you for my pets. Thank you for my health. Thank you for my possessions. Thank you for our relationships. Thank you for books and learning. Thank you for safety. Thank you for my teachers. Thank you for nature. Thank you for communication. Thank you for diversity and similiarities. Thank you for laughter. Thank you for food. Thank you for clean water. Thank you for pine scented air. Thank you for the ocean and the seagulls. Thank you for my boat and land vehicles. Thank you for the movement. Thank you for the sights. Thank you for the sounds. Thank you for the smells. Thank you for technology. Thank you for the natural world. Thank you for the ideas and music. Thank you for poetry and song. Thank you for equations. Thank you for colour. Thank you Lord for all.

Pro Choice -Abortion Lobby - Latest Set Back

When I first worked in an abortion clinic a quarter century ago the conventional wisdom was that a 'fetus' was not 'human' and that "life' did not occur until 3 to 6 months later.  The idea was that in removing a 'fetus' one was really simply taking out a 'growth' or a 'tumor'.  At that time I was screening pregnant women and making the referrals for abortion even before I later did abortions.
At that time I was probably considered 'pro choice' and there was clearly some sad but few cases in terms of maternal care and unavailability of contraception.  That was a quarter century ago.
Since then ultrasound and other advanced technologies have indicated that life is present at a much earlier stage.  Morning after abortion pills and contraceptive advances have been astounding, providing all manner of scientific information.  There is even a resurgence of abstinence as a contraceptive approach, something as strange as yoga or vegetarianism was when I was a young doctor. As important sexual behaviour has been influenced by a whole range of sexually transmitted diseases previously unheard of. Along side this is a pornography industry geared to both men and women with some of the greatest stake holders being todays business women.
Politics commonly lags far behind scientific advances and businesses are simpy entrenched in what is most lucrative.  I was doing 'street medicine' and volunteering my services in those old days whereas today abortion is truly Big Business and highly lucrative. Canadians who went across the US border were routinely 'scalped' by the 'curettage cowboys' keen on making a fast buck.  Here abortions are scheduled and run like a factory compared to all the messiness of obstetrical practices.
Then abortion clinics advised patients to avoid obtaining ultrasound.  This was because once people had ultrasound which amounted to truly 'informed consent' the benchmark of standard medical practice and truly transparent clinical delivery, the business clinics found that many who had ultrasounds decided against 'abortion'.  Patients still go on to have abortions fully informed and as increasingly evidence showed that those who had abortions had subsequent psychiatric problems with increased depression risks, this transparency may well change that.  In surgical practices, being informed for loss was found to improve post operative results. Hence no surgeon today would consider an amputation without fully advising the patient of the procedure and likely pros and cons of outcome using the latest media to assist in this informational session..
So here was where abortion shifted from science to politics and business. The book "Aborting America' certainly raised all manner of concerns. The scientific work of Dr. Philip Ney and colleagues further raised concerns about the ultimate 'costs' of abortion societies.
Now in British Columbia doctors are advised not to tell parents of the gender of the child for fear that women will abort the female fetuses.  China is accused of using abortion to indeed build one of the largest male armies in the world.  The anti feminist campaign there is said to start in the womb.
In Canada it turned out for radical feminists that when boy babies were aborted it was okay but when parents were preferentially aborting female babies that was not part of the grand plan. Subsequently all parents are denied the information that could help them make and 'informed choice."  In this case 'pro choice' becomes decided 'anti choice' and 'discriminatory'.
Why all parents should be penalized and not allowed to know the gender of their child because a minority of individuals are using abortion for what radical feminists call 'frivolous' reasons is uncertain. Apparently pro life folk long ago contended that many of the 'reasons' supported by pro choice folk for 'abortion' were often 'frivolous' and 'uninformed'.
At this same time as Rush Limbaugh is roundly condemned for questioning why he should pay for others contraception when a girl wants her contraception paid for by the health care program at a religious school.  Obama even steps into this providing a shoulder for the poor girl, a law student, to cry on.  We have long come to expect drama from Russ Limbaugh but this bit with Obama  harkens back to the medieval religio political plays done for the masses of the day.  The jokesters meanwhile have a hayday making fun of the need for Post Clinton Democrats to support the broadest appeal for abortion and contraception.   In the end it seems that  abortion is something that non abortion folk will be encouraged, if not forced,  to collectively pay for so long as only boy babies are aborted perhaps.
Politically there is a desire with the advances in scientific knowledge, the evidence of 25 years of practice, the pros and cons of that process, the ready available, even publicly funded contraception choices and now abortion to review this whole subject again.  Politicians, judges and lawyers all either tremble or salivate at the thought whereas science plods on.  By the time the politicians catch up science may well be working on immaculate conception much to the terror of religious groups. Only last year a transexual man had a child and extra uterine conception and delivery isn't the thing of science fiction.  Bio ethicists are meanwhile doing push ups mentally with the idea that life may be as close as thought even as scientists have developped the first trans-matter delivery systems physically confirming.
It reminds me of the great joke where scientists inform God that they are now ready to make a human, and just as they pick up some dirt to complete their experiment, God says , get your own dirt.
The critical factor of public funding in these economically challenged times is not whether funding something is good, it's always good to spend somebody else's money on any good cause. The trouble is that if we fund one thing another doesn't get funded.
Radical feminists argued 'my body my own' and that might have been true but the courts held that men who believed women were using contraception but lied were still accountable for child support.  As a male, I am biased.  I simply  don't agree that I am excluded from all discussions relevant to the future generations of society especially when radical feminists want only boy babies to be aborted.
Finally when did a 'tumor' or a 'mass of tissue' become a 'gender' Gender is implication of life and humanity so denying parents the right to know the 'gender' of their children is a somewhat draconian measure of a group claiming 'pro -choice' while denying just that.  Knowing the gender of children, for those who are having children, can help them in planning the future of their children, those that live of course.
Pro Life has to date been more scientific and indeed increasing supportive of all  'rights' in the community, not just those of a privileged few.
That said, there is a real need for ongoing support of children whose parents are not traditionally motivated towards parenting.  The courts have had an abysmally costly and punitive record regarding children suggesting that if we collectively took the billions of dollars that have historically funded 'court fights' and put that 'war chest' money into the 'peaceful' raising of children supporting primary care givers especially in formative years the whole issue of 'abortion' might well itself be viewed differently.
In the area today there are many questions of bio ethics, and much of today's debate simply couldn't have occurred 25 years ago because the knowledge wasn't there. Despite the abortion lobby being happy with the present lucrative business deal it seems reasonable for society at large to consider that review may well be  indicated.

