Homeopathy - Medical Mondays

Anti-rheumatoid and anti-oxidant activity of homeopathic Guaiacum officinale in an animal model

Amrita Sarkar, Poulami Datta, Asok Kumar Dasa, Antony Gomes

Laboratory of Toxinology & Experimental Pharmacodynamics, Department of Physiology, University of Calcutta, 92 A P C Road, Kolkata 700 009, India

aNational Institute of Homoeopathy, Salt Lake, Kolkata, India.

 

DOI: http://dx.doi.org/10.1016/j.homp.2013.08.006

Background

Homeopathy is a popular form of complementary and alternative medicine. Guaiacum extract is said to be useful for pain and inflammation, but there appears to be no scientific evidence to support this.

Aims

The aim of the present study was to evaluate the anti-rheumatic and anti-oxidant activity of homeopathic preparations of Guaiacum officinale (Gua) on experimental animal model.

Design

Rheumatoid arthritis (RA) was induced in male albino rats by Freund's complete adjuvant (FCA) at a dose of (0.25 mg heat killed Mycobacterium tuberculosis/ml of emulsion). Gua mother tincture (MT) (prepared from the latex part of the plant) (MT), Gua 30cc and 200cc were purchased commercially from King Company, Kolkata, India. Male albino Wistar rats (130 ± 10 g) were divided into 6 groups: Sham control; Arthritis control; Standard treatment indomethacin (0.25 mg 100 g−1 p.o. × 5 alternative days), Gua MT (1 ml kg−1 p.o. × 5 days) treated; Gua (30c 1 ml kg−1 p.o. × 5 days) treated; Gua (200c; 1 ml kg−1 p.o. × 5 days) treated. Anti-rheumatic activity was examined through physical, urinary, serum parameters. All the results were expressed in terms of mean ± SEM (statistical error of mean n = 6) at each dose level. The level of significance was determined through one-way analysis of variance (ANOVA), p < 0.05 was considered significant.

Results

It was observed that body weight, ankle and knee diameter, urinary parameters (hydroxyproline (OH-P), glucosamine, calcium (Ca2+), creatinine (CRE), phosphate (PO43−)), serum ACP (acid phosphatase)/ALP (alkaline phosphatase)/Ca2+/CRE/PO43−/gamma-glutamyl transferase (GGT)/Lipid peroxidation (LPO)/Glutathione (GSH)/Superoxide dismutase (SOD)/Catalase, serum GGT, serum interleukins like IL-1β/CINC-1/PGE2/TNF-α/IL-6, IL-12/IL-4/IL-6 levels were significantly affected. After treatment with Guaiacum in all 3 regimes was associated with normalization of these parameters compared to control group.

Conclusion

These findings suggest that homeopathic G. officinale possesses anti-rheumatic and anti-oxidant activity in experimental animal and these activities may be more significant in higher potencies.

Keywords:

Guaiacum, FCA, Arthritis, Interleukins, Anti-oxidant

Friday Fun Facts

A complete change where we no longer rely just on so called evidence-based medicine but we look at the long tradition of usage; we look at patients’ experience. We cannot deny this. It is completely absurd … we don’t take note of how patients feel about themselves. It is maddening that good inquiries are ignored… Why is it that the conventional community will persistently ignore these studies.
— David Tredinnick, Member of Parliament of Bosworth, U.K.

Salicylates and homoeopathy in rheumatoid arthritis: preliminary observations.

Salicylates and homoeopathy in rheumatoid arthritis: preliminary observations.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1429555/

R G Gibson, S L Gibson, A D MacNeill, G H Gray, W C Dick, and W W Buchanan

Abstract

This paper reports the results of a pilot study in which 41 patients with rheumatoid arthritis were treated with high doses of salicylate, 3.9 g per day, and the results compared with a further 54 similar patients treated with homoeopathy. Both groups were compared with 100 patients who received placebo. 2 The patients who received homoeopathy did better than those who received salicylate. The design of the trial was such, however, that it was not possible to distinguish between the effects due to the physicians and the effects due to the drugs and a further trial is planned to elucidate this point. 3 Patients on homoeopathic treatment did not experience toxic effects.

