The Morality and Psychosomatic Pain?

Why do bad things happen to good people?

This is the central question of religion. It further is a central question for understanding ‘pain’ in psychiatry.  

All pain is a ‘psychosomatic’ phenomena.  Psychosomatic means that body and mind are involved in the experience.  Psychosomatic does not mean speak to cause and effect but does speak to associated phenomena and potential contributing factors and possibly a different approach to solution.

For example a child is caned and strapped..  I pick this example because being caned and strapped was a recurrent experience of my own attending Viscount Alexander and Vincent Massey High School in Fort Gary Manitoba.  Fortunately this was not a routine occurrence though physical punishment by school administration was normal for a previous generation. Death by school caning was a social problem that preceded Japan’s embarking on WWII. It should be noted that while Nazi brutality has been extensively documented so that the word Nazi conjures up brutality, Japanese brutality is similarly understood in the east in all the countries which Japan invaded.

What is good. What is bad are questions of ‘interpretation’ and ‘morality’ not at all so obvious as some would argue.

The Japanese perceived their corporal ‘punishment’ of students as did the administration at my school in Winnipeg.  The Nazi’s felt the same.  The history of the world tells us that corporal punishment was indeed the norm for all nations with rare exception.  Consider simply the history of punishment in the Royal Navy, the leader of civilization and guiding light of the world, until the redistribution of power in the early 20th century. Records of hundreds of lashes slowly are reduced to tens of lashes and it was not uncommon for sailors to experience permanent mainming or death from their ‘correction’.  Further minor faults were very aggressively punished and only slowly was the ‘rod spared’ for worse crimes.  In Islam today according to Islamic laws , which some describe as barbaric, since the punishments went out of vogue sometimes hundreds of years past, the cruelty and offence of punishment remains as a historic note for all nations.

Hollywood would have us believe in the chivalric notion of the loving kind mother showing great sentimentality by heroines when faced with unpleasant punishments on the live screen.  Unfortunately this marketting to the ‘fairer sex’ for the pure purpose of selling dish soap is a travesty of abuse of public education as propaganda.  Attending my first boxing match I was shocked to see how lustful and violent the women audience were.  Historically matriarchy as opposed to patriarchy has been associated with torture and punishment.  

What did occur historically was that race horse trainers did note that a different approach to training from whipping gave better results.  Doystoyevski’s portrayal of the man beating his horse to death is an obvious example of the limits of corporal punishment. The Japanese government actually had to have committees to look into the death rate of children in institutions from corporal punishment.

Further modern psychology especially forensic psychology became interested in Sadomasochism, an ongoing issue of Hollywood and the upper classes in general. Just as today we know that pedophiles flocked to the church for access to the children so sadists flocked to positions such as prison guards and police for their access. Not much different than alcoholics seeking work as bar tenders or sex addicts seeking work as prostitutes.  Obviously the majority are motivated by money and more lofty aspirations or driven by need rather than greed. Still this significant minority are attracted to these positions of power simply for the means to act out their aberrant tendencies or desires.

Now move forward a half century and note the advances in what people historically called civilization. I remember being strapped by teachers in elementary school and while others in my class probably don’t remember the day I certainly remember when the strap was removed from the classroom, teachers denied the right to corporally punish students and this moved to the sole domain of the Principals Office. I graduated before Principals were denied their bit of physical activity and would only be billy clubbed by guards and surreptitiously physically punished in custody.  It was frowned upon by even my early 20’s when I was involved in demonstrations to leave evidence of injury.  It has been decades now since anyone in authority has physically abused me though I continue to be exposed to repeated verbal abuse and public humiliation and exhaustive shaming.

Raising white chickens I learned that the chicken with a black feather was visciously attacked by the other chickens. This is natures way of removing aberrant genes from the gene pool and one of the reasons that Utopian Darwinism is questioned as genetic difference is removed rather than celebrated in nature normally.

In my study of the Canadian school when I was interested in birth defect, IQ and school drop out I found that public schools punished the slow learner and the fast learner.  Not surprisingly the slow students dropped out. What was offensive to those who’d asked me to study the matter, where I first learned that politics funded research was my finding that the students smarter than teachers and administration, the high IQ kids were also dropping out of school.. The public school faced with ‘one shoe’ for all served the masses but not the “deviants.”, euphemistically termed “outliers” by those secure in their mediocrity. 

Apparently I had a high IQ.  Whatever that represents, blessing or curse.

But I was beaten repeatedly for correcting teachers and to this day am punished for pointing out that the Emperor has no clothes.

I’m kind of autistic in this regard and have taken delight in a new Canadian television show called the Good Doctor.  I self identify and story tellers have long known that even children love a story in which they can see themselves. I’m delighted with the excellent ratings of the show because I expect that it speaks to Canada as a ‘colonial’ nation more than it speaks to medicine.

In a Colonial nation there is a fixed upper class. Here in British Columbia, the game was rigged in the last generation for the English immigrant to win. In Quebec the French born person is a Royalty and Canadian life has it’s apartheid but it’s not so much by colour but by class, origin and family. When I lived in England I saw very quickly that upward mobility and wealth in society was relatively easy if your family was wealthy for generations and you’d been to the proper school to get the right education.

Dr. Jordan Peterson has pointed out some 10% of students due to lower IQ or even lower emotional IQ are ill fitted for modern society and unlikely to find even work easy.  The rise of the peasant class. Brutal maniacal killers like Lenin were able in an earlier generation to claim to represent these ‘masses’ and there by gain fortune and power for his own deeply evil designs as a mass murderer. Hitler similarly used this means to elevate himself. Today the closest we compare is late night shows with people begging for money for a variety of species of cuddly animals without any concern for reptiles and insects and certainly not the very underprivileged bacteria necessary for life.

