Clin J Pain. 2009;25:273-280

The Natural History of Complex Regional Pain Syndrome
Robert J. Schwartzman, MD, Kirsten L. Erwin, BS, and Guillermo M. Alexander, PhD

Objective: Complex regional pain syndrome (CRPS) is a severe
chronic pain condition characterized by sensory, autonomic,
motor, and dystrophic signs and symptoms. This study was
undertaken to expand our current knowledge of the evolution of
CRPS signs and symptoms with duration of disease.

Method: This was a retrospective, cross-sectional analysis using
data extracted from a patient questionnaire to evaluate the clinical
characteristics of CRPS at different time points of disease
progression. Data from the questionnaire included pain characteristics
and associated symptoms. It also included autonomic, motor,
and dystrophic symptoms and also initiating events, ameliorating
and aggravating factors, quality of life, work status, comorbid
conditions, pattern of pain spread, family history, and demographics.
Comparisons were made of different parameters as they
varied with disease duration.

Results: A total of 656 patients with CRPS of at least 1-year
duration were evaluated. The average age of all participants was
37.5 years, with disease duration varying from 1 to 46 years. The
majority of participants were white (96%). A total of 80.3% were
females. None of the patients in this study demonstrated
spontaneous remission of their symptoms. The pain in these
patients was refractory showing only modest improvement with
most current therapies.

Discussion: This study shows that although CRPS is a progressive
disease, after 1 year, the majority of the signs and symptoms were
well developed and although many variables worsen over the
course of the illness, the majority demonstrated only moderate
increases with disease duration.

French Semis

In semi-final action, little Cibulkova just won the opening game, breaking big, bad Safina's service.

Cibulkova hits nice and deep, pretty flat, and is moving Safina around, at will.

I'm just sayin'!

Could be a trend. (I *do* like Safina; More than individual players, though, I love a good match!)

Serena may not know what to say next about rankings...

On the men's side, I continue to have trouble pulling for Federer. Don't know exactly why, given that Nadal is not around to divide my loyalty.

Wing Suits/Base Jumps

Fred urged me to watch this last night. Afterward, he said, eyes glistening, "I am going to do that before I die."

And he smiled a very happy smile.

toujours, ce sacré miroir (et moi, là-dedans...)

I don't know what I am doing with this blog anymore.

Honestly, I'm not fit for human company. Unwashed, in the same clothes I wore yesterday -- I hurt so badly last night that washing and changing were unimportant. Sleep mattered, that was it. Even so, sleep came in spurts of 45 minutes. She's down! She's up!

La Bonne et Belle Bianca Castafiore gave me a look of pure disdain this morning. "Que t'es bête, prof... complètement bête."

To her, it is a matter of will, getting better, an area in which I am found sorely lacking. The fact that there are ungrowable pathogens destroying my bones, and apparently getting into some soft tissue (one side of my face is swollen, to the point where I have a permanent headache and my glasses are digging into the side of my head)? Not pertinent to The Castafiore.

Will it all away.

She is something of a changed woman these days -- being an out-of-work Diva has been both a curse and a strange blessing. Fred and I admit to appreciating the decline in the ear-splitting frequency of L'Air des Bijoux, and that blessed mirror, that laugh approaching hysteria.

You see, Bianca only sings L'Air des Bijoux from Gounod's Faust.

Not that this is at all out of the ordinary, an operatic star fixated on one role, one lyric, one composer. We all can get stuck on our favorite things, certainly on a cherished ditty. But..."Ah, je ris de me voir si belle, dans ce miroir..." -- ad infinitem? ad nauseum? I want to reach through the time and space of fiction to shake that stupid Marguerite, to point out the obvious devil traits before her in the unctuous Faust, all in the hope of getting La Bonne et Belle Bianca, the Milanese Nightingale, to shut up!

So she thinks I am an idiot. I can take it. She has called me worse things, in the middle of some madcap caper or other, usually seeking the approval of Captain Haddock -- what better way than to throw the extraneous French professor under the bus?

Feels like I've nowhere but *here* to emote; My thoughts are hardly worth noting anymore -- repetitive tripe.

I am spending the day making and fielding phone calls from doctors' offices. Now that there is a workable plan to put in place, there's nothing much for me to do except fret. And I am almost too tired and in too much pain to do that.

The current task is the assemblage of medical records that I am to hand carry to this guru of a medicine man, a mere half-day's drive from Marlinspike Hall, deep deep in the Tête de Hergé.

