Cheap Vicodin! No prescription needed!

OK< so I stole this image and I have this title to increase my page views but really, that is what this minor blog is all about. My Electronic medical record system , despite being in a very underpopulated isolated little town, has many of the capabilities of the one I used in Colorado. That lends itself to a bit of analysis of how I practice differently in New Zealand than I do in the USA. I can see all my prescribing habits, what prescriptions I write for diabetes or hypertension or , most curiously , for pain control. Now one might think that because we work with a population that works under very difficult situations , such as driving heavy equipment around a giant pit mine on the top of a mountain in extreme weather, -------------------------------------------------------------or maybe spending day in and day out working with livestock such as sheep and dairy cattle, that I would have to be treating these poor folk with lots of pain meds. ----------------------------------------------------------------------------------------------------------------------------- No sirree! Americans take 136 million prescriptions of vicodin a year. We account for 5 % of the population and take 80% of the prescription narcotics. I reviewed my prescribing last month, for a full months worth of patient encounters, maybe 400 or so people, I prescribed narcotic pain meds 16 times. And that includes tramadol for 9 prescriptions which in the US doesn't even count. So 7 prescriptions of real opiates. And 4 of those were for codeine, which an ER doctor in the states would not dream of prescribing for pain due to its " low Potency". All but one of the prescriptions was to cancer patients. I shudder to think of what I have prescribed at home in a month to all those with "unrelenting back pain" patients who need their oxycontin. ----------------------------------------------------------------------------------------------------------------------- My diagnosis: Americans are wimps and doctors have bought into it and created a massive public health problem. We see pain like a housecat that when it rubs softly up against our leg we need to pop a percocet. And if it dares to scratch us we are on fentanyl patches for years. I fear I might be a very unpopular doctor when I return to the states with my Nancy Reagan mantra, Just say No! And by the way, Michelle would like you to get out and exercise and stop eating all that sugar crap with your vicodin.

The Biggest Bulldozer in the World

This past weekend was once again spent in Westport;  intermittently rainy and quiet, we enjoyed sleeping in late.  We still took a day trip though, this time to the Stockton coal mine for a tour of open-pit mining.  I never thought I was interested in coal mines, but Stockton is the biggest employer in town, and we wanted to see where our patients spent their days.

The coal here is very high-grade, and 100% is exported, mostly to India, China, and Japan but 10% of it goes to the U.S.  None of it is burned for energy but is used to make steel, and the highest grade is used in manufacturing of items such as dialysis filters and space shuttle insulation tiles.  It was a great tour:  the guide used to work in the mine, so he knew many of the workers and drivers, and we got to see all the action.  Of course, we also got to wear hard hats (mandatory safety equipment).

After locating a coal seam, bulldozers, rip up the
hillside to get to the coal.   The coal is then dug out,
transported, graded, ground up, and transferred to even larger trucks.

These larger trucks haul the graded coal to large bins, where an automated system fills carts to be carried down the hill .  One ton of coal is loaded into each cart, three carts per minute, 24 hrs/ day.  The carts are transported via an automatic rope system, down the hill to the train station.  Five trains, with 30 cars each, move the coal to port every 24 hours.  It's a big operation.

After the coal is dug, full-time restoration crews smooth out the hillside, top it with crushed granite and soil, and replant vegetation.  We didn't get any photos of the restored hillsides, but they look pretty good.  The mine is serious about environmental concerns.

Of course, all this digging requires serious equipment, and for some of us, seeing the big trucks was a highlight.  Here I am standing next to the biggest bulldozer in the world (125 horsepower), and Eric is seen next to a "medium sized" truck.
Turns out, the mine likes to hire female drivers because studies have shown women save fuel, report equipment problems earlier and have less accidents.  Way to go girls!

