Unintentional overdose on carfentanil

I have asked my children to share this with their friends.  
Amount of carfentanil equal to size of grain sand can kill; so before drinking anythingin public, quietly ask yourself if you can be sure of where it came from and have been.

"carfentanil directly contributed to 142 deaths from Jan. 1 to April 29, which amounts to 50% more than the total number of such deaths in all of last year."

Myths, the source of addictions

Addiction, a common humanity, is the mental attachment to myths; premature morbidity and death is a consequence.
Myth: “I hate vegetables” or I love junk food”
Translation: “what my mind loves, hates, craves and avoids are more important than what my body needs” consequence: Metabolic syndromes, cancer, etc.
Myth: “my doctor can help me with medications”.
Translation: “Medications can help my mind ignore the warning signs from the body and continue making poor choices”
Myth: “I can’t live without tobacco, cannabis, benzos or opioids”
Translation: “my mind can exist after I have destroyed my body.”  or as per HAL 9000 in Space Odyssey “This mission is too important for me to allow you to jeopardize it.”
Myth: “if I look a certain other way, own a certain other thing, be at a certain other place, have a certain other friend, certain other family, certain other job and certain other government, I’d be happy”
Translation: I was born with some fundamental defects in some fundamentally defective world and can’t ever be happy”.
T. S. Eliot Quotes. “We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.”

Mistakes

I think some ancient story has it that certain Adam listened to his companion, chose to consume an apple he isn’t “suppose” to; and that’s why I exist to tap on my Apple Iphone and learning and sharing perspectives with potentially 7.7 billion other minds.  “Mistakes are the portals of discovery.” — James Joyce

Alcohol and emergency visits

I read: “Ottawa – New research shows dramatically rising visits to emergency departments (ED) related to alcohol, especially for women, with a 175% increase in alcohol-related visits from young people aged 25 to 29. ”

This is a testament of the successful and mostly unbridled marketing of one of many addictive substance to a population in which common sense has become uncommon.  In a society, where substance use is a way of life, celebrated, used to celebrate, has our attention and actively promoted at the same time while people are dying from opioid overdose; any more studies on correlation between alcohol consumption and other social issues (such as crime rate, mental health challenges, chronic health challenges, domestic violence, etc. ) will likely yield  similarly expected findings.
Canadians spent $22.1 billion on alcohol (a rise of 3.5 per cent from the same period a year earlier);
16 Billions on tobaccos;
102 Billions on processed food and beverages;
4.8 Billions on pot; rate rising at 1.2% per year.
250 Billions on healthcare (< than 3% of that on illness prevention which includes immunizations)

4.9 Billions on vegetables.

Perhaps, the government needs to take a step back and make sure all its policies actually make sense.  

Why so many peanut allergies?

Ottawa – Worried about peanut allergies in children? A practice article in CMAJ (Canadian Medical Association Journal) outlines five things to know about early introduction of peanuts in infants to reduce the risk of peanut allergy.
  • Infants who are fed peanut protein regularly have a lower risk of peanut allergy.
  • To prevent peanut allergy, peanut protein (such as peanut butter or powdered puff) may be introduced at home for most babies between 4 and 6 months as one of the first foods.
  • Babies with severe eczema are more likely to have peanut allergy, and those with no or only mild eczema are best-suited for peanut introduction in the home.
  • Infants with risk factors for peanut allergy, such as severe eczema, egg allergy or both, should be seen by a specialist before peanut therapy introduction.
    To reduce the risk of peanut allergy, 8 grams of peanut protein (1 heaped teaspoon of peanut butter) should be eaten at least twice a week.

  1. Does this finding also imply that the evidence-based, scholarly and well intended advise taught and disseminated by the medical community “to wait to introduce certain food till 12 month of age” may have actually contributed to the growing allergy challenges?
    What other potentially harmful advises are we disseminating as physicians?
    How do we know how to “first do no harm?”

The Art of Complaint: Who, why, what and when.

