Sunday, May 31, 2015

4 weeks till retirement

With four weeks to go I am now in the process of downsizing my professional life. Mostly this is clearing up any issues at work, deciding what pieces of professional equipment and library I'll keep or give away and going through my email archives deleting everything that is no longer needed.

Then there is the seemingly endless unsubscribing from email lists, professional organisations etc etc etc.

Since a fair amount of these come through my work email address (which will be shut down when I leave) rather than my personal one, this isn't a particularly onerous task, but since I am initially holding on to a few subscriptions (in the heavily discounted "retired" category) I need to transition everything I am keeping over to my personal email/mailing addresses.

It also seems only right to do my bit to save the planet by unsubscribing as much as possible, or else the magazines just keep coming, years after doctors leave our practice.

I've got 10 clinical days and 2 teaching visits left. That's not much at all is it?

I've become an expert in tax law, in fact my obsession with money at the moment is all consuming. Totally understandable given the huge change about to happen, but I'll be glad when it's all over. With my final pays I'm maximising my salary sacrifice benefits and contributing the maximum pre tax super contributions before the end of the financial year. I'm counting every penny.

The contract for the sale of Marrickville has been prepared, an auction date determined, and soon my tenants will receive notice.

There is precious little left for me to do.

I am literally counting the days, even half days, till it is all over.

I've given up thinking about my back. I get twinges now and then but most of the stiffness is gone. I'm still noticeably weaker: my bridges have a sag and my lunges are all over the shop!

My ski fitness is pretty poor, but it's better than it was in January prior to me going to Japan. Certainly my core strength is better. I'm still struggling to get into a regular exercise routine and hope to be back running soon. Really enjoying the new bike, but haven't been out on it as much as I should.

The ski gear is all packed. Has been for quite a while. Just have to add a few apres clothes and the electronics and I'm done. I have a "job" in Wanaka cleaning rooms at the backpacker hostel 2 days a week in exchange for free accommodation, plus I do night reception 3 evenings. All sorted.

Ah, it's a waiting game...

Wednesday, May 20, 2015

Travel hacking, it's all about the points

This is part 2 of my foray into the mysterious world of finding the loopholes to save money on travel. In part 1 I talked a little about the best cards to use to pay little or no foreign transaction fee or overseas ATM fee. In this one we'll talk about points. Frequent flyer points, or miles as the yanks call them.

The vast majority of information out there on the web relates to the North American, more specifically USA, market where it has been possible for many years to apply for new credit cards with healthy signup points bonuses, then discard them after the points have been awarded. This is known as credit card churning, and can be quite lucrative. Apparently it doesn't actually affect your credit rating too disastrously either, especially if you are paying off your debt on time.

Because of the huge US market, there's a lot more competition, especially as their banking sector isn't quite as regulated as ours is. Umm hello, GFC??

Recently, however, Australian banks and financial institutions have been offering some of these deals too. However, they are nowhere near as generous, and often the points offered are awards points, not frequent flyer points. Transferring awards points to flyer points is often not lucrative here, with poor conversion rates from 2 to 1 or even less. My Visa card, for instance, can earn me 1 FF point for every $4 spent. That's just plain ridiculous, and why I don't bother doing the transfers.

But it's worth keeping an eye out for these deals, and working out whether a year of fees is worth the points bonus. No, they aren't likely to be fee free...

Amex cards seem to offer the best points deals, and as more places accept the card, the more points one can earn. I currently have a gold Amex affiliated with the professional College I belong to, although I believe that that affiliation has ceased. At present I am paying no fees on the card, and every dollar spent is credited as one Qantas frequent flyer point. Needless to say, I use this card to pay for as much as possible. That's fuel, the local grocery store, Bunnings, strata contributions on my investment property, airfares, car hire, season passes to ski mountains, indemnity insurance, and other sundry bills that will accept it. Even adding in the extra cost I might be slogged for paying with Amex, it's a better points per dollar spend than Visa or MasterCard offer.

So far I've got just shy of 130,000 points which will get me a return flight to Europe but it's peanuts compared to what's out there for the taking.

Recently I started reading the Australian Frequent Flyer website, which is a pretty good resource for anyone starting out this journey. There I learnt about dynamic currency conversions and how they are usually a big ripoff. Lesson learnt, always pay in the local currency of the country you are in and let your bank do the conversion.

I also learnt that it's possible to pay your tax bill using a credit card that earns points. I have had to pay a few thousand dollars extra tax this year and now realise I could have converted them into points. For those with businesses doing quarterly BASs, this is a pretty awesome way to earn a lot of points. I'm going to work out how to pay my capital gains tax this way, which potentially could earn me more than 100,000 points. Yeah, it's going to be a big tax bill...

