Thursday, July 24, 2014

How Much Methadone is Enough?

Methadone is used for 'pain control' and as a substitute therapy for opiate dependence. I'm only speaking to the latter today.
When a person starts a methadone maintenance program they may be using a wide range of compounds and dosages of pills, snorted heroin or injected heroin.  If one is 'new' to their opiate dependence there are detox programs and Narcotics Anonymous as alternatives which can be done alone or in combination with 1-3 month "treatment centres" followed by group living 'recovery homes' where drugs and alcohol are banned.
"New" usually means the person has been using regularly but not necessarily daily for less than a year or two.  When they are at the point of daily use and experiencing 'withdrawal' symptons without opiates they are 'dependent', and not just abusing drugs.  They're 'hooked'.
People who are early in their addiction where the amounts they use and the frequency of use is low may still benefit from methadone maintenance therapy but may also be good candidates for the alternative "substitution" therapy, Suboxone - a pill form combination of buprenorphine and naloxone.  Buprenorphine is the active opiate replacement medication while naloxone is the antagonist that makes the drug 'ineffective' if it is injected.
When a person comes into the Methadone Maintenance Program the normal dosage of medication that is used to 'start' regardless of the 'amount' of drug the person was using on the street is roughly 25 to 40 mg.  The concern of the methadone doctor is 'overdose'.  No doctor wants to 'kill' a patient to 'help' them. There is no way to know 'what' a person has been using on the street, since there is fluctuating purity of compounds and commonly dilutions.  It is understood that the 'starting' dosage is often not enough to stop the cravings and even other withdrawal symptons such as sweating, wide pupils etc. If a person has been injecting a whole lot of heroin this dosage of methadone may only take the 'edge' off.  People often take heroin in their early stage of starting methadone because they can't tolerate or wait for the right amount of methadone to be reached. The dosage of methadone is then increased every 5 to 10 days by the maximum amount of 10 mg to the dosage which is 'enough' for the individual patient.
The 'right' amount of methadone is that dosage which stops 'withdrawal symptons' and addresses specifically the 'physical' craving symptons.  The physical craving symptons are different from the 'psychological' craving. With psychologically craving all manner of expectations are associated with the 'getting high' or 'escape' the drug gives. A person knows they have reached the state of not having 'physical craving' when indeed the person is using methadone and if they try heroin say, "It doesn't work for me...it doesn't get me high anymore...it's wasting my money'.  The methadone at that point is blocking the opiate receptors.
Psychological craving is associated with the psychological aspects of peoples continued use of drugs past what they bodily "need."  Asked why they kept using some admittedly say "I had nothing else to do.... I was bored...... I thought I'd get higher..... I was lonely....The drugs were there.....  I just wanted to pass out. "  The psychological craving is part of the 'crazy' of drug doing. It's why overdose and death are common among heroin users.  Addiction is a deadly disease.
The World Health Organizations studies showed that people who were on at least 60 to 80 mg of methadone a day did better in the long run, staying in the programs, getting into Recovery, not relapsing to street heroin, than those using only 20 or 30 mg of heroin.  These are looking at large numbers. I have a couple of patients using less than 40 mg but their street use was low and infrequent. Further the lower dosage seems more likely a successful solution for those who snort rather than those who use IV heroin.  Suboxone may indeed be a better alternative overall for this group.  Others on low dose are slowly being tapered off,as they have done well on higher dosages, are off other drugs, have stable lives, may be back at work or school and generally are succeeding in the community.  This is when a patient may be on a slow taper but get to a very low dosage where it takes some time to come off 'the last little bit'.
Therefore anything under 100 mg of methadone can be consider standard or moderate dosage.  I have other patients on 220 mg and know of others on more. 200 mg is more in the 'high dosage' range. Patients who are on methadone for years, with 'clean urines', jobs and families, may over time need to increase or may decrease their methadone dosage. The dosage is a matter between the doctor and patient. It should never be 'judged' out of context.  Many of my patients who became 'hooked' on opiates following trauma who still have chronic pain but lost control of their prescription drug use for whatever reason, get back to normal lives on methadone maintenance but continue on the methadone for 'pain control' and just simply stay in the methadone maintenance programs. I have seen patients whose 'addiction' behaviourally was addressed years ago and they have been drug free and are living wholly normal lives in the community but continue to see the methadone maintenance doctors esssentially as they might see a 'pain specialist prescribing methadone'.
There are individuals who are 'rapid methadone metabolizers' and they need a higher dosage and may even need to have their methadone split to being administered twice a day.  To know if a person is a rapid metabolizer, the symptomatic picture is that the patient feels well immediately after but by evening or early morning is experiencing withdrawal. The doctor and the lab then do a series of blood level measurements after the methadone is taken to establish the peak and trough of the drug level and see when this is occuring. In rapid metabolizers the peak is the same as others but the trough occurs much more rapidly and remains low causing the patient the discomfort.  This may occasion a higher dosage than normal or splitting the methadone into two doses morning and evening.
Also crystal methamphetamine and cocaine will influence the subjective need for methadone as both are stimulants result in the patient physiologically or psychologically (or both) 'needing and wanting' more methadone to do the job. Commonly when patients stop their cocaine or crystal meth abuse their 'need' for methadone reduces drastically.
That said, some patients have other medications on board and if any are metabolized by the same system that metabolizes methadone or are associated with respiratory depression these have to be seriously considered. Benzodiazepines , (diazepam, clonazepam, lorazepam, etc) are all contraindicated in combination with methadone as the combination was the cause of death in sleep and overdose with methadone methadone maintenance programs. Indeed the prevailing wisdom to date as a result of  scientific evidence is that opiates and benzodiazpines are contraindicated together in general.
With all these considerations I asked Dr. G. Horvath, a leading authority on the clinical use of methadone, on how he would assess if a patient was on enough or too much methadone. Dr. Horvath is an addiction medicine specialist with a very extensive clinical experience in the Downtown Eastside Vancouver  where he has the Doc-Side Medical clinic in which a half dozen methadone doctors practice as well. As one doctor said, "he's seen it all'.  No one has but he's closer than most.
He wasn't terribly concerned about the 'dosage' even into the 200 range.
"If you are ever concerned about the dosage being too high, arrange with the pharmacist to know the actual time the medication was witnessed, then see the patient between 4 and 6 hours later. If they are not drowsy at that time then the dosage isn't too high. If you want to be even more scientific get a peak and trough level for the drug from the lab to ensure you're assessing their level of consciousness at the peak level of the drug. You can check the pupil size too."
This was extremely beneficial information to learn not just for the measurement of the 'dosage' in clinical practice,  but for me to answer questions from treatment centers,   therapists and others who have patients in mixed meetings where some of the people attending are on methadone and others are not.  Complaints sometimes arise that persons on methadone negatively affect meetings by being 'on the nod' and not able to 'participate'.  In the majority of cases I was asked about the individuals depressed state of consciousness was the consequence of benzodiazepines or other medications which the treating methadone doctor did not know about.
There are countless patients with legitimate pain legitimately on opiate medication attending advanced education and training without being obtunded and passing out in the classes.  When this is happening it should be seen as a red flag. Dosage of medication needs to be assessed with the prescribing doctor and  pharmacist and urine testing needs to be done to confirm that only methadone is being used.  The stat random urine test is best if a person appears too drowsy to participate and a person thinks their methadone level may be the cause. As I have said the most common cause is other drug abuse or use of other medications that the methadone doctor may not be aware of.  Most commonly the drowsiness in the cases I investigated was the excessive marijuana usage or benzodiazepine abuse or abuse of other opiates in addition to the methadone.
Here in Vancouver we have the benefit of an enlightened Minister of Health and pharmanet program which allows us to review easily what has been prescribed to an individual patient. Urine drug testing is a standard part of methadone maintenance programs and if there is a concern a "STAT" urine drug test can be ordered any time.
  However, in many other cases the methadone patient in the classroom who was nodding off was doing so because of poor sleep, sleep apnea, homelessness or even because the lecturer was utterly boring.  Many other explanations need to be considered.  Too often it is assumed that methadone or the 'dosage' of methadone is the issue.  Of course , sometimes it may be, but more often than not, that's not the case.
Commonly, the problem with a patient dropping out of methadone maintenance and returning to street heroin use is that the methadone dose isn't enough. There is a 'right' dosage which is specific to the individual.  That's when the Methadone Dosage is "enough".

