More Rotten Pot -- That's "Pot Pourri" to You!

Hmmm. I began this hodge-podge of an entry on October 3, and promptly forgot about it. In fact, when I stumbled upon the list of my dozen or so drafts, it was quite enlightening. As in: Oh, so that's where I left that thought.

Today is October 11, 2008, and I am different than I was on October 3. Primarily, I am much, much poorer, having lost beaucoup d'argent in the market. My health care costs (insurance premiums, co-pays, out-of-pocket, and care not covered) use over 85% of my private disability income. I am responsible for keeping the household afloat, so supplementary monies from my investments are the only help I have. Rather: HAD. I pay all utilities (except water), groceries, and half the mortgage -- plus, I cover the inevitable unscheduled expenses that occur in the maintenance of your average centuries-old European manor located in the Tête de Hergé. Stuff like the costs of reparation of smoky Rembrandts when Marmy decides to do a little vertical marking. Like weaving a textile patch to match the one-of-a-kind medieval tapestries that depict the warring and artistic history of the Castafiore family. Yes, and the more mundane stuff -- a better grade of lawn mower, hedge clippers, HVAC repair, and the odd new roof. So, as my investment account was decimated, my panic grew in countertime, in immensity. I cannot show fear to the Fredster, to the Felines -- not even to La Belle Biance Castafiore. "Don't worry!" I practically crow. And my-oh-my, the afflictions that go with living with CRPS / RSD? The exacerbations due to emotional stress? I've got 'em! For once, I will spare you the laundry list. (There is one thing, though, that has me confounded -- a blistery rash that feels and looks like a bad burn. Not knowing what to do, I slathered on some betamethasone dipropionate cream. When in doubt, find the closest steroidal concoction!)

After deleting all the now irrelevant detritus from the draft, and after adding all the flaming issues of the day, this is the sad bit that remains:

• I have fallen in love with Jon & Kate plus 8 -- I sometimes watch marathon sessions of the television show and am simply in awe... Laughter comes easily: yesterday, one of the sextuplet boys ran to Daddy, full of eureka and aha, to whisper "I am your son!"; Kate keeps her toenails painted because another one of the boys has a toe fetish; The twin girls shop for each other's Christmas gifts but insist, as well, that they each *receive* the same item that is being gifted... Still, I wish Kate would ease up -- verbally -- on Jon, although I get that she is maxed out in every imaginable way. He's amazing, she is awesome -- I am slack-jawed, and those children are blessed.


• Austrian National-Socialist Joerg Haider is dead. Saves me some trouble. Why is Mugabe still alive?


• I killed Pinochet. Yes. Yes, I did. Shush! I did, too! Much in the same way that I kept the paper cutout of the life-sized head of Jesse Helms impaled on my cork bulletin board with a 5.5-inch Henckels boning knife.


• What makes hydrogen peroxide fizz?


• The mail just came -- and despite my instructions that no bills find their way to me this morning, Fred somehow allowed Plumtree Orthopaedic Dudes' bill into the pile of junk mail (a Vera Bradley catalog, a Fidelity mailer on "retirement planning," and my yearly "invoice" for our CCF-sponsored Ethiopian child). How is it that my insurance refuses to pay for the services of the PA who apparently assisted my orthopedic surgeon in my recent surgeries? Even more wondrous... how is it that said PA *dares* to charge me $7,427.12 for his services when he is as much a surgeon as I am? And... jagged deep breath... what the hell is this additional $17, 125 listed as a balance? Plumtree Orthopaedic Dudes have always engaged in crooked billing, in my experience, but after two go-rounds, years back, I gave up trying to fight it. So how screwed am I? If you have followed my saga, you know that my real and actual (i.e., not the PA) orthopod is yammering the pros and cons of gifting me with a new right shoulder prosthesis, once he is convinced the infection that decimated the success of the old one is definitively gone. Will he proceed if these charges are still in dispute? Because in dispute they are. The hospital bill was over $100,000 and was paid in full by insurance... what is the problem with resolving the surgeon's fees? Could it be that they have finally caught on to the fraudulent billing (primarily double-dipping, duplicate charges in masquerade)? I have excellent coverage and am darned lucky to have it -- but I pay over $17,000 a year for the privilege (privilege?). Where did I stash those spare millions?


