Beautiful day and shitty problem

“It’s a beautiful morning,” he said. I was walking my little black and white cockapoo, Gilbert around the trailer park. He’d just had his morning constitutional and I was carrying his contribution to posterity.
“It sure is. I love the clear blue sky, I said, looking up.
“It’s almost like the dessert.  I never thought I’d like the dessert but I love the air there.  The mornings are like this. “ I appreciated what he meant. Though Vancouver was in a rain forest by the coast this day had begun dry and crisp. We’d had the hottest temperatures for a couple of days with everything dried out.
I walked on to deposit Gilbert’s plastic bag dumpster donation.
It’s a beautiful day.
I’m grateful for my health. I’m walking without pain. I have clothing. I have this terrific little dog. We had a great night sleep. I have this terrific sleep apnea machine which really results in deeper less disrupted sleep when I use it. I have a temporary solution to my toilet problem and am slowly working on a longer term solution. I am grateful for the bed and my home.  I enjoyed my motorcycle ride yesterday and am grateful for the training and skill and the motorcycle.  I loved the Blenz cold coffee Frappe I had. It was good to be able to spend money on a little luxury like that without a cancern. I am I thankful for my work and income as it allows me to help others and travel to be where I need to be for family. I like that I have such a wealth of training and experience that I can use it for good.
I am thinking of the future though looking forward to having the resources to sail again , this time in islands and later to the Caribbean and across the Atlantic. I dream of a drive to Alaska and I look forward to travelling across Northern Canada. I want to do more motorcycle road trips too. I’ve so many ‘dreams’ which I’m so thankful for.
Gilbert just barked up a storm.  The valve on my septic tank outlet is broken and sewage has leaked twice.  It’s been pumped 2/3’s dry but there seems to be no way that the new valve can be placed in without the risk of more spillage.
“The woman was crying when it leaked,” the manager said.  “We’ve got one or two a summer but it’s usually our septic system."
“I was on the internet and it seems to be a rather significant problem because there’s no really good way to suction out the tank if the valve breaks with it closed.”   I ‘d been watching various you tube presentations and seen that the actual valve isn’t complicated but that when it was time to change if it broke closed there was this problem of a flush of fluids before the valve could be replaced.
The pump companies didn’t have a means of pumping out through the toilet because their hoses were 2 and 1/2 inches at the smallest. I figure this is an ‘engineering problem that could have been solved with a double valve system especially in these ‘ecological’ and ‘sanitized times’.
“When it happens people just let it dump then hose it down. That’s how everyone has been doing it.”  A plumber explained to me.  This would probably work in winter but in these incredibly hot days we’ve had this summer that’s just not a solution for the neighbours.  Right now the temporary solution has me covered for a few weeks but I may have to remove the whole tank and take it into the manufacturer and let him solve the valve issues.  It’s about a 35 gallon waste holding area before the connection to the municipal system and it’s accessible so could be removed but no one is willing to do this in the heat.
I confess I’m quite interested in this ‘shitty’ problem and am learning about that ‘delays’ are common throughout the world. Just like my inability to get the crawfish in New Orleans because it was ‘out of season’.  Too much tv with it all the ‘instant gratification’ and magical solutions.  I’ve had this toilet problem now for several weeks with several people grappling with it and no one yet having a solution.
Today I’m cleaning away everything that would prevent the removal.
It’s a blessing to have the heat and sunshine. I am thankful for that even if it does interfere in my getting  my septic system fixed. It’s kind of a ‘funny’ problem too, shitty but funny. Something about waste has an element of amusement attached to it.  I am powerless now and will pray for an answer while I work at preparing for the worst.

French Quarter, New Orleans

I’m been singing the praises of the food and people of the city of New Orleans.  It’s amazing how much revitalization has taken place since the storm.  I saw no destruction except some buildings were still closed.  The French Quarter was certainly alive and welcoming tourists and ready for business. I look forward to going again someday.  I’d like to drive there and have time for more visiting. This trip was for the IDAA conference at the Hilton and to quote Jim Croce "there’s just never enough time to do all the things you want to.” 

St. Jude Church, New Orleans

I loved this church in New Orleans. Ironically I had gone to the near by great cemetery where the still remembered Voodoo queen is laid to rest only to find the cemetery closed.  I then happened on St. Judes. St. Jude is the Saint of Lost Causes. I certainly have thought myself that on occasion.  Probably why of I love the great Blues numbers played so well in New Orleans, “Oh When the Saints” .  I do want to be in that number but am so easily distracted by the world.  While I know I was interested in the ‘shrine’ of the voodoo queen, as an artist,  the Lord of Creation, the Jesus of my understanding, intervened and took my steps to the nearby St. Jude’s.
It was open and inviting. I walked in, crossing myself with a bow, then kneeled in the pews and prayed.  I like to pray in churches. I like to sit and meditate.  I did this for a while until a cell phone rang and the only other person in the church, a woman, began to carry on a conversation with some distant person about groceries and shopping.  It was my cue to leave.
Outside there was a crypt to the Virgin Mary and a garden. Lovely places to sit and contemplate faith, hope and deliverance.  I was lost but now I’m found.
Jesus Christ mean’s ‘christ within and christ will come again’.  Often for me the sense of lost and found is moment by moment. I listen to the latest in politics and this seems like hell, then I see someone helping another and I feel I’m in heaven. It’s perspective.  I like St. Jude.  Probably because it took the Beatles to introduce me to this saint.  Then throughout my life I’ve had the sense of being lost and found.  There’s a sense of alienation, something triggers a feeling and memory and I’m back in the past my life being threatened and feeling that sense of helplessness, horror and imminent death or dismemberment.
St. Jude’s was a lovely church to visit , pray and meditate in. I love these sanctuaries.  I am so thankful for the work through the ages of Catholics and Christians that have created these shrines in the west. I am thankful for religions the world over that have made ‘third spaces’ that remain today where I can visit and feel safe. I can even feel a bit of serenity at times.  New Orleans is a city of energy and also peace.

