Friday, February 13, 2009

Hiatus and the Wordle Terminus

I am having my fourth major operation since late August on Monday and am, for some reason, a nervous nelly and not much use to anyone -- so in lieu of writing my insecurities over and over
-- please find below some reposting of entries from yesteryear to take up the slack.

And I'll see you on the other side! I am hoping to be home by Friday, but the surgeon makes no promises (and takes no prisoners...). All good thoughts are appreciated.

Also -- do you hear the buzzer? Yes, we have come to the end of the latest Wordle Challenges.
(Once again, Fresca reigns supreme.)

Wordle Challenge #4: Lincoln, Gore Vidal
Wordle Challenge #5: The Adventures of Tom Sawyer, Twain
Wordle Challenge #6: 1984, George Orwell
Wordle Challenge #7: The Clown, Heinrich Böll

Wednesday, February 11, 2009

Stump the Sussex Spaniel

I'm in love with Leopold, the Great Dane. More correctly known as Ch Sasdania's The Prophecy, he stole my heart away and, incidently, won Best of Breed. He didn't make it to Best in Show competition so I am sure he and his handler/owners appreciate his titular position here at elle est belle la seine la seine elle est belle.

With my abject apologies, I just don't get Stump, the Sussex Spaniel that took Best in Show. Sired by Ch Three D Genghis Khan, the dam to Ch Clussexx Three D Grinchy Glee was the ever effervescent Ch Clussexx Sprinkled With Dew. So who has been dropping acid -- putting this dog in the "sporting" group? He looked... tired. Exhausted. Almost asleep. But clearly, I know nothing -- the crowd went wild everytime the poopy-faced 10 year-old Sussex Spaniel took center stage. (He had to take rest breaks every 10 paces.)

The Scottish Deer Hound was pretty impressive -- but did they have to name him Tiger Woods? In the end, despite obvious beauty and stellar breeding -- a little too tweedy. Far too casual, far too something that some bonny nanna might knit and purl.

The Brussels Griffon made everyone's list, I think -- incredibly perky, with an air of agreeable insubordination about him that is endearing. He clearly thinks himself quite The Big Bad Boy, that little griffon! Prancing around on tiptoes, cutting his eyes -- he'd make a great Best in Show, but no-o-o-o! We want that tired old Stump.

Making it all great fun for me, and everyone, was Mary Carillo. I have enjoyed her since her tennis days -- and am ready to crack up whenever she is doing commentary. She has really branched out -- the Westminster Dog Show, Chinese cultural doodad reporting during the Olympics, as well as maintaining her bread-and-butter sport of tennis. She and John McEnroe are old mixed-doubles partners, and together they are a regular riot.

It hardly needs saying that I know absolutely nothing about dogs in the context of good breeding traits -- my context is one of friendship, man's best friend, that sort of sloppy thing. My last dog was Emma, a sorta golden retriever from a local shelter. She was the embodiment of joy.

photos courtesy of

Doing It Twice

The next surgery is scheduled for Monday, February 16, at an as yet undetermined time. I know that they prefer to do "dirty" cases last, so I anticipate a late afternoon start time. Due to Fred's hectic schedule this week, the only day we can get the pre-op testing and all the admission details done is Friday. Cutting it close, but the nurse said it would be okay.

She hugged me again.

Everyone is hugging me. It makes me nervous.

The PA was sweet -- a tough adjective for such a big, tall guy to pull off, but he does. The two of them sort of crashed in my exam room -- I am like a comfortable piece of furniture over there -- and I was surprised to hear them violating HIPAA all over the doggone place, much as they did last week. Not that I remember, or even care to remember, any of the patient names they tossed around. They were not badmouthing anyone (except for the occasional raised eyebrow and shift in tone of voice) and they were clearly exhausted. Dr. ShoulderMan is running them ragged. Red-rimmed eyes, the both of them.

This was my informed consent: "You know the drill, right?" Actually, I am fine with that, though I did have a moment of feeling pissy about how blasé we all are now about slicing me open. This will be the fourth major operation since the end of August, the third on my right shoulder. They anticipate removing the spacer that's in there and either giving me another (if still infected) or if everything is pristine, giving me another prosthesis.

NOTHING showed on the x-rays of the left shoulder -- which absolutely blows my mind, because I cannot even use the damned arm, and the slightest jostling causes intense pain. The PA will show ShoulderMan the films today or tomorrow, to see if the Master has a different interpretation.