Ah... a wrinkle. Yes just in the space between the last paragraph and this. My MDVIP Go-To-Guy called to say I will likely see the Wizard next Tuesday. He paused and then regaled me with the heartwarming story of how, seeing that the Wizard-Guru Man has just relocated here from Ohio, he's not had time to establish his insurance connections. "That might be a problem for you," opines my Go-To-Guy. Bull Crap Bull Skeet of Tête de Hergé is an imposing monolith of a health insurer, indeed.

YOU THINK? GAWD...

Am I so sick that I am supposed to be able to magically bankroll this consultation? I have spent over $20,000 thus far this year on health care -- and that money came straight out of my investment account, the account that was not to be touched because it will hopefully, one day, have enough in it to comfort, shelter, and feed The Fredster and The Castafiore, as well as the Four Felines. It was never meant to be money spent on BCBS, hospitals, doctors, repeatedly unhelpful tests, and month after month of intravenous vancomycin...

That money was supposed to survive me, god damn it.

ah... je ris... je ris... de me voir... si bête, si bête... toujours dans ce sacré miroir...

The expert we are consulting doesn't even have an established surgical team, barely an office -- he is a new prof at the medical college there. Yonder. One of the administrators is going to attempt to get his provider numbers with Bull Crap Bull Skeet of Tête de Hergé tomorrow.

But everyone knows my situation vis-à-vis the paddle and the creek -- so I may have to write a magic check.

Henckels Professional "S" 5 1/2 Flex. Boning Knife

Two long days, finally over. Ahhh. I know it sounds pitiful, that two days of moderate activity should take such a toll -- ask me, though, whether I care!

A great plan has been hatched -- thanks mostly to my intrepid orthopedic surgeon, the famous Dr. Shoulderman. He has tracked down a colleague who specializes in people with weird joint infections... and said person just happened to have recently relocated within a three-hour drive of Marlinspike Hall, deep deep in the Tête de Hergé.

In other words, if said person can work the promised miracles... there won't be a tiresome trek to Baltimore. Think good thoughts, cross your digits, do whatever it is that you do.

I remain... the same. In my mind, I feel worse, I feel desperate... but no, I am not worse. I am consistently bad. What makes me feel desperate is the stress of unrelieved pain, sleep in spurts of 45 minutes or less, and fear.

Sometimes I think seeing Dr. Go-To-Guy every 3 to 4 weeks, emailing him weekly, is definite overkill.

And then I realize how blessed I am, because between those appointments and the back-and-forth of emails, my anxiety is kept at bay, and the little sanity I have is preserved. He knows my hold on reality is becoming... let's say... tenuous.

Do you know what I did last night?

Of course you don't!

Intending to get some fresh water in my trusty Hillary Clinton for President water bottle (holds over 32 ounces!), I wheeled to the kitchen sink, unscrewed the top, and proceeded to dump the "old" water on the floor.

Yep.

Listen, when I get beaucoup tired, as well as beaucoup sick? Weird doings, strange goings-on.

We are still looking for our Henckels Professional "S" 5 1/2 Flexible Boning Knife -- that I absconded with during a night of fever and sweats.

As well as about three spoons.

When mind and body decide to merrily decompensate -- I have a thing, apparently, for culinary items.

We even went through the trash, searching for the boning knife. Hmm.

Sotomayor: Wise Latina

Good grief.

She is not bringing "racism" to the court. Rather, she is bringing, ineluctably and fundamentally, race itself, this smug little arriviste, this cheeky chica!

{Sorry. It's such a beautiful day!}

There is no need to fear a "bubbling crude" seeping out of the ground, bringing the Clampetts from the Ozarks to Beverly Hills -- in all their crudeness -- unprocessed and raw.

You'll feel better if you name it "life experience," more a considered thing of rich usefulness.

This reeling dance has caused some folks to reconsider that hefty concept of "empathy," and -- weirdly -- to announce that empathy scares the bejesus out of them.

OH, MY GOD. She might prove to be empathetic. And, I presume they presume, intellectually weak enough to be empathetic only toward sameness...

But I don't want her to overcome, aspire to overcome, or even consider overcoming, that which distinguishes her from the other justices.

Differences? How about *depth*?

I hope that she will plomb the depth of her differences -- not only as one more rich source of information, but also to heighten her awareness of areas wherein she may have bias. That's the hope I have for every Supreme Court Justice.