Sunday, 10 December 2017

Winter Vacations !

Wanta Winter Vacation Eh??

We’re thinking about our winter vacation again.  We had an interesting and enjoyable vacation last year but it doesn't always work out quite as one expects.  Only a few years ago we had a somewhat different story.   We like to drive   No worries about what you can take and what you have to leave at home.  I remember taking my entire painting kit on a vacation which was to establish me as a great artist.  (I never actually opened it but still, I might have.)  The removal of the necessity to deny to one’s spouse the space to take along those items that cannot possibly fit in to a single suitcase, most of which seem vital, notwithstanding the fact that they may never be actually worn, almost guarantees a successful holiday.  I should add that taking along my own electronic toys totally allays the boredom of shopping as I scan the areas around ladies apparel vendors my better half is exploring for free wi-fi internet connections.  I am no longer the miserable curmudgeon that I once was when I had to wait too long. 
So we started rounding up the paraphernalia that the luxury of traveling by car allows.  I placed my extra-large Eddie Bauer hold - all in the middle of the basement floor, about two months ahead of departure time and threw everything I could possibly need into it long in advance so that I couldn’t forget anything.   The credit cards were packed and the traveler’s cheques were purchased. I was feeling confident that I had taken care of everything.  Now I could relax and just wait until it was time to load up the car.
        It was the Saturday prior to our departure, all our bills were prepaid, the appropriate credit cards were sitting on my desk with my Health Care Card, auto insurance and every other document I could possibly need.  Time, I thought, to pack all these vital papers in the special Samsonite organizer I had bought in the days before I was fully organized.  It even had a special compartment for holding our passports.  As I packed our various documents into it, on that cold Saturday at the end of January, I contemplated the delightful, warm, sunny February we would find in Naples, Florida.  For some reason I flipped our passports out of the wallet to take a quick look at them.   Ohmigod!  Horror of horrors.  The expiry date was the middle of February and we weren’t getting back until the beginning of March.
“Irene, get ready, we have to go and have passport photos taken.  Our passports expire on Valentines Day.  I don’t know if we’ll be able to go as planned, but if we get our photos taken today and I go down to the passport office on Monday morning, maybe we can get an express passport renewal in time to leave on Wednesday as planned, though I’m not too hopeful.  At least I hope that we won’t have to delay our departure by too long.”
She didn’t even call me an idiot or give me a hard time. 
         “Okay,” she said, “I’ll get ready as fast as I can.”
The Clerk at Black’s Photography emphasized that we must not smile or show our teeth.
“If even a tiny amount of white shows the picture is not acceptable.”
I assured her we would have no difficulty whatsoever in not smiling.
I went on line as soon as I got home.  The government web site covered it all.  I learned more than I ever needed or wanted to know about passports, including the fact that it takes about four weeks to get one.  I also learned from the US site that a passport should be at least six months from expiry to gain entry into the US.  The only glimmer of hope from my research was the discovery that there is a new expedited pathway for passport renewal for Canadians, and for an additional fee there is also an express route.   
I was at the passport office before they opened on Monday morning and after appropriate begging and groveling was promised a renewed passport for Irene and me for a mere additional thirty dollars apiece. The clerk was really nice because when she informed me that a piece of white tooth showing make the passport photo unacceptable and I looked as though I  was going to break down, she pulled out a black marker and eliminated the white spot, while informing me this was our secret as she could get into serious trouble for altering an official document!   There are still some kind people around!
I had scheduled a major pre-safari servicing of my trusty Honda Accord.  You know, a “check the steering, check the breaks, check everything, replace everything, damn the expense, our lives may depend on it, type of overhaul.  Especially check the brakes, I cautioned them, because the brake light seems o come on occasionally.   When I picked it up they reassured me that this car was indestructible. 