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (682K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  • Brooks PM, Stephens WH, Jr, Stephens ME, Buchanan WW. How safe are anti-rheumatic drugs? A study of possible iatrogenic deaths in patients with rheumatoid arthritis. Health Bull (Edinb) 1975 May;33(3):108–111. [PubMed]
  • Girdwood RH. Death after taking medicaments. Br Med J. 1974 Mar 16;1(5906):501–504. [PMC free article] [PubMed]
  • Huskisson EC. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127–1131. [PubMed]
  • Lee P, Baxter A, Dick WC, Webb J. An assessment of grip strength measurement in rheumatoid arthritis. Scand J Rheumatol. 1974;3(1):17–23. [PubMed]
  • Lee P, Anderson JA, Miller J, Webb J, Buchanan WW. Evaluation of analgesic action and efficacy of antirheumatic drugs. Study of 10 drugs in 684 patients with rheumatoid arthritis. J Rheumatol. 1976 Sep;3(3):283–294. [PubMed]
  • MANN LB, WEBER AB. Control of post-pneumoencephalographic headaches with EC 112; a preliminary review. Bull Los Angel Neuro Soc. 1953 Mar;18(1):52–54. [PubMed]
  • Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed]
  • ROPES MW, BENNETT GA, COBB S, JACOX R, JESSAR RA. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed]
  • Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976 Jun;2(2):175–184. [PubMed]
  • TRINDER P. Rapid determination of salicylate in biological fluids. Biochem J. 1954 Jun;57(2):301–303. [PMC free article] [PubMed]
  • Webb J, Downie WW, Dick WC, Lee P. Evaluation of digital joint circumference measurements in rheumatoid arthritis. Scand J Rheumatol. 1973;2(3):127–131. [PubMed]
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1429555/

Most Common Children's Teething Remedies

Is your child teething? Homeopathy can help!

There are a handful of very useful homeopathic remedies during children’s teething. The most common complaints that happen at the same time during the pain of teething include, rashes (cheeks and bum), congestion (stuffed up, runny nose and earaches), sleeplessness and therefore irritability and loss of appetite. Luckily there are some awesome Homeopathic Helpers during this trying time.

Here are some ‘indications’ lifted from our homeopathic Materia Medicas written by Vermeulen and Tyler.

Calcarea Phosphorica:  teething, dentition

 Likes to be alone. Children scream and grasp with hands; cold sweat face; body cold;  Heat in head, burning on top running down to toes. Sweaty heads.

SCHUESSLER Tell us how this drug was prepared by Dr, Hering. says " It is absolutely essential to the proper growth and nutrition on the body. It is found in blood - plasma and corpuscles, in saliva, Gastric juice, bones, connective tissue, teeth etc., Has a special chemicals affinity for albumen, which forms the organic basis for this salt in the tissue cells, and is required wherever albumin or albuminous substances are found in the secretions. It also supplies new blood cells, becoming the first remedy in anemia and chlorosis. it is of the greatest importance to the soft and growing tissues, supplying the first basis for the new tissues hence necessary to initiate growth.

Chamomilla: Chamomilla is turmoil in temper.

    If Cham. is a sick baby he is easily spotted. He will whine and howl and insist on being carried. The moment the tired mother or the jaded father tries to sit down, or to set him down, the music starts afresh; and the trouble is worse at night.

    Or, short of this, he stretches out his little hand for thing after thing, and when it is offered pushes it away in disgust. "He does not know what he wants" (says Nash), "but the doctor knows - it is Chamomilla. "   Another thing Cham. can't stand is Bed.

    Cham. thrusts the feet out of bed (with Sul., Puls., Med.). Is driven out of bed by pain or intense discomfort and misery.

    "The chamomile pains have this peculiarity as a rule, that they are most severe in the night, and then often drive the victim almost to despair, not infrequently with incessant thirst, heat and redness of one cheek: sometimes also hot sweat in the head, even in the hair.