Sunday, April 22, 2012


Laura, Gilbert, I and the Mazda MX5 Miata enjoyed our visit to Seattle today.  We'd spent the night in the Chehalis Best Western, a great hotel for welcoming Gilbert. After Portland Seattle with it's skyscrapers and ocean port seemed more sophisticated. Lots of tourists especially around the Pike Market. I've  been coming down to Seattle for years.  Another great visit if only for lunch and a walk about the district where Cafe Bengodi is. The I5 was definitely less exhilerating in the Miata than on my Harley Electraglide. Laura preferred the Miata as she'd complained about being buffeted by the wind on the back of the motorcycycle  on the I5 just outside Seattle. Gilbert just prefers being with us..DSCN0415DSCN0416IMG 1059DSCN0412DSCN0418DSCN0413

Cafe Bengodi, Seattle

I had the best seafood pasta I've had in a long while. Laura loved her pizza too. The garlic bread was scrumptuous.  The waiter was informative, extremely professional and a true delight.  The street was highly entertaining.  I'd recommend this restaurant to anyone who loves Italian cooking.  Gilbert was happy to sit outside with us, enjoying dog watching as much as we enjoyed the people watching. IMG 1059DSCN0411IMG 1060DSCN0415

I believe

I believe in one God.
I believe God is the creator and the creation, father, son and creating creation, the holy ghost.
I believe that God is omnipotent, omniscient and omnipotential.
I believe that God is Good.
I believe that as there is one time and that time is now then the unfolding of creation is expanding and perpetrating from all directions to this moment and every other moment in a myriad of possibilities beyond my own capacity to comprehend at this moment.  I believe that this explains fate and free will.  That I am free to choose my fate and fated to choose what I freely do.  I believe that paradox is central to my perception of creation. I am "seeing as through a glass darkly'.
I believe that of all the emotions best associated with God's relationship with creation, love is the the best to describe that relationship and in turn I love God., the father and the son.
I believe the Bible is a holy book and the words of holy men who have known God and God's will.  I believe that even if "all roads lead to Rome"  some are definitely more rocky, painful and longer than others.
I believe in life eternal.  I do not believe that with death I cease to exist but rather that a new adventure begins.  I believe this life a chapter in a book that God is writing.
I believe this life is some sort of play and that as I learn more more will be revealed.  There is meaning to living and living brings meaning.
I believe I must understand myself and others more than judge them.
I believe Jesus commanded "Do not be afraid' and that fear kills and harms.  Fear itself is an enemy though there is healthy fear which might better be called 'respect'.
I believe all the world's religions are man's attempt at knowing God and understanding the relationship between God and Nature and God and man.  I believe that religions which encourage killing are less evolved than religions that encourage love.
I think that life often can be compared developmentally with children and various ideas and actions have a place and time developmentally but are wrong at later stages in living.  Hence a 40 year old man or a culture might think about where it dumps its waste better than an immature man or culture. However  as most tribes and cultures have survived to this date tens of thousands of years then like species each has it's own intrinsic specialization and adaptation so should be considered humbly when one compares at all.
I feel that prayer and meditation are important to my relationship with God as are congregating with others in worship and praise.  I believe that we are to relate to God alone and in community.
I believe in love but I know that words and platitudes do not speak as clearly as actions, service and sacrifice.
I believe.


Every one whose been to Portland, loves Portland.  I've yet to meet a Portland disclaimer.  This would be my umpteenth visit.  I'm always passing through and rarely stay.  Much younger it was on the route between Vancouver Canada and San Francisco, two cities I'd live in.   Last year I'd ride down on my Harley Electraglide coming up the Gorge before circling back to Canada.
A few years back it was the location of a medical conference I attendeded.  I was there a week.  The Oregon people who put on the conference were the finest.  I sailed down the coast of Oregon a couple of times so have met my share of Oregonians I've admired.  Always bright.  Something about the area begets intelligence.  A lot of ruggedness.  More apparently immune to the flakeyness on the west coast than Californians and British Columbians.  Too much pot though. I encountered that this trip and noticed it other times. The weazel dozy quality, clever but limitted feeling I get around chronic users.   Pleasant enough people but really monetary.  I remember growers with shot guns.  Marijuania fields in back woods.
This day it was the grunge in the old district.  Kind of eco hippies.  Makes me wonder if peace was as important to me in my own youth as apparently free sex and pot.  Loose women and loose lips.  Strays the lot of us.  Escapees from suburbia.  Mixing our affluence and decadence with the predators and dangers.  Domestic dogs gets loose.
Laura had never been to Portland.  She made the plane jump from Vancouver Canada to LA to go to Disneyland.  She didn't like the drinking in the Old District.  A part of me identified with the chaos and wild.  I lit up just a bit and wanted to wade in.  Overaged and plump. I'd have been silly. Glad to be sober.  But I saw her reaction.  Not wanting to be in the danger amongst the regressed.  Animal howls came out the street pub.  People drinking all day.   There was the Salvation Army and the Union Gospel.  Then it dawned on me.  This was just the downtown eastside a little upscale.
I was glad to drive on to Rose and Pearl.  Nice upscale becoming districts of a city, reclaimed warehouse past.  I'd driven my Harley here last time, remembered cruising all around this district, riding up and down streets, just looking. Feeling the slight anxiety the yuppies project on bikers.  Even one a lone.  A different kind of wild. Upscale and dangerous.
Today I was driving the new Mazda MX5 miata with the cute blond and the cockapoo.  I lacked a surf board but the image represented a 60 year old source of power. Not the mercedes kind that hides the owner inside.  But the sportscar type that suggests a certain freedom and yet suggests accomplishment.  It's a long time since I back packed and hitch hiked across Canada and the States but you think an old guy in a sports car might have done that where as an old guy in a mercedes probably wouldn't have.  That's what people think anyway.   I know better.
Laura and I couldn't help but compare Pearl to a kind of Yaletown Kitsilano area.  Portland is much bigger though.  There's more streets.  I love the rows and rows of outdoor cafes.  There's a lot of European flavour.  Something about it makes it seem more established than  Seattle.  Something about the bricks.  The buildings aren't sky scrapers but little half Chicago structures.  As squat sort of place. Lots of Rivers and bridges.
We parked the car on the street and walked to Portland luggage. I've been looking for just the right over the shoulder bag for these weekend jaunts.  The one I'm using, a nautical semi waterproof one from my sailboat is just fine. But it's blue and grey and heavy.  I don't need such substance. I want some thing lighter and black.  Then my laptop case was heavy leather for carrying on the motorcycle. Again I don't need one so heavy.  We took Gilbert with us. Looked at bags.  Handsome men and beautiful saleswoman.  Everyone helpful.  I so wanted to find the right bag.  Almost did.  Wrong colour.  We walked on.  Laura didn't really want anything.  I thought I should get her something from Portland.  Evidence shed' been.  Leaving her with Gilbert outside I nipped into Nordstroms and saw the shoes she'd once before wanted and couldn't find her size.  Bought them.  She was delighted.  Changed on the street.  Gilbert as excited. He's excited any time.  Enthusiastic over Laura who was gushing about the shoes.  I remembered the last time I was here.  The help I got at Digital Camera. I pointed out the lingerie store I'd bought Laura a night gown at.  "I still wear that, ' she said.
Then it was sitting outside drinking coffee, Gilbert lying under the stable. We were watching people go by.  Lots of eye candy. Real variety of clothing.  Different from Vancouver.  Same and yet different.  More diversity. More white too.  Gilbert was looking at dogs.  Less terriers.  More labradors.
We had to be back in Vancouver the next day. I didn't look forward to the long day of driving.  Figured  I'd drive back for a couple of hours now.  I was tired but would rather have less the next day.  With coffee perked up.  Back in the car I programmed the GPS for a Best Western near Toledo.  I like the lodging feature on the Garmin Nuvi.  Alternating Blue Colar Comedy with the symphony channel and country rock we drove up to Best Western Parkplace Inn and Suites in Chehalis.  We got a great meal from Kit Carsons down the street and watched several episodes in a row of NCIS.  Gilbert slept on the bed between us.
Easy drive home today.  I've already walked Gilbert.  Just need to shower and shave.  Laura will want a bath.  Now I'll go down the hall and get us some of the continental breakfast.  IMG 1037IMG 1047DSCN0407IMG 1042IMG 1045DSCN0409DSCN0410
Last night my face was a little sun burned from riding with the hood down.  Road trip in the miata nearly as much fun as on the Harley but different.