How I perceive pain is best seen on a scale 1-10 with the contribution of mind and body being apportioned.  Chronic pain is separated from acute pain as acute pain, pain that lasts minutes or days isn’t the burden on society that chronic pain has. Chronic pain is more ‘mental’ as well.  

Men who have been caned in studies have been known to experience pain, the same objective physical injury 10 times another person who has not been caned in youth.  There is no ‘greater sensitivity ‘ for the upper classes as the white feminists argued when the black feminists challenged them about their relatively safety and security.  The universities at the time were doing ‘take back the night’ dances in which more lighting was put on the campuses to protect the privileged upper class feminists when the threat of rape on university campuses was the least in America. By contrast nearby black ghettos were the hotbed of rape and were not funded for ‘lighting’ or even much of a concern to the ‘take back the night’ crowd.  This idea of ‘sensitivity’ is itself a luxury of psychological value but not at the physical level.  The innocent is immediately more impugned by violence but their background of relative safety and comfort also gives them the means to be resilient and flexible.  There is a reason in history for the officer class and the tendency for race horses to be trained with the best of food, shelter, exercises, discipline and training. 

Women who have not been informed about menstrual cycles or have been sexually raped by painful intercourse early in life or had negative genital experiences are at great risk of having many times more genital complaints, cramping, abdominal pains etc.  

So the question is best considered if the sum total of the pain is 10 and 5 is assumed physical and.5 is assumed psychological is the physical component ‘5’ or 2 and the mental component 1 or 5.  

The example of a gunshot wound would appear straightforward ‘physical’ but if the gunshot was occasioned robbing a bank it’s a different ‘experience’ to a gunshot experienced saving the life of a child.  The body of a poor or rich man, the actual physiology will have similiar impact. However if a person has been beaten as a child they will fear the pain as greater than a person who has not. 

Add to this consideration my patients who are masochists. A group of people for whatever reason have found that inflicting pain while masturbation or during sexual orgasm heightens the perceived enjoyment. There are some neurological components as well as psychological components to be considered but it remains that this person may indeed feel ‘pain’ differently than a person who only experiences pain as a message of harm.

If a professional fighter experiences a blow as compared to an innocent the professional may well ‘know’ the blow was not ‘disabling’ and ‘will heal’ based on previous experience of fights as compared to the ‘shock’ of the innocent who experiences the blow and believes wrongly they are disabled , near death and rather than continue the attack reverts to a fetal position and prays.  I rather like the latter though have found when that didn’t work I’ve been forced to salvage what remains of my pride and body by actually fighting back which as original as it seemed the first time has significant historical precedent for stopping the pain.

In my work doing hypnosis and hypnotizing people for surgery I further found that distraction could well ameliorate the experience of pain. I was cutting a person with a knife but I had used hypnosis like I’ve used xylocaine injection to stop the pain.  Acupuncture distracts the body.  Mentalist apparoaches may work as well as physical approaches. Paradoxically with chronic pain exercise reduces the pain in the long run.

Now this addresses the existence of psychosomatic pain. So pain mostly is bad and good people and people designated as bad can have pain. It’s been said that pain is mandatory but suffering is optional.  

If a person considers themselves as bad they will indeed experience or perceive greater pain. Depression prolongs and worsens pain. indeed at one time chronic pain was called ‘somatic depression’.  All pain is psychosomatic.

Good people have pain.

Bad things happened to good people. However religious people who perceive negatives in life as ‘lessons’ from God rather than as ‘punishement’ or even as ‘random bad shit’ do better with recovery in general.  Chronic pain is addressed in the context of how does it affect what I do compared to what I did. IF I perceived myself as a good person because I was a surgeon and I loose my hand in a criminal minds episode to a cannibal I am more likely to have ‘phantom limb’ pain than perhaps a man who has his hand chopped off in Saudi Arabia for stealing a piece of bread to save the life of his dying child.  Understanding the ‘meaning’ of a person and their purpose and the meaning of the ‘pain’ and a person’s ideas of ‘good’ and ‘bad’ do alter the perception of pain.

Disability is a further issue because it appears quite surprisingly people who are high paid as beauty contestant judges appear to not experience the disabling pain that people who have similiar injuries do when the latter works 12 hours in a cold stinky outdoor fish plant.  

Just some thoughts about pain and perceptions with some ideas about past and present and the understanding that these factors can have and influence and change outcomes and indeed help us to understand better why bad things happen to good people.

This doesn’t even get into the issue of ‘secondary gain’ where a person injured or claiming to be injured when they weren’t even injured can be rewarded for the ‘drama’ of pain presentation.  Today some 40% of claims are ‘false claims’ and knowing that should explain to some extent why insurance companies are so slow to ‘assume’ a person is good , despite every special interest group insisting their group doesn’t lie.   

In Canada a convicted  terrorist who maimed an American soldier was rewarded  10 million dollars. 

