A Nation in Pain
Oct 19, 2014|
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And Josh Bennett Johnston. Happy how was your weekend. Extracurricular thing that you're always cinema -- great weekend yes. -- Tonight we're gonna talk about OK and pain treatment for current and addiction. But also the mental health effects of pain tour and being in pain yes. Dealing with chronic pain. Chronic acute to prepare and how do you treat the paint how do you treat pain what's the best way to do it and -- Medication can become addictive with alternative. You know. What's the best way to treat pain and how do you treat someone with addictions sure they don't if they're in pain so that they don't. Become. Addicted to this. Medication yes. And you know you often hear about people who are in recovery it's a huge fear that when did they might get injured or have to undergo surgery. And be prescribed these medications for their body doesn't know the difference that they might need to for pain. So great topic. Every -- -- talk about it and what we know is is to huge problem. Because tonight we have an expert with us we have two guests joining us the first one is Judy Foreman she's in national city syndicated. Medical journalist and author of the book a nation in pain killing our biggest health problem and cheese and it's an amazing book awesome book. Cover to cover. Full of think elements of basic -- she's with listening to is a step freighter at the Boston Globe so most of you heard of -- And is now freelance health and science columnist for several publications. Including the Los Angeles Times the Dallas morning news she's in the studio with. -- hi Judy welcome thank you I've heard of the Boston Globe because there. We're also going to be joined the telephone and by Janice Kaufman. Genesis vice president of addiction treatment services for north Charles foundation incorporated. The director of big addictions consultation for the department of psychiatry Cambridge health alliance. Indians assistant professor of psychiatry at Harvard Medical School have also heard of Harvard. She's worked with addictive disorders for more than forty years in direct treatment she's worked through program development teaching. Local and national policy initiatives just tons of stuff and she's joining us on the phone tonight. Welcome to and scraping by Jim welcome director radio thank you. So so start by talking to GG. Did you get interest in pain. Six the hardware -- and by the hi ginger and was kind enough to let me come visit her addiction treatment center. In -- I got it intrusive which is sort of mild word for when I had an excruciating. Neck pain. That the cause wasn't clear initially but it turned and I head. A bunch of things around my neck my vertebrae were sliding over each other I had posters I had degenerative discs. And it really hurt on a scale of zero to ten it was about a twenty in my pain was excruciating. Even now you know here we're sitting in the studio with earphones on at that time I had a talk radio show. And just haven't -- these little earphones and professionally -- phones but they weren't ten pounds. By the end of the show I would be in agony. So you know I was in science writer at the globe and medical writer I kept thinking you know why on earth would this team be there I mean. -- nephew during your hand in the fire you learn not to put your hand back in the fire but this kind of chronic pain is completely non adaptive and so. In addition to being curious about my own case that became curious about how how common it was and what caused it and that set me on the path for the spoke. Was it provoked by something -- was this just like you know normal process of aging in your case. Probably the latter although I had just got really only -- and am really only trying to -- just look at haven't put any any. But I mean there was no real explanation except that I didn't have a laptop computer. And it is crunch over so my necklace and it really bad position a lot but. That was true for a lot of other people in new and that it didn't happen to them so I really have no idea. So any and you hacked it -- treatment yet. Dad I think that. If any no well I got a lot actually. I went to that the people who specialize mystical design interests which are basically the ability Asian doctors. And I went a couple of a couple of them and then finally found a really great team and knew -- -- this is not a paid political announcement they were they were really terrific. Mom I did take -- -- say we're somewhat helpful not slam dunk I did acupuncture did -- Did not -- chiropractor. Chiropractic I did not too. Marijuana but what really I think gotten better was in intensive exercise and physical therapy program and we can. Going to that later if you -- but yeah that really that really turn it around. So so you can't -- and to spoke to try to. -- I mean so I was favorites -- athletic. Well hey I thank you I wrote this book partly because emphasize Saturn and and the physiology of painfully and that is actually really interesting because. Anything that involves involves -- nervous system in the brain is Charlie Anderson. But also there was there's a sense of outrage that I failed because there's so many people in pain. They're an estimated a hundred million Americans in pain which means more people are suffering from chronic pain and cancer. Heart disease diabetes and aids all put together. And yet the government spent the NIH the National Institutes of Health spends less than 1% of its massive budget on basic pain we search. And medical schools -- teach about pain. There was a big study from Johns Hopkins in 2011 and they looked at a 117. Medical schools around the country. And found that the median number of hours spent teaching would be docs about -- was nine out of four