3 AM Lougheed Highway

For several weeks now I’ve been waking periodically at 3 am.  I remember Paul Simon and Garfunkel’s album 3 am Bleecker Street. I think that’s what it was.  3 AM comes to mind. It’s since I returned from New York City.  I put it down to the jet lag at first. Then it was just the stress of closing an office and trying to find places to put the bodies.  Where can I see people and how can I schedule them.  It’s been stressful.  All the while January and February as the most difficult months for psychiatric patients.  I’m in the midst of the fentanyl overdose crisis as well.  The deaths disturb me.  It’s not the same as the suicides. I felt those more deeply in my early years of practice when I didn’t understand the nature of anger.  I saw so much depression back then as simple sadness.  Now I know it’s true nature much better.  I’m less likely to see people die as I attend to the anger and hence the fear.
We are afraid.  Many do a lot to block this out.  The rage about the “change" in politics is so ironic.  The very people who cried out for ‘change’ , now facing it are desperate and alone. Minority in despair.  I am at least hopeful. I’ve been worn down by the weight of taxes and the burden of doing the work of a half dozen men and women while watching so many grow rich off my labour.  Yet I’m not ‘suffering’ in the area of ‘things’.  I don’t have a house, not any more.  Women in my life took those things leaving me with what I wanted, the vehicles.  I have to admit I love vehicles far more than I like the boxes that people live in. It’s childish in a way. The whole system is geared to the ‘little tricky tacky boxes’.  Yet I’m living in yachts or on wheels unable to commit to the insanity of the city.  I’ve committed so much, my time, my life.  I’m now even deeper into the denseness of humanity.  Once working mostly alone I’m now in the depth of clinics with lots of people and bodies about.  It’s so much like my first general practice. This business and hustle.It’s invigorating.  I’m leaving a monastic zone in a way. There’s less couch and more stainless steel and sterile environments.  I’ve examining tables and the accoutrements of medical equipment all around me.  I ‘m tempted to do surgery again. I miss cutting out lumps and bumps.  I really enjoyed the office procedures.  I like the ER and the scope procedures. The cutdowns and the lumbar punctures. I’ve come full circle.  I’m back in the setting I began.
I’m still asking questions. Still recording.  Still offering answers.  I’m ordering tests.  MRI’s and EEG’s and blood work. Tomorrow I get to see the results of an ultrasound I ordered. I’m interested in that. I’m writing letters advocating for my patients despite the outrage of the judge and the bureaucrats who couldn’t accept that I’d taken an oath as a doctor to be an advocate for my patients.  The Judge and the Bureaucrats were so far removed from the human reality that they’d left their own oaths far behind. It didn’t matter that years later I was vindicated. I paid a horrible price for allegiance to the sick and dying.  The robust are such bullies.  I am afraid.
For a year a man who threatened outright to kill me and kill my dog roams free and continues to threaten me.  It’s a wake up call to the death of the country. The systems failure blazes bright in the death threats of a lone stranger.  Nothing is more poignant to me than the system is in crisis and people en mass are more and more afraid. I don’t blame them. So am I.  I look over my shoulder and sometimes carry a knife. I need the pliars for my various vehicles but the knife is there and it sometimes comforts me.  So much of my tax dollars goes to protection and I’ve known so little protections. I have been robbed repeatedly , white collar crimes and blue collar crimes and here my life continues to be threatened.
No wonder my patients are insane.  I like the the expression that the inmates are running the asylum. That’s certainly my take on the world today.  The judge was peculiar and there was no real system to address his peculiarity.  The impairment of individuals is tested in the world of medicine and flight and yet so many areas that should be considered ‘safety sensitive’ are left to the jungle.  The expressions of anyone are like the tip of an iceberg. So much rumbles underneath. I listen all day to the inner worlds and am truly amazed that the world unfolds as it should. That judge might simply have had a brain tumour or liver disease more likely and yet there he was red face and in rage shouting in the court at me who to my mind was simply doing my job. And no doubt he was doing his as he saw it too.  But arrogance and fear exploded.
I don’t know what to make of so much of my life as I look back. It’s so often been about bullies and then I have to in humility wonder why I didn’t walk around the shit in the street.  I keep coming back to that.  Now that I learn weekly if not daily of those my age with disease or dying. There’s little time left and I’ve never figured it out and it really doesn’t seem much different than when I came on board. More confusing really.  More troubling.
I’m waking in the middle of the night.  I’m immersed in long days and it hearkens back to internships and other times in my life when I worked 12 hour days and was up in the night.  I have gone so many nights without sleep, Delivering babies. Midnight calls of suicidal.  I answer calls most days now. I like that so very late in the game I’m being paid for things I did for free for 30 years.  It’s about the money for so many and yet it wasn’t for me and now it is.  There’s so little time it seems.
And I bought the truck. I accepted the debt.  I felt I needed to drop an anchor. The temptation to run away to sea was getting ahold of me.  My dog is sick, an eye gone blind and he does like trucks.  Mine had been so unreliable at times.  It wasn’t the trucks fault. It just was old and this year the diesel mechanics didn’t find the problem I took it in for until they’d had the truck three times and I’d lost days in caring for it. I love my Miata on warranty with the Mazda shop maintaining it with amazing professionalism. It’s the same with the Harley dealers, Trev Dealy. Now I’ll have a truck that’s on warranty and the manufacturer will ensure that it’s running for me and I can trust them as I’ve done in the past and did with this truck till the warranty ran out last year.  It was just the trouble light in the end.  Nothing wrong with the machine but this light would come on and I’d respond.