Saturday, April 21, 2012


I love this government town.  Beautiful setting. Great restaurants. Terrific little shops.  Perfect people watching.  Laura and I had lunch at the folk cafe.  The paninini's and salads were superb.  Gilbert loved the government building. He has a nose for politics. Last time I was here I was alone on my Harley Electraglide. This time I hadIMG 1038d Laura and Gilbert in my Mazda MX5.    DSCN0406IMG 1039IMG 1036IMG 1033

Garmin Nuvi 2595LMT GPS

I bought my Garmin Nuvi 2595 LMT GPS at Best Buy for approximated $250.  I'm a sailor and have been depending on Garmin for decades without fault. I've also a backwoods garmin for wilderness camping and hunting.  I was glad they made these portable ones for the car which could be attached to the dashboard with a suction cup. I've a Mazda Miata and Ford F350 truck so liked that I'd be able to transfer my gps from one vehicle to another.
The car gps is way superior to the other gps for it's function.  The display is visible with very little distraction from driving.  In addition there is a voice feature. A comedian did a very humorous sketch of his love for his gps lady.  She sounds like a school teacher.  When I plot in my route by declaring my destination she tells me where to turn and prompts me about upcoming turns.  A little vehicle on the screen shows me driving along the grid with names of roads displayed.
Richmond BC is a blackhole bermuda triangle.  It's been one of the areas of largest growth in the Vancouver Canada region because the realtors have ensured there is no signage on the streets that can take you back to 99 south.  Once you leave the highway you enter a vortex Maze. Most people give up and just buy property and live there.  This has been especially true for Chinese people who come to Richmond to visit family and can never return.  I've made it in and out on several occasions with only hours of loss of life and heart felt prayer.  I can say today that the Garmin Nuvi guided me out of this place where dragons be on  the shortest but wholly counter intuitive route.  This was especially appreciated  as the Hitchcock  birds had eaten  the bread crumbs I'd strewn behind the car as I entered Richmond.
On the I5 the Garmin guided me across 4 lanes near Everett and took me off the freeway on the most convoluted exit to get me to the Best Western Navigator late at night.
There are accessories too. Blue tooth for adding your phone.  An interesting audio book feature which comes loaded with a Bill Bryson sample. Great choice.  There's several other apps including calculator and currency exchange which I don't need but are added features.  It came loaded with maps for US and Canada and more can be loaded.  Further I can get these updated as part of the Best Buy Garmin package for free. Warranty for a year.
In the convertible the volume for my older ears could be better but it's adequate. With the roof up it works just fine.  The limitation is the audio books with the roof down. So I'd like a little more audio boost if I could.  It finds a variety of commerical places so far the best being gas stations. Lost in Richmond needing gas I used this feature and it took me to the nearest gas station. Now that's a treat!. It's weakness was in just navigating to another city.  I kept entering Seatle and it wanted a specific location in Seatle.  So I'd personally like a less specific search criteria for plotting. Maybe it's in the garmin but so far it's been so idiot proof I haven't had to read the instructions.  I might read them to find out how I can do this without knowing a specific place in the town. That's just how I travel across country town to town.  However I have a list of restaurants in the Garmin.  We inputted Best Western Navigator in Everett and that got us here.  We'd been to Best Western Navigator and liked it. I'd have liked a hotel app feature rather than restaurants.  But I just have to input the hotel chain and town so it's pretty simple. In addition to finding gas stations it finds other things of every day living like laundry.
Having used a Garmin gps fish finder I know I can input into the memory favourite places myself. I just haven't figured how to do this and again may actually have to read the instructions. When I was trying to read the instructions and input the garmin on the dashboards with both hands while driving Laura grabbed hold of her door handle. I have noticed that that's her indication to me that she's panicked.  I later read in the instructions specific notice IMG 1028 to avoid just what I was trying to do.  It's recommended that one pull over to the side of road and put in the text instruction for the destination while the vehicle is stopped. This naturally takes all the risk and fun out of driving with a gps but likely contributes to getting one to ones destination too.IMG 1029

Friday, April 20, 2012

Turning Point Recovery Society Gala Fundraiser

Last night Laura and I so enjoyed another annual Turning Point Gala.  This was our 5th one since they began and this one celebrated 30 years since Turning Point began. In 1982 Jim Ross and some fellow addicts and alcoholics banded together to have a house where they could live sober while putting back their lives after the devastation of years of the disease of addiction. With the  security and spirituality of Turning Point homes hundreds of sick people have found they way back from the abyss returning to health, employment, family and citizenship.  The spiritual message is simply that there is clearly more than death on the street that a human is meant for.  At Turning Point men and women leave the shame of addiction and gain a life of dignity in recovery.
Actor Rob Lowe humorously shared his ideas and feelings about real living, his 20 year loving marriage, his adored sons, his work as an actor doing the best he can be with the people he most cherishes.  His talk was spiced with anecdotes of childhood friends like Charlie Sheen and even stories of time with Wayne Goreski.  The room was packed full and he received a standing ovation.  A lovely soul and fine human.  His memoirs, Stories I only Tell My Friends, is naturally a best seller.
The very beautiful and chic Randene Neil from Global BC news team hosted the night marvellously  for the fourth time.  Fred Lee from CBC brought his immense enthusiasm and good will with an extra helping of hilarity to his role as Auctioneer.  The much loved Turning Point Recovery Society Executive Director, Brenda Plant spoke of the year's accomplishments, the difficulties of stigma facing those with addiction but the success of opening a new  woman's only home in Richmond. The hope is to open another home this year on the north shore.  Her heartfelt thanks went out to  all.  Randene read lists of dignitaries from Vancouver and Richmond present to the applause of all.  Again this year Finance Minister Falcon was there in great form.  The Fred Lee and Kevin Falcon combo was high wit at its finest.
Westjet tickets to anywhere and back were auctioned. Terrific weekend getaway packages  to Spinnakers in Victoria with whale watching, Tofino's Pacific Sands Beach Resort with Coastal Hotspring Tour, and Whistler Pan Pacific with River Rafting and Ziptreking.  In the silent auction there was a wealth of jewelry, dinners, lunches,  paintings, Canucks Tickets, spa packages, RCMP bomber jackets, all manner of  perfumes and lotion packages and even Canadian Tire contribution of patio sets.  Laura was really pleased that I was able to beat the pack and get her the Mary Kay and Bumble and Bumble Hair Products I knew the girlie girl in her would enjoy.
The Four Seasons meal and service was exquisite.  I loved the fine threads, the ladies most elegant in gowns while the men in suits cleaned up well indeed. I enjoyed the best of company at our Rosemary adorned table, Laura and I sitting with our friends Ganesh, Anita and Darren while tonight I was delighted to make a new friend of globetrotting Jason.  As always I loved to see my friend Malcolm, Bill  and colleague Peter.
This Turning Point Recovery Society  Gala event of the year was spectacular in every way.  IMG 1013IMG 1015IMG 1025IMG 1009IMG 1020IMG 1017IMG 1011

