Monday 29 May 2017

Canada's Drug Culture.

  It was a nice sunny weekend afternoon and my wife and I were taking a walk past a crowded outdoor cafe where the students and young folk were having fun drinking coffee or beer or other cool drinks.  In a place where a couple of years ago pulling out a cigarette would have caused a riot, we noticed a few tables around the periphery where folks were smoking.  As we passed by one such table, I recognized that this was not any blend that I recognized from my smoking days. It was pot.  Not a single person was jumping up and down with rage, no one burst into a paroxysm of coughing, no one was complaining of the noxious effects of the slip stream exhalations, in fact no one seemed to notice at all.  It was quite like the old days. I almost felt nostalgic.  It was as though inhaling marijuana into one's lungs was harmless, even though there is no evidence that it is less harmful than tobacco.  Despite the millions of dollars and man-hours spent on smoking cessation programs with considerable success, there is a serious risk that now the liberal government is making smoking pot in public an option, that cigarette smoking and even (perish the thought!) the harmless practice of vaping will become fashionable.  Why, even the Prime Minister likes to take a little suck on his dubie once in a while, so it must be alright!
   Despite Canada's dismal record of drug addiction, and it is dismal, particularly among the youth, this government is doing tremendous damage to the population by perpetuating the notion that marijuana is harmless.  This flies in the face of the evidence, but the politicians and their administridiots really don't care about that.
   So, what do they care about?  That's easy.  They care about votes.  They care about taxes.  Make no mistake, there is going to be a fortune in this for the government.  Between taxing the legitimized dealers and the users, many of whom will become addicted, there will be huge sums of money shuffled into the treasury.  But most of all, they believe that a population of drug users will make a population that is traditionally difficult to handle, easier to manipulate and fit into the Great Social Engineering Scheme that the Elites are planning for you.  
   The permissive society will cost our nation dearly.
Comment, if you have anything to say!

Friday 19 May 2017

Black Market Medical Records.

   So, you think when you go to your doctor and pour your heart out, everything is secure, top secret, confidential ?  That's the way it was once, but not any longer.  Your entire medical history may be available for as little as ten dollars!   The erosion started as long ago as the sixties when medicare dictated that for your doctor to get paid, he had to write your diagnosis on the billing slip that he submitted to the government.  Doesn't matter what the nature of your complaint is, your privacy really didn't and doesn't matter to the administridiots who dictated the terms of the heath care game.  Patient's would sometimes plead with the doctor to avoid filing in the true diagnosis. 
   I clearly recall a patient coming to see me to plead with me not to fil in the true diagnosis.  The conversation went like this.
   "Doctor, my sister-in -law works for the health care commission.  If she sees the diagnosis it will ruin my marriage.  Can't you say I just had a cold or something."  So, being young and stupid, out of compassion for the distraught woman, that's exactly what I did.  When I related this to a senior colleague he was aghast.  "Don't ever do that again," said he,"you could really get into terrible trouble.  The folks knew about that when they voted for medicare, now they have to live with the consequences."   He was right, that was part of the deal.  I never did that again.
   Medical confidentiality was never of any importance to the legal profession, especially when it was obstructing them from getting information they wanted.   On a few occasions when I was trying to keep information confidential on behalf of the patient, it was made quite clear to me I would be subpoenaed.  When I consulted a lawyer, it was explained that if I was subpoenaed and refused I would be guilty of contempt of court and could be fined and/or go to jail! (and by the way, if the patient wanted to sue for breach of confidentiality, they couldn't as long as I claimed the protection of the 'Canada evidence act'.)
   The Electronic Health Record only made thing worse.  The early enthusiasm I had for computerized medical record that would make a patient's medical information available across the spectrum of physicians, specialists and health care providers was staunched fairly early on, by the realization the the politicians and their health care administridiots had something quite different in mind.  What they had in mind was a massive data collection that had no relationship to the patients' health but rather to their long term plans for social engineering.  Many of the physicians I speak to nowadays feel the the electronic system undermines rather than facilitates their attempts to provide excellent health care.   But that is not the thrust of this blog, which is that computers will never be safe and that your health records will be available to anyone who is prepared to pay a reasonably competent hacker a relatively cheap price to obtain them.  Not many folks realize that, or if they do, they don't care.  Other and more dangerous consequences of hacking lie in the development of 'ransomware' in which the hackers can disable vital hospital equipment or scramble data and demanding a ransom to unscramble the data. 
   I have no doubt that someday soon, a very smart medical group with a catchy name like 'Healthcare Confidential' will come along with a data disguising program that will enable the patient to be reassured that any part of their history that they deem too personal to be accessible to the administridiots will be suitably encrypted and not obvious to the medically uneducated.  This will be expensive, of course, but I have no doubt there will be many who would wish to avail of it.  
   I wish I had thought of it a few years ago.  In the meantime, good luck!!  
Comment if you care!         