And so they "consented" me for bilateral shoulders on Monday, but with no real intention to do both -- the two of them said it was definite for the right side. In the interim, I am to try taking more muscle relaxants, and doing "whatever works." God, I wish ShoulderMan had been there. Not that I don't trust the PA and the nurse -- they are excellent -- but he is supposed to be the freaking orthopedic genius. And as nothing is working, I am kind of clueless how to help myself. Maybe I will slap the stupid TENS unit back on and groove to the funky beat...

Okay, so maybe he was busy, off somewhere saving limbs and lives. Or attending a conference full of ultra-important information that he really needs to know. Possibly, he is delivering a paper of earth-shattering significance, being the Bone Sage.

This morning, I tried using the arm, with no improvement and excessive pain. So I switched back to one-arming it with the infected-as-all-get-out right arm. [We all know it is still infected, or re-infected, if one wishes to engage in semantics. My fevers, white count, C-RP, etc. all are screaming to be acknowledged.]

And then I blithely, unconcernedly, stupidly, picked up the full carton of milk. No, that wasn't so stupid. What was stoopid was doing it twice. (Back on 22 May 2002, after falling and fracturing my leg and other skeletal parts, the Evil Deaf Asshole Nurse made me stand on it -- slamming the door to the hall shut and hissing "It's not broken, stand up, standupstandupstandup!" And so I tried, falling back to the floor with another loud c-r-u-n-c-h sound. With such a great initial result, of course I tried it again -- at her effing urging. By then, my entire foot had rotated to an inhuman angle, the leg was purple and swollen, and, unbeknownst to Evil Deaf Asshole Nurse, unbeknownst to me, CRPS had begun...)

Ummm: Flashback.

{Who is that screaming? And is it now or is it then?}

I am prone to flashing back with doing-it-twice pain -- stoopid pain that could easily be avoided -- also when I am fearful.

Erin was my physical therapist -- home visits -- back in 2002. My left arm was messed up (nothing like falling on a freshly operated body part) and immobilized in a sling. My right foot and leg were in a cast, non-weight-bearing. My right arm was kind of bad off -- it had initially been scheduled before the left for replacement and I don't recall why the switch was made. So when the time came for me to try standing up, with Erin and Fred right there, I could not do it.

It felt physical. I simply could not do it. I was weak, the one leg would not hold, it was impossible.

There surely was no relationship between my hyperventilation and shaking, and the impossibility of standing beside the hospital bed that completely took over the bedroom. So when Erin began asking what I was afraid of, I had no clue. I kept trying to stand, then sinking back onto the bed, more and more approaching real exhaustion.

Once Erin elicited the underlying truth -- that I was not just afraid of falling, but that I knew with complete certainty that I was going to fall -- she and Fred got so close to me, so obviously had control over anything that might happen, that I conquered my fear just long enough to quickly stand, then sit back down.

Erin cheered. It wasn't easier after that, but I began to make some steady progress. Now and then, I would still get "stuck" by memories. Don't ever forget that fear is powerfully paralyzing. Fight fear at all costs, Dear Readers.

All of which to say that I could learn to appreciate black coffee.

Still, I am a coffee fanatic; I like it the way I like it; The rest of the day is instant doodoo if I cannot get properly prepared bean juice.

Good thing I am not nervous about Monday. Good thing I got over that stoopid fear of falling. And of doing it twice.

Tuesday, February 10, 2009

Wandering around PubMed

From the neurology/psychophysiology journal Pain, 2009 Feb 3:
The association between ACE inhibitors and the complex regional pain syndrome: Suggestions for a neuro-inflammatory pathogenesis of CRPS.

de Mos M, Huygen FJ, Stricker BH, Dieleman JP, Sturkenboom MC.

Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Dr. Molewaterplein 50, Room 2157, 3015 GE, Rotterdam, The Netherlands.

