US interests in 'Free Tibet' movement: it's hard to be an activist.

The recent violence surrounding the Tibetan protest against Chinese rule has taught me a little bit about "news behind news." Although there have been many US citizens who were interested in the welfare and rights of Tibetans for decades, the US has not offered any opinion one way or another towards Chinese government until this past month (as far as I know about Tibet issue). I was thinking why US government proper would be so interested in voicing their opinions this way until I remembered all kinds of news I've been hearing about China.

If you go back for the past year, most news and statements towards China have been Orwellian. China is investing heavily in natural resources in Sudan and has indirect ties with what's happening in Darfur. China is aggravating global warming. China eats babies. China grows horns. China is the devil.

True; most of the news has factual basis (minus the horns and eating babies). China does have horrible human rights record. However, the effect these news and public statements seem to be getting the American populous ready for another war. A preemptive justification for conflict of any type between US and China. Of course, I would sound pretty dumb to imply that US and China are going to war anytime soon. But, it doesn't have to be a physical conflict; the Soviet and US were never really in physical conflict during the cold war. In fact we may actually be in an economic war between China and not even know about it. But I digress.

I feel 'Free Tibet' has become another China-bashing bandwagon for the US media conglomerates (and subsequently the powers that be) to jump on. This is a difficult situation for activists because it is hard to maintain neutrality when a big power is also supporting your cause. From what I've observed from history, wiser and safer (for the people we are helping) course are taken by activists who take the independent, neutral path. Even if the government or the media walks next to us for the moment, we will continue to walk straight until the mission is accomplished.

Tibetan people's rights must be respected.
The government of China, as are all governments including our own, should be held accountable for any human rights violation.
The activists must be vigilant about unsolicited alliances which are often wrought with ulterior motives. We do this not for our ignorant pride, but for the people we work and die for.

With the recent escalation of Tibetan protest against the Chinese government, Dalai Lama spoke against the violence and even threatened to resign from his executive position in Tibetan government-in-exile if Tibetan protesters continue to resort to violence. Initially, I thought it was a prudent thing to say for a buddha to say until I thought that it may have been a political move to separate the goverment-in-exile from being associated with the violence aspect of the protest. If I was a buddha and a leader of people, I would just have said, "please stop fighting" without the negative consequences of not obeying what I believe is The Way. As much as it hurts me to say write this, I think Dalai Lama's spiritual leadership may have been compromised by political needs.

It is better for a parent to console a hurt child then to threaten orphanhood. Tibetan people need Dalai Lama. The world needs Dalai Lama. He may not quit his leadership. He may not threaten his own downtrodden people.

Guys, it's true what they say about surgery. It's not human.

I am going to sleep and getting up earlier and earlier. Like 3:30am this morning. It's back breaking work. I'm sore every day. Please call the whambulance, etc.

But what "they" didn't tell you is this work is as fascinating and worthy as it is hard.

Is all. Gotta go study and preround.

Children cry and laugh.
Snow faces smile ear to ear
Nose runs on red cheeks.

Freezing air, fingers,
Bike wheels turn fast, fast!
On Cold February Morn.

Yours truly was published in UNC-Asheville's weekly newspaper, the Blue Banner.

With a small pile of kindling situated close by, Aram Harijan, the hitchhiker, pulled out a lighter lent to him by a friend, and reached down to spark a fire.

Nothing happened.

He cursed the broken lighter, and chided himself for not being better prepared. Violently shivering, Harijan climbed into his one-person tent, and again turned on his iPod, falling asleep to a podcast of a medical lecture.

I still remember that moment like it was now. This reminds me that I need to invest in a zippo lighter.

2 minute cocaine talk

HISTORY

Caca-Cola® contained 0.75 mg of cocaine per ounce until 1903 when increasing knowledge about stroke, heart attack lead to discontinuation of cocaine. Cocaine received little public or medical attention for the next 70 years, until the "crack" cocaine epidemic of the 1980s. Cocaine is schedule II substance; can be prescribed in 4-10% solution for topical ointment.

CRACK, POWDER, FREEBASE?

Salt form is more water soluble at room temperature. Therefore, it dissolves in mucous membrane and can be absorbed directly through the nasal epithelium. This is the snorted cocaine. Can also be injected. Like chewing tobacco.

Base form is water insoluble and will not be absorbed across the epithelium. It cannot be injected either because it remains as a precipitate in most solutions. However it has a low vaporization temperature and is thus smoked and absorbed in vapor form through the lung epithelium. This form is only smoked. Like cigarette.

$ TO $$$$. HOW IS AN EXPENSIVE DRUG LIKE COCAINE MORE PREVALENT IN A POORER POPULATION?

Cocaine really is expensive in any form. However the salt form usually requires a higher dose per use than freebase form. Crack cocaine is usually sold in smaller quantities (1/10th gram 'small rock' costs ~$10) and anybody can afford it at this level.

WHERE DOES THE NAME "CRACK" COME FROM?

The freebase cocaine crystal has small amounts of water. As the crystal heats, this water boils and makes crackling noise.

HOW DOES COCAINE WORK? Dopamine, serotonin and NE reuptake inhibitor. Ventral tegmental area to nucleus accumbens reward pathway is activated.

USEFUL INFO ON URINE SCREEN TEST: Benzoylecgonine is the major metabolite of cocaine and is present in urine for 2-3 days. Chronic users therefore cannot escape detection if they present to ED or clinic after this window.

WHAT SHOULD I BE CONCERNED ABOUT?

Body: STROKE, AMI (beta blockers can precipitate AMI in cocaine OD), SEIZURE, WITHDRAWL (pains, tremor, chills, involuntary muscle movements).

Mind: Psychosis, mood disorder, motor disorders (akathisia "crack dancers"), SI.

Relationships: Money, significant other (trading sex for crack), legal issues (arrest due to possession; violence or stealing stuff. see money).

Taking care of patients who abuse or are dependent on cocaine (may not resemble reality)

Approach to patient: First remember countertransference. This patient is not the crack cocaine patient from yesterday or the neighbor who stole my beloved playstation. Even if the patient is unreasonable, looks dangerous (and may well be dangerous), and/or smells bad, patient could still use an advocate - especially now in the hospital when they seem to have no control in their lives.

Decision to admit: Remember cocaine abuse or dependence is just as much as a social condition as a biologic disorder. Let the axis guide your decision on whether to hospitalize the patient or manage them in outpatient setting. If you send them out, make sure they have social support that would encourage the patient to stay sober.

Gather collateral information. Once admission was decided, collateral is going to be useful in understanding and management of patient as well as discharge planning.

Nursing Supportive environment with diet and sleep ad lib

Bio

Take care of existing medical conditions.

Benzodiazepam may be used in SEVERELY agitated patients or sleep issues.

Depression longer than 2-3 weeks or SI may require antidepressant treatment.

Risk of relapse is highest in early withdrawl; craving is easily triggered by stress or other drug-related triggers (like a spouse on crack). Patient should be referred to treatment program for ongoing care.

Social

Wounded soldiers aren't told back to go back to battlefield after their trauma, so why should this patient go back to the place that traumatized them? Think about relationships, family, money, work, education, Vocational rehab. www.ca.org.

Therapy

No one therapy is better than another. High intense and long durations are associated with better outcomes. Treatment of other psychiatric comorbidities.

Credits to wikipedia and uptodate articles on cocaine.