Alternative

This article “What Do Doctors Say To ‘Alternative Therapists’ When a Patient Dies?” by Ranjana Srivastava appeared on my Facebook newsfeed yesterday.  I couldn’t resist reading it.  I think you should read it too.

First of all, it is clear I am a big nerd when this is the most eye catching thing I saw on Facebook.

But, the big reason it is eye catching is because I was curious what it would say.  And it said what I thought it would.  We say nothing.  We don’t talk about it with others.  We talk about it amongst ourselves.

It also echoed a lot of feelings I would describe having around alternative therapies.

I am probably one of the more “loosey-goosey” of the people in my department when it comes to alternative therapies.  I am touchy feely, I inherently trust people and I do believe that there is value in a lot of things we can’t or haven’t necessarily studied.  I’m that kid who did a presentation on medical marijuana in research rounds and concluded that it isn’t all bad and we really need to look into the stuff more because people are using it whether or not we think they are or should.

I ask people what they take over the counter or with supplements.  I explain why I ask.  You see, some products, although “natural” act in ways that counteract the actions of chemotherapies or radiation or other drugs.  Sometimes in terribly harmful ways.  Ways that make cancers not respond to treatments.  Or ways that make side effects worse.  I ask because I care.  Not because I want to judge you or make you feel foolish.

Actually, some of the drugs that we give people are “natural.”  Some chemotherapies are plant derived.  They are natural and very toxic, but when used appropriately can treat cancers.

I see nothing wrong with trying something different when nothing is working.  I see nothing wrong with adding things that have low risks of harms that may help.  I see nothing wrong with doing things that are healthy for you.

I do see something wrong with people who are encouraged to spend their life savings on a “miracle drug.”  When people risk their lives to procure enough cannabis to make the oil they were told online was a “cure.”  When people entrust their health to internet “doctors” and people who make a profit from preying on the sick and the scared.

Many of the “miracle” agents on the internet are anecdotes.  Sure, everything starts as an anecdote.  But, that is why things are tested, because we are often wrong and they are one-off events.

There is some laboratory in anecdotal data about cannabinoids.  I’m not refuting it.  I’ve read it.  But, there is no cold hard evidence for it as a cure for cancer in humans beyond the odd case.  Could it be coming?  Maybe… But that day isn’t today.  And there is cold hard evidence for other treatments in some cancers.

It scares me that some people believe the person that will make a fortune off of them buying their concoctions is more trustworthy than the person who makes the same amount of money whether or not they take the treatment.   It upsets me that people think I am the one brainwashed because I am offering medicine with evidence behind it, with the experience of time, the monitoring of governing bodies and the backup of provincial funding.

It terrifies me to know that supplements and some complementary therapies (not all) are not regulated at all.  In fact, often they aren’t even containing what they claim or have contaminants that can be harmful.    And people die from complications from these therapies.  Just like conventional medicine.  But in a lot of cases we don’t even know some of the risks.

When something claims to work almost all of the time or have no side effects… It probably isn’t for real.  Too good to be true is something I see a lot.  But people want it to be true.  And why not?  Some people have nothing left to lose.  But really, everyone has something to lose.

It also makes me sad that some of my colleagues think all complementary or alternative therapies are bad or dangerous.  It is scary to see people doing things we don’t understand, so I get it.  And it is hard to trust when people you cared for and gave your all for die, sometimes because they gave it all up for the wrong choice.

Miracles happen.  There are things we don’t understand how they work, but they do.  There are things we know do work and they scare some people because of misinformation or lies spread through all kinds of media.

When people forgo conventional treatments or risk counteracting treatments for something advertised on the internet or sold by an alternative provider, it makes me uncomfortable.  I’ll be honest.  When people die doing this, it makes me sad.

Complimentary and alternative therapies can be many things… I send people for massages, acupuncture, reiki and I think chiropractors do good work. I encourage spirituality and  and exercise.  I preach good diets and appropriate vitamin supplementation depending on need.   I think cannabis can be an option for some people for symptom control.  I am okay with you doing something else so long as it isn’t putting you or your treatment at risk.  I can’t stop you from doing something I don’t agree with or trust because you are your own person.  But, I can be honest and tell you why it is concerning.  I can review the evidence.  I can help you interpret it because I have a background in reading that kind of stuff when many people don’t.   I’d rather know than not know in any case because your health is important to me.  And I make no gains or losses by having someone take “my treatments.”