years. Even veterinary students get more pain education and that -- candidate what kind of stuff for the teaching them about it. Not much I -- to the extent that they are they're basically telling doctors to be very wary of appealing -- so in terms of non opiate treatment for pain -- what's actually going on with pain. Doctors really don't know and they are they've surveys of doctors show that they feel really. I'm prepared to deal with pain patients and yet he is the main reason -- go to doctors so what really -- this book was this sense of a huge mismatch between. The number of people suffering and what the government and medical schools are doing to help. In the meantime money can. I'm just because a few times in the book you mentioned her and yes I is about simulations. And I met and am -- -- danced identity talks about it. Addiction. And opiates hands. Anna and I thought it was really important so content can you tell us how you got into Europe what you're insistent. Yeah. Well. I first. Got involved in working with patients with addictive disorders and -- the first. Population that I worked with with people who had opiate addiction. And on my -- particularly interested. Because. You know I came from a generation I was in college in the late sixties and seventies. And there was a lot of experimentation. With drugs and some people moved on and went out with their lives other people got stuck. And I found that particularly curious as to why some didn't. Just couldn't you know move on. So that was my initial. Into an addiction and by chance. Connected at Cambridge hospital into the more and -- -- treatment programs so that was my first exposure. And I have haven't -- Yeah totally. Fascinated with the patients. I was intrigued by the your illness was. And pressed by the strength and creative content of the patients who retreated. And you know -- buyouts to many levels to this that it was. Totally fascinating to me it was a crossover between psychiatry and medicine which I've loved. The -- issue I think was over time from made. And particularly working with patients and methadone treatment HIV people with hepatitis. Chronic pain diabetes. Or Patrick -- And the stigma associated with patients with addictive disorder in their inability to get campaign. Treatment and away that felt humanely and really attended to their problems and so they became a population. In addition. To the general population and that got worse. Is that got no access to treatment. So. You know those with some of the major reasons I office and about eighteen years working at Brigham and Women's Hospital running an addiction psychiatry -- -- -- place -- people come into the hospital with. Acute pain chronic pain. Active addictive disorders. Patients in. In recovery but we're faced with having to take pain medications. For that there are cute. You just surgical procedures or because they had chronic pain and the kinds of issues that came up for them. I mean I could go on and worked with medical care professional which did disorders and some of the problems that they raise so. My interest just evolved over time and you know I was delighted to have. Had a chance to talk which duty because she's done really. Incredibly balanced job in her. Book and nation and pain and we had a really good time talking about this issue was developing. Well I mean it when -- winner of the book I think the important thing is. People in pain are treated like suspects no matter no matter what I mean yeah and I've I've known that from me I've known that from everybody. And it instead of it being Mikey to an opposite ends of the spectrum. You know there's no you know addiction isn't physical illness people should be screened for it. But people shouldn't be treated as bad people because then -- right and that's when I feel that feeling over and over. Maybe just it seems to me especially women they going to treatment nice you know hi I have this pain night. Well it's this notes that where you know words in your head and it's just it's really a shame. Because. Just because she can't see it. Addiction you can't see. Pain doesn't mean it doesn't exist yet and that they color system and -- and when we come back from break we're gonna talk about. How are you both see page treatment of pain that works. And tenured and address specifically with people and addictions. And -- -- back -- her -- give us a car. 6172666868. And sharing your story. Welcome back I. What are we talking about a minute are you talking to. Well we're talking to a couple people we have Janice -- Vice president of addiction treatment services for north Charles foundation -- -- many other things who's joining us on the phone in studio tonight and we have Judy Foreman is a nationally syndicated medical journalist and author author of the -- the nation in pain treatments are simple. So Judy let me let me ask you if someone you know just a typical patient goes to a provider of doctor. And they report pain they're dealing with some sort of acute or chronic pain what's the process like -- being assessed how were they treated. What's typical from your research. Offers -- a big difference between acute pain and chronic pain and we should probably make that distinction. Officially chronic pain is to find his pain lasts more than three to six months so let's take -- your pain that -- -- was my pain was chronic it was it was a bad year. With acute pain healing after surgery for a car accident you break your arm or something. That's pretty straightforward and generally the medical system does a pretty good job of that. But at but chronic pain is a totally different animal it's not just acute pain it doesn't go away. What happens is the nervous -- kind of ribs up. And just like you know when you learn French you learn to play the piano -- the -- you practice