Wednesday, July 23, 2014

Israel and Arab Conflict

As a Christian I want to weigh in on this conflict.  When I visitted Jerusualem, the Israelis were in charge of the city but they made it possible for the Christians and Moslems to live and function in the city. They respected the property of other faiths and 'shared' the city.  This was readily apparent to me as a visitor. 
Right now Moslems (albeit extremists, apparently) are beheading Christians. They are burning churches. Every religion has a history of doing this sort of thing in the past. The Moslems are doing it NOW.
Moslems have been accepted all over the world in nations of Christian heritage. 
My friends in Israel have tolerated rockets being randomly fired at them. I assure everyone if the City of Vancouver was to be routinely shelled by Surrey it would be yesterday that Vancouver would be invading Surrey and stopping the people who were bombing them. 
My Canadian patients who are soldiers tell me that it is common practice for jihadists to hide behind women and children.  The Communist Viet Cong used this tactic in Vietnam. The reason the media gets so excited about this is Canadians, Americans and Israelis don't conceal their weapons in hospitals and don't use their children as 'suicide bombers'.  There is no history of Canadians using 'women as shields'.  This is not because feminists would object but because it's 'unChristian' and very 'un Canadian' and un American. Jews don't 'use their women and children' for weapons. 
It goes to the very nature of the 'personhood' of men and women and children in Christian, Jewish and even western secularized societies that began in the enlightenment.
Enlightenment has not happened in large parts of the world. Women are mutilated and killed and children are not protected.
If as a Christian I am being shot at or my family is being shot at, I can 'defend' myself.  If you are hiding behind your wife or children to shoot at me, I will 'unintentionally' potentially shot your wife and children because I will protect my family.  The media pictures are silly because they don't give this context. 
I defend Israel's right to exist. I defend Israelis right to stop having bombs daily thrown at them.  I defend Israel's right to exist.  I don't think anything the Israeli's have done to date 'justifies' the continued' terrorism' , 'yes, terrorism' and 'criminal' behaviour of 'aggressors'.  As a Canadian I would in their place do exactly as they are doing. As a Christian I would too. 
Right now we can see in Iraq and Syria what Moslems are doing to Christian, Jews, and each other. I don't want this barbarism.  Of course there are great Moslem individuals. The Koran is full of butchery and tribalism. The old testament Bible is full of butchery and tribalism.
The Christian bible is the New Testament and thankfully the teachings of Jesus are far more civilized than the teachings of Abraham, Moses or Mohammed.  I think everyone, even Christians, would do well to consider carefully the teachings of love that is the foundation of Christianity. 
Right now, there's a propaganda war going on. 
In the Bhagadvagita when Arjuna says to Krishna the war is raging and his family is fighting on either side, Krishna responds the real question is not which side but rather whether you participate or not.
I know Aetheists are full of shit but I kind of prefer them to wishy washy agnostics who want a mommy or daddy to wash their ass.  I'm a theist.
I'm on the side of Israel.  Of course I wish the Arabs would stop attacking them and I wish the Moslems would do more for their brethren moslem Palestinians.  I fear for the Palestinian Christians. I fear for all Christians right now in Moslem countries. I didn't fear for Christians in Israel. 