Pulsatilla:

Pains in upper and lower teeth, worse towards evening. When in pain they are lying with head low, lying on sound side. Feels worse from warm food or drink. Can't keep quiet during pain, walks constantly about shaking her head. Toothache ceases out of doors, returns on coming into room. Feels better when outside or with open windows for fresh outdoor air. Mild and yielding disposition, especially when the patient in normal health was good - tempered and mild (or even frivolous and waggish). " " Pulsatilla is especially adapted, " he says, "for slow phlegmatic temperaments; and little suited for persons who from their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered, ".

Coffea Cruda: Sleeplessness

Phytolacca: Painful gums with teething

Rheum: Digestive complaints with teething. Odourous perspiration and urination.

Belladonna:  Fever & Redness with Heat Radiating. Dilation.

Combine the use of these remedies of course with breastfeeding and all the usual easy comforts like giving them something icy cold to chew on (also some may choose amber necklaces), lots of naps and as much nourishment and immune boosters as you can think of. These homeopathic remedies are natural, with no toxic effects so there is not a worry about ‘overdosing’. If you choose a remedy and it isn’t showing improvement, try a different one, no ‘more’ will make that difference.

 

 

Homeopathy Vancouver Friday Fun Fact

Dr. Todd Rowe MD (H), CCH, DHt. Homeopathic Program Director of the Phoenix Institute of Herbal Medicine & Acupuncture quotes a study by the New England Journal of Medicine; “revealed that over 50% of patients use alternative medicine here in the United States but 90% never tell their Medical Provider that they are using alternative medicine.”

Homeopathic Remedies for your Hot Summer Holidays

Emergency Remedies to bring to your beach days:

For sensitive skin:

Calendula can be used internally as a homeopathic remedy for sunburns that do not blister but feel hot, burning and itches. Urtica is another commonly used homeopathic remedy that can be taken internally for a typical sunburn with no blisters but itching and burning.

Cantharis is an excellent homeopathic remedy for burns that blister or are about to blister. For any serious burn, cantharis is a potent healing to relieve the pain and promote the healing of second degree burns.

For sunstroke or heat exhaustion; If you've gotten more direct sun than your body could handle at a time you may have headaches, dizziness, weakness, nausea, fever, flushed skin, dry skin and even confusion or fainting. You would definitely need to re-hydrate as much and as soon as possible. Belladonna is a powerful homeopathic remedy that can restore your strength. Belladonna can act fast if it is the correctly indicated remedy. Glonione is another potent homeopathic remedy to have on hand in case of sunstroke. Cuprum metallicum if there is some cramping of your muscles that develops along with the sunstroke.

Homeopathic FAQs: How is homeopathy different from naturopathy?

Homeopathy is a specialized ancient form of natural medicine. Seeing a naturopath is like seeing a GP (general practitioner) of natural medicine. Homeopaths are specialized in homeopathy and therefore will give homeopathic remedies using the whole homeopathic system of medicine, not in an allopathic manner. Naturopaths (and anyone who buys homeopathic remedies at their local health food store) can choose remedies using an allopathic philosophy. However, homeopaths can use remedies incorporating the holistic principles of homeopathic healing learned in their four years of minimum training. You can read more in depth about some of these principles on our blog.

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Homeopathy FAQs: What are the benefits of a natural approach to healing?

The process of healing varies from person to person depending on how ill you are, or on your levels of vitality. In the days/weeks after taking the homeopathic remedy you may find that you feel better in yourself - you experience an increase in energy and/or your complaints improve gradually or may even clear up completely.

With an acute or recent illness your improvement may be quite swift. Or it can be a more gradual process, especially if you have been suffering from a long term, or chronic complex illness.

Some people experience a slight worsening, or aggravation after their treatment (healing crisis). This usually occurs within the first day or two of starting a remedy and is a good sign. Aggravations mostly do not last long (part of a day or two), are manageable and are accompanied by an increased sense of well being.

Some Homeopathic Pharmacies are older than conventional pharmacies!

Some Homeopathic Pharmacies are older than conventional pharmacies!

You may experience a "return of old symptoms", in other words symptoms that you experienced in the past may resurface, and these too, are a good sign. They indicate that your body is clearing out an old disease pattern and are generally short-lived. This is always a good opportunity to ask yourself whether your symptoms are familiar, whether they remind you of something you have experienced in the past.