Monday 15 May 2017

The New World Order.

  I recently  came across this little story that I wrote many years ago for a writing class I was taking while on  sabbatical in North Carolina.

                                                              The New World Order. 
             "I think the North America Free Trade Association really is screwing the U.S." Phil commented, scooping a leaf out of the swimming pool with the long net designed for that purpose.
            "Yes, Canada too." Steve said, squinting into the setting Carolina sun, "In fact, everyone I know seems to think that. I can't understand how we got into it"
            "Ah," said Phil,"It's because that was the decision of the New World Order."  He skillfully trapped another leaf.
            "What new world order?"
            "You mean you've never heard of the New World Order?  You never heard President Bush's New World Order speech?" asked Phil, incredulously. "You guys up in Canada really don't know what's going on."
            "Of course I've heard of Bush's new world order speech.”  Steve responded with a look of feigned disgust, “Guys like you are always reading ominous meanings into situations. Bush was talking metaphorically, all he meant was that someday we are going to have an ideal, peaceful world where everyone is going to live in perfect harmony, and we are all going to love each other and never fight any more wars. Pure political rhetoric,that's all."
            "Oh no, we're talking conspiracy here," Phil said seriously."
            Steve smiled, "You've got to be kidding."
            "No I'm not!"
 Steve's face assumed a more pensive mien.
            "You're not the first person who I've heard say that, though I must admit that I certainly didn't give it any serious consideration. In fact, I considered that individual to be a nut."
            "That’s no way for a psychiatrist to be talking." Phil was interested, “but tell me about it anyway.”
            "Well," began Steve, "it must be about five years ago now, when Anne and I went to Porta Vallarta.  It was one hell of a holiday because we both got really sick, not the usual 'Montazuma's Revenge', but a very high temperature and a violent headache. I started out with it and I must say was so sick that I thought I probably had a viral meningitis. I was just considering calling a doctor when I woke up feeling better.  That very same day Anne started to get ill,and ran the same course. By the time we were both up and around, we decided to take a trip on a ferry across the Bay of Bandera, to some little picturesque village. The ferry ride was pleasant enough, but as we were sitting relaxing on deck, we were approached by a pleasant enough man in his forties, with a slight foreign accent.  We chatted a while,and he told us he was a Mennonite minister living in Western Canada.
            He was a rather extroverted sort of fellow, who talked a mile a minute and after talking a while his manner became increasingly serious.
            'The whole world is in a desperate state,' he said, 'and is being run by  small, clandestine groups of people, who are gathering more and more power.'
            'And who may they be?' I asked, suspiciously.
            'They are the New World Order, didn't you hear President Bush's speech.
Mostly they’re a bunch of Freemasons.'
            'Pretty farfetched, I think it's all a bunch of poppycock.' I was growing wary.
            'I can prove it,' he said,a knowing smile on his face, 'Put your hand in your wallet and pull out an American one dollar bill.’
            I did, and put the bill on the bench between us.  He turned it over,face down and pointed a finger at it.
            ‘See that pyramid, and the human eye on it. That's a well known Masonic sign. And that's the agreement between Masons all over the world that the New World Order is going to take over.'
            Well, Phil,you know me, and by this time I was getting pretty fed up with listening to this guys garbage. Next, thing he is telling us that Hitler was half Jewish, and I come to the conclusion that we have a real loony on our hands. So, not too politely, I tell him to get lost, that I really have no time to listen to any more of this nonsense and with that, Anne and I moved to the most distant point of the ferry we could find.  That's my story of my
previous experience of the New World Order."
            I pulled out a dollar bill and threw it down on the table.
            " What do you make of it." Steve asked provocatively.
            He picked up the dollar bill, turned it over, examined it carefully and shrugged his shoulders.