I have learned a few perspectives that help me.
Who? People are more likely attentive, when the challenge personally affects them.
So reflecting and disclosing clearly limitations, most importantly mine, help everymind see things as they are.
Why? Above is only truly possible, when my intention is for the greater good of everyone.
What? There seems to be no shortage of “problem lists”, real and imagined. I think it is important to redirect everymind’s attention to what is real and begin the change within me. “If not part of the solution, then must be part a precipitate” — chemistry joke.
When? I used to feel disappointment when results fall short on the metrics I have preconceived. Now, I understand the irreplaceable “tincture of time” and “infinity of my ignorance”.
My tree grower friend buried bunch of nuts 12” deep and waited 3 years to see which might send up shoots. He planted the pinhead size American ginseng seeds and waited 2 years before the first germinated. I am learning more than just growing trees from my friend; I am learning to be patient, free-up some space in the bondage my expectations and embrace the yet unknown.

Penny for your thoughts.

100 Billions galaxies in Universe.
200 Billions solar systems in a galaxy.
100 Billions humans ever born.
7.8 millions different animal species.
400,000 different plant species.
300,000 edible plant species.
200 plant species consumed by modern humans.

102 Billions spent by Canadians on processed food and beverages in 2016.
4.9 Billions spent by Canadians on vegetables and fruits in 2016.
7-10 servings of vegetable and fruits per day recommended by Canada food guide.
4.6 servings of vegetables and fruits per person per day actually consumed by Canadians.
90% of Canadian children are not meeting current physical activity guidelines in Canada.
65 percent of students in college or university in 2016 reported experiencing overwhelming anxiety in the previous year (up from 57 per cent in 2013).
46 per cent reported feeling so depressed in the previous year it was difficult to function (up from 40 per cent in 2013).
13 per cent had seriously considered suicide in the previous year.
2.2 per cent reported attempting suicide in the last year (up from 1.5 per cent in 2013).
50% of the Canaduans will have or have had a mental illness by age 50.

80%, according to Health Canada, Canadian adults have at least one modifiable risk factor for chronic disease (self-reported tobacco smoking, physical inactivity, unhealthy eating and harmful use of alcohol).
$250 Billions spent by Canadians on health care.
$300 Billions tax revenues in Canada.
$6604 is the annual healthcare cost per Canadian.
30% Canadians are either diabetic or prediabetic.
$26416 is annual health care cost per Canadian with diabetes.
10,300 Canadians died as a result of an apparent opioid-related overdose in last 3 years.

Everymind’s business

Workload in healthcare is due to illness.  Abandoning technology is not the answer.  It is like throwing away the hammer because I missed the nail and hit my finger.  Using technology effectively is one answer.  Another answer is getting the attention of everyone and provide education and support in self-management.
As healthcare is at the crossroad of social sciences, arts and sciences; it’s solutions require wide collaborations between many disciplines of knowledge.
Invest in “googleresque” software teams to design, unencumbered by imagined fears, efficient EHRs that empowers and trust physicians to provide care.  Allow them to create “universal” software that feels like “wind beneath our wings” rather than “ankle weights”.
Automatic audio archive of details of clinical encounter may sastisfy billing and legal needs and free the user from work not related to direct patient care to focus on the patient.

Self-management education and support is everymind’s responsibility to its body.   Everymind needs to pay attention.  It needs to start formally at the earliest opportunity in a school system that is “cradle to grave”.

Artists, entertainers and opinion makers, skilled at attracting publics attention, may provide the much needed informal education and support to a diversity of minds.  This diversity of minds requires a diversity of “languages”, approaches and medium.

I think pain is the universal “language” the body speaks to the mind of the consequences of its food and activity choices.  Prescribing medications without education and support in self-management is one way for care providers to help the mind ignore the body’s warnings.  As care providers are given the mind’s attention due to pain from the body and sufferings of the mind; care providers may interpret the pain to a mind made attentive by pain and redirect its attention from imagined to real needs.  In accordance to spirit of CanMeds, physicians may be empowered and supported to begin conversations within their own circle of influence to raise awareness at every echelon of our society.  This conversation may include patients, learners, employees and community groups.  It mis also  include leaderships in healthcare systems, education systems, government and corporations.  Being led by leaders without awareness would be like having “the blind lead the blind”

GERD and PPI

I think, GERD, more often than not, is the way the body informs the mind of the mind’s poor food choices.
PPI is a way for physician to help the mind ignore the body’s warnings.