Health problems are symptoms of imbalance - a warning sign from your own body that it is not functioning as well as it could. The earlier you address a health concern, the easier it is to resolve.

What can I expect from homeopathy?

Homeopathic medicines are designed to stimulate your body's natural ability to heal itself - to act as a catalyst for healing. Overall, you can expect to see a lessening of the frequency and intensity of your chief complaint and everything else that might have come along with it. Homeopathy is like a “two-for-one” or even a "ten-for-one” deal because we are never treating only one health concern at a time, but instead treating the more deeply holistic you or WHOLE you all at once.

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Review of the Film “Vaxxed: From Cover-Up to Catastrophe”

I looked at the data that the CDC whistleblower was providing to Andy and Brian and it is the most compelling evidence of fraud I have ever seen in my life. I realized in that moment that I was looking at probably the biggest story of my lifetime. As a journalist, I realized it was a story I had to tell.Del Bigtree, Producer of Vaxxed from Cover-Up to Catastrophe

Practically from the opening scene, the film Vaxxed grabs our attention and doesn’t let go until it has elicited every ounce of empathy and outrage the human heart is capable of. Back in 2013, William Thompson, PhD, a senior scientist at the CDC was so wracked with guilt about his participation in a CDC study on the timing of the MMR vaccine and autism that he finally picked up the phone and called Brian Hooker, PhD, biologist and autism dad, to tell him where to look for the evidence of CDC deception. Vaxxed is the story of what followed, revealing evidence of collusion, corruption, and fraud at the very agency charged with protecting the public health.

The film was accepted by and then unceremoniously ejected from the Tribeca Film Festival after a firestorm of media attention which almost unanimously condemned the film even though not a single reporter had seen it. The media attention may have turned out to be a blessing in disguise, however, as it has many people who haven’t investigated the topic before asking, Why? What is so special about this film that so many people wanted to kill it? And so it was that the film opened last night to a packed house at Angelika Film Center in New York City. As a long-time New Yorker, there was a particular thrill to seeing this film at this theater. Angelika is my very favorite theater in New York. I have many vivid memories of terrific and thought-provoking films seen there, while surprisingly I have no clear recollection of any films screened at the Tribeca Film Festival.

Dr. Andrew Wakefield, who started his adult life as a research gastroenterologist studying Crohn’s disease and ulcerative colitis at the Royal Free Hospital in London, had his career destroyed by a case series he wrote with twelve other eminent gastroenterologists and researchers back in 1998 that suggested the possibility that the severe bowel disease they were seeing in children with autism might be associated with the measles virus found in their guts. Parents of eight of the twelve children in the series reported that their children had been developing normally or close to it until they received the measles-mumps-rubella vaccine (MMR). Scientific researchers look for patterns; they don’t spend their time and energy on random guesses out of the blue. If a researcher finds a pattern in what they’re seeing, that’s usually a good sign that there’s something there to investigate. Wakefield et al’s research was merely suggestive and didn’t draw any conclusions, but it clearly touched a nerve in some very powerful circles as this case series is used as a touchstone in virtually any argument involving vaccines and autism.

The fascinating thing to me is that the facts about this research are almost universally mischaracterized in the media to the point that we get comments from people all the time making wildly inaccurate statements like “that doctor was convicted of fraud and sent to jail!”, “Wakefield admitted he made it all up,” or “he performed dangerous and unnecessary procedures on children.” (Wakefield was not a clinician; he performed zero procedures on children, and the person who did perform most of these supposedly “unnecessary” medical procedures, Dr. John Walker-Smith, had his medical license reinstated when a judge reversed the previous GMC finding.) The whole thing would be comical if the effect of silencing debate and investigation were not having such a horrendous impact on so many children’s health.