Current things I'm doing to increase my points balance is purchasing myself a Qantas gift voucher every Christmas. Each December Qantas offers a 10 points per dollar spent gift voucher offer, so if I use my Amex to purchase a $500 voucher, I earn 5500 points, plus the points I earn when I actually fly using the redeemed voucher. It is also a tricky way to avoid paying credit card charges: there's no credit card charge on purchasing the voucher and the voucher is redeemable dollar for dollar. The voucher needs to be redeemed within 12 months, so you have to plan to use it before purchasing it. I should probably look at spending $1000 given my latest propensity for skiing in Japan as well as New Zealand.

Another way to get points is to use Qantas cash. This is the travel card that Qantas offers, where you can load various currencies onto the card for use overseas. I'm not a fan of travel cards in general as I think there's too much gouging on foreign exchange and ATM fees, plus they don't do that many currencies. I prefer the ease of the Citibank Visa debit card, which stays loaded in your home country currency and only does the foreign exchange when you go to the ATM. My previous practice has been to use my Amex for purchases, which also offers 1 point per dollar, but it too gouges large commission fees. Qantas cash have just announced a bonus points offer on loading of money into the card until June 30, so it might be worth giving it a trial on my upcoming NZ trip. If I just use it for purchasing and keep the Citibank debit for cash withdrawals, I might do a comparison between it and the Amex. Of course the cheapest option for purchases will be the 28 degrees card, but no points earned with it. Will report back on this one.

I do a reasonable amount of online shopping, to the despair of my retail shop owning friends, who get very angry with me for pointing out that some retail shops don't exactly provide a good enough service to stop me hitting the websites instead. I only recently discovered the Qantas Online Mall, which is essentially an entry portal which then tracks your cookies as you go online shopping, be that eBay, David Jones or a few other places. So instead of going to eBay directly, I go through the Online Mall portal, log in, then go on to eBay. My purchases then all earn points, anything from 2 points to 8 points per dollar spent. Sure someone's using those cookies to sell to some marketing people, but I don't really care. I'm always signing up for various deals and then unsubscribing when the email spam gets too annoying. There's no such thing as a free lunch..

The AFF website talks a lot about status credits. I've never really hankered to travel in the pointy end of the plane, but if it's possible to gain silver or gold status fairly easily then I think I'd enjoy the extra luggage allowance for ski trips, and lounge access for layovers. Other frequent flyer programs offer faster tracks to higher status than Qantas, and if affiliated via One World, you can use the benefits on Qantas as well as any other One World carrier. The standout here is American Airlines Advantage program, which could see me gaining higher status from flying across the Pacific and back. I've been contemplating a North American trip in the near future anyway.

Another advantage (ha ha) of the American Airlines program is you can purchase flyer points with cash, and they often run special deals as well. The real clincher is that American Airlines treat Australia and New Zealand as the same country, so I can fly to New Zealand from Perth for 10,000 redeemed points, which I can purchase for $300. Qantas offers award flights for 25,000 points, plus fuel surcharge, which American doesn't charge, or I can get a cheap economy flight for $500-600. So yeah, I just signed up to AA.

I recently took advantage of the option on Jetstar flights to purchase miles and status. A flight from Sydney to Perth in October cost me $118 (before luggage), plus an extra $20 to purchase miles and status credits. That's not a bad deal at all.

I do hope I haven't bamboozled you all with all of this. It's a bit of a learning curve for me too, but it shows that you don't really have to go around changing your spending patterns, you just need to know what to use and how, to get those points rolling in.

In summary:
1. Citibank visa debit card and 28 degrees credit card don't charge foreign transaction fees, so are the cheapest way to purchase products and withdraw cash from ATMs overseas. But neither earns frequent flyer points.
2. Amex cards offer 1 frequent flyer point per $1 spent overseas, but have quite high conversion fees.
3. Qantas cash also offers 1 frequent flyer point per $1 spent overseas, I am yet to compare its conversion fees against Amex. Special bonus points offers come out regularly and these are times when loading the card for an upcoming trip is most advantageous. However, this is a prepaid card, not a credit card, which has both advantages and disadvantages.
4. American Airlines frequent flyer program, which is a One World Alliance member, has a fast track program to higher status levels, and offers members the opportunity to purchase flyer points with cash. For people flying between the west coast of Australia and New Zealand there is the opportunity to purchase award seats for $300 rather than the usual $500 - $600 for a discount economy fare.
5. Cheap Jetstar tickets offer the option to purchase miles and status for not a lot of money. Enough status credits and you're swanning it in the Lounges and getting larger baggage allowances. Worth purchasing.