Man flu

I really am a little embarrassed by my reaction to a minor illness.  Right now I've only got a stuffed up head after a few nights of poor sleep. I've been blowing my nose leprechauns.  There have been chunks of banana coming out when I cough. Physically I'm drained as if a vampire sucked my blood just last night.  My will to live is whimpering.  I doubt I could fight an argument.  Call me what you will but I am a whimp.
This is called a 'manflu' by the contemptuous.  Internally I'm questioning my belief in life, belief in God, wondering what I could barter for a future and certain of near death approaching.  A part of me wonders if this is a taste of what I will receive in pestilence for sins from masturbating to not flossing and definitely second helpings of hagen daz ice cream.  I'm actually thinking seriously sick thoughts like going back to bed.  In bed alone like this I just imagine more despicable death. My infectiousness is minimal if I don't speak.  Speaking I could convince the world to suicide en mass like lemmings.
I feel what aetheists must feel. I think my mental acuity has reduced to that normally experienced by  communists or jihadists.  I know it must be such a nasty bug that one would hope to improve their inner being by chopping off the head of someone else.  I feel removing my own head would be an improvement.   Indeed I've always known I could feel quite a lot better anyday whacking off my head or the the head of some of my superiors Not all of them. Just a particularly grotesque creature of middle management whose pompous stupidity has on occasion had me thinking his head might better be used for a book end. I've not done it.  I wouldn't do it.
Indeed, the thought only materializes when I fear I might die through man flu. I honestly would rather let the authorities know about this deceitful little prig and leave his future in their capable hands. Its just that if I'm dying from manflu why go out alone.   I find my resentments grow stronger when I'm alone contemplating the possibility I have ebola.  If I had ebola right now and didn't particularly want to visit a hospital since I rather like doctors and nurses who could I visit instead?  Naturally tax departments come to mind.  But tax departments are not the real problem in society. They are just obedient functionaries of those greedy rich folk who take away my hard won earnings to give them to their useless cronies.  So if I had ebola I might well visit a 'law maker'.  But I voted for these people. How come taxes have grown throughout my life and my percentage of the pie has decreased? I don't know what radiation sickness would feel like but this must be how it feels the day before.
By contrast the cost of headstones hasn't really increased so much.  That's what I really need to focus on. My immediate future.   If I have a terminal flesh eating disease right now maybe I should purchase a "preventative" headstone.
Alternatively my nose may just be the first site of alien invasion of nano warriors intent on messing with my mind.  What should I really  do before an American drone targets my nostrils or a black car comes to take my nose to Rosswell.
Well, I confess, right now I'd like to thank everyone.  I'd really like to thank everyone, all my enemies, ex wives, their mother in laws, the tax men, the thieves, the bullies and especially the lovers and the friends and families, and the wonderful pets and all the entertainment, yes, I'd like to thank them all. Because frankly without cold there is no hot. Without evil there is no good.  It's all been a particularly interesting story that's captured my attention. This life has been the best interactive movie I can imagine and the cast of characters in this movie have been awesome. I truly love my co stars and the arch villains who in my mind, though doubtfully in theirs, have been most like comic book characters because they've been so characatured. 
If I'm to die today blowing my nose and bursting a waiting genetic aneurysm I want everyone to know that I loved you all.  I really did.  It's been a tragicomedy of first order so no doubt God has taken tips from Shakespeare and Spielburg in writing up this life I've somehow bumbled through. It's been a really long run. I didn't expect to live till 30 and here I am twice that age. 
All the people I really 'hated' when I was younger, especially the older bigger guy in the YMCA locker room who kicked me square in my naked nuts so hard I fell over breathless. I forgive him.  I forgive everyone who wronged me.  Even the beaurocrats who lied and cheated and covered up their killing and tried unsuccessfully to pin their deaths on me while still getting away with the money.  I forgive them because really they were never more than comic strip rats. Little pacman cheese eating characters in a bigger drama.
I forgive even God because frankly I've been looking for and calling on God all my life. His appearance has always been a best a 'wee small voice' or at worst an obvious 'god print of a very big shoe on my butt." I've thought the main problems were between me and the writer ie God.  I always had this love hate thing going with the writer. There I was in my dream world with the most perfect woman in the world, a regular modern day Helen, when next thing I know I'm pissing her off something fierce because the writer screwed up my lines.  At other times I've thought the writer had good lines but it was the director that made my delivery something less than 'attractive'.  Mostly I wish I'd just shut up in a generation that said 'let it all hang out'.  Well I would have done a whole lot better if I kept some of my sick secrets to myself.  Like the time I ogled her friend.  Now what writer would put such temptation in a script.
I figure there are these lives that are written by men. We're great and courageous and make things and fight wars and stuff. It's all Viking and Valhalla and serious and Veblem and intellectual and Neitze and then when the writer sleeps his wife writes in some challenge. Then Cupid descends on the hero and next thing he knows he's got arrows not in his heart but in his penis. I've known that itch.  It was years ago, decades really, half a century or so but still I remember how I hurt her.  The true love who I later found out herself was sleeping with a friend.  But that was then when "love the one you're with' was all the rage and no one knew about aids or morality and we all wanted to re invent the wheel like Marx and Engles and other such fools. 
I was passionate then. 
Now I'm dying with snot surely bombarding the blood brain barrier seeking to establish meningitis in this instrument of higher learning I've used so infrequently.  More often than not I've been trying to get money and stuff to impress the girl or show someone I'm not just anyone.  I've been a lower companion. I've been a person who was concerned about appearances. I've bought a name brand item and flaunted it , slyly, all the while hypocritically making fun of those whose lives are shallow like mine but care not what I think.  I've prided myself on my being an outsider. I've made a virtue of necessity.I've made fun of the rich and when rich I've made fun of the poor and when poor I've made fun of everyone. I've been judgemental and superior and snarky as any journalist or writer can be all the while seeking to be attractive to the very one who 'gets me'.
Now dying of man flu I love them all.
I've already said that my family will have all my possessions. My brother is my brother, wise and good.  He's also administratively sound and sorted out my parents stuff when I personally would heave before a mess of other persons stuff, barely capable of keeping track of my own underwear and socks each day to be able to show up to work.  I've always been a bit absent minded and distracted and truly would have been diagnosed ADD OCD and any other acronym if my teachers and others weren't just satisfied with calling me 'BAD".  I was different. I had odd ideas. Mostly I've seen that my odd ideas were simply decades ahead of their time.  I'm on some track waiting for a bus that's picking me up at a different time and place than the herd and then I'm somewhere behind the lot at other times.  I don't even know if  I care anymore though I can honestly say I've been lonely a lot of my life. My loneliness has been greatest in love.