I’m like that with beepers and alarms. Too many nights of being awakened by alarms and minutes later being at the side of some one injecting drugs or bagging them. It’s 20 years since I did that. At least 5 years since I was at a near death event.  If I wasn’t a psychiatrist I’d call this ptsd.  I’m thankful the nightmares are silent now.  I don’t know what wakes me.  I go to sleep at 10 or 11 and get several hours of restful sleep and then I’m asleep again for a few hours. I’m tired in the day though.  It’s wearing.
Psychiatry is being in the room with despair and grief scratching finger nails on a chalk board.
It’s no wonder people are like this.  Look at that Judge.  The power he had and how much he abused it.  Look at the beurocrats I’ve known and how much they’ve abused their power. And I’m no better. If I point a finger I must see that three are pointing back. I couldn’t have made that judge’s job easy, interfering as I did in his killing of my patient.  Dragging the process out.  In his mind if I’d not have got involved they could have killed her earlier quicker.  Alternatively he probably thinks that my involvement killed her.  I doubt he thinks. He didn’t seem to have much capacity left but then I was blinded by my own partisan ship.
That’s what transference and countertransference are about.  I am always looking at my own face. What I see in the judge is what I reject in myself.  He represented the State, the Emperor, the Bastille, the God and I represented the patient who long ago had spent all her money and her family’s money fighting a Borg.  I often have thought of ‘identification with the aggressor’ when I’ve come up against these beurocrats and officials who Kafka wrote so well about in the Castle. They were equally well described in the Trial of Camus.  Maybe even 1984.  I think of suicide.
Then I remember Patton who upon hearing Hitler say that ‘our soldiers will die for the fatherland’, answered “that’s exactly what I want them to do.”  Now I could same the same for the judge and beurocrats but I don’t because spiritually I know I ‘attract them”.  I stand up and make myself a target. I wear bright clothes and I attract the blood sucking insects. I wave the red flag at the bull and call it out of the shadows. I'm a distraction. I show the sickness to the world and then the world chooses or chooses not to deal with it. I've learned more about corruption by the 'cover up' than any other means.
I buy a truck and the thieves will be watching me.  I see it as reliable and able to the do the job and a debt I must pay which will keep me working for a while longer when I really should be running off to sea. I could put the dog on the motorcycle and take to the open road.  Done. Not coming back. I'm out of here.  Take that Jack.  Hit the road Jack. Paul Simon's songs keep coming back.  I’d like  to join a circus if I didn’t think I was already in one.  The politics of the country astonishes me but so much is a consequence of seeing the world through the eyes of journalism and so many of them are seriously insane and drug addicted and serving what big money partisanship wants to hear.  It’s like knowing the workings of the internal combustion engine.  Once just driving the machine not knowing how motion was achieved.  Today I understand what is happening under the hood and yet it’s all still just energy and motion.
I am awake at 3 am . I was on Bleecker Street. Now I’m near Lougheed Highway.  I’ve eaten some left over pizza.I’ve gone to the bathroom a couple of times.  I’ve drunk some juice. I’m feeling tired again. I tried reading but the history I’m reading of the Sumer and Assyrian empires and now the Persian empire is just dull. It doesn’t put me to sleep. I’ve read a dozen books about that region this last year.  One was a history of Armenia. Another was a history of the Ottoman. I really do like Ataturk.  Another was a book on the Christian church before they were conquered and all the priests killed and a million or so murdered or forced to convert.  I read a history of Egypt too and one of Ethiopia. I’ve read so much about the region and  I've seen so many people who once lived there but now have come here.
City dwellers are at home no matter what city they are in, as if city’s are just different houses now. They talk of ‘culture’ but the culture to my mind is in the land. It’s in the mountains and streams and flora.  Cities are symmetrical.  They lack so much that I only find when I drive a truck out to the country and camp and hunt and fish.  It’s been too long since I was in the woods.  I understood this in New York City where so many never leave that space ship place but I’m a product of the wilderness. I’m too long without being in the outdoors.
I’ve walked this week by the river in the park where men live rough in the woods. These wilderness places in the city. They’re sordid compared to the wonders of the truly wild Canada. We’re planning on going out there again in a week or two. Maybe this weekend.  I worked this last weekend and many weekends before , not all the weekend but enough , paper work and forms and reports.  And people just say ‘it’s just a little bit of writing' and object when I say they have to pay since they see that I ‘m 'free' , a government service that the government no longer pays as it pays itself.  I languish whenever I wait in government offices where the pace is that of a snail. I miss the courts where there’s that pre scientific revolution sense, pre industrial age, the age of old men in wigs and cigars.  But today its’ the smell of pot.  these places are all the traffic jams in the modern world. Passive aggressive and covert aggressive bastions of pout power.
I am ‘law and order’. I was so thankful that in dealing with judges I knew, dozens that were outstanding and only two, the lecherous divorce judge who couldn’t keep his eyes off my ex’s crotch and breasts and lied through his teeth as I was told so well he would; and this other fellow.
And my addicted mind doesn’t focus on that other brilliant man whose mind was truly a wonder. That was a judge to behold.  Here in Vancouver. He’d been head of the Law Society I was told. What a truly brilliant fellow. There was so much material to understand and he summed it up with an erudition of genius. Then he gave a judgement that would have impressed Solomon. I liked the lady judge who tried another case I was involved in. Her questions were so insightful.  I really truly admired her.  I loved the Mark Twain like humorous brilliant American judge I lunched with often best. My father's friend was a judge.  Then there was that drunken judge who lived down the street.
Yet my mind doesn’t focus on these or the dozens more incredible judges I’ve known who I most admired. Tonight it’s a resentment. I’m thinking of this man, this one judge,  who I was told later whether it was true or not, was a notorious drunk ,which certainly would explain his ignorance and buffoonery.  He hated my patient for her long term sobriety and had utter distaste for me while all I was trying to do was educate him about the gross deceit and utter devilry of the psychologist whose report killed my patient more than anything else.  But then her lover did too but that’s too simple.