Monday, July 21, 2014

Monday Morning

I am up. 6 am.  I woke first to a dream of driving in mud and sleet unable to see the road through the windscreen. I stopped the car.  Then lying semi awake old resentments poured in. I saw an axe going through the skull of history.  I began praying for the past.  Praying for enemies. Praying for God. Praying for peace. Praying for love.  Resentments are taking poison and hoping the other guy will die.  Abortions are abortions. The gifts the girls give.  We truly are a death culture.  I think I like Christianity partly because it’s real.  Hanging death about our necks we hope for eternal life but know that hear and now they’re burning our churches.
Gilbert jumped up on the bed as I was leaving.  Little fur ball.  Monkey dog lying on his back. I rubbed his tummy. Chucked his ears.  
Toilet.  The Emmett Fox book on the counter.  Usually Emmett is uplifting.  I can’t say what he said this morning. In the eyes, out the ears.
I moved onto meditation. Sitting cross legged in the living room.  A half hour of prayer and quiet time. Hard to unbend.  Stand, turn the lights on.
Make coffee.  Open fridge, eat yoghurt.  Fragments of ginger cookies. Share with dog.  Coffee, evaporated milk and honey.  Ah.
Internet slow.
The alarm goes off. I shudder. I thought it was the phone. Patients calling me at dawn, midnight, 3 am. Nurses calling me every half hour. Screams in the background.  Blood curdling screams.  Squeaky toys that suddenly stop.  Human sized moments.  The dog is looking at me.  It’s just the alarm.  The illusion of control.  Sometimes the prayers work better.  Today I’m still sleepy.  Almost go back to bed.
The mail isn’t so bad. Not like some days.  No emails from patients. No cries for help. No threats of suicide. No angry threatening litanies.  Just irrelevance.  All irritating with the slow internet.
Then Facebook.  It’s Monday Morning.  The friends aren’t doing much better.  Still in the trenches. Gathering to go over the wall.
How many times like this have I thought I could phone in sick?  How long will I remain self employed before I lose my business? How many mental health days can a psychiatrist take? Meanwhile people are killing people elsewhere and getting medals for it.  Others are burning churches and destroying 2000 year old art and patting each other on the back. Meanwhile millions in refugee camps are wondering what they’re going to do today to get on with life.
When I lived in an apartment and the water wasn’t rationed by the amount in the tank or the size of the water heater, I’d stand forever under the hot nozzle and pray for the power to dress and get out of the house.
Now I’ve a sports car or a motor cycle.  I must only think as far as which to ride.  I barely survive any ride on my motorcycle in Vancouver.  The decision to ride my motorcycle is a death wish.  No one in Vancouver uses their turning signals. The drivers are looking through a maize of marijuana smoke at the roads under constant construction.  We’re due for another episode of Falling Down with Kirk Douglas.  It could be filmed in the Downtown East Side where the zombies on drugs stagger about the streets marked 30 km/hr.  Riding my harley they veer off from staggering and come at me to  touch the bike and stroke my leathers.  Gilbert rides in a box in back.  I’ve thought of getting him a toy shotgun to set the mood for rides in the city.  Better to take the sports car.  Fuel efficient.  Top comes down.
Dare I look ahead to the weekend.  Dare I think of joining friends in the United States to talk about life in the fast lane, to get away from the people who negate your daily yearly decade after decade getting up to go to work working early working late working weekends and think it’s all unfair.  I should be sitting smoking a big cigar rather than working in the car wash.  The anger is palpable.  It’s there in the office.  “If you don’t give me drugs, I”ll get you. I’ll get you. I’ll get you.”  Thinking now about the guys with guns wanting benzodiazepines.  I must go visit my friend whose face was slammed when they came and took his jewelry.
Some of us work.  Others take.  Some of us give. Others take.  Most days I’m thankful my mother potty trained me. These boys and girls didn’t have mothers like mine.  They destroy and hate while men and women create.
This is all just self pity.  This is all avoiding getting up and going out the door.  I remember thousands of days I was afraid to go out the door.  Nightmares.  Omens.  Fear.  It’s just a matter of getting into the shower.  The structure and routine will take over. I ‘ll soon be in the chute that takes me to the workplace and another cup of coffee. Somehow that second cup of coffee at work does it. Then I’m just reacting. The problems comes through the door by the dozens, hundreds and hundreds of complaints a day. I’ve only answering the question about the eye tick when I’m being shown the rash.  Always the papers are pushed in my face. Always I’m being bullied to sign my name to something I don’t know if I agree with. I’d like more time to think about something but theres the phone calls and the faxes and the constant threats from above.
I think of Bob Dylan, “You’ve got to serve someone, may be the devil, or it may be God, but you’ve got to serve someone.”  I believed in the Prime Minister until his anti male prostitution laws. I remember the day the Liberals brought out their anti male gun laws, their anti rural, anti western, anti woman little girl gun laws.  Now here are the Conservatives playing the same kazoo.  I’m supposed to support and trust those above me.  I’m supposed to support sanity but if I look closer I think the bars on the asylum are to keep the crazies out.  I understand all too well why people stop getting out of bed.  I understand all too well why people drop their pens and clipboards, computers and iPhones and walk away from the War.  I understand why Lenin’s promise of getting out of the war was so attractive to the men back then.  Of course he didn’t say they’d just have to do Stalingrad and Leningrad because the paperwork always piles up over weekends and holidays. Nothing ever goes away. That’s Karma. Retribution.
The shower is waiting. Gratitude lists work. They really work.
Thank you God for Gilbert. Thank you for life. Thank you for work. Thank you for love. Thank you for showers. Thank you for coffee. Thank you for locomotion. Thank you for my fingers and toes. Thank you for the love I’ve known. Thank you for yoghurt. Thank you for this day. May I serve God and do good. May I become the best man I can be. May I serve my patients with the respect they deserve and may I be a channel for your healing.  Thank you for the memories. Thank you for sleep. Thank you for prayer. Thank you.

Lord Jesus Christ, Son of God, Have Mercy on Me, the sinner.