the better you get same thing happens the nervous system learns to process pain. Ever more efficiently which it gets better and better at it which of course worse and worse for the person. So the nervous system cranks up and -- pain becomes its own disease. And that is a concept that is really important and central to the whole Paine field. But a lot of doctors don't really know that. The other thing that most doctors don't know is itself from the immune system called -- cells GL IAL. Also helped with this cranking up process. So it's much more complicated than doctors ever learned tonight on our so late night hours of medical school. What to make a distinction before you go on there's a big difference between addiction and physical dependence. To addiction is a primary chronic general biological condition. Characterized by impaired control over drug use. The compulsive use craving even committing crimes to get the drug. Physical dependence is very different it's a state of adaptation to the drug somewhat analogous but not totally to -- diabetic needing insulin. So if you put if -- my -- you -- me an opium is. In a few weeks I will become dependent meaning my body has adapted to having my little we sectors in my nervous system full of I'll appeal it. Which means that if I -- Cut you know stopped cold Turkey. I will go through withdrawal have flu like symptoms I'll feel terrible. You you can overcome this without too much trouble in most cases by tapering off very slowly although some people have a hard time. Even if they're not addicted merely in quotes depended. But if there's an important distinction because. If you take ill feelings for any period of time there's a 100% chance it's a certainty that you you'll become dependent. But there's not a 100% certainly far from a that you become addicted. The figures for actual rates of addiction are all over the place they range from. Less than 1% less than 2% to about 30% no one really knows and it depends on your your family history so. There at third important distinction to be managed I'm sure Jan. Can verify sure so if I go to a doctor and he shows me that little chart you know with the with the pain scale a smiley face -- and sat face and I the other. I mean how did they assess this you know this potentiality that somebody might be coming in seeking medication. Compared to somebody who jets might you know -- really the truth yeah. Basically. It's it's really hard because it is all based on self report. Com and the assumption far too often especially in emergency rooms. If someone says they're paying the assumption by many many doctors and nurses is that the person is just a drug seeker. Bomb and it is so horrible but this they have to colliding epidemic that's a horrible situation we have a genuine drug abuse epidemic and we have an epidemic of poorly treated chronic pain and the suspicion basically falls on. -- patients their first perceived to be potential abusers and usually only secondarily as pain patient so it's it's a major problem so Qian. Can you tell us a little about. Your reaction to panic and there's. Well I mean I think that. Judy made some very important clarification -- between. Dependency and addiction that there are two different an ominous. -- from my perspective. I think about it a couple of ways when a patient comes in and and they report that they aren't paying. I believe them. I respect their report. We may have different ideas about what would be the best way to treat their pain. But one of the things that patients struggle -- it and provided as well is that this this whole business does is it real pain or not. And my response to that is pain is whatever the patient tells me it is. And so it is real to them. And there are many components to pain in people expressed -- a lot of different ways. And so I think it's just really important my first point is this sort of say we need to report we respect the patients reported pain. And if they say they're campaign there and pain. Patients with addictive disorders. Are very much treated. Like -- alike they are drug seeking I think. Oftentimes people who requested. Pain medications. In general are treated like -- drug -- But if you happen to have an addictive disorder if you happen to be on methadone maintenance treatment for example are. People north and treatment for an active addictive disorder. And you happen to have pain which is significant percentage of the population have you are seen as drug seeking. But -- but I think that we have to really pay attention to. If somebody has an addictive disorder. Or maybe in remission and has had an active it is addictive disorder in the past and is now in recovery. We need to respect that as well so we need to -- Being mindful of that they have pain. And we also have to respect. Complexities have been addictive disorder which can really -- the mine in the presence of getting old yet. That everything is under control and they're not going to be a problem. So you know there are a lot of ways in which I think about it. In terms of making sure that we're keeping both the disorders on the play and we're paying attention to blind. As we're addressing the other. I can get into some of the ways in which I think. That works as well as what we know. Or so soon that was again Jim we have a caller we have Paul. I'll tell what what's your question. -- -- my question. Two part question number one in the history of -- attack. I don't with -- it was a Germans but -- -- different ethnic groups of culture is what we shoes. -- you know when it was so called what was morphine. Heroin whatever may -- indication I think they'll be it's -- -- -- people listening and then number true. Probably -- now. Well so much trying to treat patients it's much like the criminal justice system which isn't work. Probation