The suicides wake me in the night. I used to see their faces like stacks of cards angry and haunting. All were calling to me and demanding why I didn’t save themselves from themselves. I awoke hundreds of times to their accusations. I’ve never done enough.  I’ve failed them.  I’ve failed life not being able to sell life to the dying. It’s not like I’ve had any help from this government.  Since PM Trudeau has come to power it’s been all about the killing of the spirit and the bodies. Physician assisted sucide and pot and sharia communism.  “Don’t get me going” he said when he did that show. photo op number about quantum computers showing he didn’t know Shroedinger’s cat from a neutrino. What an idiot! But then I’m tried to ignore the idea of my own description of genius.  I’ve denied the high IQ and the education and the different take. That’s been not about superiority but about difference.
I talked to another Mensa today and loved how he descried his disability and how our government and society have never understood our “difference’.  A low brow thug wouldn’t grasp the ‘difference’.  There’s such a trade in disability and hidden deficits.  I loved hearing Candice say how difficult it was to be beautiful.  The ugly are so full of envy and anger and fear.  I loved Leonard Cohen’s line “We are ugly but we have the music”.
The judge was a thug that day but for all I know his wife was dying or more likely cut him off sex long ago when she caught him with some barnyard animal.
Trudeau reminds me of the stupidity I had 25 years ago when my father tried to caution me about the bullying of the French Canadians and how they had always stolen from the west, Montreal is built on the imperialism of their relationship with the west. It's been going on since the fur trade days.
But then the cities today are just the same with the rural regions. Imperialists.  It’s a really silly lens , this ‘privilege’ and ‘racism’ lens, These paranoid ideologies of I and me.
My task is to know God.
I’m one in the father. I’m one in the spirit. I’m needing to get myself out of the self pity and out of the division within. I have to identify with Carl Jung’s collective unconscious. I have to pray that I am more able to help my patients. Some are battling with cancer and I wasn’t able to help my brother.  But that’s my selfishness. I just feel alone and afraid.  It’s like when we were told to climb under our desks and put our hands over our heads and I asked “but what about the radiation’.
The pretty teacher ran around like a top in a circle screaming and ran off to get the principle who came back and badgered me and my friend Kirk saying we weren’t supposed to talk about radiation and look how we’d upset the girls.  The men and boys  weren’t supposed to upset the girls. But the girls have the vote. Meanwhile the teacher was crying,   I was just thankful they didn’t give me the belt again.   The principle liked using the belt.
I remember the teacher throwing the wooden hammer at my head and hitting me so hard I fell down. The egg I had on my head lasted days. My mother complained to the principle and school board but they all said I deserved it because of the questions I asked .  The kindergarten teacher pulled down my pants in front of the class and hit my bare bottom with a ruler saying I was disruptive.  "all you boys are disruptive.  Billy you're just the worst today'.  And i took my turn being stripped and caned as a child as the girls giggled and giggled and another different boy got his bum bared another day.  They loved the spectacle and these women teachers loved to impose punishments but I can't tell which were worse.

It's sad that I remember the beatings and the canings and the belts and the hammers and all that negative stuff when there's so many days I just loved to learn and how I loved the library. I loved the library. I met Leonard Cohen and Souster and C S Lewsis and Ray Bradbury and Plato and Jesus and so many more incredible people in the library.  And the librarian was always nice and some of the finest people I knew in the world were teachers. Only one threw a wooden mallet at my head. Only another one caned my bare ass in class. All the rest were fine.  Really  But the principle liked the brutal ones best.  The principle was a devil.  I learned that when I was a professor and understood better how he did his work. The school was a major success thanks to him and he didn't sweat the small stuff. Not when he expelled me.  Overall I'm thankful for the teachers he brought in and the education I had. I was the fortunate one.

Did you know that Einstein asked that same question about vacuums, he said to me after the class had all laughed at my question before they knew I was the highest scorer in physics. I liked chemistry better. I could see the molecules in the air. Everything was the periodic table for me at one time. I would see the world as if through an electron microscope and it was so beautiful.
I miss the meditation. I miss the early morning hours with the symphony cello player, the lawyer and the businessman sitting silent as the sun came up, our minds focused on the breath and the awakening of a new day.
I miss so much in my life.  The love making as a young man with a young woman.  My first wife is still the beauty she was back then. My mom and dad and brother. The dogs.  The home in Fort Garry. I can be wistful and in tears with all the love I’ve known and how much I took for granted.
Today I have to force myself to see the glass half full. The doctor said I was going deaf and wants to take an MRI. They ‘re find there’s nothing there or their pictures will show a brain tumour that’s been a hidden secret. I wouldn’t want to lose it. They’ve taken so much of me. I'm probably just a cancer that's not been cured.
EE cummings talked about them too. And Thoreau.  He knew them.

It’s a problem of perception. This identification with the aggressor, the externalization of the fear.  God is love.  All is love.  All is peace.  “I am the bubble make me the sea.” Yogananda.
“Do not be afraid’ Jesus said, not as a suggestion but as a command.
When the man pulled the gun on me I made him put it away. How. I talked to him.  Another time I pulled a knife on the young man with a gun and chased him back to his friends with their motorcycle.  It was a very little knife.  I always carry a steel pen since the solder held me hostage and said he’d kill me.
the plane crash was something.

I’ve been blessed with experiences. I’ve had an adventure this life.
And my friends let me breakfast with their sons and daughter and my nephews actually wanted to play with me.  I always am amazed at my good fortune.
I am blessed beyond my wildest dreams. Not really. I wanted a spaceship. But this earth is just a really big space ship hurtling through space.
I ‘m enjoying the old star treks on netflix.  I watch them at night when I come home remembering how I watched them after school as a boy.