Sunday, July 20, 2014

Vancouver summer -sailing, boat work and church

Sailing really is a part of Vancouver Summer. If not sailing then the glorious beaches.  It’s a port city and English Bay is one of the greatest protected harbours in the world.  The great freighters anchor there all the time.  Coal Harbour and False Creek are even more protected but many is the night I’ve anchored out in English Bay.
This Friday I was sailing there with a group of guys.  With all the boat repairs these last few years I’ve rarely felt comfortable with more than one or two all the boat.  Those who’d come out with me were no strangers to boat world and the finicky issues of scows and breakdowns.  But now that the hull and rudder, masts and rigging are restored, I’ve a new engine and a new genoa, I feel the boat is no longer one surprise after another.  The damage the boat took in ocean crossing and heavy wear is all repaired.
With the old engine on a couple of occasions the exhaust system failed and filled the cabin with smoke.  Not a pleasant experience for guests at all.  My sailboat is once again reliable. For me it’s always been safe and seaworthy but as a solo captain I could be fully engaged in such issues as roller furling jams or starter motor failures or bilge pump issues. Now I can actually trust the boat to not need me.  It was a delight to enjoy the ride and the company.   Fun to show people facts of nautical life and associate these with daily life. What’s true north and magnetic north?   Why two people winch better tailing than one alone.  The boat is a marvellous thing for seamanship but also extraordinarily experientially.  The sea and sky and mountains are all so inspiring and calming.
The Volvo Engine remains a joy.  Silent and clean running.  I love my Volvo D2 -40.  The Ray Marine autopilot got practically no use at all.  Jeffrey and John were more than capable helmsmen.  Then sailing, Carter and Tom with their small boat racing experiences got the maximum knots possible with the lightest of winds.  With my knot meter being replaced, Jeffrey found an Android app that gave the speed and heading off gps.  Next we were ‘racing’ in my old cruising vessel. The SV GIRI, old lady she is, was quite surprised with all the attention her tell tales were receiving, after my rather lazy sailing: point, set up the sails, put on the autopilot, drink coffee and correct course hours or days later.  Not these guys.  4.6 knots and finally 5 knots with only 12 knots of wind from the SE.  My boat doesn’t fly in light winds. It’s 13 tons with a full keel. But the new North Sail Genoa and the bottom freshly painted and all the attention to detail, well,  the GIRI  really  outperformed herself.
I’d got this magnificent lemon tart from East Vancouver Bakery on Hastings on the way to the boat.  It was devoured along with the ginger cookies and raspberry cookies.  I should have brought sandwiches but I was late and glad the bakery had the pie.  So soft drinks and carbs were all the crew were fed.  Together we suffered on tart, feared scurvy but somehow managed to survive.  There were no pirates and we lacked cannon subdue West Vancouver.  We did fish but only caught kelp.  I’d forgotten the fishing line but John heard the spool zinging out so we didn’t loose the tackle and did see we’d caught kelp.   No one was left behind. No one needed to walk the plank.  The cat of nine tails didn’t come out.  Gilbert utilized every crew member at some point to toss the tennis ball.  The sun was hot.   Vancouver is awesome for sailing.
We motored back under Lion’s Gate Bridge and across Coal harbour, stopping at Lonsdale to let folk off  before finally docking.
Tom stayed the night. Pizza is a terrific food requiring little preparation except making the request. Gilbert went back and forth between our beds not wanting to short change either of us on his doggie company.
Next day we worked together on the fine tuning boat electricals.  Rather Tom worked on  fixing the wind speed indicator and later the electrical outlet and radio.  I read Patrick O Brien.  Gilbert got Tom or I to toss the tennis ball. When a tool or extra hand was needed I shone.  The glyph was solved.   Tom had sorted through my offshore spare box and claimed all the new Yanmar parts for the old engine,  starters, alternators, water pumps, injectors, impellers and a mess of other parts I had as necessary back up. With the new Volvo and no plan to go offshore this year I certainly don’t need spare engine parts for another engine.  What was lacking through this process was music.  That did occasion my shaving and going out. The radio was dead.  Ralf’s Radio had a newer Clarion model which could be fit into the existing harness.
Armed with that, back at the boat, Tom installed the new radio.  I got the Chinese Food. Eating dinner we listened to Handel’s water music.  The boat hasn’t had tunes for over a year.  I don’t even know what I did to short out the old radio but the new one is spectacular.  It works. I have a wealth of songs on my I phone so we checked out the stereo with symphony, opera, Third Day, Steven Bell, Joni Mitchell, Fleetwood Mack, the Animals, Garth Brooks, Cohen, Lightfoot, Phish, Old Blind Dog,  Pink Floyd, just about anything that seemed like it would be a ‘test’ of the sound system.  The radio passed with flying colours.  I’d met our neighbours while I was putting together the Canadian Tire Deck Box and installing it by the boat.  When midnight came and we were still playing music loud on the new radio, I don’t know they were thinking as fondly of meeting me.
Meanwhile Joan Baez was singing at the Vancouver Folk Festival.  A friends wedding was going on in Surrey.  I’d wanted to go but Tom was able to work on the boat with me now. It’s not always possible to have a day where we can work together and with all the Yanmar parts , he was glad to solve electrical problems for me. I haven’t a clue when it comes to ‘instruments’  and electrical.  Too many moving parts!  Tom’s quite happy to go through the system with the voltmeter checking resistance and voltage. I quickly get confused and only do this in a pinch. It’s not something I feel comfortable with either, knowing I can blow an instrument worth hundreds of a dollars or a thousand or more not knowing what I’m doing.  Out in the ocean with no one but myself and a ham radio or phone I’ll do the work with an expert on the other end but at dock I’m really glad when someone like Tom knows his way around electrical systems.  Getting the main components of the  electrical systems working last week myself was  a real joy. I’d found a short and a breaker disconnected but I’d also been lucky.  Tom’s approach is more systematic and knowledgeable.
I’d actually planned to be sailing to Nanaimo for the weekend but with the rain and Tom’s offer to help first with getting rid of the Yanmar parts and with doing the electrical work in exchange, well, it was a done deal. I was tired too in the morning too. I’d not been winching sails or living on the lean for sometime and all the use of the unused muscle groups had me happy to do little but assist.  I couldn’t believe Tom when monkey like he ran up the mast. I really don’t like climbing up my mast, but pilot that he is, he thought nothing of it.  Fixing the antennae off the Oregon Coast after a hurricane  solo sailing has somehow put me off to being at the top of the mast. I’ll do it. I’ve done it, more times than I remember, but it’s not something I would have done that day. But Tom had to check out the wind indicator and I downloaded the specs off the Raymarine website and that’s how he found that a wire had been misplaced.  Voila! The wind speed indicator suddenly sprang to life.
Today we made it to church. I say I’m pretty much a winter and spring Christian because in the summer I’m sailing any weekend I can and in the fall I’m away hunting any weekend I can.  Father Mark Greenaway Robbins was happy to see me.  Knowing I’d been out sailing, he says, he’s sure I know what I’m doing but “I pray for Gilbert.’     Gilbert is much loved at the church and everyone was glad to see him. I missed the church family and was glad to see everyone. AJ and Kevin and the kids look so great.   There’s now at least a a dozen or more folk  I feel close to just coming to church, going for coffee and visiting.
There’s a church picnic next week.  If I wasn’t planning on sailing I’d love to go to that.  It’s at the Sea Farer Mission and I love the work they do.  Father Mathew works with the men in the Down Town Eastside around St. James. The Sea Farer Mission works with all the Christians, mostly men,  that usually come to Vancouver on the working boats.  A lot of men away from home for long periods. I was given a prayer poster  with a picture of a young man at helm when I attended the Sea Farer Mission years ago. It accompanied my ocean crossings and was dear to me. In the back ground there’s a picture of rough seas and Jesus.  I just had it framed as it was getting so torn and worn. Tom put it up on the wall in the boat this weekend. Nothing is coincidence.
I did reports last weekend and answered emergency calls all weekend. This weekend I decided against doing reports and only had a few emergency calls.  With Mabel in the office, the anxiety of changing staff is mostly over.  Summer usually is a less demanding time of work though it’s never easy.  Early spring is the roughest time and compared to that this is light duty. The sun makes all the difference. Everyone is outside and exercising more and there’s just less gloom.
I’ve come from a swim and hot tub.  Mida fixed up the boat and my home. She put out pillows with sparkling bling on them. They brightened up the cabin and were a great choice. All the guys and me were thankful for the ‘woman’s touch’ but this was a particularly ‘eastern’ touch.  It really gave the boat a touch of the exotic.  A poll concluded that none of the guys would have thought to buy pillows with sparkling bling on them but all of us enjoyed the effect.
They’re fighting in the Ukraine and Middle East.  Gilbert thinks someone should introduce them to yellow tennis balls.  I think that life is just too full and precious with surviving and maintenance and getting along that I certainly wouldn’t want to have to deal with missiles falling in the backyard or planes being knocked out of the sky.  Two Malaysian airplanes down and whose to say it was the Ukrainians and Russians and not some group that has it out for the Malaysian airline.  Having just been flying around the world back from Russia I’m glad to be alive.  I was in Kuala Lampur last year and it’s not some ‘third world place’.  It’s as modern as New York. A great modern city so what’s happened to the air craft could happen here to Air Canada. There but for the Grace of God go I.
A weekend to be thankful for.  I’m truly blessed,  I just have to hold that thought. I’m looking forward to getting the guys out sailing again.  I’m planning on taking others out who want to go sailing too.  I’ll balance it with solo sailing since given my work and life it’s sometimes just necessary to be alone. Solo sailing is then at times like medicine.  This though was about camaraderie and sharing the joy of sailing together in the glorious English Bay on a sunny summer day.
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Saturday, July 12, 2014