“participants with the highest intake of fruits and vegetables had 33% lower risk of GERD (OR = 0.67, 95% CI: 0.51-0.88), after adjustment for confounders. Women with the highest fruit and vegetable intake had 36% lower risk for GERD (OR = 0.64, 95% CI: 0.45-0.91).”  https://www.ncbi.nlm.nih.gov/m/pubmed/29259636/

Behavior challenges

My behavior challenge is not doing too much of what easily grabs my attention; rather it is not doing what is important.  By cultivating a “beginner’s mind” and direct it’s attention to what is important, desirable behavior will naturally manifest.

What is group therapy?

I think what I have learned about running groups ( and working with mental health) is that every patient and situation is unique.  What works great for one may not for another.  While groups may allow participants opportunities to listen to a wide range of perspectives from others, develop increased mindfulness or awareness of their inner truths, experience a sense of uniqueness, oneness, acceptance and other healing truths; it is not necessarily accessible or helpful to everyone.

I have experienced many challenges using groups; some within my control, some within patients control and some helps me experience the importance of “patience, open-mindedness, trust, beginners mind, gratitude, generosity, acceptance, non-judgement and non-striving”. (Jon Kabat-Zinn)

I now run several groups in a rolling enrollment model within a “Patient Medical Home” to minimize barriers to access: financial, familiarity, geographical, capacity, timing and stigma.
I have also gradually gotten better at helping individuals work through their personal challenges of joining and staying with groups.

While I often receive gratitude from patients who experienced benefits; I fully realize I am merely one of many “helpers” on their journey to growing awareness.  I try to remember to thank them for the opportunities to bear witness to their limitless capacity for inner transformations.

Fear of the unknown

I think some brains are wired to fear the unknown and some to embrace. This is one of multitudes of neurodiversities. Neurodiversity is life’s existential strategy; as is biodiversity, gender diversity, ethnic diversity, cultural diversity and perspective diversities.
All the “isms” arise from over-generalizations or imprecise judgements of what is “good” or “bad”. Sense of oneness arise from awareness of individual uniqueness and equanimity.
“Differently than before, he now looked upon people, less smart, less proud, but instead warmer, more curious, more involved. When he ferried travelers of the ordinary kind, childlike people, businessmen, warriors, women, these people did not seem alien to him as they used to: he understood them, he understood and shared their life, which was not guided by thoughts and insight, but solely by urges and wishes, he felt like them. Though he was near perfection and was bearing his final wound, it still seemed to him as if those childlike people were his brothers, their vanities, desires for possession, and ridiculous aspects were no longer ridiculous to him, became understandable, became lovable, even became worthy of veneration to him.” Siddhartha 11.2 by Hermann Hesse

What is racism?

Racism is not just an outward expression but also an inner judgement. An imprecise judgement arising from insufficient perspectives of reality. This inner judgement may manifests in hypocrisy, discomfort and sufferings. Awareness of this inner judgement is the first step towards greater awareness of uniqueness, oneness and acceptance. Is there a need to tell the right hand not to hit the left hand?

What is a physician? Interpreter of pain and suffering.

As the body speaks to the mind through pain and the mind creates its own sufferings; I alone may be given their mind’s attention.  Perhaps, the greatest value I, as a physician, can and can alone give to my patients are perspectives of how life really is.  To do that I must first look inward and find the answers.

“Everything that is made beautiful and fair and lovely is made for the eye of one who sees.” — Rumi

The notion of outward “privileges” in life is inherently an imprecise judgement. It may mean differently to different individuals in their unique experiences. These illusionary divides results in sufferings.
The inward privilege I am grateful for is an experiential awareness that is uncovered when I pay attention to these very same sufferings.
“Everything that is made beautiful and fair and lovely is made for the eye of one who sees.” — Rumi

“Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.” —Rumi

The air I breath, the water I drink and the molecular accumulations that I narrowly self-identified as my body could all have once been some part of some prehistoric T-Rex. In a way the dinosaurs has become me. As cell death is part of a my physiology; species extinction is evolution. As the T-Rex couldn’t have fathomed of becoming part of me; no more can I possibly be sure of or even imagine the essence of “my” future existence – possibly, as part of some collective consciousness (or unconsciousness).
“If it be true that there can be no metaphysics transcending human reason, it is no less true that there can be no empirical knowledge that is not already caught and limited by the a priori structure of cognition.”
— C.G. Jung, The Archetypes and the Collective Unconscious
“Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it.”
“You were born with wings, why prefer to crawl through life?”
— Rumi

Fall prevention in seniors

In Canada, more than 137,500 seniors (age 65 and older) were hospitalized for injuries in 2017/18, with most injuries caused by falls, according to new data from the Canadian Institute for Health Information (CIHI). 
Falls are also the top reason for injury among seniors seen in the emergency room (ER). Falls accounted for 60% of all reported ER visits among seniors, with an estimated 20% admitted to the hospital.

For fall prevention and maintenance of quality of life, I share with my seniors the following ideas:
1. Avoid starting to use walkers ( and canes) in possible; reliance on walker may cause development of poor postures if used improperly.
2. Avoid adopting automatic chairs that helps one standup and stair elevators if at all possible. They encourage disuse and accelerates muscle weakness.
3. Do three sets of Sit-rise exercises daily. Record the number of reps on a log and bring them in for discussion at our next visit.

Life’s privilege

I feel great gratitude for my privileges in life, of having some perspectives on life and for life.
I think life is about having sufficient perspectives and paying attention to ones that works.
My mother and father immigrated from Taiwan to Canada with their 4 children. Mom worked as housekeeper; my father worked as a janitor. They raised their family while making minimum wages. They cooked every meal and lived simple. We were blessed with a country that welcomed us, where education was subsidized, healthcare was free and opportunities abound. I was surprised to find out that library books were free to borrow. We furnished our home with perfectly usable furnitures we’d pickup from curb side. It was easy life compared to where we had came from.
I believe while Canada is full of opportunities, it is the perspective of self-reliance I learned from role models in my life, such as my parents and my teachers, that allows me to benefit from the opportunities. For long time I assumed everyone had such empowering perspectives. Now I know it is not so. I think it is one important perspective I wish to share with those asking for my help – it is equally as important as other social determinants of health. 
Perhaps we need more resourcefulness rather than resources.

Change

“Life’s most persistent and urgent question is, ‘What are you doing for others?”
— Martin Luther King
Be the change that you wish to see in the world.
— Mahatma Gandhi
Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.
— Rumi
(The ecstatic poems of Jalal ad-Din Muhammad Rumi, a Persian poet and Sufi master born 807 years ago in 1207, have sold millions of copies in recent years, making him the most popular poet in the US.)
I also believe “people can change”. I know I have. I have seen my family change. I have seen my patients change. I have seen the world change.
I think my transformation begins on the inside. It is a growing awareness. This awareness is beyond head knowledge; it is rather a knowledge confirmed by personal experience (the painful ones especially grabs my attention) or by experiences share by others in authenticity and received by me in gratitude.
The latter process can be facilitated in a Talking Circle.
“Talking circles are a non-hierarchical form of dialogue. Participants sit in a circle, which symbolizes completeness, and discuss a topic. The thoughts and feelings of all participants are valued equally.”
http://www.edu.gov.on.ca/eng/aboriginal/strategygr05lancircle.pdf
The following are Group Norms used in the self-management education groups I facilitate. My intention is to provide a safe space for authentic sharing, deep listening and growing awareness.
As a listener:
I shall respectfully listen to others perspectives as their own and not offer comment or solution unless explicitly asked.
I shall respect confidentiality of everyone.
As a speaker:
I shall respect everyone’s time by being concise and share what I believe is relevant to the group.
I shall not make jokes about others or single other people out, even if I have good intentions.
I shall bring value to the group by only offering my personal and authentic perspectives and experiences by using the “I voice”
I shall try to contribute to the group by sharing my authentic experience even if it is only one word or one sentence, however, I know I do not have to share if I choose not to.
Thanks for writing and reading.
Have a great day!

What is happiness, complacency and oneness

I am grateful for my life and my life as a family physician. I tell my patients happiness are transient moments and so are sadness. T...