Again, you're welcome.

Tuesday, May 19, 2015

Why I travel slow

I was having a conversation with a couch surfer I recently hosted about how I always like to use up a visa. I suspect this comes from my upbringing of not wasting things, hence why I over eat and am a hoarder, but that's another story... It also goes some way to explaining why I travel slow.

Sure if you've only got a 2 week vacation, you've only got 2 weeks, but if you're on a longer trip you have the luxury to take your time. A longer travel period for me doesn't necessarily mean travelling to more places, it means spending more time in each place I visit.

My approach is to pick a country I'd like to visit and find out how long I can spend there on the typical tourist visa, or exempt period, and what other visas or extensions might be available should I wish to extend my trip. Yes, just one country at a time. Others may try to fit as many countries as they can into a 3 month trip to Asia, I do pretty much the opposite.

Despite the fact that I am not a long term traveller (yet) I have never ascribed to the idea that I need to see it all. I know I can't. The world is too big, there's just too much out there. and trying to see it all is frankly overwhelming. However, taking time to look around, chat to locals, go for an aimless wander in a strange town, eat at a local market, always creates fantastic experiences and memories I will cherish forever. Sometimes it is a beautiful piece of architecture, or an interesting museum exhibit, a view from the top of a mountain, or across fields of green or a sandy beach, but it may just as easily be blowing bubbles with kids, chatting with a street vendor, or sharing snacks on a bus.

Knowing I can't see it all means the pressure is off. There are no expectations. I don't HAVE TO do or see anything, which leaves me open to opportunities.

I by no means prescribe to the idea of travelling without knowledge or direction. That, to me, is both disrespectful and arrogant. If you are in a strange place you should not expect to rely on the hospitality of others just because you haven't bothered to do your research about a place before hand. A little bit of language, a little bit of pre reading about the culture and norms, makes a massive difference to how locals will treat you.

If you've been reading my blog for a while you'll know that I research my destinations in great depth, from books, guidebooks, websites and blogs, including foreign language sites which I translate using Google Translate. I do a pretty good job of finding out what's to be seen and done in the country I'm going to. I also make an effort to learn about political, human and animal rights issues, so I can travel responsibly and ethically. No Tiger Temples or orphanages for me. I'm not perfect, but I try my best to be informed.

Then, armed with the knowledge of how long I've got, I put together a rough itinerary of places I'd like to visit. Knowing how long bus rides in the developing world can take I factor in travel days that don't involve any sightseeing, and I also allow time for preparation. Like if I want to do a trek somewhere, the first day might just be preparing for it, getting food, hiring a guide and equipment etc.

Once I have my rough itinerary I head off. In practice, nothing turns out as planned. The trek turns out to be overpriced, the weather conspires against me, I find out about an alternative destination from fellow travellers and go there instead, I decide to stay an extra week because I love it so much. Sometimes a place doesn't excite me at all, so I move on. But none of that matters because I don't build up the expectations. Each day I find new things that excite me, travel is never boring.

Travelling fast, on the other hand, is exhausting. There's an agenda, a timeline that must be kept to. For me, the timeline that really annoys me is the visa expiry date, when I have to leave the country and go somewhere else. Just sometimes I'm ready to leave, but usually, there's so much more I want to do and see right there, even though the next country will be just as interesting.

I think when travelling fast it's easy to feel like you've seen the sights, ticked off the bucket list items, eaten the national specialty and seen a traditional dance, and convince yourself you've had a glimpse of the life and culture of the country you've visited. But once you travel slow, start having conversations with people about life, family, politics, religion, culture, you want to explore more, know more. You don't want the glimpse, you want the immersive experience. And its addictive.

Travelling fast you pretty well maintain outsider status the whole time. It's probably why people moan about not having authentic experiences when they travel. You've got to slow down for that. The conversation you strike up with a stranger isn't going to lead to an invitation to come to a wedding if you've got a bus ticket already booked to the next place and you're leaving in two hours. I still regret that we weren't able to go visit a village with some newly weds when we turned up in a small town in rural Laos because my travel partner's visa was about to expire and we needed to get back to civilisation. I know it would have been an awesome experience. Instead, we ended up dining with a Kiwi expat working in Bangkok who does philanthropic work building schools in rural Laos. That was a pretty interesting encounter as well.