I just want people to be healthy and safe.

Conventional medicine can’t save everyone.  Neither can alternative medicine.

It is scary, but things go wrong.  Alternative therapies (namely the various supplements and drugs and cleanses) can cause a lot of problems.  But, we don’t talk about it when things go right.  We also don’t talk about it when things go wrong.

Talking would be a good start. Regulations would be wonderful.

There will always be people out there trying to make money and preying on the sick and vulnerable. Sadly, these people give everyone a bad reputation and are the source of my distrust and skepticism.  I know there are practitioners out there who think they are doing good and maybe are not.  That is where better regulations and research could make a change.  And I know there are practitioners out there doing amazing work with the best interest of the patient at heart.

An open mind is good.  Educated professionals are better.  But, I think that opening up the lines of communication between professionals but also with patients could make a movement towards making a difference.  At least in some cases.

Advertisements

Things that keep me up past my bedtime

In order of likelihood to do so…

  • My pager.
  • World Junior Hockey/Olympic Hockey
  • NHL playoffs when the Habs are playing.
  • Travel.
  • Visiting friends or family.
  • An exceedingly good book.
  • Homework.
  • Patrick.
  • Something highly intriguing on TV (including other “less important” hockey).
  • My mind on overdrive (especially dangerous when combined with pregnant uterus sitting on bladder).

My priorities are odd.  Its too bad we spent a week visiting friends and family that wrapped up with last night and tonight being hockey and tomorrow night being on call.  And usually sleep is so important to me (and my work is piling up).

Some someecards that describe this weird relationship the M household may or may not have with hockey.  Don’t judge us too much.

Whoo!  Go Canada!!

My love-hate relationship with Christmas hospital

The hospital is a funny place at Christmas. I kind of have a love-hate relationship with Christmas hospital.

One part of me loves Christmas hospital. I love that everyone tries so hard to make it festive and that each floor or section have a different décor scheme (or lack thereof). I love that some people really rock the decorations. I get excited for the treats on the nursing units.

I love how people try so hard to make it a welcoming and festive place, even if for many people it is the last place they want to be.

But, I hate that people have to stay in hospital over the holidays. I’m glad we have the option and that these people are well taken care of. But, this weekend, I seem to have spent a good chunk of my on call rounds talking to people about their hopes to get out, their dismay about not getting out and trying to help them see or find the bright sides in the situation. It comes up a lot. And it is important, so it makes sense that it comes up.

I remember when I was about 5 (it was the year I got a Troll watch for Christmas), my Aunt was in hospital over Christmas. And she swore never to be there at that time again. I am too young to remember what was so bad about it, but I do remember her saying repeatedly she would never go to hospital before Christmas.

That is something I won’t forget.

I don’t want that for my patients. Because, unfortunately for a number of them, this probably is their last Christmas…

Our service is pretty good in that if there is any way the person is stable enough to go out even for a few hours, we try to make it work if the person and their family is wanting, willing and able.

I have one person who has the most festive room ever and plans on having their whole family in for Christmas dinner, although the logistics are still being sorted out. They are pretty excited and encouraged about being around for the holidays at all.

I saw another who only just realized home isn’t going to be an option and just wants to not be alone. Another who is going to get someone to bring in decorations. And a third who was working on Christmas cards and gift wrapping with their spouse.

Its not all that sunny, though. Some people say it won’t be Christmas this year, or get upset when talking about not being home.

I can’t make it better. But I want to. We can treat pain or nausea, but treating being in hospital over the holidays isn’t easy.

The nurses on our ward are awesome and make the best of it. We all, for the most part try to. That is what humans do over the holidays. And that makes it kind of a cool display of how people are decent.

Thus my love-hate relationship with Christmas hospital.

Day tripping with the parents

This past weekend, my Mom and Dad visited.  It has been awhile since they have been here and since we have seen them since our trips home have been limited as of late.

We got Starbucks one afternoon (mmm Peppermint Mochas) and went on a little adventure to a beautiful oceanside area not too far from where we live.

It was freezing cold out… No wonder, it is practically winter and we were by the ocean.  But it was quite lovely to have both the company and the scenery.

Snow. Yay?

I got a text from a friend while I was getting ready for work this morning.  It read “SNOW!”