• Sarah Palin, reverse-nepotism in action!


• Does crystal meth give women a high, whiny voice? Or do women with high, whiny voices have an unusual affinity for the drug?


• And, as always, I wonder, along with Bill Cosby: Why is there air?

Low Dose Ketamine and Memantine for Neuropathic Pain

I recognize and respect the frustration that doctors and nurses must experience when patients delve into the internet to obtain medical information, and then bring that "research" in to appointments in full "eureka!" mode.

That said (ar! ar! ar!), one of my MedWorm news feeds, on ketamine, turned this up:
ultra-low dose ketamine and memantine treatment for chronic pain -- specifically, neuropathic pain. As usual, the non-malignant neuropathic pain is represented by diabetic peripheral neuropathy. This use of memantine is off-label (of course) -- the drug is usually used in moderate to severe Alzheimer's disease (Namenda).

In the October 2008 issue of Anesthesia and Analgesia, doctors from the Anesthesia Department of the University of Washington published "Ultra-low dose ketamine and memantine treatment for pain in an opioid-tolerant oncology patient."

This is the abstract of the article that the authors submitted to PubMed:

Patients taking high-dose opioids chronically for tumor-related or neuropathic pain may develop pain that is refractory to opioids. One option for control of such pain is the use of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine. We describe a case of opioid-refractory pain that responded to a low-dose IV infusion of ketamine in the inpatient setting. The patient was then successfully transitioned to oral memantine for long-term outpatient management, in a novel use of this oral NMDA receptor antagonist. We present recent findings from basic research on pain mechanisms to explain why opioid tolerance, as in this patient, may contribute to the analgesic benefit of NMDA receptor antagonists.


"Memantine Significantly Reduces Peripheral Neuropathy Pain in Diabetics" was the next thing I turned up -- yes! I released the hounds! I let the dogs out! And I dare to call it research... But will I dare to stalk my internist, neurologist, and pain management doctor-dude with the information that I have culled, and will continue to cull?

Yes, I think so. It has been several years, actually, since I have dragged in any articles. Mostly, I read and then present anything interesting in a very brief oral report that inevitably results in the same reaction of "uh-huh." That is not to say there is no interest -- no, the problem lies elsewhere. The problem is that "no one knows" how CRPS / RSD really comes about, sticks around, or is best treated. I feel myself on almost equal footing with some of the more speculative researchers out there, with the difference that I cannot afford -- neither by bank account nor by insurance coverage -- the treatments that are in the pipeline.

Bitter? Moi? Of course not.

Shoot, we just added Forteo as an off-label use -- why not give this ketamine-transition-to-memantine idea a go? I think sometimes that they give me way too much credit. There is this tacit assumption that Retired Educator, succored by Fred, the felines, and La Belle Bianca Castafiore, and living the luxe in Marlinspike Hall, Tête de Hergé, can handle any amount of pain.

Not so. More and more "not so" with each passing day.

(Oh -- for those who don't know, MedWorm is a "medical RSS filter engine" and proves *occasionally* helpful in turning up germane articles -- but only if you feed the worm with very specific and well-thought out search guidelines. You must then bring the full power of your intellect to bear upon the results and vett the weird and unfounded, the scientistic and the industry-driven.)

"i carry your heart with me"

Encore un cadeau de la part de TW -- quelle image calme et sauvage en même temps. Il faut dire que j'aie mélangé la photo d'un jour avec la citation attachée à un autre -- une liberté que j'espère ne sera pas trop -- trop. Libertine? Violente? En tout cas, si cela semble ne pas marcher, ne pas aller ensemble, c'est de ma faute à moi -- ça n'a rien à voir avec TW!






nearing Seventyfive Mile Canyon on the Escalante Route



here is the
deepest secret
nobody knows
(here is the
root of the root
and the bud
of the bud
and the sky
of the sky
of a tree
called life
which grows
higher than
the soul
can hope
or mind
can hide)
and this is
the wonder
that's keeping
the stars apart

i carry your heart
(i carry it in my heart)

--e.e. cummings (from "i carry your heart with me")

Merci encore une fois, mon frère.