Gibsons Landing, British Columbia

My goodness but it’s been a long time since I came ashore in Gibson’s .  The whole harbour has had a face lift. The town is warm and inviting. It’s a real little tourist haven like the San Juan Islands towns always have been. When I was last here a decade or more ago Gibson’s wasn’t at all welcoming. It seemed it was a quiet place for the locals and they really didn’t care too much for tourists. Now they’ve thrown out the welcome mat.
I’ve always sailed to Plumper Cove  but because Gibsons was  drab when last  I was there I never made the effort to leave Keat’s Island and go across to the Sunshine Coast.  When I’d taken the motorcycle up the SunShine Coast I’d simply got of the ferry and bypassed Gibson without appreciating what a little jewel the town is.  Now I really must go back again and again.
The artisans have stores in town with a wide range of local products and crafts.  The fare reminded me of the Farmer’s Market at Salt Spring Island.  I loved the little marina store.  I got the floating rope I needed for the dinghy and the bung I needed for the buggered cockpit through hull.  The women there were delightful.  All the marinas in the island seem to now have these really friendly inviting folk working in the marina offices.  The old curmudgeons have gone somewhere, probably died off.  Their suspiciousness and superiority was enough to give anyone gas.  This marina reminded me of the well run Bowen Island marina I so enjoy.  I really must make a point of coming in to dock with my sailboat.  It’s busy in the summer but a great destination for winter cruising.  I prefer docking in winter months and anchoring in summer.  The electricity heating and running water in winter months make cruising so much more enjoyable if ones stays at a marina.  I sail year round. The weather's unbeatable right now but cruising in the islands is always great.
Gilbert and I walked up to a trail that took us up a hill to a magnificent view of the harbour.  It seems everywhere one goes theres a trail man has made to a viewpoint.  We might well have some eagle genes in the species.  On the top of the hill here there was even a park bench for sitting.  The view was truly magnificent.  I could see my sailboat at anchor as a speck beyond the furthest sailboat with all sails up.  I love Gibsons.
After we walked down and Gilbert lay in the cool stream drinking mountain water ,I stopped at Fish and Chips.  Great ladies. Funny and welcoming.  Gave Gilbert more water and a cookie. Best Ling Cod ever.  I told them I’d planned to go fishing this morning but I was happy fishing in their restaurant.
We cast off from the dinghy dock and scooted back to the boat.
It’s 6 pm. Theres a concert in the town at the modular stage by the marina at 7pm.  I wonder if I’ll skip back and listen from my boat.  Hard to move once I’m in the comfort of the corner of this couch.  Gilbert’s snoozing. I’m drinking perrier water.
So far it’s been a really full day, though I can’t say where its gone.  I did appreciate the Hallelujah choir and orchestra playing for me with the medals and such for getting off my ass  and going to town earlier. I just think a nap would be nice now.  It’s till pretty hot,   I do have a book to read.
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Keats Island anchorage, Boat Engines, Christianity, Personhood and Recovery