offices police officer's action almost assume everybody is lying now. Because people in the in in this city say people don't keep it real people almost expect that they need to lie. While you can stretch the truth. And we're gonna put up play away. -- that way. Thanks Paul I think that is one of the major concerns and that's as everybody is treated is about the mind. And I know we only have a little bit was huge and so can you kind of address. Well I mean I think that if somebody. You know we're talking about patients with addictive disorders. We know that. You know alliance I don't I don't know we'd like that the word line but you know sort of representing a person. You know perceive -- is part of an active addictive disorder. And that patients will do whatever they community in need to do in order to catch what they need. So that could be true. If they're trying to see the pain medication for our. Chronic pain. And they are trying everything they hand to get what they perceive they need to. You know -- for that treatment. So. You know I think that we have to keep in mind that. Patients will. Tell us what they need to tell us in order to get what they need and people would detect active addicted to sort of that's -- -- -- And I need to pay attention to that and I understand that on the one hand on the other hand. You know I -- to need to look a little deeper to find out you know what this campaign complaint. And whether the ways in which we can't help them hopefully get on a road where we can. Get real about what's really going on food and and put together. A approach that would be safe for both treating pain and also. Keep being honest with their addiction. Well thank you Jenn and thank you for joining us. And Jan is. She's a vice president. Vice president addiction treatment services for north Strauss foundation in Cambridge and we wouldn't and they'll be back from our break thank you for the call to keep calling. And. -- -- Welcome back I'm happy. I was -- down at dusk and get -- he -- and I still the word spread out enough that this assignment yet. And we're here with. We're here with two wonderful. -- experts on pain different aspects of it we're here with chief fireman who wrote a book and nation in pain which everybody should read and you know a lot more about pain in the new effort but he wanted to know -- -- -- know what you wanna know it yeah fastening. And Janet Kaufman -- them from north house foundation and one of the things we we've been talking about it you know opiates you know -- of its European medicines and they're not there must be other ways of treating pain and I definitely just both people here would know about them and I Judy can you tell us some of the other options of ways of treating people in pain. Yes there are a lot some more effective than others not surprisingly. There are some sort of traditional western treatments like surgery. Killing nerves on various. Techniques for sort of intervention techniques in medicine. There are some affect me in the right cases for the right candidate patients they work really well put in general. Particular surgery for back problems on. Did the data suggest people should not leap into surgery anyway and it when it's the answer -- pretty good answer but. Often it's not the answer and there's a lot of fear of the -- failed back syndrome. And in the prices back hasn't failed that doctors of feel the person. But there are a lot of other things I have a whole chapter interestingly in the book on marijuana for pain. And it's I got very Anderson going to these pink conferences because marijuana seems to be. -- closely. As effective as oh feelings for pain and it is way less addictive and even a federal government which has a very confused policy about drugs and -- Concedes that there are no deaths from marijuana alone and the reason is marijuana unlike OP -- does not cause respiratory depression. So you don't. Died from marijuana I mean if you drink and and take -- and driving -- carcass that's a different scenario. But there was recently a study in the last couple weeks showing that states that have legalized marijuana. We're reporting far fewer OP would be -- related deaths so. No one knows exactly why there's some data that marijuana plus -- appealing it's. Can reduce has a synergistic effect as they can reduce the quantity of OP -- -- taking. And if people are taking it for pain maybe they're getting the relief they need for marijuana which is a way safer drug the fan appeal it's true I'm. So -- and so if I if I went into your office and I had -- and I had it was in recovery from. You know my heroin addiction. How would you work with me if find it says you know guys back I had a background and I was starting to take painkillers again. This is that someone who's been recovering play. -- -- -- Well at least not back down is -- cover line is and recovery. I eat very important point to make I think -- -- So I mean I think that Eric look we're dealing with two. This -- that we have to keep in mind I think what I would say that the patient. Is. Being having addiction very actively apart if you treatment plans are -- and addiction approach is very important and so it's important -- top. Sponsor family member. To be going to counseling during that time so that Cuba and you know what we would say you know keep an -- on -- steps. Be able to deal with any cravings that appear on medication that medication made praying for you and to puts safety. Factors in place for you to help you. Monitor. Your use of pain medications. I think the first thing I would say is that there -- very important to be honest with your pain treating. Position. -- have an addictive disorder and that you are on methadone treatment and that hopefully. The collaboration of the pain treatment. Along with the fuel