Monday, October 20, 2014

Hay Bay Home

My brother, Ron and Sister in Law, Adell have bought a second home near Nappanee on Hay Bay. I confess, I love that family are living on a place called Hay Bay.  Driving through the Ontario country side with fall colours of red and orange and yellow we see a sign Hay Bay Women’s Society.  I don’t think it’s narcissism to appreciate the location by name but a sense of deep belonging. Next year I’m hoping to get back to Scotland to the Aberdeen area from whence grandad came, where a Hay is apparently a dime a dozen.  One of my brother’s realtors was a Hay too.  Makes it feel all sort of right in an odd way.
Last time I was here I was attending my nephew Andrew and his bride Tanya’s wedding at the Canada Club wearing the blue Hay Hunting kilt.
When I flew into Ottawa to attend the Canadian Society of Addiction Medicine Conference my brother met me and Gilbert my cockapoo at the Ottawa Airport.  Great to be with family. Nephew Allan , just completed undergrad psychology waiting to begin masters program.  Over delicious Italian at Poccopazzo family owned restaurant I got to catch up on the latest doings of chemical engineer movie making nephew Graeme and geologist nephew Andrew and his beautiful  publisher wife Tanya.  Graeme’s horror movie Ragnarock Cabin has opening to coincide with Halloween this year.  Tanya and Andrew were on a pumpkin hunt in preparation for a Halloween party. It all seems so civilized.  I feel like I’ve descended from alien planet out in the wild west when I come home to this happy normalcy.  My brother and sister in law are both retired so we no longer commiserate over the challenges of work with all it’s attendant frustrations.  My stories only serve to remind them of their past.  Ron continues his investing from home while I’ve never seen my high school principal Adell not bustling about with home making.  Her primary student this visit is Eva, Allan’s little brown Chewy the wooky  looking cockapoo.
Having just bought another house, all the talk is about landscaping and decorating. They’d just moved the weekend before.  When my conference finished Adell and Allan picked me up with Gilbert already on board and we drove the two hours from the city to their new rural retreat.  I loved seeing the quaint hobby farms along the river. The red barns of Ontario are so picturesque with the red leaves of autumn sumac. Cattle and horses were interspersed with hay fields and corn. Graeme and Andrew have seen deer in the forest on the way here.  Adell pointed to the white swans in the marsh nearby.
The house isn’t visible from the road.  Nearly 5 acres of waterfront.  Down a short road between spruce and pine is the garage  at the first level. The roof of the large two level home sits next to the parking at the lower level.  We entered through the great veranda on the second floor. “I hope to screen this all in next year, “ Adell said as she showed me the upper rooms, a regular Marriott guest suite where I’d be staying.  Bamboo hardwood floors throughout the upper guest area.  Down the bamboo stairs is the music room. Adell sings soprano with several choirs still.  When I told her about attending Carmen recently she said, “I love singing opera but don’t much like attending it anymore.”  I’ll always remember her as the beautiful young girl solo in the church whose voice touched the heavens.  Ron’s veritable collection of guitars was in the music room.  The great living room had a heated cement floor and large fireplace. Dining room and kitchen were part of the pattern with the glass panel doorway looking out on the huge expanse of front yard opening onto the lake. From there I saw Gilbert and Eva running wide circles about the property at breakneck cockapoo speed.  Everything is large, large walk in pantry, large cupboards.  “There’s no basement ,” said Adell .  Of course that explains the need for the storage spaces.  Ron has a couple of sheds in addition to his garage.  The master suite is beyond the large two person whirlpool tub. It has lots of walk in cupboards and another elegant bathroom. It opens onto a a patio where no doubt the Lord and Lady of the house can take afternoon tea and contemplate their apple tree orchard.
Allan and I bought day fishing licenses at the Napanee Canadian Tire.  With Ron’s kevlar canoe and fishing gear, fishing rods, an Adell packed picnic and Gilbert in a life jacket in the middle of the boat, Allan and I, like countless coer de bois before us, set out on the great fishing adventure.  Ron had taken a break from driving his tractor pulling his rotor tiller through his planned potato garden to push out his wheeled aluminum Fendock.  We pushed off from shore before he figured how to lay down the wood flooring.
Allan paddled in the bow while I j stroked in the stern.  For a guy who at his age was white water canoeing the Winnipeg River, I couldn’t recall the last time I’d paddled.  The technique is never lost but the muscles sure weren’t happy.  Neighbours further along the shore waved and spoke to us as we passed.  They were all out doing yard work, burning leaves in fires,  chatting on lakeside decks.
“How far are we going, Allen?"
“Getting tired already, Uncle,”
“No just wondering,” I lied.
“There’s a marsh a long the shore up ahead, where mom sees the swans,"
At last we stopped paddling and Allan put a Canadian Wiggler on my line.  I began casting. “This was dad’s favourite lure, “ I told him and then went on to tell about Dad taking Ron and  I fishing in Northern Saskatchewan, catching pickerel and cooking the fillets over a driftwood fire on the shore.  We casted either side only once tangling lines and the wind pushed us along the outside of marsh.  Allan told me about his research interests in early child education.  He’d applied for research grants and was waiting to hear.