I love returning to the same market stall for breakfast each day, and seeing the smiles of welcome that come with familiarity. Being able to chat with the transport guys without them haranguing me for a ride, even learning their names. Ending up teaching English in a secondary school for a day, travelling there through lush scenery on the back of a motorbike, then having another session with university students training to be English teachers. Having a long conversation with a mother about her dreams for her daughter and her worries about how her late night texting is affecting her sleep and schooling. Conversing with a farmer in a rice paddy in the wilds of northeast Vietnam, who is seriously worried about climate change because it doesn't rain at the usual times any more, but floods and droughts are getting more frequent.

It's these connections that you make with people, no matter how disparate our backgrounds, these little acts of familiarity, that stop you feeling lonely when far from home. The realisation that although this family may live in a dirt floored hut with unreliable electricity and no running water or toilet, they have similar dreams and hopes for their children, concerns about the environment, disdain for corrupt politicians, as someone living in a double brick house with a big backyard in Australia.

It makes sense that we want to stay connected, and I mean on a personal physical level, not virtually. It feeds our souls more than ticking off a bucket list of sights and vicarious experiences ever will. I will never forget hot-air ballooning over the Serengeti, or skiing the Tasman Glacier (both of which are true bucket list experiences I would highly recommend), but I'll also never forget all those people I've shared snacks with on long bus and boat rides (I never sit with the westerners, always with the locals, they know where the more comfy seats are), my knight in shining armour in Malang, the complete strangers who've invited me into their homes, and the fantastic couch surfing hosts I've stayed with. Those people are what makes travel sustainable for me, and I mean for my soul.

Slow travel is pretty kind on the pocket too, as transport costs tend to take a good chunk of your travel dollar so if you're moving less you're spending less. Staying longer in one place can often mean a discount in accommodation too. Local hospitality can also be incredibly generous but should never be expected. I believe that I have a responsibility to contribute to the local economies where I travel, and taking advantage of other's generosity only to make my travel dollar go further is a pretty heinous act in my moral code. Unfortunately I see far too much of it in my travels.

There really is quite a bit of ugly out there on the road. I've met people travelling on next to nothing who do it with such generosity you feel you are doing them a favour, but I've also met my fair share of sneaky cheap selfish stingy cheapskates, who are obsessed with getting the lowest price or paying nothing and are just plain mean about it. Unfortunately the former aren't quite as common as the latter, but I've been lucky to meet some, who totally live the reciprocity of giving in a non monetary way. I did my fair share of living on a minuscule budget back in my 20s and I decided I'd never travel like that again. Budget travel is one thing, obsessing over the price of everything is quite another, and no way to enjoy yourself. Luckily, that's no longer an issue for me.

Karma. Pay it forward. These concepts apply just as much to travel as daily life. Travelling slow allows me to make connections, be generous to others, not just think about myself. It feeds my soul and keeps me wanting to travel further and longer.

Just slowly...

Sunday, May 10, 2015

Travel hacking, or the art of squeezing your travel dollar further

Just because I have a tertiary degree and work in a profession that earns a high income doesn't mean I travel in a luxurious fashion. I grew up in a family that didn't have any spare cash, so our holidays were usually caravanning or house swapping, and then as a teenager into rock climbing, caving and bushwalking I relished camping in the great outdoors. Seriously, I don't think someone who enjoys bush camping can ever see the attraction in a sterile hotel room, no matter how swanky.

On the other hand, getting a person outside their comfort zone to experience a night out in the bush, can be either terrifying or life changing. I'm glad this isn't an issue for me, because it hugely broadens my options when travelling.

Accommodation is one of the largest expenses when travelling. I'd estimate that anything from 30-50% of a travel budget will be spent on somewhere to sleep each night. But if you have an attitude like mine, where a bed is a bed is a bed, then as long as it's clean and safe, it'll do. No I don't need aircon, an ensuite bathroom, a TV, internet, a pool, my own room etc etc. If the price is good I'll take those options, and just sometimes I'll have a little splurge, but I don't need those things when I travel.

Sometimes I think it's because I have created my little paradise here in Drummonds, where my needs when it comes to luxury have all been met. I have a spa in my bathroom and a great big blue ocean just across the road, so maybe I don't seek those things when I travel. But I also think it's because for me, travel is about the experiences I have outside my bedroom, not whether my bedroom that night is in a hotel, guesthouse, hostel dormitory or tent. It just doesn't matter to me. So why spend more than I need to?