In the mornings, I stagger from my closed curtains bedroom into our windowless bathroom, so I exist in oblivion to the weather unless it is raining hard enough for our leak to drip or is windy enough to shake the windows or sunny enough to shine through the curtains (which is not likely at 7am where we live right now).  It has been unseasonably mild the last two days or so, and I live in a bubble in which I check the weather only  before venturing outside to catch the bus, so that wasn’t exactly on my radar.

Now, lets be realistic.  I live in Canada and it is Fall, so snow is a given.  But that wasn’t the shock factor.  The shock factor was my initial gut response…. “Yay!”

WHAT?!?!

I don’t say yay to snow.  I’m more of a bah humbug, go away winter kind of person.  Usually I’m anti-festive until December and even then I get cranky if things are excessive.  I only like snow on the holidays not overlapping my travel plans (which it always does). The one thing I always love are Starbucks peppermint mochas and gingerbread lattes.  Mmmm.

But, that has been changing.  I started doing things like sending out cards (I need to buy my cards this year) and decorating.  I still don’t like excessive or commercialism, but I think because I am embracing the reason we celebrate, I am embracing the celebration more.

But moreso, I think friend is rubbing off on me too much.  And I’m okay with that.

So, I almost said yay to snow.  Not quite.  But almost.

My flu shot soapbox

Please allow me to pull up my soap box…

It is time for what is becoming my annual flu shot rant (see here and here for previous).

I got my flu shot this week.

Unless you are allergic to it or have another medical indication to not get it, you should too.

I mean, we are all running around terrified of Ebola and really, afraid of getting sick in general.  But, most of us are too chicken (or cocky or ill informed or paranoid) to get a simple measure that prevents a common and potentially deadly illness.  It is simple, it does not make you sick and the risks are really low (you can actually get some similar complications at random or from a bout of the flu).

Just to point out some facts… You can get the flu shot if you are pregnant.  This came up at work the other day.  It is not contraindicated.  It is advised (I know, there is limited data on fetal risk because the population data does not suggest an issue, but if there was a giant issue, they wouldn’t be doling it out to pregnant women… That is bad PR and asking for a lawsuit).  You can also get the flu shot while on most cancer treatments if you time it based on the advice of your doctor (ao came up at work)ls.  It is free in a bunch of workplaces and also if you have a chronic condition that puts you at risk if you were to get the flu.

Last year, I had, at one point, 3 people in ICU on ventilators (aka life support) with the flu.  The FLU.  And they were all in their 40s-60s.  Not old people.  Not necessarily people who were sickly before.  Crappy luck.  Bad strains.  None of them had received flu shots.  They all survived.  Not everyone is that lucky…  I also had a patient I cared for on an oncology related service die from complications related to the flu during their cancer treatment.

I have watched people die or nearly die from the flu.  I don’t want to watch more.

I know the vaccine isn’t perfect. Sure, there are years where they miss the mark in picking the viruses, but they still do confer some immunity and other years they are spot on.  I know people don’t trust doctors because apparently we have been brain washed.  And there is limited research on each specific year’s vaccine (because they are basically similar with different strains).   But, I like to hedge my bets.  It is simple, quick, easy and has more evidence behind it than most of the stuff seen on talk shows.

Don’t kill my patients.  Don’t kill my family.  Get the shot, it is extremely unlikely to make things worse and it probably will make things better.

Rant over.  I’ll step down again for now.

 

“BIFFs’ Weekend”

Last weekend, we had yet another awesome weekend.

We went away to a place near Kouchibouguac National Park with two of my best friends and their husbands (Child&D and L&C).  We decided last year to make it an annual tradition to go on a “BIFFs’ trip” (BIFFs is a word we made out of the abbreviation best friends forever back when we were in very early undergrad… We don’t really use it anymore, but it works in the context of naming the trip).  A trip where V&D, L&C and Child&D and Patrick and I could go away just (kind of) like old times no matter where we were in this world.  

Unfortunately, it didn’t quite work out that all of us could go.  I was very disappointed.  Such is life.  But, we went to the park from our separate corners of country and met for a weekend adventure.  It was all the more exciting for me because it was most of their first times there and it was where I spent a large chunk of my childhood summers.