            "Funny, I’ve been spending them all my life  guess I never looked at one that closely before," he said. "that symbol is certainly there, I don't know what it means."
            "Well I'll tell you what I'll do," Steve said, "I'll phone the treasury department tomorrow, and tell them I'm a numismatist with  special interest in paper money, and that I'm studying the iconography of paper money and want to know what the design on the back of the one dollar bill means."
            "Don't do it from my phone number and don't give them your name or address,either," said Phil seriously.
            "You're joking" Steve said.
            "No,I'm perfectly serious" he said, perfectly seriously.
            "What do you think might happen?" Steve asked derisively.
            "Anything could happen," he said ominously.
            "Here, in the United States ?"
            "Yep," he said.
            "I know you’re kidding me now."
            "No, I'm not. So if you make the phone call don't do it from here."
            Steve was leaving for Durham in a couple of days, so the next day,sure that Phil wouldn't really mind and that their talk of the previous evening was just the usual kidding they often indulged in, he phoned the Treasury Department.
            "Hello," Steve said."I'd like some information,please."
            It took him a couple of minutes to realize he was talking to a machine.
After going through the usual aggravating automated rigmarole, he finally got through to a human, who sounded more like an automaton than the machine had.
            "I'm trying to find out what the symbols on the back of a one dollar bill means. I'm a coin collector and I'm doing some research on paper money."
            "One moment,sir, and I'll connect you to our research department."
Steve waited for what seemed like an eternity, then a business-like male voice,
            "I understand that you were inquiring about the symbols on the back of a one dollar bill," it said. "can I have your name, address and telephone number, please."
            "Er, I just to wanted ask a question about some pictures on the  paper currency," Steve said.
            "We can't give you any information until you answer the questions I just asked you, sir".
            Steve thought he  heard an ominous click on the line and hung up right away.
            A queasy feeling came over him, which lasted a few minutes. When it settled he laughed at his imagination.
            "That Phil really psyched me" he thought. "What an idiot to hang up like that."
            Although he wondered whether he should tell Phil about this incident, the fact that he had been asked not to make the  call from the house, and did anyway, embarrassed him. He soon forgot about the whole episode.
            Over the next few months, He carried on with his work in Durham, and frequently he and Anne spent the weekend with Phil and his wife. He never mentioned the event again, and as Phil didn't either, he knew he really had let his imagination run away with itself.
            Three months later, just before they boarded their flight to continue the sabbatical abroad, they decided to phone Phil and Jane, to say goodbye.
            "Hi Jane," Steve said when she answered the phone. "Let me talk to Phil."
            "He's not here right now," Jane said. "This morning he had a call from the Treasury Department, and had to go right down to see them today.  I sure hope he’s not having trouble with his taxes.  He paid so much this year maybe they want to give him some back." She laughed nervously.  A horrible thought crossed Steve’s mind, “I’ll call back tomorrow,” he said.
            Steve had a restless night as he so often did nowadays, but on this occasion his mind kept racing back to Phil’s trip to the Treasurey Department.
His mind kept playing over that phone call of months ago, that long wait and ominous click.  He hoped he hadn’t got Steve into any trouble.  He resolved to tell Phil about the call he had made from the house and face the music.  He gave up trying to sleep at six o’clock, and started rehearsing what he was going to say to Phil as soon as it was late enough to call.  At nine a.m. he picked up the phone, relieved that he had decided to unburden himself after all these months, and to  tell the truth.  He picked up the phone and dialed the number.
Jane answered the phone.
     “Jane, Steve here, “let me talk to Phil”
     “Oh Steve,” She sobbed, “Phil is in the Intensive Care Unit at City Hospital, He was hit by a hit and run on the way home yesterday."”
      Phil died the next day.  The driver of the car was never identified. 
        (After posting this  I  looked up 'New World Order' in Wikipedia  - yo might be surprised!)   