Cheap and cheerful is usually fairly easy to come by in the developing world. In the west your cheap options (besides camping) are hostels, backpackers, airbnb and couch surfing, all of which you access using the internet. The opposite is true for the developing world: if it's on the internet it will be at least midrange in pricing. Good old fashioned research and walking around looking finds you the cheaper places. Using a guidebook usually limits you if you only stick to their recommendations, and you are also likely to be subject to the Lonely Planet price hike that occurs when a place gets featured in one of their publications.

Everybody travels with electronic equipment and wants to be connected 24/7. For me, that means purchasing local SIM cards with access to wireless internet, and not relying on my accommodation having WiFi. Being a voracious reader of travel blogs I see this come up again and again, where a blogger is searching left right and centre for a hotel with WiFi and ends up paying a lot more for their accommodation as a result. WiFi is becoming ubiquitous even in much of the developing world, but until it actually is, I prefer to have access already covered, and save my pennies staying somewhere cheaper. I'm also old enough to remember a time when the internet didn't exist (shock horror!!) so I know I can survive without access to regular Facebook updates!! But it is fun posting updates when you're camped on top of a mountain!

As an example, last year I spent 2 months in Java, Indonesia. I couch surfed maybe 10-11 nights, camped 2 nights, and the rest of the time stayed in guesthouses and hotels. I spent $450 on accommodation, that's an average of $7.50 a night. I also purchased a SIM and phone/internet credits for the time I was there. This cost me $32.30 for 2 months. Typical cost for accommodation that has WiFi in Indonesia is likely to be between $10-30 per night.

The next big cost when travelling overseas is foreign currency and ATM transaction fees. These really add up quickly especially when foreign ATMs have withdrawal restrictions that are only a few hundred dollars yet your bank slugs you a hefty $3-5 each time to use your card in a machine overseas. Then they charge 3-5% in foreign transaction fees. For instance, when I had my minor cash crisis in February this year in Japan, I withdrew $882 in Japanese Yen using my usual card from an Australian bank (in my case CBA). I got slogged $36.48 in fees! In Java in 2014 when I failed to top up my overseas card, I had to use my CBA card for a withdrawal. I withdrew $187 and was charged $10.61 for the privilege!

So I now have cards I use overseas. Cards that have no fees, no frequent flyer or awards points systems, but also don't cost me an arm and a leg to withdraw money.

Each country has its own banking system, so each nationality has to find their own travel hacking solutions, and for Australians it's the Citibank Visa Debit Card, and the 28 Degrees MasterCard.

The Citibank card is a Debit Card which carries the Visa brand, meaning you can use it most anywhere for purchases, using EFTPOS or an ATM. It isn't a credit card. This means you need to deposit cash into the account before you can use it. You need to allow 2 full working days between when you transfer money electronically into the account and when you expect to withdraw that money. I discovered that on that trip in Java in 2014. In general it will only take 24 hours (weekends do not count BTW and why don't computers work on weekends??) but 48 hours is a better safety net. Once that money is in the account, you can take your wee card, pop it in any ATM with a Visa sign on it, and withdraw money with absolutely no fees at all. Yes there is a small foreign transaction fee but as the foreign exchange rates offered by Visa are extremely competitive, you are not losing out on any other way of purchasing foreign cash.

You need to keep using the card to keep it active. I found this out when I rang Citibank late last year about my pending trip to Japan to discover that my card had been deactivated as I had not done any transactions on it for more than 3 months. For a card that may not be used at all for months at a time whilst back home, this is pretty important to know, or else it could be a bit of a shock to arrive in a foreign country and not be able to access your cash. Yes this happened to me in February, but not for that reason. Now I have set up a recurring payment of $1 which gets transferred electronically into my Citibank account on the last day of every month. This keeps the account active.

Now what about using a credit card overseas? Personally, I'm wary of using credit cards in the developing world, particularly after my visa card was used fraudulently in 2008. But I do use them regularly for purchasing airline tickets, for more expensive purchases like new skis or ski lessons and if I ever stayed in a posh hotel.

I own a lot of credit cards, and this year I plan to reduce them down to just those I need. First I have an AMEX card, which I managed to get fee free through an affiliation with one of the professional bodies I belong to. Old boys club privileges! This is linked to my Qantas frequent flyer account, so I get one point for each dollar I spend. Any purchase that can be made on Amex, does. Food, fuel, Bunnings, Strata contributions, all racking up those frequent flyer points.

