Our show this week featured three stories of what we call 'Unfinished Business'.  Earlier this year, a BC hospital bet and lost big on one.  We asked the President of the hospital's charitable foundation what went wrong.  We had more from Generation Rx: our town hall last week examining the epidemic of  prescription drug abuse that's spreading across Canada.  And, we got reaction from Ontario's Minister of Health and Long Term Care to our debut episode this season that looked at the increasingly complex nursing jobs that personal support workers do at retirement homes in the Province of Ontario.  Click oin the link to sample your reaction to the show.

Generation Rx, our town hall on the use and abuse of prescription pain relievers, continues to generate strong reaction from you.

Kay Stephenson-Wrack sent this email:  "One of the biggest problems with prescribing controlled substances like OxyContin is that so few doctors know how to help their patients quit.  "Addiction" and drug dependence become a self fulfilling promise.  I know!  After six hip replacements, two strokes, a knee replacement, and spinal stenosis I know how to do it!  Although methadone and fentanyl are their own misery to wean-off, OxyContin can be quite uneventful.  Encouragement helps, and directions like "just quit" do not!"

Glen Millis of Calgary writes:  "I wanted  to know or would like to hear a recovering addict face those who turned them on to drugs, and explain why it was a good thing to try drugs.  Perhaps it could be a talking point to young ones to ask friends who suggest drugs.  Will you be there for me whan I am 30 and homeless? Will you pay my bills if if I become unemployable?  I hear of students urging friends to try drugs because they are not wanting to do it alone.  Thanks for listening."

Sam Brown of Oshawa sent us this:  "I waited avidly for your Generation Rx show.  I listen to your show because usually you are willing to say things other people will not, and take things from all sides.  I was saddened because your show could have been a public service announcement for why we need the new governement narcotics watch program.  I have chronic, near-disabling migraines, along with another neurological condition.  Unfortunately, the meds I take for both of these interact, and also the doctors who treat both generally refuse to contact one another, resulting in uncoordinated care.  I get about twenty migraines a month, which would have rendered me unable to work by the age of twenty-three.  Thus, my doctor is attempting to manage them with narcotic meds.  I know this is not ideal given my age and their addictive potential.  I take the situation very seriously, watch my dosing, watch the number of days in a row I take the meds, etc. I have now been able to keep a steady job, and am I do not believe showing signs of addiction.  However, the attitudes of health care workers and the general public grow stronger towards the idea that people like me should not be on painkillers.  I feel at your show you did not have any strong advocacy for people who do have legitimate use for pain drugs, except in the case of "people dying of cancer".  In my case, either I am not receiving properly coordinated care by my doctors, or this is the only treatment available for me, I am not sure which."

We received this lengthy email from Roger Mitchell, a family doctor and GP anesthetist from Cranbrook, BC:  "I very much enjoy your well thought out and eloquent program.  I am writing as a colleague.  I am "an almost retired GP anaesthetist" I have worked most of my career in northern and western Canada and most recently south eastern BC. The problem I would like to address is the dirty little medical secret which is pandemic across all of Canada. I hope a program like yours might spur some action. The problems are centred around inadequate and non-timely pain intervention.  I have had the joy of reducing or eliminating an individual's  pain. This is one skill every MD should possess, but unfortunately the new wave of MD's are ingrained with the fears of patient "addiction" and or drug abuse and the ever present College on our backs. Hence these fears have made cowards of us all.   I have lied to get patients admitted overnight for observation following surgery when really all I wanted to provide was good analgesia. But there are no acute beds for this, and by bed blocking for analgesia, I interfere with the following day's major case which is a day admission for a big surgical procedure.  I have seen similar and equally horrible suffering endured by terminal patients, who are desperately under narcotized. Their MD's had no clue about how to safely administer the plethora of available options. Given you have so eloquently presented the perils of liberal narcotic dissemination, please consider reviewing the very real and much bigger issues of inadequate pain treatment. 

You may recall two years ago we did a show on the terrible affliction of chronic pain.  In it, we interviewed a woman who found relief from her pain in the form of an electrical stimulation device implanted in her spinal column. 