My back aches. I've joint aches too. All the places where I was unkind to a joint demanding it Flex or Extend to the max to protect the rest of me from a fall or kick or some such physical trauma.  My joints have taken the beating.  Now they tell me of weather changes.   Now I've a manflu they hurt the worst.
I'm popping ibuprofen and aspirin by the handful so my brain is not inflamed.  I'm sweating, clammy.  My body wants to over heat and blow a gasket but the medications are keeping me cool. My arteries would clog with blood clots were it not for the thinners I've poured in the system to keep it working. I'm messing with the internal chemistry and yet believing God works through us to the best. Why does he want me to suffer this minor manflu. Must I read the book of Job again to remember it's not all about me. I don't have any special corner on suffering.
Am I being asked to remember how little I can truly tolerate any disease before I'm a screaming idiot. My optimism is lost when I'm unable to breathe. My optimism depends upon my open nose. Without oxygen I'm a rather depressing sort. I know my snoring alone is soon likely to cause neighbourhood noise restrictions.
Garrotting once fashionable rapidly has been replaced again by beheading.  Kill Bill,  I took personally.   A return to the sword. When the ammunition for the AK47 runs out you can always depend on a sword.  I really should be practicing with mine. Today I need a microscopic one to get the little bug that's wasting all the white cells in my sinuses.  Some Brad Pitt demon at Troy has Trojan Horsed my sinuses. I'm a mess.
I'm too young to die.  Death has no respect for age. Should I not be lying on a southern beach with a bikinied babe rather than going to work in the cold rainy north. I can at least be thankful it's not snowing.
 I miss the days I worked out of my home, I miss the country and the cleaner air.  Now that I cannot breath I know I've accepted city air.  My nose may simply be in mutiny. It would rather have  more of that wonderful fresh country air I used to love.  I followed a woman back to the city.  I keep returning from the high seas and deep woods to the city for culture and women and friends. There is more comedy in the city.  But the very air leaves something to be desired.
If I died right now I'd just be thankful. It's been a good life. There's so much I wanted to do though. I have books to write. Several books. I've sails across oceans to make and motorcycle runs and northern hunts and fishing to do. I've languages to learn. I've drawings to draw. I miss dancing. I'd like to dance again.  Viennese waltz.  Ballet. I would do more tai chi. And swim again underneath the seas. I'd like to ski again.  Yes, go up to Whistler and Blackomb or even just Grouse and glide forever to the bottom. No longer interested in black diamond trails but just wanting to enjoy a Blue Trail forever. I miss trade wind sailings. I want to fly. I want to feel my soul leave my heavy body and return to the light.  I want to laugh more.  I want to make more music. I want to  play more tunes with friends.  I miss the boat bands and harmonies.  I want to hike more.  To do the Grouse Grind again.  I want to see the Sphynx and visit the castles of Ireland and Scotland.  I want to walk on the great wall of China and visit the monasteries of Tibet. I 'd love to lie on the beaches of India and visit Madras.  I want to visit Chile and Peru.  There's so much left for me to do.   I once only wanted to visit Mars. Now even that may be possible in a lifetime or so.  Now that we know the moons not cheese it holds so much less appeal.  Maybe there's something better to eat on Mars or Saturn. I'd like to meet a truly pink lady from another galaxy with a way of orgasmic congress that didn't involve a defecatory organ.  Somehow a Spock mind meld would by pass the ancient taboos.  There'd be the possibility of great love without lust.  Do I really want to forego the carnal? Even God did a turn on earth.  I'd like an organic intergalactic space ship with built in vacuum cleaner and self laundering clothing..
I had hopes and dreams that have not been fulfilled.  I fixed he toilet on my sailboat dozens of times replacing pumps and bowls. I've sutured up hundreds of bodies and convinced a thousand or so not to kill themselves and leave their carcasses about for others to clean up.  I've thought there was no end of people I was asked to see. All I sometimes do is  convince them not to shit where they eat.
Every once in a while I'd meet a person looking for something more than money and lust. I liked most giving solace.  I like empathy.
Today I'm not sure this man flu will last more than a  day. I could get well and muddle on with my life.  I might not even thinking twice about my own near death experience.  We take for granted our often daily brushes with death. All around me there are those dying of viruses. People die every day and I don't say thanks enough. The anti vaccine gang have invited measles back into the world while those who don't remember to wash their hands pick their nose and rub their hands then handle my food and money. I found a couple of hairs in my food this week.  There are countless regulations but ignorance spreads quicker on the internet than all the health and truth teaching that had taken millennia to acquire. Fear mongering passes as science.  And religious nuts around the world insist they have the answer.  I think they want  to enslave the minds and hearts of the terrified.  At the same time children are given guns,
 Mohammeds wife was 7 and Mary had Jesus at 14 and Radical Feminists would jail any man who looks at a woman.  I've always been attracted to breasts.  And legs.
Now I'm attracted by beds and clean sheets.  I'd like more bombs and satellites and rocket launchers and  a cave where I could hide in peace and die. I worry about the future. The administration has changed the care places into their own private domains of beaurocratic chaos and irrelevancy.
I have no better idea. I'm just afraid. I forgive those who 've been in accounting and decided we didn't need ammunition or antibiotics or antipsychotics. Those bean counters who didn't quite get it right and those judges and law makers who complained about the street people hoarding but wouldn't jail the speculators.  Right now there's no place to own and live in Vancouver because those that would profit have created an appearance of scarcity by manipulating markets.  I just want to get away from people that even think like that.  I want to clear my head.
I want my nose to stop dripping. I want my face to unswell. I want to crawl into a hole and pout. I have a dose of self pity. I'm whining. I'm boring myself to tears. I'm being silly. I'm not dying. I have a little bit of manflu and not even a  saintly woman would respect me in my ambivalence and uncertainty. I'm assailed with doubt. My normal self confidence is depleted by the malaise I feel in my body. I have this dull ache in my head.  I'm depressed. I know other people whose lives are like this.   . I can't concentrate. All I can do is try to breathe.  I am desperate for air feeling uncertainty about the next breath. I have this pain in the back of my throat like something is trying to reach up into my mid brain with a pick fork.  What did my mid brain do that offended the world or God that I got man flu.
Oh well, I have a patient. I 'll try to cheer him up. Anything is better than thinking of my own demise. 