Tuesday 9 May 2017

Opioid Constipation and other problems.

   More than fifty thousand Americans died from drug overdose last year.   Death from synthetic opioids including Fentanyl rose to 9,580.  Deaths from prescription drugs like oxycontin are on the increase and are easily available both legally and illicitly.  CDC figures indicate that American life expectancy has decreased for the first time in many years, in no small part due to drug overdose.  Contemporary statistics for  Canada do not seem to be available but published estimates for 2007 indicated 47,000 addiction related deaths.  Despite the removal of oxycontin from the Ontario drug plan because of the ease of abuse and its decrease as one of the drugs of addiction, closely related drugs are available the overall rate of opioid fatality has increased by 24%.

   Testimony to the widespread  extent of the problem is the fact that opioid constipation is a favorite topic of big pharmacy advertisements these days.  In my many years of medical practice opioid constipation was rather uncommon outside hospital where patients who required narcotics were usually successfully treated prophetically with stool softeners and laxatives as necessary and sent home on them.  Opioids were prescribed for severe pain that was was not relieved adequately by the many other types of analgesics /anti inflammatory drugs that are less addictive and debilitating.  Narcotics were prescribed a great deal more judiciously in those days despite the fact that we were just as concerned with pain relief as contemporary physicians.  Physicians who did prescribe excessively were likely to get a visit from the RCMP.  Narcotic prescribing was sometimes suspended and on occasion licenses were revoked.  We were very aware of and concerned with the consequences of narcotic prescription for more than short time periods and the objective was  always to control pain with less noxious and toxic treatments.  Often, we were successful.
   Now opioids are prescribed so frequently that Opioid Constipation is a common disorder in working, walking and driving patients.  Turn on your TV to watch the news during dinner, and you may well be greeted with Big Pharma's cavalier witty ad for their bold new treatment for Opioid Constipation.  The healthy looking patient jokes with his doctor on receiving his prescription, "I guess I've been holding it in too long, doc!!"  Very funny!  Movantik, (Naloxegol) is believed to reduce the constipation effects of the opioids without reversing the pain relieving or analgesic effects of the  opioid, when given in  the prescribed dosage.  It too has its side effects.
    The recently published guidelines regarding prescription  of opioids for non cancer pain may help, but guidelines are only guidelines, not rules and it may be difficult to explain them to the addicted patient on the other side  of your desk.  Physicians will have a very difficult time in getting the genii back in the bottle, particularly when the permissive society is busy uncorking other bottles. 

"We lost our son in July 2014 at age 22 from Heroin overdose after a long eight year spiral into drug use which started with abusing marijuana. During these years he easily bought illegal drugs as well as prescription drugs from his friends parents medicine cabinets… He also purchased synthetic packaged drugs from “Smoke Shops” also called “Head Shops” which sale their harmful addictive products in decorated packages, call them different names and can legally sale them. Our son was sold “bath salts” from a Smoke shop which he crushed and snorted. The product ate holes in his brain and was causing liver damage and his body to shut down within one week of daily use. He was delusional and put into ICU for two days. He survived it but damage done… Society has a whole has to make changes. People have to be educated on the disease of addiction, doctors have to be more restricted on writing prescriptions, much tighter border control, Smoke shops regulated, kids taught about the dangers of drugs use and what they are saying no to. “Just Say No” is not working anymore and Red Ribbon Week has become more about door decorating and dress up than the seriousness of drug use in most schools. A change of mind set and the ability to deal with stress and pain has to start at a young age so as people get older they will not rely so much on pain killers and drugs which alter the brain. Xanax was very easy for H  to get and so addictive. He later took up Heroin and this became his drug of choice. Families should not have to live the way we did with our son during his battle. Society has much work to do to combat this problem."
   Universities across the land are finally attempting to  take some measures to address the growing problem and some are using Narcan kits, an emergency opiate antagonist that reverses the effects of an overdose, in the hope of saving lives.