David Petepiece of Williamstown, Ontario wanted to tell us of a very different outcome.  "My neck was injured in a fall at work.  First the non invasive approaches like physio and drugs, then surgery to do a spinal fusion which only made things worse.  I was living on narcotics until I heard your show on chronic pain and the story of a woman who got great relief from a neuro stimulator.  My internist had never heard of one but googled it in her office.  Soon, I had a referral to a hospital based pain clinic, underwent two trial implants to see if it would work for me, psychological tests to see if I was crazy, finally, the full implant surgery took place and my journey into hell started.  For three months my surgeon and his associates failed to recognize I had developed an infection around the stimulator electrode which was pressing on my spinal cord. Gradually I had trouble walking, required so many narcotics I was hallucinating, lost feeling in my hands, was falling down outside in the cold and could have frozen to death but no one realized what was happening.  I went to a physiotherapist who did some tests, said something is very seriously wrong neurologically and faxed a letter to my surgeon.  I headed to the hospital.  Finally ,the surgeon realized I was infected and did emergency surgery to remove infected bone, tissue and the stimulator.  Now I am left with a scarred spinal cord, cannot walk properly, have many other issues due to spinal cord scarring and again need lots of narcotics to survive.  Please share this story so that others who rely on the information on your program know the down side to the 'good stories.'"

We also received several comments in response to my interview with Adrienne Bakker, President and CEO Royal Columbian Hospital Foundation.  The Foundation's B.C. Vacation Home Lottery sold just forty-four thousand tickets instead of the anticipated one hundred and twenty thousand -- for a three million dollar loss.

Margaret Young of Ottawa writes:  "In addition to confirming my decision of some time ago never to participate in this racket (only twenty percent return to the hospital!), Ms. Bakker said something that I reacted strongly to  She repeated a frequently-heard statement that "If you don't have your health you don't have anything."  What nonsense that is.  First there is the obvious issue of what is "health."  After all, most of us have something wrong with us at various times, and these health problems often compound as we age. I've just passed through 14 months of awful health.  Did I ever feel that I had nothing valuable in my life?  Not for a minute!  I'm a  senior and I see around me lots of people with hearing and sight losses, arthritis, and many other problems.  Do they mope around thinking that because they don't have their full health they have nothing?  Absolutely not. They are as active as possible and eager to wring as much joy from life as they can, no matter what the state of their bodies."

Jill Whitaker Portugal Cove-St.Philips in Newfoundland and Labrador writes:  "I've never been much of a fan of hospital lotteries; the phrase `water down the drain' crosses my mind.  It always seems much more sensible to me to send a donation equivalent to the price of the lottery ticket to the hospital.  After all, the likelihood of winning is pretty remote - and doing it my way, at least I get a tax receipt.  I'm also not funding a company that manages the lottery and keeps a large percentage of the ticket price so the hospital gets far more money.

Our interview with Deb Mathews, Ontario's Minister of Health and Long Term Care, generated comments on both sides of a divide.

Karin Sonne of Toronto writes:  "I used to work as a PSW, mostly doing home care and primarily palliative care and was asked to do many things I should not. I refused to do so, telling them to call the office to have someone qualified sent out.  I know some of my colleagues would go ahead anyways."

Ben Lehman of Peterborough, Ontario writes:  "When I heard your story recently on PSWs it made me wanna speak up about my girlfriend who is a psw in Peterborough and what she deals with.  She recently quit her job because of she is a gentle and caring person, and thats why she wanted to do it to help others.  Where she worked on a regular basis watched other PSWs abuse, neglect, and assault the residents, she was threatened if she said anything.  The union wouldn't help her.  The worst was that fellow psws formed a clique that she wasnt part of.  She cared about the people she served.  I think more needs to be done to regulate not only the psws but the people that run the courses."

Don Francis of Richmond writes:  "I just listened to your interview with "Jen" and the Hon. Deb Mathews.  The segment  was misleading and incomplete. It was incomplete in that it did not make any mention of the the new Retirement Home Act while praising the regulation and control in Long Term Care.  It was misleading when Dr. Goldman, with Jen as a prop made it sound like all retirement homes use only unregulated, untrained personnel to distributed medications.  This misrepresentation ignores the requirements of the new Retirement Home Act and the established standards as subscribed to by members of the Ontario Retirement Communities Association. I have owned and operated a retirement home for over twenty years.   Dr. Goldman should be better effort informed before he trashes a whole industry."

On the program, we said that unlike long-term care facilities, retirement homes exist in a regulatory grey zone.  But in Ontario, that is about to change. 

Mary Ferguson of the Retirement Homes Regulatory Authority based in Toronto writes: "Ontario is in the process of opening a regulator for retirement homes in 2012 so it would be a good opportunity to look at what is planned, how it will impact seniors, PSWs and the retirement homes sector.  Saturday's follow up session failed to speak with spokespeople for the homes - just PSW and Deb Matthews, whose terrrtory is nursing homes.  For a  balanced view of what Ontario is doing and how the province's deal with it differently, we would be happy to work with your producers to develop the information and connect you with some sources who are knowledgeable."

We look forward to speaking with the regulator some time in the new year.