Thursday, April 19, 2012


Wikipedia defines Paranoid as a "thought proces believed to be heavily influenced by anxiety or fear, often to the point of irrationality."
It's as good a definition as any.  Freud stated though that a "man who does not lose his reason over certain things can have no reason to lose" (Freud 1895).
Paranoia is therefore considered a useful developmental 'defence' or 'stage'.  Fear of alieness is self protective. Discrimination is healthy and beneficial to individuals and the species.  Immunology is essentially the biological science of the 'same' and the 'other'.
In psychoanalytic psychiatry Rycroft 1968 describes paranoia as " a functional psychosis characterized by delusions of grandeur and persecution, but without intellectual deterioration. In classic cases of paranoia, the delusions are organized into a coherent internally consistent delusional system on which the patient is prepared to act."
Paranoia is seen in several modern DSMIV-tr diagnosis.
Paranoid Disorder is a specific persecutory delusional state that is relatively fixed.  Patients will say that they believe they are being followed.  They believe people are talking about them. They believe that people are watching them.  What's significant in the grandiosity involved.  A standard question is 'why would they be watching you."  Tied into the paranoia is an inferiority complex with egomania for sure. I remember a cleaning lady who believed the RCMP had invested millions of dollars in watching her, surveillance being a very costly affair.  Addressing this she expressed a sense of wonder but wasn't rational about the obvious discrepancy about her mundane life and the belief that it warranted dozens of men in uniform following her every day.
Paranoid disorders aren't usually associated with hallucinations.  If these are present we consider the diagnosis of Paranoid Schizophrenia instead.
In Paranoid Disorder there's a often a believable thead despite the over the top character of the concern.  A person might have a specific conspiracy theory. In one case a man believed his boss was persecuting him despite his leaving the firm a year before.  Another woman believed her ex husand was spying on her in the bathroom.  A tragic man who had been in a concentration camp believed the nazis were still watching him.
Mostly these people are highly functional and capable unless their paranoid delusional state was addressed. The son of the man who'd survived the concentration camp said his father was fine so long as no one mentioned Nazi's or the news didn't focus on Germany.  If something triggered his delusional state he was convinced the neighbours were spying otherwise he was able to go about work and care of family without much evidence of this very disturbed 'corner' or 'compartment' of his mind.
Paranoid Schizophrenia is more commonly more dispersed and often coupled with hallucinations. Whereas paranoid disorders often remain constant with often poor response to medication, paranoid schizophrenia can respond well to antipsychotics such that the patient will realize and have insight into their previous pre medication insaniety.  With paranoid disorders medications have modified the level of concern but mostly the patients have felt their ideas were true but that perhaps they'd 'reacted poorly'.  'Still it's true what I said.'
Paranoid Personality Disorders are persons who don't have frank delusions or hallucinations but persist in maintaining the idea that they are the subject of persecution.  They see the world in black and white, us against them.  They do well in oppositional parties, cults and marginal church organizations.  These institutions can give them a place to 'associate'. Any group association can generally help to modify these people.  Alone they tend to maximize their bizarre ideas.   More often than not they are loners. These people insist that Jews are controlling the world. If not the Jews it's the Conservative Government of Canada, the Democrats, or the Republcians in the States. Sometimes the identified enemy is anyone that will help maintain the person's paranoid position of one downmanship. The secondary gain in paranoid personality disorders is evidenced in the power that individuals and groups who function as paranoid can bring to their cause.  Indeed media these days is often seen as promoting paranoid personality disorders.  Once drug dealers ravaged America with marijuana smokers and jazz muscians seeking the daughters of the wealthy today it's just terrorists in general.  There's always an element of truth in paranoia and the more discrete the more alluring.
One interesting paranoid disorder is 'pathological jealousy'.  This is the situation where a person will believe everyone is out to get their mate and that their mate is out to betray them with everyone else.   Again there's a combination of inferiority complex and egomania.  There's narcissism and entitlement and often some reason for the concern.
Medications are highly beneficial with paranoid schizophrenia. The original meds for this condition were Chlorpromazine and haldol.  While these medications are still used especially in institutions newer major tranquillizers have been developed with less side effects and greater specificity for the neurochemical deficit.  Dopamine channels are thought to have been overworked, defficient or imparied and the medications restore the brain chemistry to the appropriate balance. Modern research shows that different areas of the brain are 'overfiring' and the inhibitory channels aren't working appropriately.  Untreated modern scans show that the brains of paranoid schizophrenics increasingly lose matter with late stage subjects showing enlarged ventricles and decreased frontal lobe functioning.  Early psychosis units are now the mainstay of treatment with recommendations for early intervention.
A brief psychotic episode lasts weeks to months.  Schizophrenia is definitely diagnosed when a person has a year of delusional thinking especially if this persists despite medication and therapy.
Paranoid disorder is ameliorated with medication.  The newer medications for treatment of paranoia in general are much better tolerated with little or no side effects in the low dosages which are usually most beneficial.  These medications include rispiridone,olanzepine,  seroquel (quitiapine), abilify (aripiprazole) and ziprasidone.  Sometimes patients will need just the least amount of medication whereas others need a much higher dosage. Medication is titrated against an identifiable sympton.  A person who won't go out of the house because they're sure that the devil is going to get them this day may well return to work and activities and church without the extremely persecution on any of the above medications. It's as amazing to see the restoration of function of people tragically brought down by mental illness.  Medications in this sense are like insulin and digitalis in terms of the break throughs and advances they have provided individuals.
Interestingly there is a depressive disorder which is associated with paranoia.  In the above cases paranoid disorders and paranoid schizophrenia and delusional jealousy don't respond to traditional antidepressant medications.  Paranoia as noted is neurochemically seen as related to dopamine receptors whereas depression is most associated with serotonin and noradrenaline receptors.  However in psychotic depression, the particular form of depression associated with paranoia a person can indeed have essentially two overlapping disorders. The treatment is first to treat the depression but to modify depression treatment with the combination of the medications already noted. Abilify works well in this regard but if insomnia is a problem seroquel commonly is coupled with the antidepressant medications for benefit.
Paranoid personality disorders don't respond to medications generally. If they do it's usually the lowest dose of one of the atypical antipsychotics.