Work breaks, back logs and psychosomatics

I'm a week back from a couple of weeks in Istanbul and Turkey.  It was an incredible learning experience with daily touring and education in mosques, churches, museums, art galleries. I really felt like I was in an "immersion" program, far more intense that my medical study programs.  I had read extensively and taken multiple audio courses before going. Then while I was therein addition to have a guide I was reading and writing daily.
Returning home I was most afraid of the dreaded post overseas airplane 'flu'.  So often I've caught a cold travelling. Once I returned from the third world with dysentry but mostly I've just developped winter colds because of the stress of long flights and contact with so many different people in closed spaces.
Many doctors I know and many businessmen don't take time off from their work, simply because the back log is overwhelming when they return.  I've resisted the temptation to stay in the harness and cope with the excessive daily work.  Instead I take these study breaks and even go on vacation.  Extended weekends don't cause much back log but whenever I'm away from the office more than a week it's bedlam when I return.
When I return from Russia last spring my staff had left and returned to inform me they'd decided they didn't want to live in Vancouver.  The backlog combined with staff turn over was murderous. I worked weekends for weeks and late into the night each day.
There haven't been sufficient psychiatric resources in Vancouver in decades.  If people with physicial disease had to face what people with mental illness do on a daily basis they'd go insane themselves and add to the overwhelming backlog.
When I graduated I saw people weekly and had a waitlist of a month or two.  Now I'm more likely to see people at 1 to 3 month ,sometimes 6 month, intervals and had a 2 years waitlist till I limitted patients to my very specific subspeciality area and also more commonly accepted patients from family physicians I knew.  Increasingly general practitioners and especially walk in clinics want to cherry pick their patients and 'dump' more complex or complicated cases (see psychiatric cases) on the specialists.  All the 'cream' has long been taken from medicine by the midwives, psychologists, counsellors and health food stores.  The 'worried well' just aren't the issue they once were in the standard medical practice.  Probably because they want 'strokes' and only the 'alternative health care folk' have the resources of private funding to entertain the 'worried well' or 'walking wounded.'  Too often the public health care system is serving only the most desperate.  Everyone that pays taxes should have access but often government health services 'triage' resources for the most desperate meaning everyone else is waitlisted months to years.
When I began in psychiatry my patients rarely had more than one or two diagnosis.  Today it's more common for my patients to have multiple psychiatric and physical diagnosis and often major social and financial issues.
When I go away there's no one I can refer to.  It's been 20 years since I could have another specialist 'cover' my practice.  Last year I saw several patients from practices of my cohort clinicians who were simply 'orphaned' when their doctor retired.
In the British Columbia model every patient seeing a specialist must be referred so when the specialist is away the family physician is supposed to provide the care alone.
The irony of this is that only last month it was made public that Quebec doctors on average were seeing only 10 or 11 patients a day whereas the physicians in the rest of Canada were seeing at least 30 patients a day.  Most GP's I know are seeing more like 50 a day in Vancouver.
There's just not any 'fat' in the frontline systems.  Of course this doesn't speak to the Monday Morning Quarter backs.  The Canadian health Care system compared to the German Health Care system has 20 x the administration with no evidence that any of that administration is improving health care delivery or services.
I think I'm just belly aching because despite my best efforts I fear I may be getting a 'cold'.  A facebook cartoon went around about the "ManFlu" with the proverbial woman asking the sick guy in bed, 'can I get you anything, orange juice, soup, kleenex, your balls, maybe?"
I got back last week and all I could do was face the deluge of work that was waiting for me. I was in the office till 7 or 8 each night and missing lunches and hardly taking time to pee.  I had a series of other obligations but the emergencies and despiration demand just took precedence. All I could do was go to work, 'put one foot in front of the next', 'do the next right thing', then get home and sleep. Jetlag was a problem because I was waking at 3 am.  I'm thankfully back to a good nights sleep but now I've the dreaded post nasal drip.
People have cancer, bullet wounds, bankruptcies and alien abductions. Meanwhile I'm here swallowing to see if the throats any rawer.
The fact is it's all psychosomatic.  I'm a whimp. I have 'self pity' at having work, I should be grateful and thankful and glad to have a purpose and use. So normally when I 'overwork' I get sick because as a child being 'sick' was the only way I could miss school.  There were no 'mental health days'.

I have a resentment at the government services too. Alright I admit it I've a resentment at Billionaires. Inflation being what it is I want Bare Naked Lady to put out a new song, If I had a billion dollars, just to keep up with the times.  There's just so much waste and misuse in the system and no one asks me to be Sultan or Emperor. Instead we have millions being made on heroin and cannibis and I'm here like the proverbial dutch boy trying to get people off drugs when the real money is getting people addicted.  Self pity.  Poor me.

It's the January in BC blas and I've been on vacation. Imagine the poor sods who just have to live through January.  Worse is those Climate Change Deniers in Winnipeg and the prairies who have lost all faith in spring with the snow deeper and streets dirtier.

All I've got to complain about is post nasal drip. But I'll milk it.  I'll whine.  Tonight I'll go to bed early. I missed the first week back onslaught of disease but fear I've taken a shot on the second week.  Soon I'll be in medical student ichthitis, convinced I'm dying and certain I've a new Canadian ebola strain when all I have is at best the 'manflu'.  It's so embarrassing.
The other thing that gets me is lice and scabies.  I'd rather run from polar bears. Except I'm feeling lethargy.