Marlborough Wine Tasting Weekend

OK, so I have been reading the latest hit on my Kindle, Trout Fishing in America, Hoping beyond all hope that it will help with my pitiful fishing success in New Zealand. But Alas, Likely not to be but if the blog seems a bit 1965 then there you have it. So check out the beautiful label of the Sauvignon Blanc that put New Zealand on the wine map and then check this out: Our photo from our tasting yesterday. As you can see the clouds rolled in and my plan to tour the Marlborough wineries by bike was defeated but our day was outstanding none the less. First of all, we stopped at Nelson Lakes national Park on our way over and had a wonderful short walk through and area of beech trees oozing honeydew that attracted Bellbirds and Tuis and Silvereyes and Robins as if Captain Cook was still out to sea and had not yet wrecked havoc with is stowaway rats on the bird life of New Zealand. But not to be detoured too much by fantastic local fauna, we arrive shortly in the Marlborough Wine country, and as enormous as it seemed upon arrival, the first winery we hit was not only excellent but certainly had a deep connection with us, as you can see Seresin Winery had fabulous sustainable Pinots and sauv blancs but of course how could we not think of this: Of course Jerry preferred Cab to Pinot, not that I know for sure, I would guess Zinfandel. And to top it off the "Pour Girl" , Not to sound too Sideways or anything, at Spy Valley, our next stop, was a New Zealander who had spent several years in Boulder. She was delightful and you can guess how nice it is to run into people that have things in common with you when you are so far from home. . Like Liquormart in Boulder. A touchstone if there ever was one. Yesterday on our planned biking excursion, the rain started falling. As we have not seen any rain for over a month, despite living in "Wetport" we decided to drive to vineyards rather than ride. It was fabulous. We tasted at a few and then had a wonderful lunch at at Wairau River winery. Of course we hit Cloudy Bay Villa Maria was one of my favorites, though the single vineyard wines they had at the winery were way more complex than the ones I now buy at the New World Supermarket, though complexity is not really required after work when you are scoping out white faced herons on the estuary and just want a glass of nice white wine., We did have a fabulous dinner, as gourmet as we have ever had, at Hans Herzog Winery yesterday evening, http://www.herzog.co.nz/dining/pdf_files/herzog_menu.pdf , never having had Smoked eel or beef tongue, never the mind together on an appetizer, it was a culinary highlight of our trip as well as our food history, As you can see, the vines were heavy with the grapes and the harvest for the grapes to be used in the sparkling wines was to start today. As we drove home in heavy rain, we were wondering what that would do to the harvesting timetable. Our trip was great, we stopped again at Nelson Lakes National park on the way back for a two hour hike during which we were serenaded by all the New Zealand forest birds rueing the arrival of stoats and rats and wasps. Not to mention Sheep, cattle and People.

What to do when you actually have to work during the week!

OK so the girls have flown back to the States and our week of vacation is over and we have to work Monday through Friday like other working stiffs, how in the world are we going to maintain our run of continual excitement you ask. Well, aside from the obvious answer that we won't, let's just see. When we arrived the first week was quite cool and rainy and lived up to the warnings that we had received that the West coast should be called the Wet coast and we would spend six months in a dreary rainstorm. Actually after that first week , the weather has been brillant, warm but not hot, sunny , dry and perfect for outdoor activities, unless of course you are a farmer or a blade of grass on the golf course, then you are begging for a return to the more normal rainfall. We are actually on water restrictions due to lack of rainfall. SO you can see, the golf course is quite dry, which has not prevented me from grabbing a quick 9 holes after work on a very playable links type course. Some of the first patients I saw in Westport suggested I join the local golf club and they were quite helpful it getting it set up. Though I am told it is a much more playable winter course, I have had fun on the few rounds I have played. But golf is not the biggest draw locally. This past weekend had two days of horse races with Trotters from all over the South Island and quite a community event . The town has a large and beautiful race facility that is used only a few times a year. There were the races along with food and drink and lots of betting and a chance for the locals to get out and enjoy a beautiful day. But there are other even less American events at work. Though there was a cricket tourney and a croquet event that we missed out one, We caught a few games of lawn bowling which I was alerted to after seeing a particularly sinister knee sprain in one of the contestants in the emergency room. But of course there are also those events which we partake in the states, such as the triathalon, which I competed on with my city hybrid bike and my not ready for prime time running technique. Happily, we have another three day weekend starting tomorrow and are off to the Marlborough wine region for a little wine tasting by bike tour and some nice gourmet meals in the wine country.