I've mentioned medications first because paranoia, even more severe intransigent monosymptomatic delusional disorder where the paranoia is highly specific and highly resistant to change, can respond to medication.  Medications in these group of patients often are the first step in treatment and can often allow a person to overcome their paranoia to enter into some form of therapeutic alliance.
Sadly today given the litiginous society we live in , paranoids are often the prey of unethical lawyers.  Police often have a 'frequent flyer' list of paranoids in the community who commonly call the police for help when they experience delusions.  One of my patients, well known to the police. often wakes in the night convinced that some famous actor has raped her.  She herself is very beautiful and it was a concern initially because she falsely accused a star who indeed was in town making a movie. There was no association and no consequence, the star being a mensch of the first order despite the threat and potential damage.  Shortly thereafter it was recognised that the patient was being raped by men who were clearly not in town and often not on the continet. A classic paranoid disorder medication had a limitted benefit but if she was under stress for any other reason this delusion might resurface despite the medication.  I was thankful that my treatment years back reduced her phone calls to the police from weekly to only a couple of times a year.  As a truly lovely and sophisticated lady she was deeply perplexed by these decreasing episodes and definitely remorseful about her causing trouble.  As a result she was highly compliant with medication and had a very good result last I heard.
Psychotherapies have not been particularly beneficial for paranoid disorders.  I've treated a few with one on one psychoanalytic therapy or cognitive behaviour therapy with the principle concern being, not allowing one to get caught up in the person's delusional system.  Normally the junior doctors do just this.  With paranoids you're the greatest friend as long as you thoroughly agree with them that the Conservative Party of Canada or the CIA or Catholics are malevolent and likely to be out to get this poor persecuted individual.  However once you challenge this premise you are rejected and seen to be part of the conspiracy and in fact more confirm the diagnosis.  Given this many psychopharmacologists limit therapy to focus on the brain disease with far greater benefit than inexperienced therapists who think that by exploring the person's past they will 'solve' the paranoia.  There is often 'trauma' but just addressing the trauma doesn't necessarily resolve paranoid disorders as it might resolve a ptsd or depressive disorder.  R.D. Laing who worked with schizophrenia wrote a book called 'knots'.  It was mostly poetry but the metaphor as it applied to paranoia and for him paranoid schizophrenia is that the knot is very good and very tight.
There is an attempt today with dialectic therapy, a new form of psychotherapy based broadly on the philosophical ideas of Marxism and showing some benefit in the treatment of paranoia. I confess I find this not a bit ironic since Marxism - Lennonism has been seen to be one of the greatest paranoid structures wholly reliant on the evil 'capitalist' . McCarthyism was a similar competing paranoid system.
Group therapy has been beneficial but only in the traditional low level 'supportive' way.  There is alot of 'rage hidden in the paranoia and commonly it is a a person with a quiet form of paranoid disorder that one day goes 'postal'.
My own exposure to an excessive amount of paranoid spectrum disorders is because I work in addictions.  All of the chemical addictions increase paranoid tendencies. The alcoholics are forever persecuted by usually the wife, boyfriend, government or boss or parents.  "If you were married to my wife, you'd drink like me."  There's tremendous self pity and grandiosity as every alcoholic is described as a 'legend in their mind', their depression being the greatest, their suffering monumental.  Alcoholism results in regression of defensive and coping mechanisms to an adolesecent stage with clear cut splitting of 'good guys - those who let me drink, and 'bad guys; , those who interfere with my drinking. All the pathological jealousy I've seen has been associated with alcoholism.  This might well explain the success of soap operas given the plops so often reflect the behaviour of alcoholics.  This indeed made Two and a Half Men a tremendous parody until Charlie Sheen's had his Purple Rose of Cairo meltdown.
Drug abuse is an even more associated with paranoia.  Most often this is directed at authority and specifically the police. A quote attributed to Keith Richards was "I don't have a drug problem, I have a police problem".  So again there's those who are for me and those who are agin me the early adolescent dilemna when the child is first leaving home, rejected parents for friends and struggling to resolve in group and out group association.  Marijuana smokers are especially prone to conspiracy theories.  Ask any marijuana smoker about 9-11 and it's sure to be an adventure in some mix of fantasy and reality.
Cocaine seems more specifically paranoia associated with money.  The 'harder' the drug the more of the frontal lobe or humanity of an indivdual is lost. Cocaine addiction and psychopathy go hand in hand with sex and  money the 'pac man' pursuit of the addict.
In all these cases treating the addiction is the answer.  For most people removing the substance for a year or two allows the persons brain to restore especially if there is a process of mental "decontamination' removing them from the cult paranoid thinking that helps to perpetuate addiction. 12 step communities and religious and ethnic communities and families can counteract the paranoid gang like thinking that goes hand in had with the addiciton.  Dr. Rabbi Twerki's book Addictive Thinking is a marvellous treatise on the negative effects of addiction on thought.  Insight therapies have traditionally proved very unsuccessful with addicts and the development of group therapy and motivational therapy and 12 step faciltation therapies often coupled with spiritual psychiatry approaches is now considered the treatment of choice psychotherapeutically.
Given that addictions are anxiety avoidance techniques and addicts collectively have by nature an underlying anxiety disorder most of the insight therapies and essentially therapies that result in eureka and dynamic realization and change as a consequence of new learning don't work with addicts because change causes anxiety and promotes relapse.  Supportive therapies usually are beneficail in the first three months of therapy when a patient abstinent is detoxing. Anxiety provoking therapies, psychoanalytic, relationship etc are used carefully because of the learning impairment implicit with addiction.  Addicts have rarely been able to grasp quantum changes but can learn more of the same old same old in a clever way.  Historically they were once using therapists consciously or unconsciously like psychopaths do, to improve their game with no real intention of changing.  Therapists who aren't trained in addiction more commonly are 'enablers' and on the street are called the 'addict's bitch'.   Meanwhile the therapist is either feeling warm and fuzzy or thinking of how much money they are making.
Antipsychotic medications are beneficial in the first year of treatment of addicts.
Commonly therapeutically I may agree in part but not in whole with a paranoid so that I don't so easily become caught in their black and white reality.  For example I might say 'The CIA can be concerning" in response to the patient telling me he believes the CIA have planted a chip in his tooth. I certainly wouldn't disagree with him without proof.  I watch NCIS and Insecurity on television so I know what spy agencies are capable. I will focus my attention however on 'why you'.  And what can you do to effectively not be overwhelmed by this fear.
Finally I like to remember, especially when I have my own paranoid moments, that Jesus said, "Do not be afraid."  My minister psychiatrist friend and colleague likes to say, "That wasn't a suggestion. That's a command."