Antihypertensive drugs interact with mediators that are also involved in complex regional pain syndrome (CRPS), such as neuropeptides, adrenergic receptors, and vascular tone modulators. Therefore, we aimed to study the association between the use of antihypertensive drugs and CRPS onset. We conducted a population-based case-control study in the Integrated Primary Care Information (IPCI) database in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during an expert visit (using IASP criteria), or if they had been diagnosed by a medical specialist. Up to four controls per cases were selected, matched on gender, age, calendar time, and injury. Exposure to angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, and diuretics was assessed from the automated prescription records. Data were analyzed using multivariate conditional logistic regression. A total of 186 cases were matched to 697 controls (102 confirmed during an expert visit plus 84 with a specialist diagnosis). Current use of ACE inhibitors was associated with an increased risk of CRPS (OR(adjusted): 2.7, 95% CI: 1.1-6.8). The association was stronger if ACE inhibitors were used for a longer time period (OR(adjusted): 3.0, 95% CI: 1.1-8.1) and in higher dosages (OR(adjusted): 4.3, 95% CI: 1.4-13.7). None of the other antihypertensive drug classes was significantly associated with CRPS. We conclude that ACE inhibitor use is associated with CRPS onset and hypothesize that ACE inhibitors influence the neuro-inflammatory mechanisms that underlie CRPS by their interaction with the catabolism of substance P and bradykinin.

PMID: 19195784 [PubMed - as supplied by publisher]

In looking through previous publications by some of these authors, it looks as if a few are quite dedicated to CRPS research, making good use of the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. de Mos has investigated past medical histories to see if any particular illnesses/events correlate with the onset of CRPS*, also researching the role of estrogen to see if it increases the risk of contracting CRPS, studying allodynia, and determining familial incidence.
*click here for complete text of that study

de Mos participated in another study that, well... it just tickles my fancy. Here is the pertinent abstract from 2007 (or click here for complete text):

Applied information retrieval and multidisciplinary research: new mechanistic hypotheses in complex regional pain syndrome.

(From The Journal of Biomedical Discovery and Collaboration, 2007 May 4;2:2)

Hettne KM, de Mos M, de Bruijn AG, Weeber M, Boyer S, van Mulligen EM, Cases M, Mestres J, van der Lei J.

Safety Assessment, AstraZeneca R&D Mölndal, Sweden.

BACKGROUND: Collaborative efforts of physicians and basic scientists are often necessary in the investigation of complex disorders. Difficulties can arise, however, when large amounts of information need to reviewed. Advanced information retrieval can be beneficial in combining and reviewing data obtained from the various scientific fields. In this paper, a team of investigators with varying backgrounds has applied advanced information retrieval methods, in the form of text mining and entity relationship tools, to review the current literature, with the intention to generate new insights into the molecular mechanisms underlying a complex disorder. As an example of such a disorder the Complex Regional Pain Syndrome (CRPS) was chosen. CRPS is a painful and debilitating syndrome with a complex etiology that is still unraveled for a considerable part, resulting in suboptimal diagnosis and treatment.

RESULTS: A text mining based approach combined with a simple network analysis identified Nuclear Factor kappa B (NFkappaB) as a possible central mediator in both the initiation and progression of CRPS.

CONCLUSION: The result shows the added value of a multidisciplinary approach combined with information retrieval in hypothesis discovery in biomedical research. The new hypothesis, which was derived in silico, provides a framework for further mechanistic studies into the underlying molecular mechanisms of CRPS and requires evaluation in clinical and epidemiological studies.

I have lots of reading and "unpacking" to do. I feel guilt at least once a day for not being proactive, for not having made the ketamine coma happen, for having decided to just get by.

Monday, February 9, 2009

92nd Street Y -- T. C. Boyle -- TONIGHT!

T. C. Boyle and Jayne Anne Phillips, Reading

Lexington Avenue at 92nd Street -- Monday, 9 February 2009, 8 PM
Tickets $19/$10 (35 years and younger)

T.C. Boyle’s stories are “artifacts of psychic aberrance, lampoons fashioned in shadow and void, and they fill a reader (as they are intended to do) with the giddy nausea of our cultural and theological confusions,” wrote Lorrie Moore. Boyle is the author of 19 works of fiction, including The Road to Wellville, Drop City, Talk Talk and The Women. Jayne Anne Phillips is “the best short-story writer since Eudora Welty,” wrote Nadine Gordimer. Her books include Black Tickets, Machine Dreams, Fast Lanes, Shelter and Lark and Termite.

If you go? Please report back!

Sunday, February 8, 2009

Wordle Challenge #7: First Line (re-posted)

[2.8.2009: Hint time! This work is translated from German, and set in post WWII Germany.]