When the wind picked up and it looked like we’d be blown too far away we paddled back into the lee of the point coming aground in the weeds.
 “My hands are freezing from the water, “ said Allen.
“I put my gloves on an hour ago,” I said.
Gilbert was sleeping in the middle of the boat. I was enjoying the cup of thermos coffee and sandwich Adell had packed.  A flock of Canada Geese rose up from the marsh and flew back to Vancouver British Columbia.  That’s where all the Canada Geese from all over the world congregate for seminars on how to avoid being shot by hunters in the rest of Canada.
We talked some more. Allan changed my lure from the Canadian wiggler to the Red Devil. "I always catch a jack whenever I fish with a red devil,” i told him then cast.  Immediately a large fish caught the hook and tugged. I watched the disturbance on the surface. “I’ve caught one, “ i shouted.  “It’s just a rock,” Allan said.  Gilbert rose to the excitement.
Sure enough I pulled in a large northern pike alongside the canoe shouting at Allan to get the net.  Untangling the net from Gilbert’s feet doing twisting pretzel contortions behind him Allan had the net and put it under the fish. “It’s too big for the net,” he said.  He couldn’t get it under the body but the head and hook got caught in the top of the net.  Gilbert was looking the fish right in it’s glassy eyes threatening to jump overboard then suddenly the hook was free in the net and the fish was lying across the opening.. “Quck grab the gils, “ I said.
“I’m not putting my fingers near those teeth, “ said Allen as Gilbert whined and the fished impatient took a massive flick of it’s whale sized tail to Jonah into the reaches of Hay Bay.
“I wanted to eat that fish. “ I said to Allen, “I never knew you were a catch and release sort of Eastern guy.”
“You didn’t pull it up beside me where I could get the net under it. I should have just used the camera to show it wasn’t all that big.”
“Admit it, you’re too weak to lift such a mighty fish."
With all that excitement and all following casts catching weeds we paddled back to the dock.  Ron had again left his tractor and rotor tilling to stand on his now decked dock with Eva waiting for the return of the Canadian couer de bois.  Eva and Gilbert were ecstatic with the reunion and yet another excuse to run wild circles all over the property.  Exhausted I collapsed in Ron’s great leather chair and watched pink finch and blue jays avail themselves of the feeder outside the main window.  I love looking out on the lake between the wedge of forest.  Every once in a while Ron came by on his mini  orange Scots by John Deere tractor to deposit wood by the door.  Allan collected it and stacked it by the fireplace. I enjoyed the warmth while Adell made a roast beef dinner which we all enjoyed later at the dining table.
That night we drove to Kingston a half hour or so away to watch Judge the movie my friend Dr. George Chalmers emailed a recommendations for.  We both love Robert Downey Jr and Duvall. Their performances in this incredible drama of family and small town America should get Downey at least an Oscar.  It was incredible acting that had me in tears at one point. My brother took care of my elderly father at times and the compassion the movie showed of son caring for dying father was very much like the sensitivity that had been shown in On Golden Pond.
Back home Adell handed me pumpkin pie for a snack,.  After that I collapsed in bed with Gilbert the cockapoo climbing up to lie on a pillow beside my head.  This morning it’s raining.  Adell made us all bacon and eggs.
Next Ron called out that we’re all going for a drive in the country side. Adell and he were discussing earlier that they’d not explored their neighbour hood and wanted to see what’s on the other side of the lake.  By the time I caught up with the plans Ron was in the Suburu with Allan, Gilbert and Eva.  Adell was waiting to lock the door behind me as I slipped on my shoes.  There was a drizzling Vancouver rain till we got to a ferry which took us across to higher land.  There we drove up to Lake on a Mountain where the dogs had a jolly time on leash exploring this ancient mysterious lake.  What they call here a mountain though wouldn’t cut muster in BC.  There was a great view of the waterways and I saw where Lake Ontario became the Reach.
Picton was the town and harbour we landed in.  A quaint little place with old stone houses here and there with the red brick two stories. Pretty little tourist site. We drove on from there to Desronto in the Mohawk territory then on to Napanee, the little town I really liked. It’s 20 minutes from their home but we’d gone all around the backside of Hay Bay to get there from the other side.  We stopped for burgers and fries at Shoeless Joe’s Napanee.  Great food and great service.  Ron and Allan were happy with the sports scores on the telly at each booth.
I couldn’t remember the last time I’d had such a fine cheese burger with mushrooms remembering times I’d taken Dad for burgers, something he really enjoyed in his last years.  Of course, Cheeseburger in Paradise by Jimmy Buffet will always be a favourite sailor song of mine. Gilbert and Eva shared a charbroil barbecued burger paddy between them and just wanted more.
After a couple of shopping stops, Cartronicpowersports for Honda 3000eu generator and Marks for socks,  we got back home where the dogs ran the length of the yard and back, glad to be free.  Ron’s been playing Four Strong Winds on the guitar with Adell singing.  I’ve just finished an after burger nap in the guest room.  It’s so relaxing in the country.  I love this house and  family. The dogs are simply the best little characters happy as can be with each other and their surroundings.
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Sunday, October 19, 2014