My mom made me a birthday party with a star trek theme.  There’s a picture somewhere.  My fondest memory.

I’m tired.
Sleepy.
Maybe I’ll get a few hours before the day and the time i suit up and jump into the ‘chute’ to slide into the day of people coming with requests and mysteries.  I have so much to learn, so very much to learn.  So very much to learn.  So very very much to learn.  Do not judge the stupid.  you are one.   The more I know the more I know how little I know.  I struggled today with an old antidepressant drug and it’s dangers. It was from when I began. A dangerous compound like cancer medication but this one had kept this person alive. “It saved my life.”  I had to agree. It was potent. Even now I’d hold it carefully. How easy it killed back then. I saw the challenge in it.  It was all we had.
We saw people suicidal and gave them medication that could kill them with just a handful of pills . It was years before the new medications came , the ones with a large margin of safety. You’d have to take a bushel to overdose and die not like the medications I trained on.  Loaded guns and we’d wait and wonder and it would be months before we’d know and all along the person would be threatening to kill themselves and I’d be in terror they would and struggling to find any reason for them to live.
Now I’m old and it’s not so important now.  I feel truly that my government wants to kill me. I really do.  For a year or so I’ve felt the globalist agenda is to kill millions according to UN Agenda 21 and that this PM is the one to be the executioner and he will kill the western canadians  before his beloved Montreal lot.  I’m tired now.
I can go back to sleep and be thankful .  Really gratitude is the key.

God is love.  Thank you Love.

I liked how the English waitresses said that to me, in cockney, after I paid for my bit of eggs and hash and left a wee tip.  Thank you Love.

Justin Trudeau the person, and Justin Trudeau, the politician - personal political ramblings

I feel badly sometimes criticizing politicians, especially spoiled rich kids like Justin Trudeau. I admit I’m envious of spoiled rich kids because I’ve taken such flak from others for being a spoiled rich kid.  So many of these ‘comparison’s’ are relative.  Personally I’d left active participation in politics decades ago. When I was young I ran in elections and was on student councils and in media and served as “youth representative to parliament’ and served in secular and church authority positions. As a physician I served in my section of the BCMA and attended meetings and rallies. In work I’ve served on committees and been directly involved in preparation and presentation of position papers.  I’ve been a member of the Canadian Human Rights Association, The Canadian Civil Liberties Association, the Psychiatrists Against Political Abuse of Psychiatry, and still am involved in a few community organizations. I am a member of a church and have done service in that church organization.  Today I’ve been on Boards but generally over the years limited my ‘political public service’ to voting, membership in a political party and contributions.  Often these days my favourite contribution in my community is attending charity funding raisers and contributing to the ‘silent auctions’.
I’ve not been involved in city politics and admire a friend who has served there. My mother was very involved in local community politics but I’ve been more involved provincially and  federally, When I last voted in a city election I didn’t even know who or what half the parties stood for.  Provincially I’ve voted and I have been involved in some provincial based debates.  Federally I’ve been involved almost continuously since I was in my 20’s.  Indeed I always considered myself Liberal, having met Pierre Elliot Trudeau and thought him really smart ‘for an old guy’.  I actually considered like many in my generation that killing off anyone over thirty might make for a better country.  I rejected the liberal party some 20 years ago citing Churchill who said, “If you’re not a socialist at 20 you have no heart, and if you’re not a capitalist at 40 you have no brains.” I was increasingly dismayed by the corruption in the Liberal party and as an English western Canadian incensed at all the wealth that Quebec acquired through the Liberal party at the expense of the West. My friend was a member of the Western Canada Party and increasingly I saw that if Canada as a whole could vote on Quebec Separation we’d likely do better without them.  Meanwhile increasingly the decisions of Pierre Elliott Trudeau were increasingly the cause for so much that was problematic in Canada. I understood that his nearly bankrupting Canada had caused both Conservative Mulroney and Liberal Chretien to have so little money for health care.  Trudeau’s principal constituency was Quebec and lawyers.  So increasingly instead of science we were getting more and more government and less and less service directly as a consequence of Trudeau ideology.
Meanwhile the communist ideas I ‘d liked as a teen ager became apparently brutal with each year of mounting evidence of the millions killed in Communist regimes. I began writing letters on behalf of scientists imprisoned in communist countries.  The eventual falling of the Berlin wall with the increasing release of information and transparency finally destroyed my love affair with Trudeau.  After the horrors of communism became known it was for me like the exposure of Auschwitz to the world, I could never again respect Communists as I could never ever respect Nazi’s once I’d seen their gas chambers.  Trudeau fell from his pedestal, his lapel rose poisoned by history.
Now I wasn’t fond of George Bush, Jr.  I liked that he was a recovered alcoholic and made no bones about that. I also liked that he was a Christian.  I loved his mother and his father had been one of the brightest men in American politics.  That said, he was a Dynastic Ruler.  Genetics is important, especially in race horses, but the European history and Eastern history of Dynasties said mostly that they were best at serving themselves and least concerned with serving their countries. I liked democracy and elections because of the competition and the belief that ‘meritocracy’ would lead to the ‘best’ choice.  Trudeau is a Dynastic Leader like George Bush Jr.  I don’t like him fundamentally because he smoked dope and did so at work.
Because my work is partly ‘police’ work, as a Medical Review Officer, it’s been my job to ‘monitor’ doctors, nurses, pilots, ships captains and drivers who themselves have ‘smoked dope’ or ‘drunk’ or ‘done drugs in office’ or ‘work’.  I personally am in recovery.  I was advised to smoke dope by a psychiatrist I saw about anxiety and bought marijuana from physicians.  Somehow the whole ‘illegality’ of the process and the ‘criminality’ of ‘drug use’ given my position as a psychiatrist began to wear on me.  When I saw a drunken doctor’s decision cause a patient’s death and saw a dope smoking doctor’s decision cause a patients death I became very concerned about the whole issue of ‘impairment’.
