ajudicator

My experience with adjudicators has been musical.

Did you play an instrument in school? Did you go to the yearly contest where you played in front of a judge? That judge is an adjudicator. I still have my little box of medals, mostly blue ribbbons, from playing my flute at the yearly contest.

When I search on ajudicator, I find a field manual. It’s not about music: https://www.uscis.gov/ilink/docView/AFM/HTML/AFM/0-0-0-1.html. I am having a really hard time with the children separated from parents. Death separates enough parents and children. I feel deeply ashamed of my country.

Centrum’s Voiceworks is a musical and healing week for me. Singing for a week and jamming on my flute and now I have a list of local people who love to sing….

Dawn Pemberton is one of our instructors and wonderful. She is a choral adjudicator, judging choruses across Canada. And one of my choral directors here, Rebecca Rottsolk, is also an adjudicator. For Mirinesse and for Rainshadow Chorale.

My son plays a violin piece as a senior for ajudication in Port Angeles. He is accompanied by Dr. Beatus Meier. The adjudicator is shy and nearly stands up when Beatus enters the room. Dr. Meier, it turns out, was the adjudicator’s professor at Washington State University. Dr. Meier is frail at that point and is now gone.

Blessings on the adjudicators and may we all be judged with love.
Mirinesse: http://www.mirinessewomenschoir.org/
Rainshadow Chorale: http://rainshadowchorale.org/
Dawn Pemberton: http://dawnpemberton.ca/
Dr. Martin Beattus Meier: http://www.ptleader.com/communityrecord/dr-martin-beatus-meier/article_eca9a1ea-69c0-11e8-889a-67013a9fdf88.html

The photograph is from the 2011 Solo and Ensemble in Port Angeles, the chamber orchestra that my son was in.

There will be a memorial tomorrow for Dr. Meier at QUUF from 11-12:30.

separation

This is one of the most beautiful and saddest photographs I have taken. It is my sister, about a month before she died of cancer. And her daughter, who was 13.

_______________________________

On the last visit to my sister, she was in kidney failure, dying. We had conversations that were surreal. All I wanted was to stay with her.

One day a friend of hers, another mother and I, were working to make her more comfortable.

“I am sad!” my sister said, and started crying.

“Why are you sad?” I said, “What are you sad about?”

“I won’t be there! I won’t be there when she graduates from high school! I won’t be there for her first date! I won’t be there when she gets married! I don’t want to die!”

By now we are all crying. “You will be there!” I say. I am certain. “You won’t be in this form. You will be in another form!”

“I will?” my sister said, crying.

“Yes.” I said, crying too. “You have to go. You have to transform. You can’t stay. But you will be there for her.”

We cried and held her.

And I know for certain that she is there, she is here, she is with her daughter as her daughter graduates from high school, goes on a date, does all the things that daughters do.

Now and forever.

And the living children must be returned to the living parents. We cannot do otherwise and call ourselves humans.

 

loss

For the Daily Prompt: famous.

This is not Michealangelo’s Pieta. This is from the National Museum of Women in the Arts, in Washington, DC. This is Apres la temepete (After the Storm) by Sarah Bernhardt, a sculpture of a Breton peasant woman cradling the body of her grandson who had been caught in a fisherman’s nets. This is from about 1876.

I took this visiting my son at the end of last year.

Memorial Day and we remember our lost. Much love to you and yours.

 

black on white

black on white

white on black

it doesn’t matter

angels falling
made to fall
at peace with falling

I let myself fall
at peace with falling

and wonder what that means?

death?

no

though there are times I long
for the Beloved
for union with the Beloved
for all in one
and one all

let go

when an angel falls
they are at peace

they are at peace
with falling

people

see black and white

people

see good and evil

people

separate
label
categorize

angels don’t

black on white
or
white on black

it doesn’t matter
there is no separation
we are one

Beloved

One

Heart and brain and alcohol, 2018

For the Daily Prompt: infect. Maybe heart and brain health could be an infectious idea…..

Heart disease is the number one cause of death in the US, around 24% of deaths every year. Strokes are fifth most common cause of death at 5%, dementia sixth most common at 3.6%, data here from 2014. Accidents have beaten strokes out for fourth place because of “unintentional overdose” deaths.

I did a physical on a man recently, who said what was the best thing he could do for his health?

“Reduce or better yet quit alcohol.” is my reply. Even though he’s within “current guidelines”. I showed him the first of these studies.

Two recent studies get my attention for the relationship between the heart and the brain and alcohol.

In this study: http://www.onlinejacc.org/content/64/3/281, 79,019 Swedish men and women were followed after completing a questionnaire about alcohol consumption.

