Category Archives: teamwork

by

small mother

I was already a mother when I became a mother. Long before I had my son. I just didn’t know it.

I became a mother at three. My mother had tuberculosis when I was born. Luckily she coughed blood a month before, otherwise I would not be here. I was born in a tuberculosis sanatorium, the first baby there in 25 years. My mother said that the staff was hugely excited about a baby. She was drugged to the gills while reading about the French Revolution and hallucinated Marie-Antonette’s head on a pole and the guillotine. She joked that she could never read about the French Revolution again. I was born, she kissed me, and I was swept away so that I would not get tuberculosis.

I was with my father and father’s family and then with my maternal grandparents. I came home to my parents at nine months. Adults kept handing me to other adults. I concluded that they were loving but stupid and couldn’t be trusted for a moment.

My sister was born five days before I turned three. My mother said that I met guests at the door and said, “Come see my baby.” Mine, because these adults don’t understand the needs of a baby, and I want her to feel loved and safe. No one will give my baby away!

Later my mother would tell a story about my sister worrying about Kindergarten. My mother could not reassure her. Neither could my father. I spoke up: “All you learn is colors, numbers and ABC and you already know those. I taught you.” My mother claimed that my sister was instantly reassured. I don’t remember: these are my mother’s stories and she is gone. But I have collected mother daughter pictures and small statues, just a few, all my life. And I wanted to have children. I liked surgery and obstetrics, but I chose family medicine, because I want to have children and to see them and be a mother too.

Health and joy and safety and comfort to all mothers and fathers and children everywhere.

 

by

joy

This photograph is from 2011. The Synchronized Swimming competitions took an enormous amount of time and work for the girls and work for the parents. And the coaches and the people who held the meets and judges. I am looking through photos and the girls had such fun together, older and younger, beautiful teamwork and joy.

by

arrival

This is for Thursday doors. A door on a barge….

I went to the Pourhouse last night. A four apartment building was arriving by barge from Vancouver. It was unloaded into the parking lot with two cranes and various trucks. Today they will be dropping power lines as they convey it through town.

d2

The beer garden was very popular…. unique entertainment.

d3

d4

d5

Everyone cheered when it was across and on land!

D6.jpg

Ready for the trip through town, dropping power lines, today.

by

diligence

I am a day behind on the A to Z Challenge but that’s ok! I started a day late anyhow….D for diligence. One of the 7 virtues. This is from the 7 Heavenly Virtues, a different list from the cardinal and theological virtues. Bravery is not on the Heavenly list. Diligence is the match for the sin “sloth“. This virtue does not double as an emotion, just as chastity does not double as an emotion. I can feel diligent but it’s not like saying, “I am a sloth today! I feel totally lazy!”

The photograph is from 2011, my daughter and another member of the synchronized swimming team. My daughter started at age 7 and could barely swim one length of the pool, much less two. She fell in love with it and continued until the team disbanded, and then moved on to swim team. It is a spectacularly difficult sport, to dance upside down in the water. They score on the Olympic scale right from the start, earning scores of 1 or 2 out of 10.

Here they are leading a land drill, with younger team members in the water. This is at a meet, so they are ready with their suits and hair pieces for the team performance.

There are so many things that can be approached with diligence that lead to the joy of doing something well and with one’s entire heart…..

ย Musicians work with great diligence too….here.

by

Cold homes

For the Daily Prompt: float.

Float… but some of my patients are not floating. They are sinking.

It has been clear and below freezing for a few days now. I have more than one patient who is not exercising or not taking care of their blood sugar or not eating adequately…. because they don’t have heat. They are staying in bed with an electric blanket or staying in one room because they have an electric heater plugged in. My house has 1930s wiring and I am told that it is a fire hazard to plug one of those heaters in.

I went home yesterday and my house felt cold. I checked the monitor: 49 degrees. I had cleaned the heat pump filters two days before and then had forgotten to restart the heat pump. It was up to 57 degrees by this morning and will be warm tonight.

Prayers and donations for the people in all our areas who do not have adequate heat….