When I became open about my smoking dope and drinking wine, no more than judges, lawyers, hospital administrators and members of the College and Physicians or police around me and likely less than what was going on in the Trudeau home, I was severely “punished’ and ‘grossly stigmatized’ and ‘subjected’ to an unforgettable near death experience at the hands of very dangerous doctors who could justify their behaviour because I was a ‘dope smoker’.  I was ‘invalidated’ and ‘lost all my rights’ and was horrendously abused as I told the truth.
Now I appreciate that Justin Trudeau wants to ‘decriminalize’ marijuana.  Marijuania has been decriminalized essentially in Canada for more than a decade.  After my harrowing experiences which occurred as a result mostly because I did smoke marijuanai and associated with those who drank and drugged, albeit in high places, I remained ‘abstinent’ believing quite frankly with the political deceit and political dangers in Canada that I couldn’t afford to be ‘witless’ among so many rather sociopathic individuals. I found that the drug and alcohol abusers in general, especially those in high places, were the most sociopathic of all.  I gravitated increasingly to those who didn’t abuse drugs and alcohol and consciously didn’t break the law.  I simply like lawful people today. My brother has always been such and my family in general has been law abiding.  So it was fairly easy for me to return to my roots and accept that smoking marijuana hadn’t just been about the drug but had included an element of arrogance and just a touch of the ‘outlaw’ superiority that dominates the underworld.  I liked that I ‘got away with it’.
Yet I went to a psychiatrist and told him about my marital problems and anxiety and he thought my drinking wine and smoking a joint was just fine.
Today I would be smoking a joint and drinking a glass of wine if only because the ‘legality ‘of the thing’ would made that whole laissez faire easy going reality attractive.  Consciously not smoking, (I’d started smoking cigarettes which was my gateway drug for marijuana, and interestingly never thought anything of nicotine till I realized how dangerous it was) I began a journey of spirituality.  I also politically became increasingly informed and insightful about ‘morality’ and ‘ethical behaviour’.
I was meditating and very involved in pursuit of the truth and being in touch with my true self when I smoked marijuana again in psychiatry. I’d tried it over in Morocco but din’t really smoke it again till I was in psychiatry. Mostly my use of drugs or alcohol was highly circumscribed by my study of medicine, my work as a doctor and my onerous on call schedule.  It was only in psychiatry and on vacation that I used marijuana again, doing it with the psychiatry staff and gravitating to psychiatrists who drank and smoked dope. Most don’t.  It’s actually only about 10 % of physicians and 20% of lawyers and judges who abuse drugs and alcohol.   It’s amazing given the opportunity we all have that more than 80% of professionals are not impaired.  The head judge of the Supreme Court of Canada was a falling down drunk but the other four judges were sober caring.  I know the head of obstetrics was a drunk but the rest of the obstetricians I knew weren’t.
When I was younger I was highly critical of the one bad apple. Today I am utterly amazed and grateful for all the men and women in positions of power who do not abuse that power.
I have made amends for my poor behaviour. I caused no death, caused no harm to individuals, double and triple checked my work and asked colleagues opinions more if I was ‘hung over’. I was considered an exceptional doctor and psychiatrist and highly celebrated for my work and even my integrity both before and after my ‘disclosure’.  The worst doctor and most immoral unethical and corrupt was a doctor in position of power who was indeed to the best of my mind sober.  Psychopaths and sociopaths don’t need drugs and alcohol to hurt people. Yet drugs and alcohol commonly makes bad behaviour worse.
I worked on ‘wet reserves’ and ‘dry reserves’ when I was a physician with the Northern Medical Association and noted that despite all other variables the ‘wet’ reserves were the places of utter hell, depravity, disease and abuse while the ‘dry’ reserves were heaven by comparison.
Justin Trudeau’s mother was an addict and I have known so many Adult Children of Alcoholics and Addicts to appreciate the difficulties children experience growing up in families with active addiction.  Justin Trudeau brother was an addict as well. His father was aloof and intellectual.  Justin indeed has a fine sense of humour at times talking about his father.   But again I’ve had too many friends and patients who have been the children of the famous. It comes with major burdens.
My parents believed in work and I didn’t get an allowance but rather got a ‘wage’ for work I did in my home. I have this antagonism about the ‘idle rich’ a communist Canadian thing.  Yet, with protestant parents I was inured with the “protestant work ethic’.  I was also raised with a lot of ‘duty’.  It was my job to help those who were less fortunate, the young and the old.  I was raised on ‘noblesse oblige’ and ‘charity’ and heavily criticized if I ‘looked down’ on the disabled’.  It was however perfectly acceptable to criticize the lazy and the drunken.  When there was work to be done everyone had to pitch in and those that didn’t do their ‘share’ of work shouldn’t get any reward. This was fundamental in my upraising.
There was also this idea that as a member of the middle class we had a taxation system that was wrong as it supported ‘white collar welfare ‘ and ‘blue collar welfare’ , the ‘takers’ and the ‘cheaters’.  I loved singing Christians songs about Glory trains and what they carried and how they didn’t carry ‘cheaters’.
I have friends who were born wealthy.  A lawyer stole my grandfather’s estate. He stole the estate of a dozen of the richest men in northern manitoba.  Since the lawyers didn’t ‘catch’ their own, and our family and our friends family lost ‘millions’ we learned at a young age that the ‘courts’ were corruptible and judges there were laws for some and laws for others.  I loved Animal Farm. It was one of the very best books I ever read.