Critical Mass or Freshman Comp

A close relative of mine is an English professor at a university that I've never been able to locate on a map. This semester he has been stuck with some Freshman Comp courses, designed to instill good writing and research skills, as well as a measure of critical thinking.

Last week he assigned a critical and rhetorical analysis of some famous protest songs and first drafts are beginning to trickle in. He began the initial evaluation of these gestational pieces today.

It is a bad sign that I should receive an email about their content so soon.

My dear brother writes:

I'm spending the morning looking at first drafts of the song project; things aren't looking too good. I give them minimal guidance for the first drafts, hoping to see just how they've interpreted the assignment. Apparently, the idea of a thesis merging literary and rhetorical analysis escapes most of my writers. (Although I must admit, it is an odd notion indeed, smacking of a grad school assignment adapted for freshmen.)

So they tell me in very broad terms about the singer ("Marley was a Jamican who sometimes visited the island of Hadee"--No, I'm not kidding) or about the hippies roaming free during the 60s or about how Donovan wouldn't dare sing "Universal Soldier" to an audience of American patriots because as "[t]he movie 'The Punisher' said it best: 'if you want peace, prepare for war.'"

War indeed. Where do I begin?

Creepy

What is worse? That I post pictures of my limbs afflicted with CRPS / RSD or that people download those pictures?

Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.

I am sorely disappointed.

Sigh.

The appropriate -- but discouraging in its very appropriateness -- response?

Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.

The significant difference? McCain, at the time a United States Senator, was determined by the Ethics Committee of exercising "poor judgment" -- poor judgment that contributed to the Savings and Loan debacle of the late 1980s and early 1990s. Barack Obama points out that Bill Ayers is “somebody who engaged in detestable acts 40 years ago, when I was 8.”

Is it noteworthy to point out that McCain's indiscretion occured when he was at the comparative ripe old age of 51 (depending on what date one chooses: I chose 1987 because it marks McCain's maverick-y response to being called a "wimp" -- that is, it marks his participation in the infamous April 1987 meetings with FHLBB members.)

Oh, did I forget to point out that once McCain discovered Keating was under criminal investigation, he ended his involvement? Selon Wikipedia:

On April 2, 1987, a meeting with chairman Gray of the FHLBB was held in DeConcini's Capitol office, with Senators Cranston, Glenn, and McCain also in attendance.[8] The senators requested that no staff be present.[13] DeConcini started the meeting with a mention of "our friend at Lincoln."[8] Gray told the assembled senators that he did not know the particular details of the status of Lincoln Savings and Loan, and that the senators would have to go to the bank regulators in San Francisco that had oversight jurisdiction for the bank. Gray did offer to set up a meeting between those regulators and the senators.[8]

On April 9, 1987, a two-hour meeting[5] with three members of the FHLBB San Francisco branch was held, again in DeConcini's office, to discuss the government's investigation of Lincoln.[12][8] Present were Cranston, DeConcini, Glenn, McCain, and additionally Riegle.[8] The regulators felt that the meeting was very unusual and that they were being pressured by a united front, as the senators presented their reasons for having the meeting.[8] DeConcini began the meeting by saying, "We wanted to meet with you because we have determined that potential actions of yours could injure a constituent."[14] McCain said, "One of our jobs as elected officials is to help constituents in a proper fashion. ACC [American Continental Corporation] is a big employer and important to the local economy. I wouldn't want any special favors for them.... I don't want any part of our conversation to be improper." Glenn said, "To be blunt, you should charge them or get off their backs," while DeConcini said, "What's wrong with this if they're willing to clean up their act? ... It's very unusual for us to have a company that could be put out of business by its regulators."[8] The regulators then revealed that Lincoln was under criminal investigation on a variety of serious charges, at which point McCain severed all relations with Keating.[8]

I am very attracted to people, politicians, especially, who are able to adjust their attitudes and actions when new information comes to light. Nothing proved more disheartening to me than W's constant noise about not changing horses in midstream, not abandoning a stance, even a clearly inappropriate and losing stance.

