Wednesday 29 January 2020

Rationed Health Care.

  1. a fixed amount of a commodity officially allowed to each person during a time of shortage, as in wartime.

   As I continue to scan through various medical publications I grow increasingly depressed.  Despite our technological advances stories of patient mismanagement and or neglect seem to be increasing.  I am not talking about medical mismanagement due to lack of diagnostic or management acumen, I am talking of the inability of our system  to adequately deal with the problems due to mismanagement of resources. The present method of dealing with the inadequacy of the system is to ration health care.  Let me state that in another way.  The gross inadequacies in our health care system are dealt with by rationing.  Of course no politician or administrator would call it that.  They prefer to pretend that the obscenely lengthy waiting times are due to shortage of physicians, or nurses, or other health care personnel.  Any such shortages are directly due to their policies.

   Let me give you one example of the outcome of health care rationing, published recently in a medical newspaper.  The writer is a family doctor and she refers to her patient and family by actual name indicating that they were aboard with publishing the story.  The story should be extensively shared with Canadians, most of whom are under the impression that they still have a competent, caring health care system, second to none, whereas in fact we have at best a second rate system heading to become a third rate one.  The patient, something of a minor celebrity, found blood in her urine in October of 2017. She consulted her doctor who despite her concerns could not get an appointment for her to have a cystoscopy to look into her bladder and make a diagnosis.  Incredibly, it took until spring of 2018 for this to be carried out. At that point there was too much blood to make a definitive diagnosis but an infection was thought to be the problem and the patient was put on a  six week course of antibiotics, after which she was to have a follow-up cystoscopy and a CT of the kidney. The antibiotics did not help.  She became weak and anorexic, lost weight and slept most of the day.  The family became so alarmed with the time it was taking to adequately investigate the disease that they paid for a private CT (technically illegal in Canada!) and she was diagnosed with Cancer.  Another wait for a biopsy and yet another to see an oncologist.  The final diagnosis was that she had originally had a bladder cancer, that had spread to her kidneys.  She died on October 1st 2018, quite likely due to a dysfunctional health care system.  
   No government official, even of the lowest rank  would have been treated in this manner.  So much for equality of treatment in a country that claims to provide equality of treatment for all of its citizens, but makes it illegal for people to pay for private health care.  (Unless they are rich enough to go  to the United States).  This is a gross infringement of charter rights.  A blended system works well in Australia and most of the developed countries, improves the accessibility of health care for most of the population and injects additional resources into health care.
   It's time for Canadians to get 'woke' about health care !
  You have your own story of health care failure? Share them. 

Monday 20 January 2020

Growing old - not so gracefully!

  Growing old. is easy.  All you have to do is stick around for long enough.

  As the list of my friends and acquaintances thin out, I become increasingly aware of the fact that I am not growing old, I achieved that status years ago, I am growing ancient.   Not bad considering the genetic hand I was dealt.  My siblings too are beating the odds and my wife who is the same age as me continues a full range of household and a not so full range of other activities.  So I have nothing to complain about.   I really never realized I was getting old.  Denial is a potent therapy when used wisely and on occasion it serves quite as well as placebo.   It is not for everyone but it has served me well through real and imaginary crises.
   However, there are certain things that cannot be denied.  That my daughter will soon be getting what we crassly used to call 'the old age pension'.  That I sometimes have to work hard to maintain a look of casual insouciance keeping up with youngsters at the mall.  That schlepping myself out of an armchair I sometimes hear myself making, what I call, 'an old man grunt'. (You know what that is if you are getting your pension). That I'm not quite as smart as I think I used to be!
   Nineteen thirty-five, the year I was born was quite a year.  The world got Monopoly, a game people still play, as well as Shirley Temple dancing with Bo Jangles Robinson and Benny Goodman playing Blue Moon, the top of the hit list. (I still know all the words - it's only the important things I forget!)
   Aubie Blake, the great jazz musician said on reaching ninety, "if I knew I was going to live this long I'd have looked after myself better."  I know what he meant.
   Many years ago while making my hospital rounds I asked an older patient how he was doing.  "Great Doc" he responded.  "I've got the system beat" I asked him what he meant.  " I'm too old to die young," he grinned.
   I let my dentist who has been a friend of mine for twenty years but whose age is nearer my son's age than mine take me out for lunch every now and again.  I figure it's the least he can do in lieu of the vast amount I have invested in him over the years.  He has re-built almost every tooth in my head- painlessly (almost).  As we chatted and I happened to mention a very close friend who bit the dust not too long ago he commented, "Yes, most of your friends must have passed away by now".
   "Yes," I answered appropriately gravely and just so he wouldn't feel too comfortable I added, "even some of my younger ones."
   For years friends - and others, have been cautioning me that one should live every day as though 'tomorrow we die'.  I tell  them not to be so absurd, that thinking like that kills people.  In fact, I live each day as though as though I am going to live forever.  I might just succeed, but if I don't, I'll be the last person to know about it.

Image result for geriatric jokes

Thursday 2 January 2020

New Vaping Hazard!

OY Vape.

Canada has a disastrous drug problem. ( More than 13,900 opioid deaths occurred between January 2016 and June 2019.) So it shouldn't surprise anyone that the government of Canada and their satraps saw fit to introduce legislation that facilitates converting the least toxic of the street drugs into killer drugs. I am speaking, of course of marijuana, now available for consumption in a myriad of ways few would have thought of until recently. The drug, which is no longer the drug your mother might have smoked has been carefully morphed into a more addicting and toxic form. The variety of presentations, make it more available and desirable to the younger segment of the population.
The latest life-threatening avenue of ingestion has seen the marriage of pot to E-cigarettes. E-cigarettes available since about 2003, were originally touted as a smoking cessation aid, the vaporized substrate was usually water vapour and some nicotine, and were a much less harmful habit than cigarette smoking, an opinion shared by many physicians. Unfortunately they were particularly popular with young people.  
It wasn't long before before the search for sensation led folks to try adding various drugs to the solution.
The Center for Disease Control and prevention in the US, as of December 17, 2019 documented a total of 2506 hospitalized cases of vaping related injuries in the US with 54 deaths confirmed on 27 States. The syndrome has been labeled EVALI (E-Vape Associated Lung Injury). These numbers represent hospitalized patients only, so we can only guess what the grand total might be. All of these patients have a history of using e- cigarettes or other vaping products.
THC, the intoxicating, psychoactive component of marijuana Is present in most of the samples tested by the FDA to date and most patients reported a history of using THC containing products. E cigs work by heating a liquid to vaporization that users inhale into their lungs. The liquid can contain anything including a combination of substances. 80% of the EVALI patients studied reported using THC containing products. 40% reported using both THC and Nicotine containing products. Some people will inject or ingest anything into themselves and have found a new delivery system in vaping. There is still a great deal we don't know about the mechanism of lung injury caused by the current vaping trends and the CDC continues monitoring the cases, testing in various ways for toxic substances and studying lung damage by biopsy and in fatalities by autopsy. They are also maintaining an aggressive educational program, including a web site, which will at least increase awareness among some of the potential victims.
The Center for Disease Control and Prevention recently announced that Vitamen E acetate, an oily chemical added to some THC vaping liquids to thicken them is a substance of concern. The chemical is a synthetic form of vitamin E that has some safe uses but that isn't safe to inhale. it is thick and sticky. It adheres to the lung tissues and interferes with their function and was found in many of the patients with EVALI. Vitamin E acetate has been found in many of the THC vaping cartridges used by patients suffering from lung disease associated with vaping. The role of the legalization of marijuana in the genesis of this new disease certainly needs clarification.