 

 

 

by

Update on marijuana 2016

I attended the Swedish Hospital Update on Chronic Pain in Seattle two weeks ago on the stormy Friday. The power went out and we were without slides from about noon on.

The first two hours and three lectures were about marijuana. Including medical marijuana and one speaker for and one against. So here are some of my notes.

In 1960 and 1970, the marijuana had about 4% THC. Now some strains have 30% THC, so long term there is no data about what 30% THC will do to a person rather than 4%. THC in strains ranges from 0% to 30% and CBD from 0 to 3.5%. However, those two are not the only active ingredients, so to speak. 537 constituents have been identified that work at the cannabinoid receptor…. that is impressive. I think it might take a while to sort out what they do.

At any rate, we don’t know what smoking 30% THC will do, because it’s new. 4% had pretty minimal psychotropic effects. 30% has a lot more. The average now is 12%. Hashish is closer to 66% and hash oil 81% THC. A patient recently told me that she fainted within the last year. She got butter from the fridge at a friend’s and buttered her toast. Turned out it was THC infused butter and she was taken by surprise on a walk 30-60 minutes later. Luckily someone was with her and she was not hurt.

Recent data is showing that there is not much tolerance smoking 12% THC regularly. However, higher doses show tolerance in about 2 weeks in a study of HIV patients with dronabinol, which is 40% THC. Another study of multiple sclerosis patients with 15/15% CBD:THC reduced pain, reduced spasticity and did not show tolerance.

There is anecdotal evidence about seizures, but no study yet. There is some evidence that CBD reduces THC induced paranoia and/or hallucinations. THC side effects from dronabinol include drowsiness, unsteady gait, delusions, hallucinations, mood change and confusion.

The growers are being very creative in names and marketing. This is re recreational pot.
There are hundreds of names and hundreds of varieties and they make interesting claims as to effects. For example:

AK47 with 36.6% THC and 0.3% CBD ….. creative, euphoric and hungry
sage with 27.5% THC and 0.7% CBD ….. attentive
flow with 23.2 % THC and 0.6% CBD ….. happy, relaxed, alert
Super Sour Diesel 22.7 % THC and 0.8% CBD ….. attentive, giggly, hungry
707 Headband with 22.1% THC and 0.7% CBD ….. euphoric, lazy, inspired

How amazing the difference less than a percent of THC makes… oh, wait. There aren’t clinical trials on this, hon, this is MARKETING.

Onset for oral is 30-90 minutes
peak in 2-4 hours
half life 8-12 hours but sometimes 20 hours

sublingual tincture
onset 30-45 minutes
peak 60 minutes
half life 3-5 hours

Smoked onset quicker and I did not get those numbers.

The emergency rooms in Colorado saw lots of people who were “trying it” but if they had only tried smoking marijuana in the 1970s, a strain with a much higher percentage made many people sick or hallucinate or frightened. The gummi bears look just like the ones for kids, so kids got sick. More sick people with edibles, as some eat too much.

People using THC before age 25 who have risk factors for schizophrenia are more likely to develop it. Family history, other hallucinatory drugs, mental health problems. The age 21 limit should be taken very seriously.

In Arizona re medical marijuana, 90% of the prescriptions were from only 24 physicians. In Colorado, 94% of the patients applying for medical marijuana did so for “severe pain”. Two of my friends in their early 20sย  got medical marijuana permits in California for “back pain”, um, ok, hooey. Some people DO have severe chronic pain….

The history of medical marijuana is that Eli Lilly produced a medical version from 1850-1940 for pain. It was removed in 1942. In 1970 it became a schedule one, that is, illegal, drug. There are a few randomized clinical trials for pain, the best ones with high CBD/low THC treatments. Marijuana smoke alone has not been proven to cause lung cancer, but combined with tobacco or other smoke, the evidence is that it is synergistic and makes things worse faster. Dependence can occur, an increase in antisocial personality disorders and there is a withdrawal syndrome for dependent folks. For the small number of people I have had working hard to stop, sleep is the most difficult issue. Anxiety as well.