We departed on Wednesday after picking up our brand new passports only a few hours behind schedule.  We had a delightfully uneventful drive to Naples, avoiding even the mildest vicissitudes of weather and as we cruised into Naples and our rented condo, I remarked to Irene, “Hey, a Honda Dealership just a few blocks from where we’re staying, at least we know where to go if we ever have car problems.”  I laughed at that ridiculous prospect.
We found our condo to be delightful and after picking up some grocery essentials settled in to organize ourselves.  The next morning was rather cool and overcast so we took a trip out to the Outlet Mall, one of those magnificent plazas, that shoppers get so excited about, where manufacturers get rid of all the garbage that they can’t sell anywhere else.  I had a few things I wanted to buy – like another few long sleeved shirts, that I had a feeling that I was going to need.  After that I settled into my car, as it became increasingly overcast, to read a good book that I’d found in the condo the night before.   I also set up my computer and iPod in case my stay became prolonged.   It didn’t and we started home just before the rain came pelting down. 
“You know,” I said to Irene, “the brakes seem a little soft and spongy.  I’m really glad I had them checked out thoroughly and new brake shoes put on the back.  I guess this whole Toyota brake disaster (remember?) is making me a little anxious.”
“It might just be from the all the rain and moisture,” she said, as the rain poured down and I turned up the wind-screen wipers to top speed in an effort to see which way the freeway was going.  We made our exit and arrived home a few minutes later.
“I hope these brakes are okay” said I.
When I got up next morning I knew that I must have been letting my imagination run away with itself, with the Toyota disaster and all.  Just for the hell of it I would test the car around the condo complex.  I got in the car, started it up and to my horror the brakes pedal hit the floor before the car braked.  It did stop, however, and I decided after some consideration that it would probably be safe to drive to the Honda dealership, which I know was only a couple of miles away.   So Irene and I got into the car and drove to Honda. 
 I drove into the service lane and was greeted by a young man whom I told I had no brakes.     
         “You’ve got no brakes,” he told me sternly, after checking out the car.
 I felt appropriately guilty.
“I’ll have to get Tony, the service manager to take a look at this.”
It sounded pretty serious to me, and I hoped Tony was a nice guy.  He was.
“Hi, I’m Tony Capobianco,” he said, “I hear you’re having a problem with the brakes?”
“Yes, don’t seem to have any!” I said.
“That ain’t good,” said Tony, who was a grey haired grandfatherly fellow like myself.  “I gotta take a while to assess the extent of the damage.  We’ll drive you home; I’ll call you later and let you know the damage,”
He did call me a couple of hours later.  It seems that the right rear brake caliper developed a leak and required replacing.  That, of course, automatically meant that the system needed to be flushed out.  It would only cost about $500. That was the good news.  The bad news was that they didn’t have a brake calipers in stock and it would take a couple of days to get one.
“Have you got a loner?  I’m a prisoner here without a car.”
“Sorry, we haven’t,” Tony said sympathetically, but we do have an arrangement with Hertz, They’ll let you have a car for a flat $30 a day while your car is being repaired.
           To cut a long story short I phone Hertz, they have nothing available because they have pulled all the Toyotas off their fleet until the brake debacle is resolved.  They laugh at me for suggesting thirty dollars a day.   I phone Tony back.
“What? I’ll phone you back in a few minutes,”
He does phone back in a few minutes.  “Call the local office and ask for Dan, tell him that Tony told you to call.” 
I did.  Dan was duly impressed.  “Sure, we’ll pick you up in a few minutes.  Thirty bucks a day, sure.  What sort of car would you like?”   
Tony obviously does have clout!
          When I called to pick up my own car, Tony said, “this is a lot of money, I’m going to give you ten per cent off.”  I hadn’t even asked!
          “Thanks, Tony,”   He didn’t have to give me the ten percent, whether or not it was previously added on.  I sort of liked Tony.
          So much for the beginning of our vacation.  The cold Florida weather was sure to warm up soon.  Things could only get better - and they did.
          By the way, when I got home  Honda issued me a cheque, without a whimper, for the brakes repairs, once I showed them the work order with the request to pay particular attention to checking the brakes!
           It's these little Gordian knots that make a vacation so fascinating in retrospect!