I also own an ANZ Visa (which isn't really offering me any points benefits), and a CBA MasterCard, which comes fee free whilst I maintain my current loans with them. Once I sell Marrickville and pay off my debt I'll be rethinking my entire relationship with CBA, but back in 2008 when my Visa card got taken down by a fraudster, that MasterCard got me my flight back home. Otherwise, this card doesn't get used. It's my back up credit card in case of foul play.

New to my armoury is a 28 degrees MasterCard. I only recently heard about this card so have applied for one online and will receive mine some time next week. Provided by GE Money, it's a fee free credit card with rather high interest rates but no foreign transaction fees. It will become my preferred card on Paypal and what I'll use overseas when they won't take Amex. It charges 3% for cash advances (even if it's your money you've loaded onto the card), so don't ever be tempted to use it for anything but credit.

The absolute rule with credit cards is making them work for you. I try to wangle as many points as possible out of my cards, I compare benefits versus fees, and I always pay off the debt in full every month. Failure to do so isn't travel hacking, its just plain foolish!!

I'm only just getting into the strange world of points hacking, which, for the uninitiated, is the art of acquiring lots of frequent flyer points for almost nothing. This has been commonplace for Americans for some time due to very generous sign up offers from various credit cards. Recently this phenomenon has arrived in Australia. I might do another post on points hacking once I've done a tad more research.

So, my travel hacking tips for today:
1. don't be too precious about your accommodation, why spend half your travel money on a bed?
2. don't tie Internet access to accommodation choices, get independent access or do without.
3. don't pay exorbitant international ATM and foreign transaction fees, get the right cards before you go.

You're welcome :)

Tuesday, May 5, 2015

From the outside looking in

One of the most difficult group of patients I have in my practice are the chronic pain patients. These people suffer from chronic pain, usually its in the lower back but for some it's in the neck, shoulders, hips or elsewhere. For joints we can usually refer them for surgery, but for non specific back pain we need to apply a multimodal approach to therapy.

The research on chronic pain reveals that certain people are more susceptible to it than others. These are people who catastrophise, and don't believe it when the doctor tells them the pain will get better. They leap on every symptom to reinforce their belief that their pain is getting worse, and seek continual investigations and escalating amounts of analgesia, develop protective movements and postures to avoid pain, reduce their activity levels to avoid pain, and suffer more for it.

The research shows that this group of people can be identified early on, and health practitioners can implement strategies to prevent some of these patients from spiralling into the chronic pain nightmare. A nightmare where no amount of multiple pharmacy makes much difference, where they are incapable of getting gainful employment, and where deaths occur as a result of overdosing on prescription medications.

Prevention starts with health practitioners taking a good history and examination and using evidence based guidelines to screen out any risk factors that suggest a serious cause for the pain. These are cancer, or significant nerve impingement necessitating surgery. All other causes of back pain do not require imaging at all, regardless of the injury. I am excluding acute trauma from this group as these patients aren't going to be walking in to my practice.

The reason imaging should be avoided is it's simply unreliable. Grab 20 people off the street, image their backs and then ask if they have any back pain. There will be no correlation between their symptoms and what their back looks like. A person with a normal Xray might have regular episodes of back pain, whilst a person with an Xray full of degenerative changes might have never had a day of pain in their life. Grab 100 people, same result. So it just doesn't give you guidance at all.

But for the catastrophising patient, it starts their journey of seeking a cause. Non specific lower back pain is called that for a reason, no-one knows the cause of it. But it does exist. And it causes a hell of a lot of suffering.

We know that acute pain and chronic pain are two different beasts. Acute pain is there to prevent you injuring yourself further, to notify you that your appendix is about to burst, or that the fire is burning you. Chronic pain isn't notifying your brain that there is real and present danger, because the danger, or whatever triggered the pain in the first place, is well and truly gone.

However, the chronic pain sufferer believes that they need to protect their painful part from further injury, so they develop intricate posturing and movements that they believe protect them. In fact these "protective postures" do the opposite, they make the pain worse, so in an attempt to reduce the pain they overcompensate even further, reducing their activity more and more, and thus the spiralling down occurs.

Managing chronic pain patients starts with trying to prevent the next one. By not imaging unnecessarily, by informing patients that their acute injury will improve spontaneously over a few weeks, that they return to normal activity as soon as possible. It also involves screening for those high risk patients (yes we have a tool to work out whether you're a loony or not!) and keeping a closer eye on them, perhaps by referring them for physiotherapy to ensure they don't develop those protective behaviours.