DEADLINE -- FRIDAY, 2.13.2009

This very difficult Wordle Challenge is perhaps *too* difficult. We shall see, eh? Identify the novel from this, its randomized first line -- or just give the author a go:

Wordle: Wordle Challenge #7:  First Line

Good luck. Have fun!

Wordle Challenge #6: First Line (re-posted)

[2.8.2009: Hint! The title is a YEAR. A very... burp... dystopian year!]


Name the novel and author from the first line wordled below for bragging rights as Wordlemeister of the Day (Week, Month, Year -- depending) and a shiny, new trophy:

Wordle: Wordle Challenge #6:  First Line

Have fun and good luck!

Wordle Challenge #5: First Line (re-posted)

I'm re-reading this and could not help myself! Once again, first line to what novel?

Wordle: Wordle Challenge #5:  First Line

Wordle Challenge #4: First Line (re-posted)

Big hint from Wikipedia, added 2.8.2009: Elihu Benjamin Washburne (September 23, 1816, Livermore, Maine – October 23, 1887, Chicago, Illinois) was one of seven brothers that played a prominent role in the early formation of the United States Republican Party. He later served as United States Secretary of State in 1869.

[SOLVED by Fresca]

For bragging rights* this go 'round, identify the novel whose first line has been wordled below:

Wordle: Wordle Challenge #4 -- elle est belle la seine

*Okay, so "bragging rights" are not enough for you? Well, solve this Wordle Challenge and you will be known, near and far (but mostly far), as the Wordlemeister of the Day (Week, Month, Year -- however it works out).

We'll throw in a nice trophy, too.

Have fun!

Broken Arrow

Buffalo Springfield drummer found dead

Dewey Martin, who helped found pioneering country rock band Buffalo Springfield with Neil Young, has died.

Martin, 68, was found dead by a roommate in his Los Angeles apartment, friend Lisa Lenes said. She said Martin had health problems in recent years and that she believed he died of natural causes.

For some reason, Buffalo Springfield, Poco, and any of the various configurations of CSNY combined to make our premier choice of music by which to do yardwork, speakers turned out the windows, noise of the mower be damned. It was something special that made me forget the blisters that came from manual edging. It was something incredible to which I could sing off-key, singing down to the dirt and grass, the hot cement, and no one could hear, or judge.

It was beautiful music.

More on Soldier Suicide

So I continue to collect tidbits of anything credible relating to the recent story on soldier suicides...

WASHINGTON (CNN) -- Every day, five U.S. soldiers try to kill themselves. Before the Iraq war began, that figure was less than one suicide attempt a day.

The dramatic increase is revealed in new U.S. Army figures, which show 2,100 soldiers tried to commit suicide in 2007.

"Suicide attempts are rising and have risen over the last five years," said Col. Elspeth Cameron-Ritchie, an Army psychiatrist. [....]

-- One week after the U.S. Army announced record suicide rates among its soldiers last year, the service is worried about a spike in possible suicides in the new year.

The Army said 24 soldiers are believed to have committed suicide in January alone -- six times as many as killed themselves in January 2008, according to statistics released Thursday.

The Army said it already has confirmed seven suicides, with 17 additional cases pending that it believes investigators will confirm as suicides for January.

If those prove true, more soldiers will have killed themselves than died in combat last month. According to Pentagon statistics, there were 16 U.S. combat deaths in Afghanistan and Iraq in January.

"This is terrifying," an Army official said. "We do not know what is going on." [....]

Washington Post

Soldiers' Suicide Rate On Pace to Set Record

Suicides among active-duty soldiers this year are on pace to exceed both last year's all-time record and, for the first time since the Vietnam War, the rate among the general U.S. population, Army officials said yesterday.

Ninety-three active-duty soldiers had killed themselves through the end of August, the latest data show. A third of those cases are under investigation by the Armed Forces Medical Examiner's Office. In 2007, 115 soldiers committed suicide.

Failed relationships, legal and financial troubles, and the high stress of wartime operations in Iraq and Afghanistan are the leading factors linked to the suicides, Army officials said. [....]

And at this point, I'd like to cite a comment left by Fresca the Wordlemeister, ever insightful in the ways of skewed statistics:
I did a wee bit of googling, but really have no more info either--it's just what you'd expect--surprise, surprise.Well, what I found actually just enraged me further: the army says the numbers, the percentages of soldier suicides, while up, are not much higher than the national average. But that's evil twaddle. The national average includes everybody. The average for otherwise healthy people in their twenties is NO WAY anywhere near that high.