Although it was my second weekend full of people, it was worthwhile.  We saw lots of beautiful scenery (and Child too tons of pictures).   I took people on random back road adventures.  I got to eat scallops at this place we always stopped at when I was a kid.  We took L and Child for their first trips on kayaks.  We saw giant man-eating (okay, not really man-eating that we know of) jellyfish and caught all kinds of marine life at the beach.  We ate a ton of food.  Played some games, including one of my favourites, Bang where the other outlaws and I won, read books and laughed a bunch. IMG_0202 IMG_0214IMG_0197IMG_0219

A highlight of the trip was the fact that the house next door seemed to be particularly sketchy and had a lot of animals.   We think that a very feral looking cat who hung around while we cooked and barbecued was part of that household.  When we went out for a bonfire that evening, we acquired a very adorable kitten, who crawled into all of our laps and ate our hot dogs (she stole them from beside someone while she snubbed him).  Patrick had to try really hard to get her to go back to what we thought was her home, only to have her show up crying at our cabin door.  She wasn’t the only one, as it turned out, cats started appearing everywhere once night fell.  IMG_0230 IMG_0224 IMG_0226

I’m lucky to have friends who have been around since I was an awkward teenager (or even tween… ugh), or who I have stuck with since they were awkward teenagers.  I know not everyone is so fortunate.  Yes, that proves to be challenging because people do grow up, get married and change, but they are the closest things I have to siblings, so I’m stuck with them for life.  Even if it is sometimes insanely difficult for some and suspiciously easy for others.

A terribly embarrassing "selfie" from Christmas vacation 2007.  Back when the Child was still literally a Child.

A terribly unflattering photo from Christmas vacation 2006(?).  Back when the Child was still literally a Child.

So, I have someone who gets up early, drinks coffee by the pound and discusses things like books, life and music.  I have someone else who hugs me more than anyone else I know (less my mother and my husband) and somehow understands my crazy and knows what I actually am feeling even when I don’t.  I have someone who will always laugh hard and long at stories with me (even if they shouldn’t be that funny).  The cool part is that although everyone is unique, they all crossover too.  

Pretty cool, huh?

The Annual M Event

We went on mini vacation to the M family reunion this weekend. I do better with it every year.

I think I am getting used to bigger family. I also think I am learning my limits and not pushing myself to do everything with everyone.

I stayed at the cabin by myself after dropping Patrick off to meet his family for the second drive in movie. I found a hatchet in the cabin. I didn’t know whether to be comforted I had a weapon or terrified who left it there.

Saturday was a beach day. I hit the beach for a run first thing, then spent the day there with everyone reading and swimming and capturing marine life.

We played mini golf that night. I beat Patrick and tied for third. It was thrilling.

Sunday was a day for leisurely travel. Spent time relaxing in the morning. We even stopped at a wildlife park!

Good trip. Despite the sunburn that I got even though I applied my SPF 30 every 2 or 3 hours.

20140714-213004-77404709.jpg

20140714-213004-77404252.jpg

20140714-213005-77405160.jpg

First intent to swim beach of the year!

We had our first beach with intent to swim adventure this weekend.

I specify because I like just going on field trips to walk around the beach or explore areas near beaches all the time.

It was still pretty post-tropical stormy, but it was hot out, so we figured the waves would be epic and the beach might not be crowded.

Problem was, we failed to factor in that ocean windy is different even compared to the harbour windy we live every day.

We also forgot that it is still really early in beach season in these parts and that tropical storm/hurricane just passing through would mean cold water.

We got to the beach and the sign read that the air temperature was 16 and the water temperature was 13.  

But, I am stubborn and Patrick is insistent.  We drove an hour.  I put on my bathing suit already.  We are going swimming!

Child and D dug a giant hole in the beach.  They weren’t as hearty stupid as we were.

You kind of felt this searing pain followed by numbness as you entered the water.  It was the kind of cold that made you think you might actually have a heart attack and die.  It was the kind of cold that numbed my still sore-ish toe enough that I couldn’t feel it even when I knew I landed on it wrong jumping in a wave.

The waves were awesome, though.  And there were no jellyfish (probably because the rough waters were murdering them all offshore.  

We might have only stayed in for under 20 minutes.  We might have had to change right after to try to get warm.  But we swam.  And that was awesome (so was Child and D’s hole.  It was as long as Child’s leg.).  Other bonus was that I didn’t get much of a sunburn because I didn’t stay in the water longer than the lifespan of my SPF fifty million and two.  Last bonus was that I got to read some of my current fun book.

I love the beach.  And I love summer weekends where I don’t work (even if I had to spend the rest of my night on clinic prep and reading).