I have been wanting to write an article about cannabis for a while now but didn’t know exactly how I wanted to present my opinion on the topic. I am a physiotherapist in Vancouver, Canada, a place that has long embraced the use of cannabis, but up until recently it carried the stigma of technically being illegal. I say technically because we have had weed shops on every other corner for years in this city that law enforcement had chosen to let function in a grey area due to public opinion. On October 17, 2018 the federal government of Canada officially made marijuana legal and countless companies have been jockeying for position at all levels of the industry.
As a physiotherapist, that works with many people with resistant and chronic pain problems, I have definitely noticed an increase in people’s openness to talking about their use of cannabis or their new interest in trying it as an option for their pain. Healthcare professionals have always had to walk a fine line in their discussions about marijuana with patients both due to legal implications and the lack of strong research on the topic. My goal with this article is to help decrease the residual stigma of cannabis by talking about its effects on pain, stress and anxiety from my perspective and to introduce a leading physician in the cannabis space named Dr Caroline MacCallum .
Pain can simply overwhelm people. It can be sharp and acute or dull, aching and chronic. It is not a tangible, physical thing, but more of a perception, or an experience. It is hard to explain this concept to someone in pain and not have them think that you are calling them crazy and suggesting that it is ‘all in their head.’ We are programmed to think that pain is related to a physical structure in our body being damaged, and if we can somehow fix that structure all of our problems will just go away, but unfortunately that is not the case. Read More
IMS dry needling is an increasingly popular form of treatment used by physiotherapists in Vancouver, Canada due primarily to the strong influence of local retired physician Dr Chan Gunn. He studied and refined the use of acupuncture needles specifically for treating persistent pain and ran a training and research center in Vancouver over the past thirty years. He engaged physiotherapists that had experience with manual therapy and taught them how to feel and treat inside the muscles instead of just pushing and prodding from the outside. It was a new modality that strayed from traditional acupuncture and pushed physiotherapy outside of its’ customary box. More physiotherapists in Vancouver adopted the new technique than elsewhere due to the local availability of training and the allowance of our regulatory body in British Columbia that permitted physios to puncture the skin.
Early adopters of IMS learned from Dr Gunn in the ‘90s, but relatively more and more have adopted dry needling as a staple of physiotherapy practice in the past ten years. I learned from Dr Gunn in 2008, after being exposed to the technique at Diane Lee’s physiotherapy clinic in 2006. In hindsight I am glad that I had some exposure to the dry needling technique in the hands of physios before I learned it directly from Dr Gunn because it helped me put the model that Dr Gunn was teaching in perspective. His model of intramuscular stimulation (IMS) is very valuable and the underlying principle that I apply when needling, but it is too simplistic and limited in its explanation and application. I wrote this article a few years after taking the IMS course to help explain to clients what I was doing and how IMS was different than acupuncture. If you want a history lesson about acupuncture and to see how many people have different views about needling, please scroll through all the comments at the end of that article. Read More
Sincere empathy can be a challenge for many healthcare professionals because we are confronted with an endless stream of people that have encountered horrible life events and we can’t possibly begin to understand the psychological stressors that they are now facing, either real or perceived. Many of us work in healthcare models that give us very limited time with a client due to the volume of people we are trying to help and/or the financial constraints of who is paying for our time. The combination of these two factors doesn’t usually result in a positive experience for patients trying to navigate through their medical system armed with only a very superficial knowledge of their bodies.
Our medical systems are typically very good at keeping people alive, but after that they can become a series of very stressful life events that cause just as much harm as good to a person’s psyche. People that find themselves caught in a cycle of chronic pain are the prime example of how someone can do everything right in their search for help, but end up having the process actually cause more harm than their original injury. Chronic pain is a combination of entangled physical and psychological stressors that shifts more and more towards the cognitive side as time passes. Every new professional that a patient sees and has to tell his story to without receiving some form of empathy and/or meaningful explanation further feeds the fire of fear, stress and anxiety related to his pain.
Healthcare professionals are trained to first and foremost screen for ‘red flags,’ or signs of something more sinister than a simple muscle strain. Physicians have the most knowledge and experience of the various sinister conditions and because of that fact their approach to dealing with less threatening issues like low back pain can become both less useful and less empathetic. Read More
Today I find myself sitting in a coffee shop across the street from St Paul’s Hospital in Vancouver, Canada waiting for my mother to have a procedure on her heart. I just admitted her through the emergency room that has the insurmountable challenge of helping the people of our downtown Eastside caught in the epidemic of our opioid crisis. It was an eye opening experience that inspired me to write this post and think further on the topic that I know is plaguing my city. I am a healthcare professional that deals with people in various levels of pain all day. I am also a person that due to a freak accident has found himself in the emergency room, in the operating room, given OxyContin, morphine and other drugs to try and help my immediate pain on a cycle of over three months. My experience talking to Lance today in the St Paul’s ER has made me reflect on my experience and realize how slippery of a slope it can be for a person to go from a normal life, to an injury, to being a homeless drug addict living among throngs of others living out their own journeys on the street.