A picture is worth a thousand words. The pictures of sailing are always so much more explicit.  I wish the scent of sea air and the cry of gulls was captured too. When I eventually get a new pro Mac computer I’ll probably uplift more video.  Right now the MacAir takes too long to render. Also there’s the difficulty uploading video on slow internet connections.  You simply don’t get high speed cable at sea. What’s missing from pictures is the corkscrewing galloping camel ride experience of a boat in water.  Newbies find it contributes to sea sickness but the older a salt one becomes the more one misses that experience ashore.  Right now a ferry has passed and set me rocking as if I were in a cradle.  When I sleep in the boat at anchor I feel like I'm back in the womb with the anchor the umbilical ford.
I stopped by Stem to Stern Marine on the way to the boat.  I’ve paid all but the last $6000 for the installation of the new Volvo Penta.  The engine alone cost $12000. I won’t even discuss the rest of the installation costs simply because no one could appreciate all the work that Alex and Ben did that warrants what my friends and I know is truly fair and reasonable price for work well done.
(I feel self pity that as a Canadian doctor I’ve been paid a third the real value of my services.  The ‘doctor cost controls’ like rent controls mean I have no competitive income and feel sorely paying the real value of others professional services when mine are so mocked. Yet Canadians happy to pay millions for hockey players never have put much faith in brains.  We’re an ignorant land.  Meanwhile I can’t truly complain because I continue to work in the lowest paid front lines of the public sector when I really could be a fat cat doctor in administration or simply step aside and work for the upper classes in corporate medicine.  Canadians are smug in their universal health care, the charity of doctors whose hourly income for their years of training, call and no overtime and no pensions doesn’t match the much maligned ‘minimum labour’ so sacrosanct to labour.  Such feelings come to mind when I am faced with reasonable bills of the best of the best, such as those at Stem to Stern Marine.  But then also I’ve the Scottish gene that is pained by any penny that passes my hand so at least those of Scottish descendance  could appreciate  my pained expression parting with hard earned money.  I was sorely tempted, when faced with the bill,  to use the brilliant East Indian  Russell Peter’s father’s line, “Yes, but what is my price?"
I’m a very thankful for my life as it is.  My life and Gilbert’s depends on my sailboat, often home and sometimes expeditionary module. Since sailing back from Hawaii  in 2008  with Tom, when we broke the mast, I’ve put approximately $25,000 a year into restoring my sailboat to offshore specs.  That means I've worked longer hours and had less time off than I might well have done if I lived in a rented West End apartment like smart people do.  With the new engine from Stem to Stern, the new new genoa from North Sails, the rigging help from Pro Tech and the advice and help from Eric at Pocomarine, Dr. Phillip Ney's inspiration, Tom's appreciation,  the major heavy lifting work of restoration is complete.
Naturally, as all sailors know we could have bought a new boat with the cost of repairs. However, as sailors, we know that there’s too good a chance if we sold our boats we’d never return to the sea, seeking instead to become fat and arrogant in a condo or apartment which clearly doesn’t try to kill you on a routine basis.  Sailboats are hazards and finicky and commonly named for women. I did indeed comment that my sailboat didn’t cost as much as my divorce and when you compare the proverbial cost of a boat with the cost of girlfriends, the boat is cheap in comparison. This explains why women rarely can bring themselves to own boats never appreciating their relatively low cost despite the high maintenance . (ha! ha! )
I do like taking people out sailing and have enjoyed infecting several people with  boat insanity. Not one individual has been so smitten by the disease that they’ve thanked me for changing their lives for ever. They're young. They folly of the young!
There’s a lovely breeze right now in this bay.  It’s gentle and smells of pine trees and sea air.  Gilbert is panting with the heat. I think he may need to be shorn to enjoy summer more.  These 30 degree temperatures with clear skies are incredible. I just feel a little guilty I don’t make it to church.  I confessed to Farther Mark at St. James Anglican Church that I was a “winter Christian’.  The truth be told I’m a ‘rainy day Christian’.  God is speaking to me now out on the water.  The other smell here is Hawaian coconut oil sunscreen lotion and coffee.
I’ve towed my AB Profile 12 A hard bottom dinghy with centre console and 20 hp honda.  Since I’m breaking in the Volvo Penta D2 -40 Ben at Stem to Stern, as well as Alex before him, said I couldn’t ’troll ‘ with the engine. For the first 50 hours you need to run it with a load, as well as fluctuating the rpms.  So I’ve been running it between 2000 and the 3000 FOT position.
That said I’m like a girl with breast augmentation wanting to wear a push up bra.  I’d love to be fishing. I love trolling for salmon in the sailboat at a thousand rpm running alongside  islands in the 100 to 200 foot depth mark, having the boat on autopilot, watching the rods in the Scotty down rigger holders, reading a book and drinking coffee.  That’s my idea of fishing. I’ve caught a lot of salmon doing just that but this morning I didn’t get up as planned.   I was supposed to be up before dawn fishing with the dinghy.
Towing the boat I lost a half to a knot of speed but still the bigger engine kept me cruising at 6 knots.  With the old Yanmar 26 hp towing the boat dropped my cursing speed from 5.5 or 5 to 4 to 4.5.  I like the added power of the new engine. It worked well last night.  But today I slept in.  I finally anchored at midnight and didn't get into bed till after 1 in the morning. The light came in at 7 pm when I normally get up for work.  I was in the V Berth and turned my face to the wall. Gilbert jumped up into the bed and began licking my ears at 8 am.  But I only got up at 9 when the cabin was beginning to get warm and close. Coffee was calling. I didn’t meditate as long as I ‘should’.  I pray but then I’m always praying to God. I feel like a toddler pulling on my mother skirts in a shopping mall kind of "prayer warrior". Not particularly Goliath.
I like that my Telus Huaweii USB wifi hot spot allows me to get mail here. I have cell phone coverage so don’t have to be concerned I forgot my Satellite phone. I'm always on call and commonly answering emergencies in the oddest places.  This week it was in my car. Another time I was called up north and had to discuss an emergency from a tree stand.  Commonly I'm interrupted at sea.  So far so good. Just "urgent" emails.  Everything is urgent these days with no resources and the aging population, all the older 'full service' gps and specialists retiring and none of the young doctors being stupid enough to die young.  So many of my favourite colleagues , the best of the best, have had stress related illness, heart attacks, cancer, addictions, suicides, divorces.  I'm so very fortunate to be alive and living the life still.
Just as I was going to cast off last night, Tom came by.  He sailed with me back from Hawaii and the last few years restored the boat's hull and mast integrity either himself or supervising others.  I think he's afraid I'll ask him one day to join me on another ocean expedition and wants the boat to be safe enough he'll survive.  He was in picking up the old Yanmar to fix up and sell with his diesel mechanic buddy. In exchange I’m hoping he’ll do some of the electrical ‘glych’ work that still needs doing on the boat. I had the new radio installed but it wasn’t connected to the GPS. Once this is done I’ll be able to see any other big boats location. That’s a new requirement from Homeland Security. It’s not ‘necessary’ but it’s sexy and I’d like to have it completed some day soon.  I’ve a windspeed indicator too that’s been disconnected.  I worked on the electrical myself yesterday afternoon and found the short that had disconnected the inverter outlets. I found this by getting shocked.  (Do not wash your hands before doing electrical work).  I topped up all my batteries and did further maintenance checking all the other grounds.
Tom arrived with the spare parts and oil for the Volvo.  Naturally that was a great excuse to sit around below decks jawing rather than getting going.  He’d been in Toronto with his family and now was back in Chilliwack.
He wanted to see the new engine, my Volvo Penta D2 -40 . So I got to show off the new baby and listen to the appreciative oohs and ahs.  “He (Alex) really did a good job on the engine mounts.”  “They’ve put all new hoses in here.”  “I guess they don’t want anything to go wrong during the time of warranty.” I had to think that a warranty was a very good thing to motivate Stem to Stern to be as thorough and caring as they are.  As I’ve got older I’ve found that I like having the manufacturers recommended teams do installations because the work is done right from the start if only to avoid warranty costs.  Tom was impressed as I was impressed.
Tom’s an engineer and he’s rarely complimentary.  I ignore his negatives a lot therefore, but appreciate his positives especially when they coincide with my own praise.  Tom had met Ben when he picked up the old engine and liked the work that Stem to Stern did. I pointed out my new sail but confessed I was not sure when I’d get the sail up because this Volvo “iron jenny’ was just giving me too much joy.
We drank bottles of Perrier Sparkling water from my freezer while we talked.  Girls always think guys are drinking beer and they're so out of date with the real world of the working man.
It was 7 pm when I said I finally had to go. Tom helped push the Giri’s bow out. Gilbert, dressed in his Outward Hound form fitting life jacket was sad to see his favourite buddy staying on the dock.
In Coal Harbour ,  I stopped at the fuel barge where the great guys there helped me fill my rear tank with 85 litters more of diesel.  It’s nearly a couple of dollars a litre which made me think I really ought to use my sails more. I filled 10 gals of jerry cans for the 20 hp Honda.  Gilbert ran all over the fuel dock.  I bought some frozen herring strips and ice cream bars.  The herring strips are for the fish and the ice cream bars are for me.
8 pm and we were finally going through First Narrows under Lions Gate Bridge.  The sun sets late in summer so it was out till 9 when a full moon took over. I got some pictures passing Point Atkinson. All the pictures were with my iPhone 5.  I’ve got the Navionics app on the iPhone and use that as my charting gps navigation aid.  When night came on and I was just coming around the Finnestere south east point of Bowen Island  I turned on the radar.  I had my steaming lights, navigational lights, iPhone Navionics gps charter, and my hand held gps, the depth indicator and hand held vhf radio,and Raymarine autopilot.  All these little stars in the boat darkness inside coupled  with a beautiful full moon lighting the calm seas outside.