They were followed from 1998 to 2009 and 7,245 cases of atrial fibrillation were identified. The relative risk for atrial fibrillation was alcohol dose dependent: that is, the people who did not drink had a relative risk of atrial fibrillation set at 1.0. At 1-6 drinks per week the risk was 1.07, at 7-14 per week the risk was 1.07, at 14-21 drinks per week 1.14 and at >21 drinks per week 1.39. They also break it down by number of drinks per day. So why do we care about atrial fibrillation? “Atrial fibrillation (AF)/atrial flutter (AFL), the most common cardiac arrhythmia, is accompanied with a 4- to 5-fold increased risk for stroke, tripling of the risk for heart failure, doubling of the risk for dementia, and 40% to 90% increase in the risk for all-cause mortality.”

Atrial fibrillation, stroke, congestive heart failure, dementia and 40-90% increase in all-cause mortality. Want to protect your brain and live longer? Quit alcohol.

Well, that instantly decreased my enthusiasm for alcohol, now down to one drink per week if that.

Here is a second study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext?code=lancet-site

“Findings:
In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.”

Ok, over half a million people followed, 40K+ deaths, 39K+ heart events (heart attack, atrial fibrillation, new congestive heart failure, etc), that’s a pretty impressive study.

A 5% 12 ounce beer is 14 grams of alcohol. Here: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Our local brewery and pourhouse usually serve pints, 16 oz, and the range is from 5% to over 9% alcohol. Two 9% pints is how many standard drinks? You do the math. Currently the recommendations in the US are no more than seven drinks per week for women (98 grams) and fourteen for men (196 grams) per week, no saving it up for the weekend, no bingeing. The UK stops at 98 grams for both men and women. The rest of Europe goes higher.

Heart and brain, how I love you! I like my brain and don’t want to pickle it. I think I’ll choose heart and brain over alcohol, long term over short term, health over escapism.

Have a great week!

More:
https://www.sciencedaily.com/releases/2018/02/180220183954.htm


https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30022-7/fulltext

http://www.acc.org/latest-in-cardiology/articles/2016/08/26/16/48/consumer-news-stroke-esc-2016

I took the photograph. It reminds me of neurons in the brain.

from the mist

For the Daily Prompt: forest.

My town is a forest at sunrise and sunset. The trees take over, dark against the sky. And look,  something is rising from the mist.

Medicine is like that too. Did the epidemic of unintentional overdose deaths catch you by surprise? People, including doctors, thought opioids were safe, if taken correctly. And that we should increase them if the person still had chronic pain. But the information is still changing and taking shape from the fog.

I have worked with the University of Washington Telepain service since 2011. I can’t attend every week, but many weeks I spend Wednesday lunch in front of the computer, logged on to hear a thirty minute lecture from UW and then to hear cases presented from all over the state.

I want to sing the praises of the doctors on Telepain and the Washington State Legislature for having this program. Here is a link to a five minute King5  news program about UW Telepain.

https://www.king5.com/video/news/local/fighting-opioid-epidemic-via-video/281-8115411

Forty two different sites were logged on. There are also UW Telemedicine programs for hepatitis C and for patients with addiction and psychiatric problems. The advantage is that all of we rural doctors learn from one doctor presenting a patient and the panel discussing it and making recommendations. We have Dr. Tauben, head of the pain clinic, a psychiatrist, a physiatrist, a family doctor who treats opioid addiction, a psychologist and a social worker. And often a guest speaker! We have a standard form to fill out, with no names: year of birth and male or female. It is a team that can help us to care for our patients.

New information in healthcare rises out of the mist….

 

Resources on opioid addiction

This is a list of resources on opioid addiction that I am putting together for a talk to a community advocate group this Thursday.

The big picture:

CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic, January 2012: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm

CDC 2018 (It’s not getting better yet.) https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html


Snohomish County:

Snohomish County:

http://mynorthwest.com/878895/snohomish-co-opioid-crisis/

https://drkottaway.com/2018/03/03/reducing-recidivism-snohomish-county-sheriffs-office-and-human-services-program/

http://www.heraldnet.com/news/state-house-backs-snohomish-county-opioid-help-center/

http://knkx.org/post/snohomish-county-jail-now-offering-medically-assisted-detox-inmates

Washington State Pain Law

https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/OpioidPrescribing

https://www.doh.wa.gov/YouandYourFamily/PoisoningandDrugOverdose/OpioidMisuseandOverdosePrevention


Is it genes that make people addicts?
(The short answer is genes are a minimal contribution. It is society and patterns learned in childhood and adulthood.)

Adverse Childhood Experiences (put people at way higher risk for addiction):
https://www.cdc.gov/violenceprevention/acestudy/index.html


Books that helped me understand addiction
(in my teens):

It will never happen to me by Claudia Black (about the patterns children take in addiction households to survive and cope with childhood)

Manchild in the Promised Land by Claude Brown (a black male writes about his childhood in Harlem when heroin hit the community. He was in a gang at age 6.)