The cost of security.....

The Olympics are long over....the cost of security for that event originally was estimated at $400 million dollars. It went a tad over budget.... $1 billion dollars!!!! And who foots the bill.....taxpayers. Now having family members who were involved in the security and knowing what they did....I don't know who got the money cause they didn't. Well most of them didn't.

Now Canada is hosting the G8 and G20 Summit in June. The original estimate for this 4 day event ..... "The costs were original estimated at 179 million Canadian dollars, but an additional 654 million Canadian dollars was requested Tuesday, for a total of 833 million Canadian dollars (780 million US)." I am not sure how they can justify a $654 million dollar increase? Isn't there something wrong with that? Who does their budgeting? That person or persons should lose their jobs instantly! I realize that it is not the 4 day event itself where the costs are incurred, it's the whole preparation for such an event. However, come on a $654 million over budget give me a break!

I ask you, if you were to run your household budget like that you wouldn't have a home now would you. The banks and collectors would take everything you had and then some. Your credit rating would plummet. So why is it ok for our government to so poorly plan and estimate expenditures and then expect by just a stroke of a pen they will get the funds they need or want?

It's just not right. I think someone should lose their job over this one! Yes national security is important. That is not my issue here. My issue is some high paying bureaucrat has so poorly budgeted and mismanaged the security funding for this event, and we as the tax payer have to foot the bill.

This brings other points to mind. Why does there always seem to be funds available for events such as this, but we have to close schools, hospitals, and shut down public services. Our provincial government is imposing yet another tax July 1 it's called the Harmonized Sales Tax or HST for short. I wonder who came up with that name. I mean really "Harmonized" what that heck is that? There is nothing "Harmonious" about another tax. This tax was suppose to replace a provincial tax....well guess what....I just got a bill yesterday and they charged me the PST, GST and the HST(which as I said doesn't come into effect until July 1st). So I am paying more taxes while my government is cutting services all over the place.

Back to the over budget security costs for the G8 and G20 Summit in Toronto. Who is being held accountable, why is this allowed to happen? If I saw one positive thing come out of these summits I would support them 100%. But nothing ever does. It's just a bunch of highly overpaid suits rubbing elbows smiling and shaking hands, and enjoying high end meals and sipping on fancy wines and libations.

Yup it just all seems so odd to me. I pay my taxes, I work hard and and I get penalized by being effiecient with my funds while the government can go over budget and no one ever holds them accountable.....Things that make you go Hmmmmmm.

Last Weekend....

Last weekend I had the wonderful opportunity to visit my family on the mainland. It was a busy weekend full of family gatherings and a very special appointment.

The family gatherings first. My sister's daughter became engaged last fall to a wonderful man. Since the engagement there have been engagement parties and wedding showers. Last Saturday my sister had a Bon voyage party for daughter, my dear sweet niece Samantha. You see the man my niece is to marry lives in Australia and that is where they shall wed and reside. My sister although extremely happy for her daughter is saddened that her only child is moving so far away. As many of us as possible will travel down under for the celebration which is to take place in February 2011, but it just won't be the same around here without our dear sweet Samantha.

Samantha will be the first of my siblings off spring to fly the coupe so to speak. We have always been a very close knit family. I have often been amazed that with a family the size of ours that no one has moved away. Well that is not exactly true, I have a brother who lived 4000km away for about 20 years, but even he has now moved back to BC with his family. My camera wasn't cooperating with me that evening, so this picture I got from my sister's Facebook.


It was a lovely party and I wish my niece the happy bride to be a wonderful and joyful life with her fiancee.

Sunday as you know was Mother's Day. I started my day out with a 10km run with my eldest daughter. Yahoo! She is a fit young lady, but not a runner. She was amazed at herself for being able to just put on a pair of runners and go. After our run we met up with my middle daughter who was working and we sat and had a nice lunch. It was off then to the mall. I have been on the look out for a dress. That in itself has been a very daunting task. I wouldn't consider myself a big person, but I am not petite either. So why then is it so difficult to find a dress that fits me? I find shopping one of the most depressing experiences. When I was younger I would be able to pick my size off the rack and it would fit. Not anymore, I must have tried on at least 30 dresses if not more. I finally found one. It's ok but it's not a "Wow" factor by any means. Anyhow, I digress. We found a dress. From there we had to head back to middle daughters house. The initial plan was that they girls were going to cook for me. Well middle daughter was exhausted from work and she also had to go pick up youngest daughter. So I opted to cook the dinner, they did the clean up. We had a nice time and they spoilt me with some lovely gifts.

Monday came and I was off to a very important appointment with my youngest daughter. This appointment I was hoping would be her last one. At a young age of 8 my youngest daughter had been diagnosed with cancer. For the first few years post treatment we were at Children's Hospital first every month, then every 3, 6 months and then finally every year. I always dreaded May as I knew it was appointment time. Subconsciously, I know I worried about it and I would stress about it. This year was no different. We knew the routine, we would report in, get the requisition to go get xrays and then return and wait to see the specialist. You know this whole time we have always had the same specialist. He is an amazing man. Anyhow, it was our turn to see him. He came in, we chatted, and as always he asked my daughter what she had planned for her life, we told her she graduates this year and of course he asked her if she was going to follow in her mom's footsteps....and as always her response was the shrug of the shoulders and a huge smile. He then examined her, looked at the xrays and said, "how long have you been seeing me?" Our response was "10 long years" He said "well I've got some good news" this is it he said, we don't have to ever come see him again! Yup that was it, she had been cleared and given a clean bill of health and no more Dr. Brown visits. That was the best news ever. That was the best Mother's Day gift ever! I cried, I hugged Dr. Brown and even as I type this I find I am becoming a little emotional. It has been such a roller coaster ride. But finally that ride is over. Thank you!!!!!

