We are up in Canada now, going to Williams Lake to spend a few days with my parents.
We are then going to look at a few communities that need doctors. Chase and Clearwater.
It is great to have a lot to chose from, since there are so many variables that enter into the decision of which job and which town do we want to go to. In British Columbia they have made an effort to define the level of isolation and from that they have determined income levels as well as benefits etc.
The distance from which the nearest specialist, how far north, population of town, number of doctors in each town, are all factors that play into the division. It seems as though we totally have our choice of living anywhere in the province we want, as there are jobs for doctors everywhere. It is so much the opposite from the situation in Oregon, where it seems that Bandon was the only place we could work. Ken is doing urgent care clinics now, but does not see that as a long term career, as the shifts are very long and he has to see a lot of patients in that time, never really getting to know anyone. Most of these jobs in BC would involve hospital privilages, something else that we can not get in Oregon. The physicians who practice in more isolated communities are compensated with special stipends and those who move there have their moving expenses covered.
In deciding where to go we have made a list of criteria. We do not want to be more than a couple of hours from a major medical center, which in BC are Kelowna, Kamloops and Vancouver. My reason for this is that should the bleeding ever become a major problem, OR if I ever have a bowel obstruction, which they told me I have a 35% chance of, I want to be in a larger hospital. Any kind of abdominal surgery on someone who has had radiation to the abdomen would be high risk surgery.
We want to be in a gardening zone 5 or higher, since this is the zone that Eliot Coleman grows throughout the winter in in Maine.
We want to be somewhere we can eventually be able to afford a small acreage, which rules out any urban areas.
We do not want to be on too much ER call, which rules out very small towns.
So you can see we are sort of going around in circles.
Some of our wish list things are mutually exclusive. So you see what happens when you have too much choice. We ARE doing our interviews on Wednesday and Thursday of this week. Obviously compromizes are going to be required.
I really feel that I am starting to get a handle on my radiation injury issues.
The sucralfate seems to keep the bleeding to a minimum most days. Some days I bleed a lot, but then I have to remind myself that there has been no bleeding for several days.
I saw a new primary care doctor a few weeks ago. The gastroenterologist suggested her...... I think he was tired of me trying to find a solution for a problem he had none for. The sucralfate enemas were my idea. Anyways, it was really an incredible visit. First of all, she had experience with radiation bowel issues.
I explained to her that I am starting to find ways to deal with my problems and explained as I have here about the low dose percoset. To my surprize she said that that is exactley what she would do if in my situation. Rather than limit oneself to an extremely unhealthy diet to control the pain........
She said that she had other women who, like me, had had gynecological cancers and subsequently developed radiation enteritis. She said that what I needed to accept was that there were no “cures” and that to a certain extent, I would just find ways to “control” the problem. She said there would be times when it is bad and times when it is better. She said that there are a number of things to try, in an attempt to control it..
First off she asked if I had tried a lactose free diet, I said that I had not, but had contemplated it. There really IS something about something being suggested by a doctor. :)
Radiation, as it causes injury to the bowels, can also damage the cells that secrete lactase, the enzyme that breaks down lactose. If the lactase is not secreted, then when you drink milk or eat milk products, the protein lastose (from milk) does not get broken down, and in essence it just rots in the gut, causing gas, diarhea and abdominal bloating. Her suggestion was to try for a week to go with no milk products and then to gradually reintroduce them to determine my tolerance level.
Although this did not help my pain, it did seem to help the continuous gas, and I do feel better without the milk. I went back to my Barbara Kingsolver book (animal vegetable miracle) and she explains (as a lactose intoleree herself) that while milk icecream and yoghurt are the worst, as you get into the cheeses you will find less and less lactose as the cheeses get older or harder.
Apparently all asians are lactose intolerant as well as 50% of african americans, and also people in general become more intolerant with age.
Most people are “relative” lactose intolerant in that they can tolerate small amounts. I gather than that is likely me in that the entire part of the bowel that secretes lactase is not likely affected, more likely a portion of it. She also explains that the softer cheeses are also the hardest ones to tolerate. Apparently the fermentation process is what breaks down a lot of the lactose during the process of cheese making. However in the manufactoring of the soft cheeses, to speed up the process, they actually illiminate the fermentation process and just add the acid(the other part of the process).
So soft cheeses purchased from the large manufacturors are often not tolerated HOWEVER, I have just bought all the stuff required to make my own mozzerella cheese and plan to attempt to make my own, and use the fermentation process.
To go with my morning latte I have been experimenting with all of the alternatives to milk, soy, rice milk, and more recently HEMP MILK.... it was terrible.
Well this brings me to Wednesday morning and we are heading off from Williams Lake to Clearwater this morning.
I will keep you posted.
jankenb @ gmail.com