I slowed down coming into Plumper Cove.  I know Plumper Cove so chose it as a destination over other anchorages. Even then I nearly missed it in the dark.  Thankfully some sailboats had masthead lights on and I was able to be certain with the binoculars showing the boats at the dock that this was Plumper Cove. The anchorage was packed. I tried setting my anchor. It was midnight.  I was in a little hole but there simply wasn’t room and I had to pull up the anchor.
I love the Italian Lofranz electric windlass.  I had to try setting the anchor three times in the dark before it took hold. I’d gone out of the Plumper Cove anchorage and around the corner to the east. A Ketch was anchored there so I chose to get in beside him. First the anchor didn’t catch and then the next time it dragged. Another boat put on it’s light and shined a flashlight at me fearing I wasn’t aware of it.  Poor boater. Midnight and this great hulk bearing down on him with engines revving and outgoing anchor chains clanging like a ghost. I’d seen it but I ‘d not expected my anchor to drag.  So I went further out and dropped the anchor in 70 feet with lots of sea room and ran out a whole lot of chain.  I wasn’t so much protected from the wind but I was hooked.  I sat anchor watch for an hour remembering the Mexican anchoring places which were far less protected.
This morning I didn’t get out fishing. I read the mail from Bernice and felt guilty for not going to the Bowen Island writers day.  What a great event that would be.  Another year I think. There are so many great things happening in the summer and all I want to do is be out in my sailboat.  Alkali Lake Round Up is on this weekend. On Wednesday when I was at Whytecliff with Archie  Jamie was heading out to this.  I remembered riding up on the motorcycle one year.  Sweatlodges and dancing in the rodeo grounds.  Great time.  I heard from Archie that George is visiting family in Scotland and Jane may be joining him.  We can expect some poetry competition for Robbie Bruce then.
Of course I’m supposed to be fishing now. Instead I made coffee and also some of the delicious instant Quaker Oats.  Gilberts panting.  I’ve kept his water dish full. I’ve been reading Alexander Kent’s A Tradition of Victory, Read Admeral Bolitho fighting “Bony’s” naval forces of the north of France.
On Thursday I was out for dinner with Dr. John Christensen, Dr. James Houston and Helen.  Helen had been in the Sudan doing missionary work. She had returned and is organizing a fresh water project for the province. She’s been talking to environmental engineers, raising money and spearheading a project  in this huge area where there’s been so much war.  She’d told of her work in the fall when she’d gone there just before the nearby fighting had broken out again.  Christians being killed by machetes and guns.  We’d worried about her and we were all glad when she came home safe.  Now in a few months she’s begun this amazing project to get fresh clean water to the area where she’d taught the children the weeks she’d been there in the fall.
I am so amazed by her industry. God works in amazing ways.  She's a wonderful channel for the Holy Spirit. She's spearheaded this project here in coordination with the Christian leader she’d met in the Sudan. The missionary group she’d gone with was just a little local group who were keen to physically and spiritually help. Now Helen has become a regular locomotive with a cause.  Dr. Houston knew a leading environmental engineer who’d led other successful water projects near there so he gave her this quiet Christian man's name whose already ensured tens of thousands have clean water in Africa.  I love how Christians are moved to do God’s work.  That's the way with the Evangelical Medical Associations work too. There's a need. Then there's prayers. Then there's someone who volunteers to do all this work. And finally there's this amazing success and all these humble people say how it was God's work. t
Asked about the Downtown East Side I caught people up on the corruption of Portland Hotel Society Scandal and how  millions of dollars were diverted to pockets, parties and limousines.   There’s a continued housing crisis because the money didn't go to the poor but rather the rich favourites of the Vancouver Coastal Health Authority.  It’s so sad because half the money that was spent by Portland Hotel Society on housing for the poor was good .  So much money was squandered on the Safer Injection Site. Dr. John didn’t know about the millions lost.  People are just aghast when I tell them about this. It's like something out of a bizarro comic book. Hundreds of thousands spent on giving alcohol to alcoholics.  Portland Hotel Society staff teaching alcoholics to make their own alcohol and no 'adult over site' for all this costly corruption.  I continued to speak of the harm reduction to abstinence projects with Methadone and how I’d initiated a patient that day on Suboxone, the ethical concerns balancing the palliative care approach of harm reduction with the knowledge that the obvious "cure' for addiction is 'abstinence.
My friends wanted to hear of our Recovery talks and I told them about the Addiction Dialogues with David Berner, Recovery Day with Anna McCullough, and my being on the board of the Canadian Society for Drug Prevention.  Dr. Christiensen was pleased to hear we were supporting the 12 step programs as they worked so well. I told them about the great Christian work, the real heavy lifting  work of Union Gospel, the Salvation Army with Harbour Light Detox, the Catholic and Anglican Churches housing societies, First United Advocacy and Father Mathew from my church, St. James Anglican, working with the isolated men in the DTES.  I celebrated the hope I saw once the Corruption at the core of Portland Hotel Society and Vancouver Coastal Health had been addressed by the Provincial Minister of Health’s call  for accountability.
I told about reading Jackie Pullinger’s work with Heroin addicts in Hong Kong. Dr. Houston knew her and told us of the old Kowloon and the Norwegian missionary society that had started it’s work with heroin addicts there in the slums. Helen had met Jackie Pullinger when she came to speak at Mission Fest.  Helen said she said “she didn’t want people with hard hearts and soft feet who would just walk a little way on the journey but those with soft hearts and hard feet who would go the distance.'
Dr. Christiensen was sad that prime minister wannabe Troudeau had condemned the Catholics of Canada saying  no one who was pro life would be accepted as a Liberal.  I said I was sorry that as a marijuana smoker he was so keen on everyone else smoking marijuana.  It haven't smoked marijuana in 16 years and certainly prefer the natural 'high' and 'spiritual' high to the low of "smoke'. I saw the ravages of the consequences of addiction and simply, the more available a drug is, the more societal problems there are.
The success of addiction medicine work is evident in the turn around seen with stopping tobacco smoking. Once everyone did it and it was glamorous, now only the tragic and ill do it and the huge costs are being tabulated while the psychopaths and sociopaths in the Tobacco companies market it to women and children and third world countries. The same folk are now behind the marijuana industry and the get rich quick goes on.
I struggle with the ethics of it all because clearly there is some medicinal benefit but in BC some 99% of so called "medicinal marijuana" was abused and diverted to recreational purposes.  All the while the medicinal benefits of marijuana compound can be met with a new pharmaceutical Sativex spray but my patients find it easier to get funding for the less medicinal ‘medical marijuana’.  I’m struggling with prescribing as are all doctors because the pressure is political and commercial.
It was very apropos then that Dr. Houston talked of business and virtue. His son is a businessman, my age , and he’s begun a project of making work serve people rather than people serve work.  Dr. Houston, long a champion of the human ‘person’ ,is himself now embarking on a grand project of a new book tracing the development of the soul through history asking friends and even former detractors to contribute essays to this project of looking at the what it means to be  human in the highest sense.  He feels society and business especially has seen the failure of using a solely 'social science' model to assess success.  He cited so many great businessmen of Canada and great corporations who didn't want their life's work trivialized as merely for profit. They'd been moved themselves to create theses great organizations by higher values and yet saw these being lost.  They were challenging the simplistic CEO's to make their work 'meaningful and worthy'.  Some of the people Dr. Houston and their son knew were the greatest families in the world and truly didn't want their 'legacy' to be a 'dirty business'.
Dr. Houston has been delighted by how people have responded positively and agreed to contribute in his book in their areas of greatest expertise.  It’s going to be an incredible work and I so look forward to reading it one day. Dr. Houston’s works on spirituality and Christiianity are classics but I’ll always love most his book on prayer.  He speaks so positively of Regent College these days having been the Chancellor and sees it now fulfilling it’s goal to serve Christians. He’d never wanted another education institution for training professionals but rather an ‘institute’. I really must check out the distinction because he said legally there is a vast difference in the meaning of ‘institute’ as it serves the people and ‘institution’ which the people serve. Regent’s College was an ‘institute’ and had run the risk he said of becoming merely another  institution.
All of us there had  found Regent so inspiring when we attended and being again with Dr. Houston was  again be in the presence of genius and humility. We missed his wife Rita who was unable to come.  He brought me a book of Herbert Spencer for me,  feeling that reading this ‘poet’ would enrich my own Christian development and my own writing of poetry.
It was a remarkable night as these always are.  A great meal in John’s house and truly inspiring company. It was hard to leave.
I of course talked about the engine the sailing I’m enjoying. I told how having exhaust no longer leaking into the cabin had stopped the occasional headache I'd noticed in the past while motoring.  Also I told John that I’d got a draw for a moose cow or calf in the area where his son and I had previously hunted so hoped Luke might get off time from work to hunt with us in the late fall.  My new assistant, Mabel, seeing the my success in the lottery, and being from Argentina had asked about moose. I told her to imagine the finest barbecue in the world and consider that for a city person like myself this takes years to obtain and at the end of the day costs as much as caviar an ounce.  A true Canadian delicacy little understood by anyone without royal blood.
Now here I am sitting in the glory of the BC wonderland.  Gilbert has gone off to sleep in the shade. There’s a cool breeze that’s just fine for me here ,in a bathing suit, in the sun. Now that I’ve reflected in this journal on the high points of my life I think I’ll make a cup of coffee and go back to reading  of wooden ships and cannon.  I "should" take the dinghy and  make a visit to the town of  Gibsons if only to give Gilbert some more to sniff. He pees and poops on the front deck so I don’t have to get him ashore for toilet but it’s another thing to do.  There's just so much to do and such heavy pressure upon me do something.  Maybe I'll just lie in the sun on deck till such thoughts pass.