   Sometimes, it  looks as though the permissive society is going to self-destruct.

Monday 1 May 2017

House call - the other side!

       Some years ago, I wrote a short story called "House call" or something like that.  A writer later challenged me to write the story from another point of view (POV), from Cindy's side.  Here is my attempt!     
PS. If you want to see the original story I think you will find it buried among my early blogs.   

                                                 Cindy's Story.

      She awoke suddenly,with an ominous feeling that things were going to go wrong that day. Her premonition was to turn out to be correct. It had been a hard night.She had worked until 2am and had earned a total of $400,barely enough to buy a gram of cocaine and to have enough left over to buy some food for herself and Jerry. She schlept herself into the untidy, non too clean bathroom and was shocked to see herself in the dirty,scratched and slightly distorted mirror. The remnants of her good looks were only just perceptible at thirty-seven,and she could easily have passed for a woman ten years older.

She could see that herself. Her mouth was parched from a hundred cigarettes,and she reached for a toothbrush and an almost empty tube of toothpaste to try and dispel the filthy taste from her mouth and restore a little moisture to her dehydrated mucous membranes. She couldn't get the toothpaste out of the tube, there was so little left. She finally expelled a small bead of the paste,and after wetting her brush stuck it in her mouth. She thought she was going to vomit, managed not to,and gradually felt the refreshing taste of the toothpaste permeate the layer of inflamed mucosa that lined her mouth. She showered, pulled on a robe,and walked into the room that served as her living room and was the single other room apart from her bedroom. It was sparsely furnished,with a misshapen sofa upon which a mishapen, dishevelled middle age man lay sleeping,contributing to the general shabbiness of the room.

 "Wake up,Jerry,you lazy bastard" she shouted, "Get the hell out of here and get yourself a job". She didn't know why she kept him around. He had once been good to her when she  needed help and she just kept him around. They hadn't slept together for years. Jerry stirred,and said "yeah,I'm going to look for something later today. Once I get a job  I'l pay you back everything I owe you" "Yeah", she said.  She looked at the small empty plastic bag that the cocaine had come in, moistened her finger and ran it around the inside of the bag,and then massaged it into her gums. She wondered how she was going  to get through the day.

      Three coffees and an hour in the bathroom later,she looked at herself in the mirror once again. She thought she looked better. Still not great, but better, she thought bitterly,remembering when she had just to walk into a room to turn every male head. "I've really wrecked my life"she thought,"I might as well be dead." Maybe that's the answer, maybe I should finish it all. She thought of her parents,and how they would feel. She still cared about them and they about her despite the strained relations of many years. But maybe they would be better off too,if she were out of the way. Her eyes filled with tears as she thought of her life now and the potential she had wasted. "Shit", she thought, "what I really need is a fix". Maybe if she got out early enough,  she could turn a few tricks and hustle enough for a couple of grams of cocaine to carry her through the day - and night. "Tidy this place up, you lazy son of a bitch" she called to Jerry, "I might have to bring someone back here."

Jerry grunted something in response,she didn't hear what. She walked out the door into the dark, fetid corridor,and wended her way toward the street.

      It was four o'clock in the afternoon,when Cindy hit South Railway. She hated the sort of day it was, cold and dark, reflecting her mood. There was no one on the street, and  she made for the bar at the Empire Hotel. The bar was empty, so she thought she'd have a drink, maybe it would make her feel better.