If people state that they use pot a small amount a couple of times a week, their urine sample should clear after a week. If it’s not clear they 1. couldn’t stop and/or 2. were using quite a bit more.

As far as Washington state law, it was described as a mess. Physicians can’t prescribe, they can only “attest” that the person has a problem treatable by medical marijuana. To attest, the physician has to sign a document saying that they are sure that not only has the patient READ the law chapter 69.51A RCW but also “understands the requirements of being a patient”. There are 24 sections. The physician doing this part of the talk said that he would only prescribe to non-driving MS patients in wheelchairs. Because he finds it hard to read the law himself, so the signing that the patient has read and understood it…. well, the driving legality issue is huge. And the provider, including NDs (naturopaths) and ODs (Doctor of Optometry) in Washington can attest. They are then immune in Washington but not at the federal level.

Every marijuana store is legally obliged to have a medical marijuana consultant present at all times that they are open. The medical marijuana consultant has 20 hours of training to get certified. Patients that are certified with an attestation can grow 6 to 15 plants but ONLY after they have been entered into a database which includes the person who signed the attestation and a photo of the patient. If they grow without being entered, they are breaking the law.

Use of THC long term, the risk of addiction is 25-50%. 17% of the addicted folks started during adolescence. Addiction is currently estimated at 9% of people who have tried it overall. About 30% of users have “problem use” and starting before age 18 increases the problem use 4-7 times. The DSM-V has diagnostic criteria for “marijuana overuse syndrome”, including not being able to stop even though the person wants to. Risk factors for addiction and problem use include early use, family history, PTSD (especially sexual abuse), bipolar diagnosis, ADHD, conduct disorder, oppositional defiant disorder. Mediating factors include parental disapproval, parental supervision, academic competence, higher perceived risk and availability.

And am I attesting? No. My MS patients get the attestation from the neurologist if they want it….

Medical marijuana consultant training: http://www.doh.wa.gov/YouandYourFamily/Marijuana/MedicalMarijuana/RulesinProgress/MedicalMarijuanaConsultantCertification
Washington State Medical Marijuana attestation form: http://www.doh.wa.gov/Portals/1/Documents/Pubs/630123.pdf
WA law: http://app.leg.wa.gov/RCW/default.aspx?cite=69.51A
And pain clinics getting closed down: http://www.seattletimes.com/seattle-news/health/pain-patients-scramble-for-care-after-clinic-crackdown/

The tree trunk is a bonsai from the Lan Su Chinese Garden in Portland. I like the thorns…..

by

Playing Poker with Putin

People keep saying, “I don’t TRUST Hilary Clinton.”

And they say, “Her smile is not sincere.”

I am confused and dumbfounded. Uh, I thought that is the POINT of politics. NAME A POLITICIAN YOU TRUST.

I DON’T TRUST ANY POLITICIAN.

So here is a game: Playing Poker with Putin.

This requires three people, of any sex.

Player 1 is Hilary Clinton.
Player 2 is Donald Trump.
Player 3 is the moderator who in this case happens to be Mr. Putin.

NOW. The moderator begins to ask questions. Every time the moderator asks Hilary a question, Donald interrupts. Donald, you can be as foul and rude as you want, though you should not swear, because you are on national television. You can talk about “lady parts” and the size of your hands. And all the rest of it.

Putin: go for the jugular on everyone.

Hilary: you have to smile. The entire time. You cannot object to being interrupted, because that is bitchy if you are a girl and manly if you are a man. You cannot show anger. You cannot show any emotion at all except a totally sincere smile no matter what the two men say and no matter how many times you are interrupted.

If the person playing Hilary loses her temper she (or he if a guy is playing the part) loses. Then Donald and Putin have to stage a mock battle throwing pillows at each other and insulting each other’s wives. At the top of their lungs. Be as mean as possible. Then Donald will turn the country into a dictatorship because “I have to be equal to Putin.”

So….my definition of politician is someone who can keep their head no matter how nasty the conversation gets. No matter how many lies are told. No matter how many insults are given. And you do the best you can in office to represent the entire country and for the good of the world.

Play on, Hilary. You win Best Politician Ever in my book.