[Damn straight. I hate statistical bull crap. Below, please note the "demographically adjusted"
-- I -- and a few soldiers -- am dying to know those specifics.]

2.7.2009 Agence France Presse
Last year's suicide rate among active duty soldiers rose to 20.2 per 100,000, surpassing a demographically adjusted national suicide rate of 19.5 per 100,000 in 2005, the latest year on record....

The army has responded to the growing problem with more suicide prevention programs, efforts to screen soldiers for mental health problems and campaigns to reduce the stigma that prevents soldiers from seeking treatment.

[Here is a thought, or three: Stop extending deployments. Protect the jobs of citizen warriors. Oh, and get out of Iraq and all other illlegally prosecuted wars/occcupations.]

US Army, Mental Health Experts Team Up to Fight Rising Suicide Rate
By Julia Ritchey

This is the first time since the Vietnam War that the rate of suicide in the Army, about 20 deaths per 100,000 soldiers, has surpassed the civilian suicide rate.

"Why do the numbers keep going up? We cannot tell you. But we can tell you that across the Army, we're committed to doing everything we can to address the problem," promised Secretary of the Army Pete Geren.

Geren and other Army officials Thursday announced a handful of prevention programs that will either be introduced or enhanced. One such initiative will be a day-long "stand-down" in which all active duty soldiers will receive suicide prevention education, with an emphasis on escorting someone who might be in trouble to seek help... [This article posits *18* possible more cases, not the usual 17.]

The Army found about 35 percent of suicides came after soldiers returned home from deployment, while another 35 percent of suicides occurred among soldiers with no history of deployment. 30 percent occurred while soldiers were in the field.

Didn't this sound ominous enough back in 2006?
U.S. Army Suicide Rate at Highest Level Since 1993 (

In 2005, a total of 83 soldiers committed suicide, compared with 67 in 2004, and 60 in 2003 — the year the U.S. invaded Iraq. Four other deaths in 2005 are being investigated as possible suicides but have not yet been confirmed. The totals include active duty Army soldiers and deployed National Guard and Reserve troops.

"Although we are not alarmed by the slight increase, we do take suicide prevention very seriously," said Army spokesman Col. Joseph Curtin.

"We have increased the number of combat stress teams, increased suicide prevention and training, and we are working very aggressively to change the culture so that soldiers feel comfortable coming forward with their personal problems in a culture where historically admitting mental health issues was frowned upon," Curtin said.

Of the confirmed suicides last year, 25 were soldiers deployed to the Iraq and Afghanistan wars — which amounts to 40 percent of the 64 suicides by Army soldiers in Iraq since the conflict began in March 2003.

The suicide rate for the Army has routinely fluctuated over the past 25 years, from a high of 15.8 per 100,000 in 1985 to a low of 9.1 per 100,000 in 2001. Last year it was nearly 13 per 100,000.

The Army rate is higher than the civilian suicide rate for 2003, which was 10.8 per 100,000, according to the National Centers for Disease Control and Prevention. But the Army number tracked closely with the rate for civilians aged 18-34, which was 12.19 per 100,000 in 2003. [Is it just me, or are the numbers beginning to shimmy?]

When suicides among soldiers in Iraq spiked in the summer of 2003, the Army put together a mental health assessment team that met with troops. Investigators found common threads in the circumstances of the soldiers who committed suicide — including personal financial problems, failed personal relationships and legal problems.

Since then, the Army has increased the number of mental health professionals and placed combat stress teams with units. According to the Army, there are more than 230 mental health practitioners working in Iraq and Afghanistan, compared with "about a handful" when the war began, Curtin said.

Soldiers also get cards and booklets that outline suicide warning signs and how to get help.

But at least one veterans group says it's not enough.

"These numbers should be a wake-up call on the mental health impact of this war," said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America. "One in three soldiers will come back with post traumatic stress disorder or comparable mental health issues, or depression and severe anxiety."

Rieckhoff, who was a platoon leader in Iraq, said solders there face increased stress because they are often deployed to the warfront several times, they are fighting urban combat and their enemy blends in with the population, making it more difficult to tell friend from foe.