So, we left his office holding hands hugging each other and with grins from ear to ear. My baby graduates this month and truly now has been given the go ahead to live life to it's fullest. What an awesome way to start this phase of her life!

The Importance of Good Pain Management

Ever since my days as a Palliative care nurse I have been interested in Pain Management. I was always amazed at the high doses of narcotics the palliative patients were on, and yet they were still functioning. During my time as a palliative nurse I learnt about various ways of managing pain in conjunction with narcotics.

When I went into Critical Care nursing many of my colleagues worried about administering to much narcotic for fear of putting their patient into respiratory arrest. Through my years of nursing I have seen pain management approached in many ways. Statistically they say that most patients are under medicated, and that patients don't report pain as often as they should. This under reporting and under medicating can have long term effects.

Over my nursing career I had attended many pain management seminars and it was only the last one I attended back in February that they actually talked about alternative treatments. At this particular seminar the guest speaker was talking about treatments and measurement tools that I was using over 15 years ago in Palliative care! I have been told that palliative care was and still is years ahead of other fields when it comes to pain management.

The other day I received a patient from the O.R. who just underwent a hip replacement. This woman was only 47 years old. Very young for a hip replacement. The anaesthetist was giving me report on the patient and told me that this young woman was on extremely high doses of narcotics and other medications. When she told me the amount of narcotics this young woman used my eyes widened and my chin dropped.

Many questions entered my head. Firstly, how is it that this young woman could be on such high doses of narcotics? What was her doctor thinking? Had she tried alternative ways of dealing with her pain? What strategies were in place for this woman once she got through her surgery to help her get off these high doses?

At this point you are most probably wondering what I consider high dosage....This patient starts her day with 200mg of Oxycontin and 1200mg of Gabapentin (this was originally used to treat seizure disorders but it has been found to help on neurolgic pain as well)....then around noon she has another 100mg of Oxycontin and another 1200mg of Gabapentin.....at bedtimes she has 200mg of Oxycontin and 1200mg of Gabapentin. So in a 24 hour period she is having 500mg of Oxycontin and 3600mg of Gabapentin. In additions to this she has Oxycodone for breakthrough pain!

Now I don't know about you, but I have nursed many many patients who have had hip replacement and have not required this amount of narcotic preoperative.

Having a sister who has dealt with chronic pain issues and who has also had a hip replacement I can most certainly sympathize with this individuals pain issues. The question for me is what was the doctor thinking prescribing such high doses? More times than not nowadays doctor's are recommending to their patients that they seek out physiotherapy, water therapy, message, yoga and meditation to name a few. Why wasn't the doctor suggesting that this patient be connected with a Pain Management clinic? To just continue to increase this patients dosages seems irresponsible to me.

At this point this patient is now addicted to these pain medications. This in itself presents a very difficult position for myself as a nurse as these patient tend to be very challenging when it comes to dealing with postoperative pain. Case in point. When this surgery was performed, it was performed under a spinal with a nerve block. When the patient arrived in the recovery room she was alert and in no apparent pain. After a neurovascular check it was evident that this patient had a good spinal in place. The anaesthetist had written orders for this patient to have what we call a "Patient Controlled Analgesia". PCA is a way for patient's to control their own pain medication. The theory behind PCA's is that it is believed that it provides the patients with a feeling control over their pain management and that they actively participate in their healing process. These patient often tend to do better and are discharged home sooner. The PCA is a machine which is programed with a narcotic set to deliver a certain amount of medication at certain intervals. There is a safe guard in the machine that will only deliver the drug within the given time...so the patient can push the button as much as they want...but the machine will only give the medication when programmed to do so. Most patients find this very satisfying and in fact statistically speaking patients tend to under medicate themselves when using this device.

Back to this patient. Upon her arrival it was determined that I would give the patient her afternoon dose of Oxycontin and the Gabapentin, so it would be on board when the spinal started to wear off. I also got the PCA going early and showed her how to use it. I worked with this patient for over an hour before I was finished my shift. She was using the pump relatively frequently but did not express signs of pain. Her vital signs were all stable. The next day I asked my colleague how the patient made out. Well as it turned out the patient went into a pain crisis. The anaesthetist had to come back in and provide more spinal medications and other narcotics. Unfortunately, the narcotics all caught up with her and she stopped breathing at one point. As a result she ended up in a step down surgical unit where she could be closely monitored.

This brings me back to my original question, why wasn't this woman on some form of pain management regime prior to her surgery? Why was she allowed to be on such high doses of narcotic?

It is so important to identify patients early on who might be at risk for narcotic abuse or that might require treatment for pain management. There are many things that can be done before increasing a persons pain medications, and there are many tools available to health care practitioner to asses their patient for possible narcotic abuse.

Pain management is so important and "good" pain management benefits everyone in the long run.