 

Continuing Medical Education, IDAA 2016, New Orleans, Louisiana

I love the annual IDAA conference. It was here that I met some Addiction Medicine specialists and chose to do gain my certification in ASAM, then subsequently in CSAM And ISAM. Now each year I am fortunate enough to some of my favourite academics given the most learned presentations on cutting edge topics in the field of addiction and alcoholism.
I loved hearing Dr. Penny Ziegler again. She presented last year on addiction in the LGBTQ community and this year again presented on ‘issues of shame’ and ‘acceptance’.
Dr. Mel Pohl is truly one of the greats in addiction medicine and one of my all time favourite presenters. He did a superb workshop on “mindfulness meditation” coupled with a ‘guided meditation’ for the whole group. The question and answer period with excellent and though I’m a long term meditator I was glad to be able to clarify a technical issue. Later Mel presented on “controversies in addiction medicine’ and was very comforting. Often as a clinician I feel alone in my work in the office and it’s extremely reassuring to learn that what appears a local conflict is indeed part of a greater whole.
I always love to hear Dr. David Smith, truly a great in the field of recovery. This year he spoke on confronting barriers to 12 step programs working with adolescents. He showed how the ‘language’ of the teens today actually was in line with that of the 1930’s when AA began but they use ‘different words’. Spirituality remains very important. His examples on engaging youth were delightful. But what was even more of an eye opener was the ubiquity of drug availability for youth in the Marin County middle class communities with the parents rarely aware.
Dr. Paul Early, another favourite, presented on the ASAM Criteria for treatment of the Safety Sensitive Worker. This was so timely for my own work and addressed the local concerns I was facing especially with the increasing use of marijuana in the community.
There were others. I ‘ve ordered the tapes for the ones I missed, I really had wanted to hear Dr. Barton on Implants, but I’ll hear them while driving along in my truck this winter Each year I’ve brought back CME disks and enjoyed reviewing them, making better use of traffic jams than giving in to ‘road rage’.
These are some of the bits and pieces of notes I took, more of collage for my own memory than anything relevant to others I’d believe. Still I like to blog these bits and pieces because I can’t say how many times I’ve been able to use the search engine on the blog to find the meeting notes.In them I’ll find the bit I recorded for ‘future’ reference. The blog has this search function that my previous attempts at keeping records of cme didn’t have. Thanks to the blog I can search for Dr. Earley and see what he’s lectured on in the past and appreciate all over again how much I’ve enjoyed learning from him and others.

ASAM Paul Earley
ASAM PPC -placement criteria
-followed Cleveland Criteria
- levels of care, not duration
- research evaluates outcome when matching criteria
ASAM Continuum software
ASAM Criteria new book
- safety sensitive criteria
Safety Sensitive
- power companies
- defence contracts
- public servants in police and fire
- airline pilots
- at tourneys and judges
- healthcare workers
- employees of pharmaceutical companies
Safety sensitive
- responsibility to public
- need to balance individuals rights to privacy /with public safety
- healthcare workers have potential to divert a usable substances
- safety sensitive workers who are placed in roles of authority
Motivational Model
- prochaska and diclemente model
-motivational model has 'fail first' paradigm
These premises do not apply to SSW's
- failed treatment decreases perception of safety
Treatment Setting
-safety sensitive workers
- setting should provide protection from media and section of society to whom you are responsible
-peers - help reduce shame
--- collegial support
---model of how a pilot, physician etc should comport themselves in recovery
Staff need to understand the work trauma associated with the work
- political context of the group
- monitoring and licensing agencies
Neurocognitive testing should occur
Physicians exhibit obsessive compulsive features normal for their group
- should include "collateral data collections"
Chronic management is structured as "contract"
Now called an "agreement"
Screening - urine, blood, hair, and nail
- polygraph
- group support sessions
(Cadeuceus - what it is to be a physician in recovery)
Managing Public Opinion
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Overcoming Barriers to 12 step recovery in adolecent
David smith
Genetic predisposition abnormal reward system D1 & D2
Addiction is a pediatric disease. Tim Cermak MD
Barriers to youth 12 step
- parents attitude to "those" people in recovery groups; don't understand or like the steps; want cure rather than chronic disease model
- school attitudes - we don't have problem - only bad kids go to 12 steps
- bottom not a good paradigm for adolescents
YPAW groups - fun in recovery
Spirituality versus religion
12 step - help others - new identity