I am thankful for this day.  It began with Angel the cat crawling over my head and then Gilbert the dog licking my face.  I am thankful for such furry cozy loving alarm clocks.  I am thankful that Angel lead me to her food and takes such great delight in manipulating her human. I am really thankful that I am her human.  Gilbert meanwhile went back to sleep, his job of assisting his sister done, and now he would wait for the leash.  I am so thankful that I have these two curious companions.   I am thankful for my friend Laura who was in the bath while I was making coffee and enjoying immensely the aroma and taste of that first cup of coffee. I am thankful for the yoghurt and banana too.  Then I looked at my iphone which I am really thankful for and the friends who post on facebook and twitter and email me.  So I have this moment drinking coffee seeing what my local world of known friends is interested in.  I'm annoyed by the Facebook pigs and worry about missing family posts given the limits of display.  But really I'm very thankful for this communication and the BBC on line which gives me an reasonable headsup to world affairs. Meanwhile Laura is listening to CBC locally. So by the time I'm in the washroom thankful that everything is working we have got the scoop locally, nationally and internationally and learned we really have no excuse not to get dressed.  After a shower I am immensely grateful,  functioning bowel and bladder, and shower are right up there as number ones, well I'm ready to get dressed. This week I'm especially pleased that I got the laundry done and can find clean clothes relatively easily.  Gilbert has his Canucks jersey on. I say he must wear it for luck so the Canucks will win tonight.
Now with Gilbert I go outside and am really thankful for the clean air. I don't much like the rain right now or chill but the air is great. So are the colourful flowers. I'm especially thankful that I can get by with a simple leather jacket and don't have to wear a parka.  And I'm overwhelmingly thankful for my new car. I love the Mazda MX5 sportscar and after putting Gilbert in get on my side and get the top down. Then I'm really thankful for Blue Collar Comedy on Sirius Satellite Radio. I'm thankful for hearing and breathing and heart beating and feeling and the motion in my body and that the pain level is tolerable.  I'm thankful that beautiful Laura joins me and we head off to her work.  I'm grateful to have such a lovely friend.
then I'm really grateful for the parking space and the second cup of coffee. I'm grateful for the work too. I'm grateful for the staff. I'm grateful that I'm able to get through the hundreds of email daily and the calls in addition to the countless demands that make up the work and that I've recorded everything as best I could though I know there are those far removed in ivory towers and Monday morning armchairs who would never think that my recording is good enough. My hand writing is not neat enough and my typing is not all encompassing. And I'm overwhelmed to answer the myriad of in depth questions in so little time.  There is never enough time and I feel like I'm squeezed in a chute going down a dark tunnel with a whole chorus of people shouting at me from every side saying remember me, I'm first, me first, me first, and all the time I'm trying to focus on the person in front of me who sometimes in the past has carried guns and knives and told me that they were going to kill me or have tried to kill themselves.  Complete strangers have walked in off the street making threats. Anonymous phone callers have phoned making threats.  I am afraid of the interactions of these new compounds. I'm hastily looking up and cross references and citing texts and talking. I used ot only listen but the change was so limitted. Now I talk more and people change positively more.  There's a sweet spot between talking and not talking and yet more and more as the medical model is demanded again I'm back to the general practice 'teaching' model and my brain is okay but yours is not. I miss the days when our minds were all that mattered but the economists don't know meaning. We're deluged with self important technicians.  I'm thankful for the lack of surprise today and that I was of use I hope to many. I'm glad I could be a cog in a great wheel. i am thankful for doing my part in the busyness of the multidimensional glass beed game that today's psychiatry is. At times I even felt like I was playing three dimensional chess again but I must restrict myself to unidimensional chess. My colleague who retired writes of resurrecting people and we know how dangerous that is.  I'm thankful for the anonymity.  I'm thankful for the mystery. I'm thankful for the colleagues. I'm thankful for the internet and wikipedia and the books in my office and the programs and all the learning that I've been so blessed to be apart of. I'm deeply thankful for my teachers, those ones who gave me such positive lessons and those one whose lesson was to teach me what not to do.
I'm thankful for my fingers.
I'm thankful for the close of day. I'm thankful for my dog. I'm thankful for driving home in a new car. I'm thankful I'm not on the motorcycle in this rain. I'm thankful that parking was so easy when I stopped at the store. I'm thankful for the delis in grocery stores. I'm thankful tonight for IGA. I'm thankful for the cellphone so that I could notify Laura that' I'd pick up dinner for us.  I'm thankfu for the great meal and the joy and fun of sharing barbecued chilcken with two cats and a dog, all of us nibbling togehter.  I'm thankful for the chicken tradition and the pets.  I'm thankful for my family. I've thought of them fondly through the day, cousins, nephews, brother, in laws, dad.  I'm thankful the Canucks won. I'm thankful for televison. I'm thankful for Cherry Garcia ice cream.  I'm thankful for this routine day, this relatively uneventful day.  I'm thankful for tradition and routine and the novel and amusing.
I'm thankful for this bed . I'm thankful for sleep and dreams.  I dreamed last night I was shooting a monstrous bear that was attacking me. I was using the small guage 30 30 that I crushed under the flipping ATV. I guess I probably incorporated the time the bear did attack me and I was shooting it repeatedly in the back as it came to within inches and feet of me but veered off to go up the tree where my last shot killed it.  When I skinned and butchered it I found my bullets had gone through the heart , both lungs and liver, guts and spleen and one hip.  It had fallen from the tree when I'd severed its spine.  It'd put a clip into it at close range and changed out the clip to shoot the final shots at it up the tree.  My 3006 rifle was touching fur in the final shots of the charge. A medium black bear.  In my dream the bear was monstrous and the 30 30 shells were having little effect yet I was backed up by afriend with a pistol and the bear didn't maul the person it was chasing who ran by me.  Odd dream.
It is bear season. This time last year I was climbing mountains and shooting over the heads of bear who lived to tell the day wary now of men with cockapoo dogs at their sides.
Iam thankful for the outdoors and nature, hunting and fishing, hiking and wilderness. I am thankful for this day. Thank you God for this day. Thank you.