CSAM - Canadian Society of Addiction Medicine - 25th Conference - Ottawa - October 2014

Evolving Perspectives on Addictions (Perspectives Evolutives en Dependences)” was a great success with participants from accoss Canada and the United States.  President Ronald Lim and Conference Chair Paul Sobey,
DSCN2600combined with many others to make this educational experience at the Marriott Hotel clinically extremely beneficial as well as addressing evolving controversies.   Having a Methadone Clinic to attend at Dr. Gary Horvath’s DTES Vancouver Doc-Side Medical Clinic on Wednesday I didn’t make the first day though heard it was extremely well received. All the research and scientific advances in the study of electronic cigarettes and marijuana smoking were addressed.  Thanks to Paul I was emailed   Dr. Mark Wares latest paper.
Dr. Alan Budney , President, Division SO American Psychological Association presented on new regulations related to Marijuana.  Dr. Peter Selby updated the group on Motivational Interviewing.
All of the slides and references for conference are available on the CSAM site.(www.csam-smca.org/Office 403-813-8217)
Dr. Jeffry Turnbull, medical director of the Inner City Health Project, Ottawa presented on evolving psychosocial approaches to Addiction treatment while Dr. Tara Tucker addressed the critical issue of Compassion Fatigue.
Dr. Kim Corace, Director, and Dr. Melanie Willows, Program Development and Research in Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, spoke on Bridging Research and clinical Practice:Key Strategies to creating innovative addiction treatment services.  DSCN2596DSCN2597DSCN2598Their presentation addressed the need and importance of the Hub and Spoke Partnership Model, the networking involved and how to get key players involved in the coordination of effort.  It was clear that a whole lot of work and effort had gone into the obvious successes of this remarkable program.
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Medical Director, Substance Use Service, Women’s College Hospital, spoke on the Rapid Delivery of Addiction Medicine Service to patients in Detox Centres and Hospitals: the H-SOAP project.  Dr. Kahan is truly one of my favourite ‘rock stars’ of Canada’s Addiction Medicine. His program identified that addicts with their particular series of crisis needed to be deal with  a hospital based service that was responsive to emergencies, psychiatric and internal medicine wards providing the critical cost saving and clinically relevant service at the time they’re needed not weeks or months later.  With his vision and experience he has developed a working model in his community that is practical, profitable and very timely indeed.
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Dr. Corey Waller,DSCN2638 Medical Director of Spectrum Health Medical Group Centre for Integrative Medicine presented on the major news topic of Prescription Medication Abuse. He was a very exciting speaker with humour, anecdotes and challenging considerations for advocacy at the highest levels.  