Sunday, 3 December 2017

Mickey and Archie Bunker.

    Nowadays, when I get news of a erstwhile friend whom I haven't seen for for a long while it tends to fall  into the obit classification.  If I don't read it in the  obituary column, the main focus of my thumbing through the Canadian Medical Association Journal or the Canadian Family Physician (mainly to make sure that I'm not there) it's from a mutual acquaintance I chance to run into.  While we are swapping yarns in the grocery store, or more likely, the liquor store about who had the most coronary artery grafts or the most successful stents, some name comes up of one of our colleagues who has recently gone to the Great Clinic in the Sky.  The other day, I heard about an old friend, we'll just call  him Mickey.
    I first got to know Mickey when we were in school in  Ireland.  He was a few years ahead of me, a short, stocky kid , from a not very affluent family, in fact by present standards, from a poor family.   He was a bright kid with a great Irish sense of humour and was friendly with a cousin of  mine who was three years older than I.  Somehow, almost miraculously, he managed to get to medical school, not an easy task for a poor boy in those days.  How that came about is a story in itself, not the one I am recounting today.  Occasionally, I bumped into him in medical school, he was several years ahead of me. The last thing I heard about him while I was still in Med School was that he had emigrated to Canada.
    Years later, I ended  up in Saskatchewan myself.  As the years went by and I was on a number of  national medical  committees that met in various cities, I would get messages from colleagues like, "Hey, you just missed Mickey, he's from Dublin too and he mentioned he knew you."   Mickey, it turned out, lived in London, Ontario and was on the faculty at the University of Western Ontario.  We always seemed to just miss each other at National meetings of one sort and another.
    Long story short, after years in  Regina and Saskatoon, our family moved to London, On.  Not long after settling in, I attended a refresher course in the city.  As I ambled around during the lunch hour break, I noticed a woman following me around.  She seemed to be looking at me in a strange way.  In those days it seemed quite appropriate to say,
   "Hey, you seem to be following me around.  Do we know each other?"
    She said, "Actually, I was trying to read your name badge."
    She glanced down at it.  "Stan Smith?"
    "From Dublin?"
    "My  husband asked me to look out for you! He's from Dublin, too."
    So we exchanged phone numbers and a few days later we had a call from Mickey to invite us over for  dinner.  It transpired that Mickey had that great Irish story telling talent  as well as a cultivated palate when it came to Irish and Scotch whiskeys.  The two blended delightfully and made listening to his stories entertaining.
    After dinner, we were discussing the sad decline of television entertainment and I happened to mention one of my all time favorites, 'All in the Family', starring Carroll O'Connor as Archie Bunker.
   "You know, Carroll O'Connor's brother studied medicine in Dublin and was in the same class as I was,"  he said, "we had many a pint in Davy Byrnes (A famous Irish Pub) at 21 Duke St."  There such literary icons as James Joyce had been frequent visitors and the fictional Leopold Bloom of Ulysses fame often  dropped in for a 'jar'. I knew it well and as a student used to go there once in a while when I could afford to and look out for some of the Irish literary crowd who used to  hang around there, so I could take a few gulps of culture while I sipped my beer.
    Mickey continued, "Carroll came to Ireland  with his wife to join his brother and study English  and drama.  He worked in the famous Gate Theatre after having been 'discovered' in a National University Drama production.  Then  he went back to New York and bit parts until he was really discovered.   Before he left he gave me his family's home phone number and he made me promise that if I was ever in  New York I would look him up and I did.   That's how several years later when I was in New York I phoned the number and got his mother.  Carroll, she explained to me, was in Los Angeles for a part in a series. Where was I staying, she wanted to know and when  I told her, she said, 'you get out of that cheap hotel and get  into a taxi and come right over here and stay for as long as you like.'  So I did and that's how I got to know Carroll's mother better than I knew him!"
   Looks like all the folks I knew who'd kissed the Blarney Stone are shuffling off!
   R.I.P. Mickey.

Sunday, 26 November 2017

Health Care System is bleeding a lot faster than my Nose!! .