Wednesday, April 18, 2012

Professionalism and Medical Social Engagement

Jack Coulehan, Peter C Williams, S. Van McCrary, and Catherine Belling in the Cambridge Quarterly of Healthcare Ethics, 2003 12 21-38,  article, "The Best Lack All Conviction: Biomedical Ethics, Professionalism and Social Responsibility" do a superb job of discussing "Professionalism and Social Engagement".  As a clinician I truly admire the way they summarize the issues clearly.
They begin by asking "Are altruism and social activism appropriate topics for medical education to address/"  While saying we 'admire' doctors who 'work in free clinics' or 'engage in public policy debates" but, "do these activities make them better doctors or simply better people?
I have had to reflect on this alot in my life because it's my personal experience that I have been penalized routinely for putting patients concerns first and "rocking the boat' or 'swimming upstream' against individual and institutional graft and corruption.
I was indeed told that my membership in Physicians for Social Responsibility and my days as a card carrying member of the Canadian Civil Liberties Association was considered a 'fault' in a psychiatrist.  While I was reading Jay Lifton, MD's books, including "Nazi Doctors',  my colleagues who went onto increased power and position were studying "business administration" and reading 'financial columns."
I began a dual speciality in Community Medicine and Psychiatry where at the time the furthest extremes of equation public and private were represented by both faculties. The Community Medicine faculty taught me public health concerns and I even wrote a paper on Psychiatry and Social Responsibility in the 80's in the Canadian journal, seeing it back paged. I wrote responses to medicare decisions in the provincial journals and was actively involved in medicine and politics.
In comparison one colleague saw roughly 50 patients for 30 years having a coffee clutch weekly with these loyal patients.  I saw thousands in comparison and worked on the toughest 'assignments'.  I am usually uttterly exhausted by the end of any clinical day.  I certainly haven't time left over for the constant beaurocratic in fighting and back scratching.
New patients are the greatest risk of complaint.  A 'stable' is never a threat.  My colleague who 'gives patients what they want' has a loyal following. Popularity is their calling.  Rate your doctor has their name as 5 star.  They cherry pick patients and had been seeing their friends only for decades.  They sat on committees and served in the main stream high profile positions.  They had energy for these functions where they ensured that the greatest funding and support went to doctors of like mind.  In the end they had 'position power'.  They never 'rocked the boat' and they never challenged the authorities.
Social responsibility is a precarious position.
I think back to a half dozen complaints I had to the College of Physicians and Surgeons and the most vociferously complaining patients on rate your doctor.  These complaints have been specifically to do with my diagnosis and addressing addictions. While in my psychiatric residency I worked in the Winnipeg Detox.  I fear I was the only psychiatrist who did that, certainly the only one I knew while I was there.  When I came to BC I just naturally continued to diagnose alcoholism and substance dependence according to DSMIV criteria, using AUDIT and CAGE screening tests when available.  Alcoholism and substance abuse disorders were simply rarely diagnosed. The standing joke in the 80's was that you didn't have an alcoholism problem unless you drank more than your doctor.
I have seen patients that other colleagues have 'colluded with' and said they did not have 'alcoholism'.  No clinician would question a list of DUI's and liver disease etc as evidenced based diagnosis but I would invariably be the first to make the "diagnosis" despite dozens of doctors seeing the patients. The patients would be outraged,
The consequences of my doing my 'job' of diagnosing 'alcohol dependence", "cocaine abuse' and other DSMIV Axis I diagnosis has been that my life has been threatened repeatedly, my windows shot out, beer bottles smashed against my windshield, cases of empties thrown at my house, my dog killed.  It would have been professional and socially responsible for my colleagues to have made the correct diagnosis but 'at what cost.'
The consequence of a diagnosis of 'addiction' was that people who were working in safety sensitive areas and were causing accidents in the work place would be 'required' to 'undergo' treatment for the addiction.However if they could get a psychaitrist to say that they were 'depressed' rather than having a 'concurrent diagnosis' they could avoid the  consequence of their actions.  Indeed if they could get a psychaitrist to tell them their mother's lack of breast feeding necessitated their drinking at the age of 50, even better.
The cost of doing the 'right thing' being the 'socially responsible' doctor, is that I have lost at least a quarter million dollars  in real money and time.  I've lost personal time to pursue my own research interests.  Instead of addressing issues of 2012 I'm mired in dealing with what was proven true and beneficial 20 years ago.  Indeed in general psychiatry circles I am surrounded by proponents of 'better living through chemistry' and considered too 'conservative' when it comes to addiction matters.  Social activism is only 'hip' if it's left wing and pro pot smoking.
The politics of medicine favour those who make the most money in the practice of medicine.  Making the most money is based on doing the old technologies and old standards of approach.  The reformer is an enemy of anyone who benefits from the status quo.
All my pro bono work in a variety of areas has in no way benefitted me in the 'hierarchy' of medicine.  Indeed I've heard colleagues contend that if I'm doing these things for free then they are without value.  When doctors have attempted to get paid for all their many hours of 'free' work people collectively become obscenely offended yet would never expect anyone else to work overtime, be on call, or work without pay.  The deeply shameful government year in and year out published the 'gross earnings' of doctors who routinely paid tens of thousands of dollars in training and started earning 10 to 15 years later and died routinely 10 years younger and worked on average 120 hours, the equivalent of 3 government jobs, yet were compensated at a penance of their worth.  When people complain of the 'nationalization' of mines and copywright theft and fixed housing income and interference in private business, I just reflect that I have worked my entire life with a ceiling, and supported government services up the ying yang through taxes and my doing the core clinical work which is what causes the overall health care services to be supported. There is no health care services without doctors but administrators and planners and beaurocrats galore ride on the shirt tails of the work of physicians, work that is commonly donated free. So every time I did 'motivational therapy' regarding quitting smoking going back
Now I'm at the end of my career and if the life expectancy of the doctors I started is anything to speak too, perhaps my life, due to stress and overwork and lack of resources or support.  So many of my colleagues I worked with in early years died in their 60's, and then there were those friends who died young from diseases the caught in their work.  Every doctor I know except some administrative government types and a few for profit only doctors generally does pro bono work.  Even in the 'bad' United States it was standard for doctors to donate their time to the indigent hospitals.  If I were paid in my office today for all the work that I do I'd be a millionaire many times over.  Looking at the fee schedules with a colleague recently we laughed at how the 'bean counters' have set it up so that hospital doctors with accounting departments can ensure that ever cent owed is collected whereas in community medicine and psychiatry bad debt in the name of the game.  I've lost 20$ of my income in uncollected fees in a bad year, 10% in a good year.  When I had a psychopathic staff person steal from me her criminal behaviour was never addressed by police or government.  The doctor is routinely treated as the 'bad' person with all those poor people who are suffering and yet it's so forgotten that doctors are patients too.
I don't get breaks financially.  I don't have people doing things for free for me.  Instead my life has been that people in business learn I'm a doctor and I am double charged even though a doctor saved their baby's life. There's a great lie in business that business people are 'big hearted' . They're not. The rich are rich by not losing money.  Yet we know the standard joke is to invest where doctors are not.  Because doctors collectively are giving it away.
So despite being reasonably re imbursed, not at all in the league of health care administrators when their time off, holidays, lunches, perks, coffees, pensions, plans and everything is truly factored in, we're still working for free alot for the sake of patients. We're covering the indigent. We're all doing our best for children and commonly women and the old.  We're staying late at bed sides and we're really caring.  But when doctors go on salary oddly they work like normal people and the whole system simply cannot afford salaried doctors here.  Salary commonly brings out the 'union' 'work to rule' ideation. Maybe it works elsewhere. Maybe it could work.  The difficulty in the field is that there are those who are communists and those who are capitalists. The socialists sit in between somewhere and mostly we thrive in a mixed economy.  My favourite cosmetic surgeon donated time to the burn clinic. He made his money on nips and tucks and could enjoy restoring children's faces after devastating burns.  The standard medical service payment couldn't pay anything near his fees and any businessman wouldn't work in the low end of the scale with the burn patients. Yet most plastic surgeons I know do just this.  Even the dermatologists, another high paying group who could all be rich overnight if they just stuck to botox instead serve in indigent communities.  It's normal to see this.