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Dr. Marie-Eve Morin DSCN2653was a true delight presenting in French on the topic of the Doctor as Drug Pusher.  The conference had provided electronic sound devices for the real time translation of her superb talk.  My french is rudimentary so I really did appreciate this assistance and knew my American friend was loving this ‘international’ aspect of the Canadian conference.  Dr. Marie-Eve Morin’s reviewed the problems of prescription drug abuse, the history and recognition of these in Quebec and the advances in addressing the issues her and her associates had made.   It was a thorough and riveting presentation. C'est bien! Magnifique!
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Clinician Scientist, Centre for Addiction and Mental Health, presented on A Case for Pharmacists and Prescription Monitoring Programs , Decreasing the Harms from Prescription Drugs.
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DSCN2669Dr. Melanie Strike’s presentation was very well received, a very revealing presentation of clinically relevant research and insights that really did touch the core and complexity  of concern in the front lines of therapeutics.
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DSCN2687Dr. Nady el Guebaly, the humble leading light of  International Addiction medicine has just published the definitive textbook of addiction medicine through Sprinter.com (ordersny@springer.com) “Textbook of Addiction Treatment:International Perspectives” Nady el Guebaly, Giuseppe Carra and Marc Galanter.
Dr. Nady el Guebaly introduced Dr. Ivan Montoya, National Institute of Drug Abuse (NIDA, Director, Practice Research Network, American Psychiatric Association. Dr. Motoya did a comprehensive review of the evidence based research on pharmaceutical treatments to date and introduced new treatments ongoing and/or under review.  This was a very exciting look at the possible future of pharmacotherapy with it’s attendant hope for those still suffering.

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Monica Bawar, PhD Student,  Neuroscience program, and Brittany Dennis, PhD Student, Clinical Epidemiology and Biostatistics, McMaster University, presented an elegant study on Factors Affecting Treatment Outcome for Patients Undergoing Methadone Treatment for Opioid Addiction: A Focus on Sex Hormones and Chronic Pain. I was delighted personally to learn from this research that testosterone levels are related to dose of opiods and that there didn’t seem to be any evidence that one opioid acted differently than others. My methadone patients occasionally complain of reduced libidido when they start treatment which struck me as strange because most of the heroin addicts in general complain of lack of libido secondary to any opiate use.  Heroin has never been considered a sexual performance enhancing drug so it was helpful to hear the detailed work of these researchers who also addressed how factors of chronic pain might well contribute to relapse in methadone patients.

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Dr. Andrew Smith, Staff Physician, Pain and Addiction Medicine, CAMH presented on Partial Agonists and Half Truths: The Use of Suboxone in the Treatment of Chronic Pain. Dr. Smith’s presentation was a most interesting case presentation with remarkable insights and developments that spoke well to the true complexity that clinical practice presents.  It was really helpful clinically to see how an otherwise difficult and tragic case of a highly successful individual with chronic pain could be best  addressed. The use of Buprenorphine was critical in the resolution of the case which had a previously hard working man utterly prostate with disability but with appropriate care back at work and doing the recreational activities that they so enjoyed. It really did speak to the miracles that we all have seen in this difficult but rewarding work.
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“What’s New in Hep C” talk by Dr. Curtis Cooper, Director, Ottawa Hospital Viral Hepatitis Program, was a fascinating  simply for telling us about the facts and success of the new and highly effective treatments for Hep C that are now available. The difficulty that remains is getting the funding for these truly historic advances. DSCN2821
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On this positive note with a celebration of all the new research and advances in the exciting cutting edge field of addiction medicine, the conference closed. Next year’s conference will be in Calgary Nov. 5-7 at the Coast Plaza Hotel (admin@csam-smca.org)
Personally I was delighted to buy Dr. Merville Vincent’s book, Diagnosing and Treating Addictions, An Integrated Approach to Substance Use Disorders and Concurrent Disorders.  Ms McCullough, now in Toronto with Edgewood,  formerly of Vancouver was in the welcoming room when I arrived. It was great to see her again.  Dr. Vincent, psychiatrist with Edgewood is one of the best clinicians in the field but also a very clear thinker in what can often be a fuzzy area. His lectures have always been well worth the effort to attend.
I was equally delighted to actually see Dr. Nady el Guebaly’s Textbook of Addiction Treatment:International Perspectives.  Copies were present for perusal but we couldn’t buy them on sight but had to order from the publisher.  Seeing them was worth the wait as all of us in Addiction Medicine have been looking forward to this comprehensive text. This book had been the talk of the Kuala Lumpur Addiction Medicine conference I'd attended last fall. Now I’m waiting for my copy to arrive and many hours of enjoyable reading this winter.
 For the flight home I was thankful to obtain the latest Canadian Journal of Addiction, the Special Edition: Medical Marihuana: Furthering an Objective Debate. Given all the nonsense in the media and the lies perpetrated by those with  major conflict of interest I’m looking forward to reviewing the truth and science of the matter.   The journal has  articles  by Dr. Nady el Guebaly, Harold Kalant, Mark Ware, Meldon Kahan, Shery Spithoff and Anna Reid.  What a great read this will be.
Thank you CSAM organizers and presenters. What a great conference! A bientot!