Wasting resources for a bleeding nose.
   A number of  years ago I had a series of nose bleeds.  I tend to take such events more seriously than I  might otherwise do, because I am on anti-coagulants (blood thinners).  It's not that the nose bleeds were severe, but with waiting times, between seeing my doctor and then being referred to an ENT specialist a fair amount of time passed between the initial incident and the specialist diagnosing and removing a small benign lesion to cure the problem.  Should I have any further episodes in the future I  was to come back.  Had I not been a physician and able to monitor my own anti-coagulant levels and adjust my own medications I anticipate that there would have been at least another three visits to my family doctor and perhaps even a couple of visits to the teeming overcrowded emergency room, to spend a few hours waiting to be seen and have the appropriate tests, etc.  Instead of one visit to the family doc and a timely referral to a specialist, our bleeding health care system generates multiple physician and lab visits, which  is not only expensive, but bad medicine.
   So, when I had a couple of very minor nose bleeds recently, I wasted no time.  Since our health care system requires  a new referral and the wait times are so lengthy I decided I  had to strike pre-emptively despite the fact that when I  had my blood test it was satisfactory.  While in an efficiently functioning health care system I would have been quite satisfied to wait and monitor my progress, knowing if I has a  serious nose bleed I could be seen by the specialist - in the emergency room, if necessary,  I know that in our system I would be seen by a medical resident and receive emergency treatment, usually after a lengthy wait and then had a consultation request for ENT which could well have taken months.   Instead, I made an appointment to see my friendly family physician and because the system wastes her time as well as mine, I had her review the three year old letter from ENT saying that they would like to see me again if there was any further epistaxis (nose-bleeds).  She obliged and now I have an appointment being set up, in case I need it.  In the meantime I have had no further nose-bleeds, but my doctor told me to go to emergency if I  do!!  It's a shame we have to work the health care system that way.
   The health care system is bleeding a lot faster than my nose!!

Saturday, 18 November 2017

Opioids -damage control in a nation of victims.

   "Something," think the social warriors, "must be responsible for the lethal epidemic of opioid addiction (and almost every other form of addiction).  God knows, those suffering from every physical and mental pain that the human flesh is subject to, could not be to blame.  In fact, when it comes down to it, they must be the victims.  It must be the fault of those bloody rich, privileged physicians, brainwashed and bribed by the drug companies, that put patients on whatever medication will get them out of the office as quickly as possible."
   You may think I  am being flippant, but that's exactly what many folks think and are encouraged to think, by our elected leaders and their bureaucrats, in order to divert blame from  themselves.   It does not occur to them, or bother them that patients who are awaiting surgery for an excruciatingly painful hip or back,or whatever, are suffering during a deliberate two year waiting list and need serious relief from  their pain.   That the mild to moderate analgesics that their physicians start them on become less effective after a while and physicians are forced to titrate their patients pain with the most effective medications that are available to relieve it.   It does not occur to patients that the very lengthy waiting lists is a deliberate policy by their elected representatives to cut the health care budget under the pretense that it is due to a shortage of physicians and nurse.  It is not, it  is due to misallocation of funds that results in surgeons unable to get operating room time, despite empty operating rooms and nurses being unemployed.   They certainly don't consider Canadians first in allocating tax dollars, so we see the ridiculous payouts to terrorists and others to whom they dispense huge sums that would be available to treat our failing health care system.   They continue to  generate layer after layer of  administridiots,  who convince themselves that they are the health care providers and that doctors and nurses are simply their serf technicians That is why we, in Canada, are at the bottom of  the list in quality of health care, in almost every category, compared to other developed nations.  When physicians and nurses ran the health care services we were near the top.  
   When  patients are in  pain, physicians and nurses will do almost anything in their power to relieve pain  and  suffering.   So, a patient who is on a two year waiting  list and visiting their physician regularly, complaining quite justifiably of constant disabling pain, expects to have their pain relieved.  The administridiot, who never comes face to face with the patient, and is oblivious to the patient's suffering suggests that physician's cavalierly dispense narcotics to get the patient out of  his office or for financial gain.   No, the physician sitting across from the patient is trying to help the patient, to relieve his pain.  He/she tries to do this without addicting the patient to pain relieving drugs and sometimes this is interpreted as callousness, or indifference to patient suffering.  The College interpreted such complaints, whether justified or not as an 'under-prescription crisis' and instead of meticulously investigating and researching the situation began to 'educate' physicians to prescribe narcotics much more liberally, often assuming that addiction was rare in people who were prescribed narcotics liberally for the relief of pain.  Meanwhile opioid poisoning lands sixteen patients in hospital each day in Canada and there has been a 15% jump in the past ten years.  The administridiots continue to place the blame for this on physician prescribing habits and sometimes this is true and partly as a result of a concerted effort of educational organizations a few years ago that were encouraging physicians to prescribe narcotics very liberally to relieve non-cancer pain.  The results were disastrous, ranking Canada second only to the United States in opioid abuse.  In an attempt to correct the damage the Royal College of Physicians and Surgeons of Canada published the " 2017 Canadian Opioid Prescribing Guideline", a document so prosaic that a final year medical student could have written it.
   Meanwhile, what is the government of Canada doing?  Well, the Minister of  Health is planning to hold meetings on allowing different drugs such as heroin to be administered outside of  hospital settings: she plans to allow drug checking services at all authorized supervised consumption sites: she want the provinces to establish temporary overdose prevention sites. None of which is  likely to have much effect.
   In fact, there are some who recommend the decriminalization of all illicit narcotic use.
   Unfortunately, we are unlikely to make much progress in this area while the administridiots are making medical decisions that they are unfit to make.  The obvious first step is to rely on experienced health care professionals to develop whatever solutions may be available.
   Making marijuana and other drugs available for recreational purposes is going to compound the problem, not alleviate it.