So this article definitely wet my whistle.  The AMA recommended 'each physician has an obligation to share in providing care to the indigent".

The authors of this article while raising the question and discussing it conclude
"In summary, it is fair to say that there is a long tradition of social responsibility in the medical profession."

Tuesday, April 17, 2012

Port Angeles

I was surprised at how big Port Angeles was.  I certainly wasn't expecting a half dozen car dealerships or the large Walmart.  I'd driven Laura and Gilbert down from Vancouver BC in my new Mazda Miata sportscar.  Northern Washington is just the best place to drive this time of year.  I love the road ways.  We'd already explored the winding back country roads on my Harley Electraglide motorcycle years gone by. Now were really enjoying them in the new sportscar.  Glorious sunshine after a winter of rain.
The ferry to Port Townsend from Whidby Island lasted less than half an hour but it's advised that one reserve.  We didn't either way and got on without difficulties but then it's early season.  We loved Port Townsend, Fort Worden and the Point Wilson Light House.
Port Angeles is only an hour drive west on the I20. Great road.  People drive up from Seattle and don't have to take the ferry. Which explained the numerous RV parks which looked really inviting. It's about 2 hours from Seattle.
I'd once come to Port Angeles in my 40 foot sailboat, SV GIRI,  some 20 years past. I couldn't recognise the town but immediately remembered the well sheltered port. Looking at the harbour I really wanted to sail back here again. We looked across Juan de Fuca Strait at Vancouver Island.    I think I could just see the city of Victoria in the distant haze.  I recollected all the sailing adventures I'd had starting or returning through the Juan de Fuca Strait.  North it becomes the Strait of Georgia and that's where my home sailing is. But Juan de Fuca has been the departure point for heading to Mexico or crossing the Pacific to Hawaii. I fondly remember returns from circumnavigating Vancouver Island or just travelling out to the exquisitely beautiful Barkley Sound and back.  There have been storms too and I believe it was to avoid one that I came into Port Angeles that time years ago.
Port Angeles is famous also for the week long month of May, "Esprit Gala". This is an annual cross dressers, transvestite, transgendered convention that has attracted hundreds. The very old and discrete Cornbury Society of Vancouver has been recommending Esprit for many years.  It's really quite the institution.  Shopping forays, lectures on make up, hair stylists, dinners and even a ball gown event, for those who wish to go formal, is hosted, according to advertisements. Again I'd never have thought of Port Angeles, ostensibly an outdoors coastal logging community,  as so sophisticated to host such a cosmopolitan event.    Monty Python had done a sketch about loggers in frocks but that was when Benny Hill and his gang were still in the closet.  We'd been laughing on the ride here listening to Izzie Edwards the cross dressing English comedian on Sirius Satellite Radio Blue Collar Comedy.
I was impressed looking at all the boutiques downtown.  Quite the range of restaurants, foods, ethnic choices, and quaint shops.  A couple of prominent lingerie shops too.  Two smoke shops which caught both Laura and my eye given the indeceny of tobacco these days.  The head shops seems less offensive these days when one considers the obscenity of lung cancer and cigarette addiction.
Looking in the brochures for the region it turned out both Port Townsend and Port Angeles are major centres for all manner of conventions. Both attract alot of eco tourism but a wide range of businesses choose these towns for their meetings. I'm not surprised. The towns have so much to offer and the surrounding environment is so inviting for all manner of outdoor activities.  Culture and logging. Who would have guessed. Yet that's surely what Port Angeles is about. Nightclubs and fishing boats too.  Everyone was friendly. Gilbert enjoyed the walks and pee breaks.
We didn't have time to stay. It was a destination for a drive. We had to be back in Vancouver that night.  I enjoyed the expresso drive through too.  The Miata was a joy too. Sirious Radio comedy channel, opera or symphony with just the occasional blue grass driving through the corridors of trees. Beautiful farms, great vistas of forest and water.  Cows, horses, sheep and apacas.  I loved the drive.  Gilbert loved the chances to run on the beach.  Laura enjoyed the sunshine and sightseeing.
Looking at the pictures I took. I have some of the spit and harbour.  It figures being a sailor.  But I've only a couple in the town. Tourism is about seeing what catches your own eye.  I happened to enjoy taking a picture of a bumblebee outside the native art pitstop where Gilbert piddled and we enjoy the native art.  Nearby there was  busy bustling casinoDSCN0385DSCN0387DSCN0401DSCN0402DSCN0391DSCN0392DSCN0395DSCN0393DSCN0398DSCN0390

Point Wilson Coast Guard Light

Just outside Port Townsend is this marvellous old coast guard station. There are terrific RV and campgrounds near by and picnic areas. The attraction though is the wild and wonderful beaches that go for miles. Orcas pass in the channel. We saw them.  Eagles soar above. Black tail deer walk about in the nearby woods. it's a mystical place.  A place that makes me want to bring and easel rather than a camera.  it deserves a whole lot more.  But we had places to go and people to meet.DSCN0366DSCN0367DSCN0364DSCN0381DSCN0377

Fort Worden State National Park

We decided to drive down to Port Townsend just for a drive. I had a new 2011 Mazda Miata sportscar and was glad for any destination near Vancouver.  The Victorian buildings of Port Townsend attracted me.  We loved the town with the great shops like the Wandering Angus full of Celtic Treasures. Then we found the Fort Warden State National Park.  We drove around the buildings snapping pictures and catching a shot of a couple of dear on the commons.  It was an idealic place to bring my RV and certainly great for just plain camping. Gilbert loved the beach.  It's truly beautiful countryside.  The monuments were well maintained. I loved Alexander's Castle.  The grounds are huge with countless buildings.  Must have once housed thousands. DSCN0359 An old army fort that had served for the Korean War but been de commissioned some 50 years.  Museums there and Water and Science museums nearby. We didn't have the time or inclination this trip to explore indoors. The sun was spectacular after a long wet winter.  Beautiful place though. Rich in history.  A young woman recommended it to us on the ferry.  I saw an old man I took to be a vet looking for  his youth .DSCN0370DSCN0360DSCN0376DSCN0368DSCN0369DSCN0363