our addiction treatment would be something that would be dealt with together. And to communication back and forth between the treated this really important. Involving. Supports active support in your life so that if their cravings that can trigger there are. Ways to deal with that. That would. Hopefully deter you from using medications. Or you know doing what one does when their addiction -- hadn't activated so here -- also I think. You know to try things that are not OP -- medications. Or maybe not medications interventions as the first course of treatment as opposed to. Medications being the first court and for many people with addictive disorders. There's so used to did this automatic thinking that you have to be a medication. That nothing else will work. That that's part of the education process for the patient as well. I think that's interesting because I think that's not I think that's our cultures that the medication is they can't Boris and to say but. That gets back to impart. Two of the reimbursement system for health care because of the doctor has ten minutes to see you fifteen minutes. And here in pain in your story is complicated. They may think they should prescribe albeit -- -- time to get into your divorce and your mother dying and all these other things to contribute to year. Distressed. And they often don't recommend. Other things in my mind you know appear to be the last remedy not the first. Exercise is harm tremendously effective for pain effect I think if there's anything that's a magic bullet for many kinds of pain not all. On exercise and physical. Activity. Is number one. And yet for people in pain there's this huge fear is -- can these GO phobia. The idea is that at eight net -- as a big name. But you know if few movie you'll you'll do tissue damage you'll make your pain worsened. To work and that is more or more likely than not to be not true. But people are often depressed because of their pain and or depressed to start with and then also gets in the way of them exercising. And as they sit around they get fat. And that also gets in the way -- exercising. And so I mean I'm really. The so convinced of the exercise I have a whole chapter on that. And while many things in medicine there's studies runways -- -- the other way. Virtually all the studies on exercise and paint point two would be extremely beneficial. There are other things too that our our free or are close to -- meditation. Is not gonna get your pain from a ten down to a 60 by itself. But it can help it might knock it down and not trip to. And once you learn how to do it that's also free it's simple it's not easy to do that people -- and there's a lot of data from. Brain scanning technology showing that people who meditate. Are less likely to get chronic pain in the first place. And also that it can mitigate the pain. Again this does not mean that the pin is in your head or that your wrong thinking or your attitude or something is causing your -- But it is a trick that you can do to help cope with the pain. And there's other things is acupuncture there's two sides as a whole slew of things that can help to some degree. And if you add them all together you can make it a significant -- not a cure necessarily that a significant dent in the -- so. I'd like to comment on what you're thinking about depression Judy if I could answer because I think that you know when people in pain. They get to pro that's right I mean if it's -- resonate and normal. Reaction. Two years of life being so disrupted. Yesterday content. And so and if you are depressed. And you're not doing the things that you know make you happy. And it becomes a vicious cycle and so figuring out ways to keep people moving. So that they and not sitting and feeling horrible about that now is really an important though it's depression anxiety. They come hand in hand for people who have pain. And for people who have acted -- addictive disorders this is another co occurring issues that comes up the. And it can get crazy you have to treat both the pain and the oppression well and I let Aaron thanks Allan thank you -- for being and and in other talking -- communication and support some honesty is. You know respecting people's pain respecting their addiction as well. We're gonna take a break now and we've actually talked about what makes it. Hello we have a great guest in studio today a huge topic. We are speaking to Judy Foreman Judy have a question for you shared regarding your book. There's a lot of interesting stuff in there about gender and pain we're genetics and -- can you discuss those -- a little bit. I certainly can't. Why don't we start with genetics because I think a lot of people there's it just is there's a huge statement to addiction there's a huge statement to paint too. And actually research on rodents and human twin studies. Shows that forty to 50% of a person's susceptibility to pain and sensitivity to chronic -- -- is genetic is inherited it's huge it's huge and it's interesting scientifically but I think it's also really great because. It kind of takes the stigma off you know I mean it it does run in families and -- it's another way to think about. The pain that you have not being your own fault because people get blamed so much. Mom there's very agency research on this I talked to one woman who has a mutation in a certain gene and she is in. Terrible pain like in a twenty on a scale of ten. Every single minute of her life and three members of her family have committed suicide I should mention that the suicide risk for people in chronic pain is twice that. A -- not in pain. Mom and a different mutation in the same gene. Causes. And inability to feel pain I talked to the family of a young girl in Georgia who had that. And that sounds like it might be great but it's not because she's gotten