Well I'm here, not contagious, not coughing, but sharing my evil thoughts rather than singing hallelujuahs and praising the Lord.  Maybe a trip to Japan for a little radiation would save me from that horror of horrors, the 'man flu'. A man flu can need a dose of Chernobyl.

Really I just think I should have a nap. Nap time should be mandated for all over 50.  A little nap would be good right now.  If I wasn't self employed I'd get the union to lobby for comfy cots and afternoon nap time.  Imagine as a kid I didn't like the kindergarden 'nap time'.  What a fool I was.

I think this blogpost started out as something meaningful and now has devolved into something pitiful. Patients have come and gone and between them I've added disconnected lines. Gilbert is groaning below the desk.  We've had a walk together.  I just "think" I may be getting a cold.  I can't remember how many times, this time of the year, I've been gargling vinegar, dousing myself in vitamin c, sometimes on antibiotics and always gargling and drinking endless soup.  Maybe I've got PTSD from living years in Winnipeg in January and just have flashbacks out here on the coast.
I got the flu shot.  I prayed. I'm a good man.  Why am I being punished? I can feel that tickle in the back of the throat like jalopeno snot just building there.  I remember when I would switch to smoking menthol cigarettes when I had these 'throat ailments'.  It's the big scnoz weakness. If I had a smaller nose maybe I could keep infection out better.

Can't I just go back to bed, pull the blankets over my head and come out when the crocuses and tulips come out.  Here that's only next week or the week after.  I'll shake this off somehow.  Typically, I'll think I can't afford to be sick.  Get thee behind me Satan.  I cast the demons out of the schnoz and pray for healing sleep tonight.  Maybe it was just the propane heater last evening.  Another source of self pity.  They're cleaning the mould in my winter home.

 Maybe I'll get some Vicks and wrap my psychological throat in socks and remember my mother caring for me when I was a kid.  Those were great days and I didn't fully appreciate them at the time.  I miss my parents and aunt as I get older. I think a good reason for death is to get together again with all the folks that have gone.  Grand dad and grandma were others I took for granted.  Now I'm older I wished I'd talked and listened more to them.

Sick

I've got a "cold".  It began with post nasal drip and a sore throat. It's progressed to full sinuses, difficulty sleeping, fever, much more post nasal drip, plugged ears and fatigue.
I know biologically this is a product of a virus, most likely, possibly some streptococcus or staph bacteria allied with the virus which starts it. I expect the viral culprit is a Respiratory Synctial virus but it could be influenza.
My normal protective immunological system has been down a few counts because of the extra stress at work.  Work is always stressful.  It's the most stressful work I can imagine doing.  Right up there with bomb disposal.  People are like that.  I'm always on egg shells but no one is perfect enough. It's a complaint society too and the people doing the most complaining aren't doing much else.
I've always figured sickness physically means I've not warded off the disease psychologically.  Last week I felt like a guy surrounded by zombies in a vampire movie with cannibal extras. The beaurocracies were in a shark feeding frenzy.  Point fingers and demanding perfection.  I'm going to die not good enough for everyone all the time.  My job is the complaints department of life and the people making most of the shit expect everyone else to keep the niggers down. Nigger in this case is no longer a racial slur but a metaphor for anyone marginalized.  John Lennon once said Women are the Niggers of the World.  Today it's beyond gender. It's the addicts, the mentally ill, the sick and those who treat them.  The 'winners' would just as soon line them up against the wall and shoot them.  They're holding back progress.
So I think my negativity and fear these last two weeks weren't sufficiently addressed. I spent a whole lot of time meditating and praying and being with other loving physicians cared for and caring but it wasn't enough.
Environmentalists would say it was just that I flew to Edmonton and back and took on the bad air in planes and the jet lag and all the other physical stresses of change of location without the slow aclimatisation that would occur if I'd driven my car up to Edmonton and back making the journey in days rather than hours.  I thought of that but there was just too much pressure at work. Everyone complains I don't see them enough or they complain I don't see their family enough, or they complain I don't see their patients enough. I've read two letters from beaurocratic psychiatrists who stopped actually doing clinical work years ago say "it would be good if Dr. Hay would see these people a couple of times a week'.  I'm seeing them every few months.  I'm stretched to the breaking and all the resources are going to guys like these two high paid 'critics' who long ago pulled their thumbs out of the leaking dam and put them somewhere else.  I'd like to have the family physician spend a half hour with the patient like I did but he's only got 3 minutes a patient today.  Then the counsellors aren't paid to see anyone but the suicidal and my patients fall in between.
But now I'm sick. I know it's because of stress and self pity.  I'm also sure I'm dying.  I 've already gone through a check list of all the other physical ailments, aches and pain, really bad pain in joints and stuff you just say is aging and rheumatism but I'm a doctor so I can link all this together into rare tropical diseases, slow virus, brain tumours, sexually transmitted diseases acquired in the 60's, the late effects of smoking marijuana then too, lack of an essential vitamin, lack of sun, lack of rest, lack of sleep - my brain has thousands of rare diseases I've seen and touched stored there and I'm holding it back like I hold back a huge dog near a bitch in heat.
So I keep it simple. I've got a cold.
Now what to do.
If I had a salaried job and worked in an office and had the ability like all bureaucrats to push aside the work for a day or a week because it's really just paper - I'd not go into work , stay in bed, get better. But most of my patients are sicker than me, even psychologically which takes a lot of work and physically I'm really interested in the guy I did an ultrasound on his abdomen last week because it felt like the Alien.  He wouldn't go to hospital so I'm the point man on his possible deadly disease. I just want to know what it is and when I do I can fix it. I love medicine. I love curing people. I really liked cutting but they don't let me have a knife any more.  Prefer my mind.  And that's only good because it saves lives but saving lives is increasingly politically incorrect.  All the money in the system is moving into addicting addicts more, enabling, euthanasia and the really lucrative endeavour of abortion.
So I become depressed and fearful and it's a vicious cycle. All the sadness floods in when I'm sick. I want to curl up in a fetal position but there's work to do. I'm not infectious really.  It's not like I'm doing surgery or dentistry.  I'm at a distance. Thank God for Advil for sinuses and Reactine.  I can put the symptoms at bay. Drink a lot of fluids.
And probably I'll just do the work I need to do and not do the other responsibilities.  Now I've got to get in the shower and get all this sick sweat off me and fake it till I make it.
I've just got a 'cold' and we make too much of these things. But them I'm older and we always said 'pneumonia was at the old man's friend' because it kills sweetly.  I'm morbid and my job is to be positive and reassuring and intelligent and caring and supportive and I miss the nurse who drove me home that night in the ER telling me I was sicker than all the children and she needed me the next day.
Fact is, I heard of a death yesterday and I'm devastated.  It was so wrong.  But at least that person so tormented will have peace. They'll be in heaven.  But it's a tragedy and so sad and it's old news.  Maybe because I'm getting older I'm more affected when I hear of the young dying.  My friend's funeral was last week but I was working and didn't make it.  We're to take care of the living.  I would have liked to have been at the funeral though.  He was a good man too.
Now I've got to rush. Always rushing.  Never enough time for all the demands.  The authorities are always upping the ante and putting deadlines on things that don't need deadlines then the man with cancer has a recurrence and there's no choice and the pregnant woman needs an answer she doesn't have any control over her time. I'm always prioritiizng but more and more bullies are telling me they need to go first. I'm tired of being threatened. One person threatens my life, another threatens my job, another threatens my security. Everyone demanding and pushing and I'm dreaming of being alone at sea again with a thousand miles and weeks between me and another human being.  God that was good to get away from the beepers and cell phones.  We talked about that on the weekend, the sense of relief we each feel when we can find a way off the grid.
It's an excuse to be imperfect. I may as well wear a bandage around my head, a black arm band as I let my nose drip and flaunt kleenex.
But I'm late. I must go.  I'm not that sick.  My guts aren't spilling out on the floor and CSF isn't leaking out of my head.  Most of my colleagues are maimed and sick and injured and they're in the play, They celebrate the hockey players when they do that for a day but all the doctors I know are struggling with illness and yet caring for others too so they're my inspiration.
Sick is a metaphor.  It's all in my mind anyway.  Please Jesus be with me today and help me to do your bidding. Help me help others in your name. And please let this foggy headedness not interfere in my decisions or memory.  Thank you that it's really nothing and not something like real morbidity and mortality, like the deaths I learned of this week.  Be with them and their families in this time of grief.