More than just a sign of intransigeance, his rigidity heralded his cruel stupidity.

Mais je divague... So I admire, to an extent, McCain's retrieval of his good sense from the edge of criminal intent and activity -- back then. What an honest guy. What a maverick. WhooHoo.

Likewise, I am very put off by people, politicians, especially, who figure, and appeal to, some sort of lowest common denominator.

In June, the Washington Wire blog at WSJ.com published this interesting take on current applications of Swift Boat style political attacks:

June 30, 2008, 6:55 pm
McCain Supporter Defends Swift Boat Attacks
Laura Meckler reports on the presidential race from Harrisburg, Pa.

A group of John McCain’s supporters came together today to defend McCain against charges that he was overstating the importance of his military service. Many remember how Democrat John Kerry was wounded by attacks in 2004 on his military record, and the McCain campaign does not want to let any charge go unanswered. More important, the spat gives the McCain campaign a reason to talk about his military service, a topic that serves him well.

The conference call with reporters took an odd turn when the supporters were asked if the anti-McCain comments, including one issued Sunday by retired Gen. Wesley Clark, were analogous to charges issued by Swift Boat Veterans for Truth, the group that attacked Kerry in 2004. The group was condemned in many quarters, and today its very name — swift boat — is used as a synonym for a slimy political attack. Even McCain condemned the Swift Boat group in 2004.

But one McCain supporter, retired Col. Bud Day, who was held prisoner with McCain in Vietnam, said the attacks on McCain were nothing like the swift boat attacks. He helped produce those attacks against Kerry, which were true, he said. The attacks against McCain are not, he added.

Put all of this in the context of Sarah Palin's most recent idiocy -- and we are back to old-school backroom nonsense, made almost intolerable by this bright and shiny, now inane, now astute, new mouthpiece. She is paving the way for another detour from today's problems in order to reintroduce Jeremiah Wright, and -- undoubtedly -- Tony Rezko. God forbid she should address the economy in lieu of "associations" that have been explained and vetted ad nauseum.

Douglass K. Daniel goes beyond pointing out the blatant dishonesty of Palin's lowest-common-denominator approach and notes a frightening racial "subtext" in her golly-gosh-gee remarks:

Palin's words avoid repulsing voters with overt racism. But is there another subtext for creating the false image of a black presidential nominee "palling around" with terrorists while assuring a predominantly white audience that he doesn't see their America?

In a post-Sept. 11 America, terrorists are envisioned as dark-skinned radical Muslims, not the homegrown anarchists of Ayers' day 40 years ago. With Obama a relative unknown when he began his campaign, the Internet hummed with false e-mails about ties to radical Islam of a foreign-born candidate.

Whether intended or not by the McCain campaign, portraying Obama as "not like us" is another potential appeal to racism. It suggests that the Hawaiian-born Christian is, at heart, un-American.

The fact is that when racism creeps into the discussion, it serves a purpose for McCain. As the fallout from Wright's sermons showed earlier this year, forcing Obama to abandon issues to talk about race leads to unresolved arguments about America's promise to treat all people equally.

John McCain occasionally says he looks back on decisions with regret. He has apologized for opposing a holiday to honor Martin Luther King Jr. He has apologized for refusing to call for the removal of a Confederate flag from South Carolina's Capitol.

When the 2008 campaign is over will McCain say he regrets appeals such as Palin's?

I am sorely, sorely disappointed. This was supposed to be the election of all elections, wherein dialogue was to be on point, on policy, and all about respecting the intelligence of the American electorate. Instead we are left with inflammatory analogies that kill the intellectual rigor most had been hungrily anticipating for the presidential elections of 2008.

Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.