Outsourcing

Simply because I can -- my rationale for almost everything these days -- I subscribe to MedWorm and receive a news feed for "CRPS" and a few other stray acronyms, synonyms. Every afternoon, I cull through whatever the offerings are. Usually, though, I will have already been alerted about things of substance by an email from Jim Broatch, Executive Director of RSDSA, a man with whom I have never spoken, and with whom I have never corresponded. Our doings are all one-way. Some time later, from a few days to a week, I am apt to receive some overlapping information from Anthony Tobin, grandfather and researcher extraordinaire. By the time I hear from Tony, another man with whom I have never spoken, and with whom I have never corresponded, the material referenced has the advantage of having been vetted by a number of "experts."

There is a difference, of course, in the content coming from Broatch & Tobin, and that sent winging my way by a random news feed.

Consider what I received today from each source.

Jim Broatch forwards an article from RSDSA's interactive content editor Jennifer Hlad entitled "Spinal implant helps Marine deal with pain from Iraq injury." I was immediately reminded that one of the rare positive results of war is a rapid advance in the treatment of traumatic injuries, and of wounds inflicted by whatever horrid new weapon has had its way in the current round of atrocities. The U.S. - Iraq War will be remembered for countless brain injuries and the emergence of PTSD as a terrible time bandit. IEDs have made severe orthopedic and neurological injuries to extremities an everyday threat. I remember wondering whether the incidence of CRPS would rise due to the prevalence of those potent and insidious homemade bombs. I guess it did.

It is not coincidental that the first sustained modern notice of CRPS dates from the Civil War.

Anyway, here's an excerpt of Hlad's article, which can be found at the RSDSA website:

Beep. Beep. Ahhh.

Bobby Joseph straightens his back, letting out a sigh of relief as electrical signals pulse through his leg, giving him respite from the piercing pain that has racked his body since Nov. 11, 2006.

"Oh, yeah," he says, grinning.

Before the surgery, 27-year-old Joseph woke up in pain every morning. Every step with his left leg brought with it a "shocking, stabbing pain." The drugs and the nerve blocks helped, but they didn't make the pain go away. Still, when Dr. Rick Foltz first proposed implanting a device in Joseph's spine to send pulses through his body, Joseph was skeptical.

"I've seen Robocop ... I was like, I don't want to be half man, half machine," he said.
Then he did the seven-day trial.

"I felt like I was Superman," he said. "I loved it. I wanted the real thing right then and there."

In early July, Foltz and another surgeon put the device in Joseph's spinal cord. Wires and electrodes send electric signals to his nerves, changing the way the pain is transmitted to the brain, Foltz said. Joseph controls the signals with a remote device, changing the pulses based on whether he is sitting, standing or walking.

"It is basically tricking your brain, so there's no pain there," Joseph said. "It is like a pulsing massage."
Joseph was three months into his fourth deployment, patrolling a street in Anan, Iraq, when the bomb went off. The blast blew him from the road's median, as shrapnel pierced his legs, his face, his arms.

"It ripped me apart," he said, showing off the massive scars on his left thigh and calf.
[....] Literal walking is a different challenge. Joseph suffers from complex regional pain syndrome, a syndrome in which a patient has pain that is disproportionate to the wounds. The syndrome is more common in patients with severe injuries, and Foltz said he sees more of it in wounded warriors because of their injuries.

In addition to the pain, patients may be so sensitive they can't even stand to have a bed sheet brush their leg or arm, Foltz said.

"It's very difficult to treat," Foltz said. "If we don't treat it right away, it can turn into a debilitating, long-term pain syndrome. So when the wounded warriors come back, we want to be very aggressive in the treatment, to get them better as fast as we can."

That's the nature of an electronic alert from Jim Broatch -- news of
progress, legislation updates, research fundraising efforts, or maybe the sharing of a new blog by one of those Obnoxious Incredible People With CRPS.
Although I've not heard from him for a few weeks, I might get some of the same from Tony Tobin of Essex, England, who was for a long time my sole source to research and the inner workings of the virtual CRPS world. He runs a news service through Yahoo! -- the impetus for which was: "Have started research into RSD after my 9 Yr old Granddaughter was diagnosed with it. Update. Said 9 yr old is now 13 and is doing well. I am proud of her." I said "some of the same," but really, what comes from Tony are vetted things -- things that he has personally looked into, things referred to him perhaps several times over from people he trusts. He is into whatever works, and is open to arguments about an idea's potential. From Tobin I get things like information on Mirror Box therapy, a journal paper, Lymphocyte Subsets and the Role of Th1/Th2 Balance in Stressed Chronic Pain Patients as well as an invitation to discuss the role of medicinal marijuana in controlling CRPS pain.
*cough*
When I am fielding the posts from the RSDSA Executive Director or the Research Grandfather Extraordinaire, I have a feeling of connectedness. Sure, I know that much of the time, material is being dumbed down for me... assumptions of my capacity for unpacking anything remotely scientific are made, and I am presumed lacking. To that end, I have my purely scientific sources. To wit: my various little Med Worms.
This afternoon I went from wanting to tie yellow ribbons around oak trees, and checking out the vibrant blogs of lithe young blond people mastering pain by sheer force of will and disposable income to... well, that place you go when you are sent this, an abstract of an article in Mediators of Inflammation:
Case Report
Expression of Endothelial Nitric Oxide Synthase and Endothelin-1 in Skin Tissue from Amputated Limbs of Patients with Complex Regional Pain Syndrome
Background and Objectives. Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS) is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Endothelial dysfunction is suggested to be the main cause of diminished blood flow. The aim of this study was to examine the distribution of endothelial nitric oxide synthase (eNOS) and endothelin-1(ET-1) relative to vascular density represented by the endothelial marker CD31-immunoreactivity in the skin tissue of patients with chronic CRPS. Methods. We performed immunohistochemical staining on sections of skin specimens obtained from the amputated limbs (one arm and one leg) of two patients with CRPS. Results. In comparison to proximal specimens we found an increased number of migrated endothelial cells as well as an increase of eNOS activity in distal dermis specimens. Conclusions. We found indications that endothelial dysfunction plays a role in chronic CRPS.
One arm! One leg! Arg! There is a reason why I am more suited for the scientistic.
(Marmy adds a particularly strident Ack! Ack! La Belle Bianca Castafiore has been stricken with tonsillitis, and her neck is wrapped in flannels, the world temporarily stripped of her opinion. Nous esperons tous qu'elle se sent mieux bientôt! N'est-ce pas? tousse tousse N'est-ce pas?!)