I don’t know Justin Trudeau.  As a person he suffered the loss of his father and the loss of his brother. I’ve lost both my parents now and empathize with those who have lost family.  I admire that Justin Trudeau is a family man but having married brilliant equal feminist female doctor and done 10 years in that rodeo I see Trudeau and his marriage as a 50’s sort of union and understand why he gravitates to the Islamic chauvinistic traditions despite his parroting the words of his female writer “It’s 2015”.
He’s an actor.  I can’t understand why the Elite in Canada don’t hire the Sutherland.  Both father and son are better actors than DiCaprio and certainly way better than Trudeau. But Trudeau has the ‘brand’ name. He’s like Kardashian’s in that way.  I’d love Keefer Sutherland for Prime Minister.  He’d give us a show like Reagon did.  America went with an actor and I don’t know how much material of his was ‘original’ but do know that when Trudeau ‘improvises’ he tends to put both feet in his mouth. He’s not that bright.  I am considered very bright and I know people like Colonel Hadfield who are extremely bright. So I rue the new politics where ‘accomplished men’ like Colonel Hadfield aren’t able to be prime minister because we get ‘brands’ or ‘lawyers’ or ‘actors’ instead.
I liked Mr. Harper because he was a western English Canadian who was an accountant and kept Canada from the fate of Greece during the world’s toughest economic times.  I’ve increasingly like the Conservative economic model too.  The Liberals and Conservatives are really two sides of a corporate coin. I like think the Liberals are Quebec Mafia and the Conservatives are American mafia.  If I have to pick between the Hell’s Angels and the Tongs being western I’m going to pick the Angels. It’s not very advanced. I make decisions in my area of expertise with great erudition but in politics I’m often limited by the horrendously dumned down and biased media filter. I miss the early days of the Winnipeg Free Press when you could actually read a newspaper and learn what was going on in the world because journalists were picked based on their knowledge not on the ability to sell cereal.
The fact is that if Justin Trudeau were to go against ‘legalization of marijuana’ and agree to be randomly drug tested (especially every time he smirks) I’d be less antagonistic. He seems like a pretty nice guy as a person.  I have a friend who is an actor and he’s a hell of a nice guy.  Good father and family man too.
It’s just that in Canada we are encouraged to question every aspect of the person who is our leading politician. I objected soundly to Mr. Harper being demonized. The Liberal followers called him Nazi, Hitler, and some actually said he ate babies.  I didn’t like the tone of the new politic discussion but since that’s where we are I find I have a real penchant for this kind of mud slinging. The Democrats and Republicans in the US have been attacking each other since the days of Nixon. I learned later that Nixon’s impeachment for what he did was only because he go ‘caught’. The democrats were doing the same.
They say ‘all’s fair in love and war’ but in truth ‘politics is mostly a war of words’ and the victimization of Mr. Harper was no greater than the victimization of Mr. Ignatieff. That poor intelligent fellow who left academics to teach Canadians was pulverized by everyone.  Canada is a collectively stupid thuggish country with little respect for accomplishment or intelligence.  Some say this is the consequence of the Brain Drain to the US.  It’s like the “tall poppy syndrome’ of Australia. Stand up and you make yourself a target.  It’s the new politics.
Justin Trudeau is our Prime Minister. He has won an election with a third of the popular vote but he’s the winner nonetheless.  The corporate party of greed of the Liberals has beaten the corporate party of Greed of the Conservatives and the NDP.  Each ‘Party’ represents it’s own base of Big Money.  The pollyanna lies each tells comes down to let me ‘spend your money’ and ‘make myself and my friends rich’.  Also all Canadian and American parties ‘promise change’ but in fact the very nature of government is to stop change because ‘reform is the enemy of those who benefit from the status quo’.
I loath the corruption in the liberals with the Chief Financial Operator having the greatest investment in the Legalization of Marijuana. Conflicts of interest like this are common. Given the recent ‘physician assisted suicide’ position I wouldn’t be surprised if some politician didn’t have an investment in a particularly effective gas agent for killing people.  But that’s just politics.
It’s all just politics.
People didn’t think America would survive George Bush and then they didn’t think we’d survive Obama.  The same was true for Mulroney and Chretien and now Harper and Trudeau.
I think it’s all above my pay grade.
In the Scottish Irish home of my birth if anything went wrong you first blamed it on the weather.  Next you blamed it on government. Then you could blame anything that went wrong on the Communists or the Catholics.  Bankers and the Elite were sometimes the cause of blame if weather, government, communists, catholics didn’t cover it. Always the tax man was as bad today as he was in the day of Jesus.  Then you could blame things on outsiders or newcomers.  As kids we liked to blame things on the old.  Then you could blame things on religion. Now you can blame things on polluters.  For a while there you could blame things on science and always you could blame things on lawyers.  We never blamed things on each other. We loved our dogs but we did blame things on the dog especially farts.
So the bottom line is we collectively get the leadership we deserve. That’s the spiritual way of looking at things.  Justin Trudeau for whatever negative I think of him represents those negatives I won’t own within myself. That’s called projection.  I am not all I could be so I blame someone. Justin is the devil in the secular world. He could be the saint too. It’s really just a matter of weather or whether the dog farted in the end.
Personally my own struggle is always with God.  I am the orubunga and I mostly think I’m the tail of the snake being bitten by the head of the snake.  Does the butterfly think the philosopher or the philosopher think the butterfly?

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.

F.A.T.

F.A.T. - Food Addiction Treatment
Obesity is at epidemic proportions in North America.  Obesity is certainly not good for morbidity or mortality. The fat we see on the outside is also surrounding and clogging all our internal organs. The heart is constricted with fat. The weight of the body is destroying joints.  The weight of the chest is obstructing breathing.
All manner of illness is more prominent among fat people.  Obesity is roughly 50 lbs over what one’s projected normal weight to height should be.  In the past this was done with routine height and weight charts. I still prefer this to fancier (Body Mass Index) but more complicated methods of assessing how fat one is.