herself severely burned and broken bones and even though and didn't know. So but -- -- the instinct thing from a scientific point of view is this is really leading researchers on a really productive path in terms of figuring out the genes that. Make pain better or -- to protect you or put you at risk of pain. And I think that's very very promising -- -- extremely interesting let. Things that was interesting is a discussion of gender because women only sane. And happy because this that there be no baby that they can't tolerate pain in my deterrent -- -- -- -- -- -- Actually it's not -- as well and women. Up until you know up until puberty boys and girls have roughly the same amount of pain. Says starting puberty Welker you know teenage girls and women get a lot more. -- we're not talking about pain that only women can get like childbirth -- PM answer breast cancer pain or something like that these are paying conditions that can strike anybody here able bowel fibromyalgia. Those things are disproportionately. A problem for women. And -- is quite sure why but it's a very real totally documented. Phenomenon that was a big -- couple years ago with. In ten countries with 85000 people. And 45% of women reporting some kind of chronic pain and only about 31% of men so it's it's a significant. Difference. One weird little sidelight to this is that despite this huge difference. Most of the basic -- research involving animals rats and mice. Is done in male rats which makes no sense of -- makes my blood boil. The National Institutes of Health is trying to rectify this and make scientists. Include female rats as well as males in the study and and to the point of recommending that journals not publish scientific papers unless the researchers do this sure. And I believe that the rats might have the same genetic predisposition. That we -- are female rats might feel pain differently -- mill -- That is probably also true and but but -- turns out to be no scientific justification for -- only -- strategies we thought that of humility too complicated they get imperious that you have babies -- for we will study them but that -- been totally blown a target at the popular they have -- -- and they get more than half the paint so that's that's crazy. -- there was a very interesting study. In Italy a few years ago that adds to my knowledge has not been replicated but they looked at transgender people. And the ones who went from male to female and started taking estrogen. Sort of reporting more pain. And the ones that went from female to male has started taking testosterone. Sort of reporting less pain. So in general there seems to be a big hormone influence on pain. And you know women often get migraines around their period in certain pain conditions for women get. Worse when they're pregnant some conditions get better when they're pregnant some get worse -- an -- on it that are -- opposed the estrogen part is really. Complicated but it's very important that gender thing is very I'm very important and some researchers now think it's so important that will end up with pink pills for women in blue pills from. So I live we have just a few more minutes and I just my -- You know you did that you've been doing this research are continuing to do recent let let -- be taken way way way when you're recommendations. Mike and I am I. -- -- well what if I really. Came away believing that the failure to adequately treat pain. Is akin to torture. Because it it really is a horrendous situation for people. That we are in a sense over regulating OP -- in our attempt to prevent addiction. We are really making it much tougher for paying patients and a lot of people even hospice care about a third of the people are still dying in pain. I was at Sloan Kettering not long ago on one of the Doctor -- talking medication to his dying from cancer in terrible paint. And the patient did -- take appearance because of the stigma I mean we've got we've got some crazy thinking going on with this. I also think a lot of the non drug. Approaches to pain management. Are huge and we should put a lot more effort into that doctors should educate themselves about this. But in the meantime money's no don't wait for the doctors I -- pain patients. Can do a lot there's a wonderful there was some wonderful pain organizations on the -- -- and in reality. US patent foundation and others have chronic pain American chronic pain association. There is help out their for people in pain but you have to go get a witness. Thank you for being with us GD. You can get teased but we know it's available at the books because we're there today at and then -- -- it's called a nation -- -- And it's incredible book it's you get and lot of research and you'll know a lot more and we have a few other things we wanted to talk about. And the Harvard and the annual men at Harvard Medical School chambers series called treating the addiction. It's streaming addictions it's every year. It's in you know the best minds talking about the best ways to treat addictions it's march 6 and seventh this year. We had a right turn we have a big event coming up on Saturday November 15 it's comics for recovery. Jimmy Tingle is headlining and we have Jack lynch -- and -- George MacDonald Katie crede -- prior. In our own -- -- hand providing music with his John -- hand trio. Tickets are available at the regent theatre. Box office or online at the region theater's website in Arlington. And it's 8 PM. And you can listen to -- turned radio on iTunes podcasts. Abolished shows. The show Libya and dared to. And we also please look at our web site. Like -- face that. Follow us on Twitter all those fun things to them just learning about tweet we just as I had between great moment. I'm thank you do -- And Ed Sweeney. Thank you guests. And remember. Be safe and. --