Dr. Wakefield had already turned his efforts toward documentary filmmaking (a previous effort, Who Killed Alex Spourdalakis?, is among the most affecting and thought-provoking films I have ever seen) when Dr. Hooker called him and told him what Dr. Thompson was saying. Dr. Wakefield encouraged Dr. Hooker to record the conversations without Dr. Thompson’s knowledge to ensure that there was a record of his statements in case something happened to Dr. Thompson to make him change his mind. This was totally legal as both Dr. Thompson and Dr. Hooker were in states where one-party consent is all that is required for recording. Dr. Hooker re-analyzed the data that he obtained at Dr. Thompson’s suggestion, and it was damning. The re-analysis was peer-reviewed and published in Translational Neurodegeneration in August of 2014, then later retracted when the journal received a barrage of attacks similar to what happened to the Tribeca Film Festival.

Prior to beginning the original study, there was a six-month research plan written up. The research plan was intended to make the study unassailable, unlike the CDC’s Verstraeten Thimerosal study which was riddled with problems from the outset (explained beautifully in Trace Amounts, another documentary that came out last year). But, again, researchers ran into trouble right away. When they crunched the numbers, they found two very strong associations between the timing of MMR and autism. In African-American boys, autism was 3.4 times as common in children who had received the MMR before 36 months of age than it was in children who were given the vaccine after they turned three. In addition, children who had been developing normally for the first twelve months of life and later developed autism were more than seven times as likely to have had MMR before the age of three as at later time. As Dr. Wakefield rightly points out in the film, all the children in the study were given the MMR – it was only the timing that varied – and the effects were quite strong. How strong would the effect have been if they had compared children who had the vaccine before 18 months (as is recommended by the CDC in order to be “on time”) with children who had never received the vaccine at all?

But no one knows because the CDC didn’t publish the data. Instead of publishing what they found and doing the follow-on studies that should have been performed, they set about systematically getting rid of the strong signals they had found. Instead of following the unassailable research plan, they figured out a way to plausibly dump 40% of the data by requiring Georgia birth certificates. This reduced the amplitude of the signal itself as well as the statistical power of the study, meaning that whatever signal they did find could be explained away as “not statistically significant.” Not only did they discard the data for the purposes of publication, however, they literally threw the data away. Fortunately, Dr. Thompson, realizing that this was at best unethical and at worst illegal, kept copies of all the data.

This study was eventually published in 2004, four years after it began, and it was immediately taken to the Institute of Medicine, a supposedly independent organization, who used this study to recommend that no more investigation be done on the subject. At the time, the study was referenced in virtually every media outlet as “proof” that “vaccines don’t cause autism.” (Though any scientist worth their salt would know it was nothing of the kind even if it weren’t fraudulent.) Thompson rightfully complained to Dr. Hooker in 2013 that we had already lost 10 years of research because of the CDC’s paralysis around anything related to autism and vaccines. If that’s not enough to make your blood boil, you haven’t been paying attention.

At the beginning of 2009, five years after this study and the Verstraeten study were published, Julie Gerberding left her job as Director of the CDC to take a lucrative position at Merck, the maker of the MMR, running their vaccine division. It’s not hard to see that Merck was quite pleased with the work she did for them.

As a bystander who has watched closely as all the events in the film were taking place, I have been indignant at the wholesale ignoring of the evidence that our children have been sold down the river by powerful and cynical collusion between CDC and corporate interests. Del Bigtree, as a producer of The Doctors, an influential medical program that often received information from the CDC, couldn’t chase the story down himself when it broke, but as a journalist with a nose for a good story, he assumed that within two weeks it would break in every major news outlet. Not only did that not happen, no major news outlet has ever brought up the subject without the obvious agenda of “debunking” the story. (As a matter of fact, my fellow Thinking Mom L.J. Goes and myself are among the very few people who have ever been able to comment on the controversy on mainstream television.) This should have been Pulitzer-Prize-winning material, and yet no one was touching it. That was when Bigtree realized that all of television (and indeed the print media as well) is controlled by pharmaceutical advertising dollars.

It is clear, both here and in the U.K., that what the respective health agencies are protecting is not children’s health, but their vaccine programs. The “collateral damage” of this policy, the broken lives of previously healthy children, is poignantly portrayed in the film by interviews with parents of affected children like Polly Tommey, another of the film’s producers, and Dr. Hooker.