Keas

On the final leg of our little vacation we drove to Queenstown and stayed with Mark Baxter's twin brother Paddy and his wife Maria. It was great to meet them but they were off for their own trip but were kind enough to let us stay in the gorgeous home and borrow their dog for a night. I still can not get over those glaciers. How cool! So we reluctantly said goodbye to Kristen and Angie as they took off for the Routeburn Track and Milford sound and we looped back north on our way to Westport. The first Night we stayed at Lake Tekapo, a beautiful aquamarine color lake that I could not capture well on film near as well as a road sign. Though they had a stunning little church on the edge of the lake plus a statue to honor the sheepdogs which made settlement of the valley possible. FYI, New Zealand has 4.4 million people and only 31 million sheep so the 20 to 1 ratio myth is busted. It is only like 8 sheep per person. And 2 cows per person. Dairy has well overtaken sheep economically. We did stop at two wineries in the Central Otago district that had very good pinot noirs and nice Rieslings. Then we were off over Arthurs pass, the highest of the three roads that cross the SOuthern Alps of the South Island in search of the elusive mountain parrot, the Kea. We took a few short hikes to waterfalls in this tiny little mountain town but did not see a kea until the next morning when I think on was looking for a morning wake me up. Unfortunately the Wobbly Kea Bar was not open for the Kea to get a drink. We felt fortunate to have seen one of the 3000 or so Keas left but upon leaving town and stopping at an overlook: We found out why Keas are called the clowns of the forest. Luckily we shooed them away from our nifty little corolla before permanent damage was done. Then we were off to Westport. It was all downhill from there.

Bird-watching and Glacier-hiking

After our night in Hokitika, we continued our drive south along the west coast. Next stop was Okarito Lagoon, locally famous as the only New Zealand nesting grounds for great white herons. We rented kayaks and paddled up the lagoon and into side streams as the tide came in, and then turned back as the tide rolled out (good planning by Eric!). It's late in the season, but we saw several beautiful herons plus lots of other seabirds.

That evening, we arrived in the village of Fox Glacier, and I was thrilled to add another bird to my New Zealand list: the wood pigeon, or kereru. It's somewhat rare, but a tree at our motel had 7 kereru in it at one time!

The next day was brilliantly sunny and warm, perfect for our day on the ice. We signed up for a guided all-day tour, were outfitted with sturdy boots and crampons and set off. After a short bus ride to a car park, we hiked about an hour through rainforest to the terminal end of Fox Glacier. Going from lush green ferns, waterfalls and moss to solid ice is striking. The front of the glacier is 100 meters high and it measures 12 km in length, but the valley it has carved is so deep that perspective is tough. Once on the ice, wearing crampons and using poles, we hiked up to some ice falls and saw amazing glacier features: crevasses, seracs, moulins. The weather did turn cooler as we were surrounded more and more by ice, but our guide (Dave from England) knew the way out.

New ice is formed as up to 50 meters of snow falls at the top of the glacier annually. Fox Glacier is a relatively fast moving glacier, and the ice moves downhill a few meters everyday. Unfortunately, ice at the bottom is melting faster than it is being made at the top, and Fox Glacier, like most glaciers worldwide, is receding overall.

Hokitika

We left the Baxters and drove with the Girls back to Westport where we wanted to show then where we lived and worked. They were quite impressed with how friendly our coworkers are! We did not have but one night here so of course we dined at the Dennison Dog and enjoyed the local fish. The next day we were of on our adventures, including a stop at our favorite walk Cape Foulwind Because, after all, how can you pass up the opportunity to watch fur seal pups! They are already so much larger than our first visit when we had just arrived. From there we continued south and enjoyed again the Pancake rocks and the blow holes at Punakaiki and Truman Track through the rainforest down to a pebble beach. Our goal was to drive part way to the glaciers and Kayak the next day at OKarito lagoon to see the White Herons. Hokitika made for a perfect stop We stayed right by the beach with a sweet little drift wood art sculpture display. But one of the most amazing travel coincidences of our lives, in the Hokitika grocery store , Carolyn ran into friends of ours from Boulder, Kay and Jack Fellows. We had no idea they were traveling in New Zealand. The odds of running into a neighbor in a little off the beaten track town 8000 miles from home is quite Low, we could not believe it. We enjoyed evening tea, actually take out fish and chips and wine, and then caught a beautiful sunset from Hokitika beach. Then we checked out the glow worms. You will just have to take my word for it, but imagine a star filled night sky stuck under some heavy rainforest canopy.