The worst indicated is the pear shape at the middle. This is associated most with development of disease.  Diabetes, hypertension, just another couple of examples.  Success is reducing waist size.  Being tall I hide that I really 'should' be 4 to 6 inches less at the middle.  I love to kid myself, that it's posture. I can 'suck it' in the belt is supposed to be 'straight' not curved at the front.
Obviously it’s a black box equation.  Too much food in and not enough exercise out.  There are those who say they have ‘slow metabolism’. Maybe, rarely. There are countless excuses.  The fact remains, obesity is unhealthy. Fat is unhealthy.
See your family physician and get a complete physical to make sure you're not fat because you're suffering from some disease like hypothyroidism.
I recommend Overeaters Anonymous. There are a variety of self help 12 step programs. They are all beneficial.  Mostly they focus one on being ‘honest’ and ‘accountable’.  They recognize that food addiction, overeating, is done for emotional reasons, to stuff emotions, such as fear or resentment.  Expectations are pre formed resentments. Fat people are commonly passive aggressive, angry on the inside, smiling on the outside, people pleasers.
The most common mental illness associated with fat is depression.  Unfortunately a lot of antidepressants cause increased weight.  Wellbutrin and Cymbalta are neutral medications that are least likely to cause weight gain. If you do gain weight with an antidepressant this can be counteracted by the addition of dexedrine to treat the 'side effect' of therapy. Other psychiatrists would add synthroid to counteract the weight gain effect of those antidepressants that cause weight gain in susceptible populations.
Often fat people are bipolar too.  They've not uncommonly had a lot of trauma.  More often than not a lot of it's been sexual.  Since sex is an athletic activity fat people aren't very good at it.  They don't like being on top and might crush their partner if they were.  They can be loving but are often hurt and hurtful lovers.
There are very important ways to reevaluate one’s life and ambition and look for more positive ways to achieve realistic goals without becoming the Michelin Man in the process and having an early death.
I recommend Fat is a Family Affair by Judy Hollis.  Excellent book. Good ideas and tools.  There are other good books out there.  Therapeutic reading is helpful
Fasting at least a day a week or by missing meals with good education and therapeutic plan is a great diet approach.  If one is on medication discuss it with a doctor knowledgeable of fasting. The principle problem is that people don't drink enough fluids when fasting. It's amazing how much fluid one gets in food so this has to be compensated for by literally forcing down a couple more glasses of liquid than one feels they wants.
There are a variety of diets. None of them is good enough alone. They must be coupled with a whole change of life and lifestyle.  People usually diet like drunks change from drinking vodka to beer without really addressing the problem.  Fat and obesity are life long problems.  The failure of diets is that one doesn’t follow them or returns to previous behaviour the first stress one encounters.
I recommend 500 calorie diets. In my obesity clinic, everyone lost 50 lbs or more in a matter of months to a year.  However, though I recommended 500 calories everyone cheated . When I had a sweet little silly headed nutritionist come in and recommend 2500 calorie diet all my big boys and girls took that to mean 5000 calories. People lie and cheat with diets.  Best recommend 500 and be done with it.  Aim for perfection and be thankful you hit the target even if you’re way off the bull’s eye.
To understand the principles of what is 'good nutrition' understand the Mediterranean Diet and the Zone Diet. All the rest is gooblygook and confusing.  There are no obese people over 100 and the diets of longevity are in the long run the best diet. If you are rich you can be a vegetarian. Rich vegetarians live long but poor vegetarians die young.  Being rich is more associated with longevity than diet. But fat rich people die the same horrible deaths that fat poor people do.
I knock 'fad' diets but there are good people out there like the Jenny Craig folk and others. Check them out and do something.
Obviously seeing a psychiatrist is a good idea.  I’m a psychiatrist and a whole lot of my obese patients had underlying ‘issues’ which had to be  addressed for the various other tactics and strategies to work.  I don't think seeing a slim counsellor is that helpful unless the slim counsellor used to have a problem with fat and now is and remains slim. Ask to see their fat pictures.  Given counsellors have the least education it's best if they have the most experience. I've got the most education and it helps that I have a little of my own experience.  I've seen too many people talking about things which never came hard for them and what they're saying only works for others like them. It doesn't work for the obese.  Obese people are resistant to learning. They're not stupid. They 'know' what's good for them. They just have difficulty 'doing' what's good.
Exercise and coaches and physiotherapists are all very helpful.  Aquafit exercise program is the best program for the really obese.  Obviously jogging is great exercise but if you're five hundred pounds and start jogging you're going to cripple yourself.  Start slow , go slow and don't hurt yourself with whatever exercises you under take.  I like martial arts. Tai Chi is great. Yoga is good for flexibility but not that good for losing weight.  Group therapy, some kind of group exercise program, is the least expensive but also the most effective long term.
An american military study showed that once a certain level of exercise was achieved, a few hours  on the military obstacle course for instance, then force feeding wasn’t associated with weight gain. This study showed that diet came second to exercise.  Most people are too fat to exercise or like exercise hence the benefit of personal coaches and beginning in the safety of ones home only to progress to the group experience.
When you lose weight, 10 lbs or 20 lbs, a size or two, then buy new clothes and burn the old ones, or at least give them to the Sally Ann.
Now having done all this there are medications which help.
First and foremost consider what medications you are taking that might be adding to the problem. High dose antipsychotics, like seroquel, often used for sleep  or anxiety often increase appetite and put on weight.  Discuss medications with the doctor and make sure if possible you’re not on anything that will be complicating matters if possible. Don’t stop medications just because they can cause weight gain by affecting appetite.  The worst medication for obesity is so called 'medical marijuana'.