Psychosomatic Medicine and Psychiatry

All medicine and surgery is "psychosomatic".  Yet politics and law and people's attitudes remain in the dark ages or simply there are alot more stupid people than intelligent ones.  No one wants to be told "it's all in your heads".
Yet that's essentially what I do, in a way, daily. I say that 'illness' is in your mind. I'm a hypnotist. I've hypnotized people so they forgot their illness and I 've hypnotized people so they had illness they didn't. I've hypnotized people and their pain has gone and I've hypnotized people and they have experienced pain.
I assisted a neurosurgeon and as we probed different parts of a patients brain they experienced pain, the absence of pain, ticks and the absence of ticks, smells and the absenece of smells.
Phantom limb syndrome is the experience of the limb that is missing.
Now face it, without a mind, and especially without a brain, experience is radically diminished.
Schizophrenia is a disese of the mind without any clearly reproducible evidence of 'body' damage.  In contrast I have patients who have existing brain tumors whose thoughts and behaviours are no different than any others.  A big wad of cancer tissue doesn't change their identity but one day a person with schizophrenia  wakes up and believes some one has stolen their identity and the identity of their familes.  One disease is bodily profound yet makes little waves in the patients life while an innapparent switch is changed in anothers and their whole life is relatively lost.
The head bone is connected to the toe bone and vice versa.
Further, psychiatrists and somatic doctors have an uneasy relationship.  The somatic doctors are really happy to pass off all the unknown mechanism disorders to the psychiatrists. After they have depleted all their millions and millions of dollars worth of tests they project their own gross inadequacy by denouncing the patient as 'invalid' in their strictly physical sense and hence 'psycho'.
Ideally as a psychiatrist and medical specialist I'd feel respected if I was consulted early on obvious connundrums but increasingly I'm stigmatized as badly as my patients.  No one wants to deal with the mentally ill or their caregivers.  We're too 'unknown'.
As a result we're desperately as psychiatrists trying to establish a physical basis for the illness of our patients to validate ourselves and them before our colleagues and society who would rather us all  be put back in asylums than allowed to walk among 'regular' people.  Indeed the stupidest of the lot, the ignorant bullies, deny any problem, deny mental illness, close asylums and put everyone who doesn't agree with them in jails.  Jails are simple places for simple minds.  Many a genius has known such confines.
Yet every time we prove a mental illness has a physical cause up jumps a physical doctor who wants to steal it from the realm of psychiatry.  Hypothryroidism was one of the last psychiatric conditions to be taken by the Endocrinologists. The Rheumatologists nabbed fibromyalgia , what we called 'somatic depression', when it seemed  there were consistent trigger points and some reason to believe it wasn't just a 'factitious disorder'.
Yet the fact is, all medicine began in psychiatry. As psychiatrists we're the oldest aspect of physicians and as physician psychiatrists were the original  witch doctors and healers. We dealt with the 'possessed' and the 'evil' and we were there when we found that so much of what was once thought to be 'malingering' and a product of 'masturbation' per se was found instead to be a virus or bacteria or a brain injury.  Neurologists are the greatest theives among our colleagues, happy to steal anything that isn't nailed to the floor of psychiatry. They even have 'behavioural neurologists' who are neuropsychiatrists by a different name.
So should we continue to lose our patients to these 'press gangs' of regular doctors or point out that most of the illness they treat with great sanctification is a product of the deviant thoughts and behaivour of their patients.  Heart disease patients are commonly alcoholics, workaholics or food aholics.
As an addiction psychiatrist I'm fully aware that most of the disease seen by family physicians is really in my territory.
It's no surprise there's a shortage of psychiatrists.  We've more psychiatrists than ever before but our colleagues have recognised that while they were pilfering our individual cases their whole fields of medicine have slipped under the umbrella of psychiatry.  Family physicians are desperately playing catch up to learn psychiatry in order to treat diabetes and asthma with any degree of success.
Everything is biopsychosocial and even the surgeon must admit his work is in the realm of the psychosomatic.
Psychiatric interventions follow diagnosis and psychiatrists have long been the end resort of diagnosis so have well documented skills in this domain. We're also therapists, psychopharmacologists and interventionists.
I just regret they disarmed me.  I liked that when I began in surgery I carried a knife and did so in family practice as well.  In psychiatry they gave me a choice, if you don't give up your knife we won't give you the keys.
I went with the keys.  Still some days I miss the knife.