Once you've got a patient with chronic pain, which is roughly pain for more than 6 weeks, then one needs to assess them for which approaches are needed to stop the spiral. A holistic approach is needed, and one of the hardest things is getting patients to understand the role that their own mental state plays in chronic pain. A patient may hear "it's all in your head" when the doctor may not be saying that at all, but trying to explain the way one's mental state contributes to one's pain. It is not an accident that depression and chronic pain coexist side by side.

The role of exercise in recovery is crucial. This works in two ways. Firstly, avoidance of protective behaviours, because these just cause more pain through stiffness and incorrect posturing overburdening the wrong muscle groups. And secondly, because when we move normally our other nerve fibres responsible for touch and position sense provide a feedback mechanism to our pain nerve fibres telling them there is no danger and to shut the fuck up.

The role of analgesia is questionable. I've prescribed my fair share of seriously strong pain killers over the years and I'm yet to be convinced that they make one iota of difference. The way patients talk to me about how the analgesia works for them is really text book behaviour for catastrophising individuals. They believe their life will be unbearable without the medication, so they need to keep taking it. I think if they weren't on the medication their pain would be the same, although there's some evidence suggesting that their pain may actually be improved. Some chronic pain specialists I've talked to have countless stories of huge improvements, even resolution, once analgesia has been ceased. But try convincing patients of that.

Working on their psychological state, preferably through the services of a psychologist experienced in chronic pain management, and on their movement with an experienced physiotherapist can reduce the suffering for these patients. For some, they can get out of the cycle of despair, but for others, especially those who choose only to rely on medication and unproven therapies like spinal injections, I never see improvement.

Which gets me back to me, and why I am discussing my work on my blog when I don't normally. The reason is because I have found myself starting to fall into the chronic pain spiral.

It's not a secret that I've had my bouts of depression over the years and that I was going through a pretty rough patch around December/ January. My holiday in Japan, despite my injury, really lifted my mood, but the protracted pain and the refusal for the pain to resolve within my expected time frame has begun to take its toll. I too am wondering if this pain will ever go away.

I have days when I am so stiff and sore that I just curl up in bed and don't go to work. I reduce my activity, because it hurts to do it. I am not, BTW, popping pills. They really don't make a difference.

This morning, having taken the morning off due to pain, kept warm under the doona until 10 and then gotten up and gone through my specific exercises for the day (a mixture of pilates and core strengthening, flexibility and leg strengthening exercises for my ski trip) I suddenly reached an epiphany.

I was doing exactly what my chronic pain patients do.


It was time to stop.

Funnily enough, by the time I had done all those exercises I was hot and sweaty and the pain and stiffness was considerably less than it had been for the previous 3 or 4 days.

My physio has very pointedly said that I can't injure myself again unless I fall directly onto my derriere. This is his way of saying the danger has passed. Although he was the one putting the brakes on my activity levels early on in my recovery I think he may be a little frustrated at my current lack of activity. I blame it all on the delay in my new bike arriving. What should have taken a week took almost 4, so it is only in the last 2 weeks that I have begun cycling again.

It's a great lesson for me, because it helps me understand what's going on in my patients' heads. I get it, I just don't choose to take that path, because I darn well know where it leads.


Monday, May 4, 2015

Gardening with Nature

The last 12 months seems to have been a turning point in my garden, where I am more often successful at growing things than not. So that's been 15 years of trial and error to get to this stage.

Personally, I think the secret to a successful garden really is time. I mean look at those gardens they feature on gardening shows, almost always at least 10 years of work has gone into them. You need time to learn about the climate zone you live in, the seasonal variations and the soil type, and to modify your little personal ecosystem to suit what you grow. Perhaps more organised people than me get there a bit sooner, by documenting the process for future reference, but for me it's so haphazard it seems more by chance than design.

I decided early on that I wouldn't use chemicals, except where absolutely necessary, and chanced upon a great book called The Natural Gardener by Jeffrey Hodges, which talks about treating your garden with respect for all creatures great and small, allowing the garden to develop its own balance. This means not naming and blaming, but seeing those little visitors who eat your greens as being just as welcome as the next one. It's not about making a pesticide from natural ingredients, because that is an attitude that continues to promote imbalance. Instead, you allow nature to restore the balance, where you allow some things to get eaten as long as there's enough left for you. There's also the option to see those little green caterpillars or snails as kamikaze soldiers who sacrifice themselves to the chooks for extra protein, as well as to the myriad wild birds and lizards who help themselves. Excessive greenery aren't weeds, but chook food and compost fodder.

At first, the greedy visitors were winning, but over the years, as I built up the soil, learnt when to plant and how to keep those plants alive (daily hand watering and summer shade are my 2 main strategies), the plants developed resistance to being taken advantage of, and the birds and predatory insects come regularly, knowing the prey isn't poisonous. Sure things get eaten, but total devastation doesn't happen, and there is more than enough food for both me and the visitors.