  She knew the barman, a rough tough decent sort of guy, who even let her run a tab, as long as she didn't let it get too high. "Give me a gin and tonic, Phil." She said. "Hey, Cindy, don't you think it's a little early to be starting?" He asked.  
  "I asked for a drink, not for your advice," she said.

  Phil didn't take offence. "Okay,"he said,"you're the boss." 
  He poured the gin and tonic and slid it along the bar. "Want to pay now,or a tab?" Cindy was just lighting a cigarette. "I'l pay now,"she said,searching her purse for her wallet. She paid him. She sat smoking her cigarette, drinking her drink, and rummaged through her purse, trying to count how much money she had left. Ninety seven dollars and some change. Not even enough for a fix. Though maybe if she ran into Gil he'd give her a break. She knew he came in here frequently, maybe if she sat around for a while he'd show up. Her mood plummetted and she felt like a drowning woman, hoping for a lifeline to rescue her from the deepeninging morass of depression. An hour and three drinks later she was still sitting in the bar,hoping Gil might show up, or at least a likely customer. She didn't feel well enough to hit the street,she had a pain in her belly and just wanted to lie down. As she walked into the street, he blast of cold air revitalised her,and she walked the three blocks to her shabby apartment house.

      When she walked into the room, she saw Jerry sitting on the same sofa,a cigarette in his hand,watching the black and white television set  The ash on the cigarette drooped towards the floor,ready to drop momentarily onto the dirty cushion.

      "I thought you were going out to get a job today" she said.

     "Yeah,the guy wasn't in today,they said to come back tomorrow"         

      Cindy felt too sick to carry on with the conversation. If she could just get a fix tonight it would carry her through for the next day or two,until she could make a little money. She slipped off her dress, the only decent one she had left,and laid down on the bed for a moment. When she awoke she looked at her watch,and saw that it was 2.40am. She felt awful,wished she was dead and called Jerry,

      "Jerry,I feel awful,I've got to get out and get a fix" she said.

      "You got no money,it's an awful night,you ain't fit to go into the street on a night like this. Why don't you call the doctor. You remember that other doctor said you got gall-stones,and would need a shot if it troubled you again. Maybe,we can get one of the young docs out of the clinic and  he'll give you a shot of something that might carry you over." 
      "Yeah,I've had a belly ache all day. Look up the number and I'l call the doctor.

      She dialled the number.

     She was just dozing off,when there was a knock on the door. A peasant looking young man walked ito the room.

      "I'm Dr. Steve Saunders," he said, "what seems to be the problem?"

   Cindy looked him over. This one is going to be easy,she thought,he hasn't been out of medical school long.

      "I was in to your clinic last week and Dr. McIntosh told me I have gall-stones,and if I had any further problems I was to call the Dr. on call and he would give me a shot of demerol." 
   Cindy had had plenty of experience dealing with interns and Drs and usually managed to control the situation, so this  young fellow shouldn't be too difficult to manage.

      He said,"Lets step into the bedroom and I'l examine you."

Jerry was sitting in his usual place,watching the TV.

      The last thing Cindy wanted was to be examined and she said so and said she would come into the office the next day for a checkup.

      "I'm not giving any shots of anything without examining you first."

   She glared at him, and was at the point of telling him to fuck off, but instead said,"Well maybe you could leave me a few demerol or talwin  pills in case this starts acting up during the night."

    Before he could answer,there was a knock at the door. No-one attempted to answer, and within a few seconds there was a longer louder knock. All three occupants of the room froze. Suddenly there was a loud cracking noise as the door burst open. Cindy recognized the two cops immediately. One of them was that bastard Sam O'Hanlon. Years ago he had tried to screw her  and she had told him just what to do. He'd made her life a misery ever since. She looked at the young doctor's face and could tell he was wondering what the hell was going on. He ducked out as fast as he could and the two cops ran after him - probably trying to intimidate him into saying something that would get her into trouble.
   "To hell with them all", she thought, as she took the last couple of sleeping pills she had stashed away.  "I'll sort things out in the morning."