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Wednesday, July 9, 2014

Cherry Picking

The Bible is a vast work written by many over centuries.  Of course it is inspired by God and is the Holy Bible. However this clear voice of love and truth require the ‘ears to hear’ and the ‘eyes to read’.  To Pontius Pilate and the Romans, the authorities of the day, Jesus was simply a trouble maker.  Throughout history the words of the Bible have been interpreted and mis interpreted.
Jesus gave us a “key” to the Bible.  Asked to sum it up he said, “Love God and Love your Neighbour as Yourself.”  Love is the answer.  Throughout history there was ‘judgement and mercy’ but Jesus said essential mercy and compassion are more important.  “Judgement is the Lord’s.   “Take the timber out of your own eye before you try to take the sliver out of your fellow mans eye”.  “Judge not lest ye be judged.”   “Forgive.’  These are the Christian messages.
Cherry picking is taking something out of context and using this isolated snippet of information for a different purposes.  It’s all too common in advertising, marketing and politics. It has no place in spirituality and Biblical interpretation.  Given that Jesus has given us the key to the Bible I consider every other aspect against the very foundation of Christianity as Jesus laid it out. Given navigation requires one or best two or more points outside my own location I can use this ‘key’ as a way to unlock the direction and course of my life relative to the spiritual life. The Bible is for me to reflect most on my behaviour not on others. It’s greatest gift is that it guides my spiritual development.
I can’t just cherry pick any old phrase from the Bible and insist that this represents the whole.  That would be like asking one Canadian what he thinks about something and then insisting this is what Canada believes as a country.
In my work as a physician,  ‘cherry picking’ is the business practice popular with the new doctors in which one picks an ‘easy practice’, avoiding complicated and sick individuals because the most money is made with the ‘worried well’. This is why the ‘cosmetic health care industry’ of ‘vitamins and ‘health foods’ makes billions of dollars a year.  The well are usually rich because they are healthy enough to work and make money. The really sick are the chronically ill and the system fails them.  As a Christian I must beware of the temptation to ‘cherry pick’ my practice for the financial benefits that come with treating the worried well.
As for learning, there’s discernment, which I use in choosing the influences about me, the friends I spend time with, the music I listen to and what I read mostly. Discernment is not ‘cherry picking’ but it involves “selection bias’.  With discernment though I’m selecting the information and influences that will help me as a Christian grow as a person.  Cherry picking is the flip side of discernment.