But I do spray the citrus with white oil. The leaf removal method was only resulting in me losing all my new growth, and as this is where the flowers and fruit develop from, I was going nowhere. So no, I'm not perfect, even though the oil I use is botanical oil, not petroleum based.

I have even got to the point where I am saving seed from the previous year's crop, which in my opinion is a real coming of age for a gardener, because you are storing and then propagating food that you know grows on your patch. It's also incredibly rewarding to give away seed to friends and to encourage them to grow their own food.

With all the rain we've had in the last couple of months, I've been waging war on the kikuyu growing in my driveway and along the verge. Kikuyu, being a running grass, is pretty tough and very invasive, so I remove it, wait for the next flush of green to reveal missed runners, then round two, three and four ensue. As my driveway is gravel and mowing isn't an option, grass just isn't welcome there. I am afraid that's just one visitor who not only isn't welcome but doesn't serve a purpose either. The chooks aren't even interested in it, but if it takes root in the chook enclosure (unlikely) I won't mind at all.

an almost weed free driveway

This weekend the red dragonfruit got a little prune job, and because a few of my friends are somewhat challenged in the gardening department, I have potted the succulents up and will pass them on to my friends once they develop roots (the plants, not the friends!!). If I just give them the cutting they'll not know what to do, or will forget to plant it, etc, whereas a succulent in a pot is almost impossible to kill. I believe my last donated plant is doing very nicely, according to a recent Facebook post!

Last month I purchased a kumara seedling from Julie at the permaculture nursery. She's a Kiwi, so I have it on authority that this particular variety, sourced through a local growers network (there are quite a few Maori and Pacific Islanders in town), is the bees knees for roasting in your hangi. I think I'll probably stick to my oven. The seedling, however is taking over. That can only mean one thing, and it's sure to be both bountiful and delicious!! I shall have to ask my house sitters to keep some for me....

My mango tree is putting out heaps of new growth, which is awesome. Still probably 3-4 years before I can expect some fruit. Ah yes, gardening is all about patience.

I had a glut of ripe dragonfruit and papaya a week or two ago, but I've managed to polish them all off and am waiting on the next batch of papaya to ripen. The dragonfruit are definitely done for the season, which is why I pruned it, but the papaya continues to flower, and I continue to do a little assisted fertilisation. Those big green fruit can be agonisingly slow to turn orange. You can still eat them green though. I make a pretty mean, very spicy, green papaya salad.

those brown bits are gouges from the big hailstones in March

Let me take you along into the "tropical garden" along the northern side of the house. With all the rain the canna have been shooting like mad, and the princess lilies are beginning to green up, no doubt they'll be flowering in a month or so. I've a few more papaya along here, including one of my original plants, which supposedly started life as a bisexual but it looks all female to me!!

There's also other 4 or 5 dragonfruit plants powering along, once these all start fruiting I'll be giving them away!

My pond has been overtaken by a dwarf papyrus (god knows how big the non dwarf variety is!), so I really need to get into action and finish landscaping the pond that is part of the tyre wall installation. My back injury has slowed down my ability to do heavy construction work, but with mindful digging techniques it's a project I hope to complete before heading off to NZ in July.

I'm particularly happy to discover that the rain has kickstarted a little patch of "Lippia" that I thought hadn't survived my various earthmoving activities in that area. Apparently it's a bit of a weed over on the east coast, but here it's a drought tolerant pretty little purple flowered ground cover that outcompetes most weeds. It should look nice around the pond and steps.

Now we are on the south side, which is currently a mess of a rock pile and a new wood pile. This area should be looking a little more business like before I head off this winter, still scratching my head as to where I'm going to put all them there rocks.....

Recently I found a seedling in my vege patch, which I potted up and am nurturing until it gets just a few more roots going. I'm pretty sure it's a Tuart seedling. This is not the first time the Tuarts in the easement have self seeded, this is what happened last time.

the Tuart tree planted by Nature, parent tree upper right corner is even bigger

Do I piss off my neighbours up the top of the hill by planting it back there? Or give it to my next door neighbours to replace the dying trees along their other fence? Their paranoid neighbour on the other side thinks they've been poisoning the trees, unaware that the previous owner pruned them heavily every time the greenery obstructed his ocean view. There is only so much abuse a plant can bear, before it succumbs...

From little things big things grow....

Bit like us really. Ciao till next month...