I know many of the people involved in the making of the film, but one of the most potent testimonies came from a mother I don’t know. Shirley Ealey brought her African-American boy-and-girl twins to a well-baby visit where a nurse lined up three shots each, including the MMR. When her daughter reacted by screaming, Ealey was distracted and didn’t notice that the nurse accidentally gave four of the shots to her son. Ealey asked where the missing shot had gone, whereupon the nurse realized she had given Ealey’s son a double dose of the MMR. Ealey was so upset that she whisked her children out of the office without letting her daughter get the remaining vaccines. At the time of the filming, Ealey’s twins were 19 years old. While her daughter speaks three languages, plays classical piano, and is an honor student, her son sits next to her on the couch happily watching Blue’s Clues on his iPad. Ealey’s tears as she contemplates the the stark contrasts in her twins’ development and what her son lost forever at that well-baby visit will haunt me for the rest of my life.

Perhaps my favorite part of the film is when Bigtree goes back to some of his old colleagues from The Doctors, where he worked for seven years before leaving to help make this film. Bigtree presents the documents to family medicine practitioner Dr. Rachael Ross and pediatrician Dr. Jim Sears, who are both cheerfully and confidently “pro-vaccine” (as always, I find myself irritated by the ridiculous premise that attitudes around a nuanced subject like vaccines can be reduced to the binary states of “pro-vaccine” and “anti-vaccine) before reading them and both visibly shaken by what they have read afterward. When Bigtree asks what Dr. Ross would say to the next parent who comes into her office asking about the MMR, she says she would tell the truth. She will not be giving it her own children (Dr. Ross had a baby girl in November of 2015), and she worries about what we are doing to children’s brains.

#autism #vaxxed #homeopathyautism #ceasetherapy

Indeed. She is by no means alone in that.

I recently watched the movie Spotlight about how journalists at the Boston Globe uncovered the tremendously damaging way that the Catholic church was handling sexual abuse charges against their priests. The journalists were blocked time and again by people willing to collude with the church in denying what they clearly knew was happening, but that just made the journalists more determined than ever to get to the truth. They were finally able to publish enough of the truth that they made it impossible for the Catholic church to continue institutional policies that allowed children’s lives to be destroyed.

Because of the current stranglehold that pharmaceutical dollars have on mainstream media, this story is even harder to get out. Just as in that situation, a powerful interest group is working day and night to suppress the facts — they know children’s lives are being destroyed by their policies and they just don’t care. Fortunately, the filmmakers of Vaxxed: From Cover-Up to Catastrophe know that, in this era of increased communication and transparency, mainstream media censorship can only postpone the truth getting out, not prevent it. So they threw their hearts, minds, and souls into this film as a way of circumventing that censorship. And they did a damned fine job of telling a difficult story that needs to be told.

Now it’s your turn to do what you can to get the message out there. See the film. Share information about it on Facebook and Twitter. Encourage everyone you know to see it — especially if they are not already familiar with the facts. Just like the journalists at the Boston Globe did, let’s make it impossible for this powerful organization to continue those policies that are sacrificing children’s lives to some bizarre conception of the Greater Good.

~ Professor

http://thinkingmomsrevolution.com/vaxxed-cover-catastrophe/

Homeopathy FAQs: Why should I consider homeopathy?

  • Homeopathy is safe.
  • Although many homeopathic medicines are prepared from plants and other substances which are poisonous in their crude form, the processing renders them completely non-toxic to be made into homeopathic remedies.
  • They can be given safely to breast-feeding mothers as well as to children.
  • Homeopathic remedies work by stimulating the body’s own healing mechanisms.
  • Holistic approaches are needed to promote and maintain a more comprehensive well-being.
  • A homeopathic perspective really helps to make sense of not only our illnesses but the health and development of ourselves and children.
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Testimonial

“When I went to see Elena in 2006, I was suffering from depression, panic attacks and was having trouble sleeping. I was missing work and knew I had to do something different than taking conventional medications that weren’t working for me. Elena spent a significant amount of time getting a good understanding of what was going on with me. After the first remedy she chose, my anxiety disappeared and I was myself again; very functional, happy and enthusiastic for life. Five years later, I experienced some similar symptoms and went back to see her and was significantly better the very day after taking my homeopathic remedy.”

— N.P., Vancouver