Comment if you have any views on  this.

Wednesday, 8 November 2017

Marijuana - Damage control.

   The lunacy of legalized recreational marijuana is almost upon us.  Reality forces us to accept that that is what a sizeable proportion of the public want and that is what the government want.  The public want it to help them to feel good, to  help them believe a host of things that are difficult to  believe, without a euphoric stimulant.  The government has more realistic goals.  First and foremost is the cash grab that drives pushers to push, second is the votes it wins them and third is the advantages they derive by keeping as much of the public as they can dumbed down.  Not to mention that many of  the 'elites' are consummate drug users themselves.
   One of the major concerns voiced at many levels has been the concern that road safety will deteriorate and the difficulty in discerning the degree of driver impairment in suspected cases of marijuana related accidents, will make offenders difficult to identify.  There is some good news for those with such concerns.  A company named Cannabix Technologies Inc., has developed marijuana breathalyzer technology and has filed several patents related to breathalyzer analysis for law enforcement and the workplace.  Some of the devices are for a marijuana ignition interlock device.  A marijuana Ignition Interlock Device ('IID') requires a driver to blow into a device installed in the car. The driver has to blow into the analyzer to confirm that he is not so loaded with marijuana that he is unfit to drive.  If he is so loaded that he is unfit to drive, the vehicle will  not start.   With regard to alcohol, an IID has been a requirement for drivers convicted of driving under the influence of alcohol or drugs for some time. Some families are voluntarily choosing to install  Ignition Interlock Systems in their vehicles as a precaution against  family members or friends driving under the influence. In our climate, a stabilizing component that is consistent in cold as well as humid  temperatures has been tested and seems to work well.
   Cannabix Technologies seems to be developing the technology to enable law enforcement agencies and workplace safety organizations to monitor traffic and workplace drug abuse.
   May they succeed in their efforts for everyone's sake.

Saturday, 4 November 2017

Patients and Friends..

Patients and friends.