We arrived at the ER at 8:45am on a Saturday morning to a relatively quiet waiting room for downtown Vancouver’s only hospital. There was one very talkative man being processed by the nurse. He was seemingly a drug addict in withdraw and his father was quietly waiting in the chair looking like he had been through this before. The dad was about my mother’s age and the talkative man was about my age. I made sure my mom was taken care of at the admitting desk and then I was told to wait for about twenty minutes while the nurses processed her. Read More
Posted in Blog
, Case Studies
Tagged with: addict
, opioid crisis
, St Paul's
This article is a detailed account of the past 90 days of my life. A big part of me wants to forget everything that happened to me over the past three months, but something inside of me wants to tell the story. I warn you, that every time I go into detail about what I actually went through, people squirm and shy away, so this is my forum to get it all out. It was the darkest, lowest part of my life to date and I am still only just collecting myself to re-establish some normalcy for my family and business. I returned to work just a few weeks ago, under three weeks after my fourth eye surgery in two months after I was struck in the right eye with a hard orange floor hockey ball on August 19th, 2014.
My wife and three children were away at our family cabin. I had returned to work for the week after an amazing almost 3 week holiday, but I only made it to Tuesday before my world changed. Earlier in the summer a client had told me about a regular pick up floor hockey game at a nearby community centre. I went a few times before my vacation, but I was the new guy amongst a group that had been playing together for a while. The only guy I somewhat knew was my client who had told me about the game.
The game was social, but competitive. Every guy had a different level of protective gear, but most did not have any form of eye protection. I happened to have my squash goggles with me, but forget them in the car because I was running late. I had never worn eye protection playing floor hockey before, but was definitely considering it with this group; unfortunately I never got the chance. I decided to jump right into the game and was having a great time. I scored five goals in the first two games before it happened. I ended up in the corner just off to the side of net. I turned back to follow the ball when I saw a split second of an orange ball flying right at my face. Read More
Posted in Blog
, Case Studies
Tagged with: double vision
, eye injury
, eye pain
, eye pressure
, eye protection
, eye surgery
, macular hole
, manny malhotra
, retina detachment
I used to beat the hell out of my body when I was in high school. I played soccer, basketball, rugby and a variety of other sports on almost a daily basis. I would bang and crash and hurt myself, but it never really slowed me down because I just took it for granted that within a few days or a few weeks my body would heal up and be ready for more. In University I tested my body with little sleep, more sports and a lot more alcohol, but I still always bounced back and kept going. Around my mid-twenties to early thirties a few things happened that started changing my perspective on life.
By the age of twenty four, I had completed two university degrees and was officially a registered physiotherapist. I’d like to think I was a lot smarter after six years of university, but I learned much more in the following six to ten years than I ever did in school. It was a time when my body seemed to start getting less and less invincible and I started gaining more and more perspective on the importance of physical health. I still played soccer, hockey and squash, but my body started taking longer and longer to recover; things that used to take days to feel better, starting taking weeks and I was forced to consider the physical consequences of my activity choices more than ever.
As a physiotherapist, working with clients from nine to ninety years old, I started recognizing that I was not alone in the weakening of my invincibility around age thirty. I would hear an average of ten ‘getting old sucks’ complaints a week, equally spread amongst the thirty, forty and fifty year-olds. The sixty and seventy year-olds tended to phrase it more around ‘this old body is falling apart,’ and the eighty to ninety year-olds just seemed to be happy if something actually didn’t hurt. Read More
Posted in Blog
Tagged with: aging
, allied healthcare
, chronic pain
, health records
, healthcare reform
, preventative health
Below is a great talk on the topic of mindfulness, or the ability to step back from your emotions and look at your thoughts and feelings in a more objective way. The way we perceive the world is hugely affected by our past experiences and future expectations as is our perception of pain and sensation in our bodies. Developing the skill of mindfulness is commonly the path out of chronic pain for many people.
Watch this 10 minute video below for an introduction to the concept.
See below the video for a link to a great book on the topic that dives deeper into the idea and the science behind it.
Mindsight: The new science of personal transformation
Click Picture for details
Please feel free to leave questions or comments in the space below and I’d be happy to try my best to answer them.