Acute and Chronic Sinusitis

Symptons and signs:
Upper Respiratory Infections (ie cough, nasal discharge, passibly fever and chills - ie 'a cold) that are accompanied by "fascial pain  (Degown & Degown' Diagnosistic Examination, Richard L. DeGowin, McGraw Hill Inc 1994)  suggests 'acute suppurative (draining) sinusitis'). If it is the maxillary sinus then the fascial pain is dull and throbbing in the cheek and several of the upper teeth on that side.  Thumb pressure tenderness may be noted over the sinus invoved. Frontal sinus involvement is noted with pain in the forehead and along the eye brow ridge.  Ethmoid sinus is medial (next to) the eye and deep feeling. Sphenoid Sinusitis generates pain behind the eye.  Chronic or subacute sinusitis is sinusitis that lasts more than 3 weeks.  Xray or CT scan may help with the diagnosis at this time.  12 week is the figure used by Mayo Clinic for diagnosis of 'chronic'.
Treatment:
Home remedies for acute sinusitis are warm compresses on the face, avoid alcohol, sleep with head up to increase drainage, antiinflamatories ie aspirin, ibuprofen, lots of liquids, antihistaminines, juices especially.
Antibiotics for empiric treatment, ie treatment where it's based on symptons and signs rather than an actual culture of the pus, include amoxil 500mg tid (three times a day) for 10 to 14 days, trimethoprim/sulfamethoxazole 1 DS tab bid (twice a day) for 10-14 days, cefuroxime 250 mg po q 12 h for 10 to 14 days, clarithromycin 250 to 500 mg twice a day for 10 to 14 days, azithromycin 500 mg for 1 day then 250 mg per day for 4 days......(Epocrates)
For Chronic Sinusitis Empiric Antibiotic Treatment changes to include Clindamycin 450 mg 4x a day for 4 to 6 weeks and metronidazole 500 mg twice a day for 4 to 6 weeks followed by a macrolide treatment for 4 to 6 weeks or amoxicillin/clavulanate 875/125 mg twice a day for 4 to 6 weeks. The last one, Amoxicillin/clavulanate may interestingly be used for acute sinusitis as well and is the only one which could be recommended for both.  (Epocrates).
Always with antibiotics avoid where person is allergic.  Note each antibioltic has side effects and those side effects will often make one better than another for an individual patient.
For this reason it's obvious that seeing a physician is the best medicine.  Ear Nose and Throat surgeons are the people who are the specialists and authorities on this condition.  They have little cameras on probes which they can use to enter and look in sinuses and extract fluid for culture and sensitivity assessment of antibiotic optimization.
Sinusitis can be caused by fungus.  It can be caused by allergies. It can represent an underlying autoimmune disorders. All infections can be made worse or arise in depression and stress. People who are over stressed or experiencing anxiety and depression have reduced immunity and risk for infections and risk for persisting infection is increased.  Rest is therefore beneficial at first.
Psychosomatic medicine suggests that people who are healthy are best able to fight illness however those who are chronically stressed, threatened, abused, neglected, over tired have less 'fight' in them. They are more at risk for having a mild illness become more major or extended. Why if a 'bug' is equal, do only certain people in contact with that 'bug' get infected.  That's what immunity is about. Some people are more immunity. Immunity is affected by stress.  Mind and heart affect immunity.
Environmental factors such as cold and damp are not conducive to sinus healing.
Sleep disorders increase risk of infections because sleep is a time of self healing. Pain disorders beget sleep disorders and sleep disorders beget reduced immunity to psychiatric and physical illness.  Too often we treat connected matters as disconnected when in fact they aren't.  Today most things are recognised as multifactorial.
However, often a 'cure' can result from a change in a specific or focal area: resolve the pain or improve the sleep, and the immune system can take care of the sinusitis.  Sinusitis affects sleep by affecting breathing and thereby can cause depression and pain is worse with depression.  So there are these inherrent cycles that can work against one unless recognised. Then the very cycles can be used to benefit the individual.
Using an antihistamine to improve breathing and drainage from sinuses can improve sleep and thereby improve healing.  Advil sinus is one of many over the counter preparations which can be used early.  While it is considered messy, the old fashioned sinus washing process is actually still considered beneficial and recommended by some ENT specialists.

MayoClinic.com is a good safe mainstream resource.