  The son of a very old friend sent my wife and me a beautiful memorial card he had printed in tribute to his mother, which incorporated postage stamp photographs of her at key periods in her life. His mother was one of the first patients I had in Canada when I started medical practice in 1963. She didn't actually choose me as her doctor. I was a new doctor in a large clinic and the busy established physicians used to offload patients to the 'new boys' to lessen their own burden. If the patients liked you they tended to stay with you because you were available. Thus were medical practices built in those days. Tweelee (that wasn't her real name, but the one she liked to be called by) became my patient and soon she and her husband became close friends with my wife and me. A life-long relationship that only death could end.
    The cover photograph was a beautifully composed picture of her, probably in her mid-eighties, sitting upright on a beautiful period couch, slight smile on her face, looking for all the world like a duchess from a previous century. Indeed, she so fit into that model of a duchess, that years earlier I liked to tease her by addressing her as 'Duchess'. I think she liked that.
    She was a remarkable woman. Born in Burma in the early part of the Twentieth Century, her father was in the British Military and her mother was a Burmese Karen, (Sino-Tibetan). She was one of the few Eurasian girls who went to a very select private girls school in England. She would return to Burma or travel around Europe and England in the summers with her uncle. After her schooling in England, her father sent her to 'Finishing School' in Paris, where Tweelee joked, she spent her time studying young Parisian Men and taking in the Parisian life.
    While returning to England on a ship, she met Ralph returning from his WW2 Navel Service and they fell in love, got married and lived happily ever after.
    Not only was she educated and elegant, she was eloquent. Sometimes it wasn't easy being her physician, because she had very much her own ideas about medical care and management. She loved to argue them, in her unique good humoured way and was always ultimately co-operative when she had finished extracting explanations. Exquisitely feminine, she was as tough as nails, when need be.
    Ralph and Tweelee were not only wonderful friends, they had values and principles that they lived by. They were fascinating. Impeccable manners from another era enhanced the remarkable tales of British Colonial life and Ralph's stories of his not inconsiderable adventures in WW2 , (particularly those aboard HMS Petard, a P-class Destroyer). His naval commitment continued for many years as Commander of HMCS Unicorn naval reserve division in Saskatoon. He and Tweelee were truly regal in their full regalia at the Royal United Services Institute functions in Saskatchewan, where Tweelee was often referred to as the real 'Commanding Officer'.
  Their wisdom, knowledge, incredible sense of humour, as well as their loyalty as lifelong friends have proven to me that that the old saw that a doctor should not have patients as close friends is poppycock! 
I miss them both.

Tuesday, 17 October 2017

From the Land of Milk and Honey to the land of pot and drugs!

Canada and cannabals.

Oh cannabis! Oh Cannabals!
From a land of milk and honey to the the Land of Pot and Drugs.
At last Canada is  beginning to get the recognition she deserves.  At last the LWLs are managing to shake our reputation as a dull, staid, hardworking, law abiding, fair, polite population descended from rugged pioneers who braved the harsh Canadian elements to make a future for themselves and their families.  They expected and got no hand-outs but family and friends and other pioneers were always there.  No snowflakes there, no whiners for 'safe space' in case someone might hurt their feelings.  No political correctness.  They did what they had to do and built this great country into what it is today,  or rather what it was until recently.  Then along came a rich boy, with great inherited wealth, posing as a crusader for the middle classes, who never had a proper job. He and his wealthy right hand man introduced tax measures that they made sure to shelter themselves from, while recklessly spending our tax dollars.  Even the health care system matters little to them as long as it doesn't cost them too many votes.  We are at the bottom of the list as far as health care is concerned.  Do they care?  Not a bit as long as it doesn't cost them votes.  I don't want to be repetitious, read my blogs if you want to know more about that.
   One area  in which they are successful is in making Canada, a nation which already has a critical drug addiction problem and alarming statistics regarding narcotics morbidity and mortality, into a drug haven.  Our Trans-National drug smuggling operations are gaining fame and just recently four young Canadians were arrested in Australia and pleaded guilty to smuggling commercial quantities of cocaine.  These crooks crossed all social barriers, one of them being a graduate of the renowned Ivy Business College here in London, Ontario. 
   ‎ Meanwhile, our liberal government is wasting no time in preparing their drug peddling future and making sure they have the monopoly in pot dealing for recreational drug abuse.  They will take in millions and so will a small group of unscrupulous doctors who are  doing that already.  Action from the College of Physicians and Surgeons? Not a word. Shameful!
   ‎ It is no surprise then that the government is getting into the  drug business.  Apart from the millions they will make, it helps them to win votes from a certain type of individual. In addition a stoned population is likely to be much less aware, let alone critical of what's going on.  It embarrasses me that my profession stands by, like a group of lobotomized fopdoodles.
   ‎So let's just carry on and become a land of pot and opioids.