Don’t drink or smoke dope.  Face it, alcohol is empty calories, leads to poor judgement and marijuana, especially ‘medical marijuania’ causes the munchies.  We used it with AIDS patients to improve their appetite and increase their weight,  for that reason.
Xenical is an interesting and relatively safe medication. It works by reducing the absorption of fats. Several of my patients swear by it. The only side effect they noticed was a little bit of loose stool and they had to be more careful about farting in public, not because of leakage but the smell was noticeable or something like that, as I remember. Didn’t stop them from using it.  There’s a whole list of side effects but compared to obesity they’re all minor.
Dexedrine and other appetite suppressants are what the models and such use. These are essentially ‘prescription’ speed.  They are excellent for appetite suppression however they are also highly addictive. When I ran an obesity clinic I used them for 6 week bursts , when people on a regular exercise and diet program got ‘stuck’. Weight loss tends to go in steps and sometimes the use of an appetite suppressant helped one over that ‘hump’.  The critical factor here is that the doctor be working closely with you and also be monitoring your weight. No sense taking these if there’s not significant weight lost. The cost of addiction then outweighs any benefit. Further the risk is that people will continue them and want increased amounts. That’s a danger sign. Further they shouldn’t be continued if they cause sleep problems.  However if a person is already on sleep aids they can be tried because they won’t necessarily be making a sleep disorder worse if taken early in the day.
I don't think it's a coincidence that a whole lot of people who got fat suddenly got 'adult attention deficit disorder and got their hands on medical speed for appetite suppression.  The tragedy of this approach is that it means the doctor isn't working with you on the obesity problem and merrily going along with the idea that you can't concentrate.  Which might be true, given how distracted you are by the munches.
Revia is a novel medication with great promise. I’ve had success with this and really should use it more. It’s not a cheap medication and I’ve thought about cost prescribing it however when I consider the fortunes that people use on unproven alternative health aids and silly fad diets, Revia is far superior. It was found that it reduced craving in alcoholics and addicts. From that it followed that it might reduce food craving. And that’s what it does. Reduces craving for foods by 50% .  It’s a relatively safe drug with great benefit .It’s really worth a trial with any obese people where the safety is assured.  It’s benefit is seen in a 3 month trial for instance and the potential of negative side effects aren’t as bad as the hazards of obesity in general.  My patients haven't had negative side effects to date.  Everyone knows about 'negative side effects' these days because it's a lawyer thing and it's out there for the ambulance chasers and as a medical disclaimer for the manufacturer. In a lot of cases these long lists are about as useful as coffee cups which say on the side ,be careful ,cup may be hot.
If these don't help really consider boot camp and a 1-4 week treatment spa where one goes for the sake of losing weight and getting healthy.  Alcoholics have embraced Betty Ford so I don't know why the fat church ladies aren't getting on the wagon too. There are many out there and they do work.  So if one remains obese for a year or two, think of the drunk husband who keeps falling off the wagon, then consider the fat farms.
It's easy to treat obesity earlier than later.  That's the case with all diseases.  Nipping them in the bud is what one does before consider nip and tuck.
After one has failed with exercise and diet and programs  one really should consider surgery though. 30 years ago I was assisting a surgeon doing stomach stapling.  It was relatively experimental back then but today it’s fairly routine with the safety of the surgery pretty much overall established compared to the risks of gross obesity.  The first step is to talk to your family physician about surgery and get a consult to a surgeon who does surgery for obesity.  You don't get the surgery that visit. He tells you about and assesses your risks and lets you know if surgery would be for you.  You don't have to decide then.  But now you know. If you're grossly obese and have been for awhile then you're kidding yourself if you haven't talked to a surgeon. It's like a person who complains about having to walk to the bus who has never even talked to a car dealer to see if there might well be a car they can buy.
I’m a little overweight. I wouldn’t mind a little liposuction but I’m not planning on stomach stapling. But if I was a couple of hundred pounds overweight and had failed at a variety of approaches I’d certainly give it a go. Several of my patients have had long term benefits from it and I’ve seen them and been surprised to hear they once were grossly obese. Their lives are going well today only they can’t gorge on food. Regular servings is as much as they can take.
The key is to get a ‘plan’ and go with it. Don’t do it alone. Work with your doctor and better still surround yourself with a ‘team’ of people including family and friends who are on board with your plans and know your goals.  Imagine how stupid the world would be still if we didn’t have schools and take a regimented approach to learning.  Stupidity can be ‘cured’ . Education even treats arrogance because the more you learn the more you realize how much more there is to learn.  Sloth and gluttony are treatable.  You don’t have to be ashamed.  It’s a life long process with no easy quick cure. Plans involve life style changes that occur for years even after making the ideal weights. My patients commonly tell me of ‘relapses’ that occurred after five or ten years of maintaining a healthy weight.  Then they go back to basics and progress through to advanced weight maintenance learning all over again.  Success is normal if you follow the steps.
With an aging population and the improvement in the comfort of the couch and the advent of the tv channel changer we’ve got more to face than the previous generations that had to chop wood for their heat and use a pump to get water.  We’re adapting as a civilization to the digital age.  And yes, just like we know that Goldman Sachs were developmentally challenged as human beings so are the folk that produce those disgusting fast food vending machines for schools.  We collectively dealt with the tobacco companies and the psychopathic CEO and their vampire disgusting children and collectively we’ll have to eventually deal with the folks ‘pushing’ sugar salt fake food substances on us and their degenerate young.  That comes later.
Before we can kick ass we've  got to deal with our own lard asses,  get out and exercise, ask for help, network, plan, strategise, and lose weight and get healthy.
What use are you going to be to the rest of us when the zombie wars start. We’ll be dragging your ass and the zombies will be charging for the greatest mass of flesh which is you.   If you want help then start helping yourself now.

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