Friday, December 31, 2010

Witness: The Death of PRN

Jason Smith, ©2005 Endeavors magazine.
The fact that I pass this on here should not be misconstrued as blanket endorsement of PRN and its activities (more like a 50" x 58" "delightfully soft" throw), nor should you look to find any glee at the organization's demise.  You especially should not infer the slightest bit of agreement with any forward-looking political endorsements. 

What you should eke out from this visit is outrage at government excesses in prosecution and criminalization.  You should bring a cold and calculating eye to the activities of the Justice Department, including Assistant U.S. Attorney Tanya Treadway and her dealings with PRN founder Siobhan Reynolds in the Kansas Schneider case.

At the end of the day...

It is what it is.

And so on

And so forth...

No, it's not that I don't care, or want you to.  I am tired.

The change needed to support real treatment of chronic pain requires such a paradigm shift by the larger society that I don't expect much more progress in my lifetime.  I mean, first, this medically supervised therapy must somehow substract itself from the ravages of the confused, confusing, and bloody Drug War.  And to do that, the Drug War must either end or be sufficiently infused with clarity and science that it will have moved beyond the horrible heuristics in which it is presently engaged.

One might wish to begin by subtracting doctors from the classification of "drug dealers," noting that the exception makes the rule, and that adequate penalties and avenues for redress are already in force.

Clearly, the Drug War, as currently prosecuted, is one of attrition.  Witness one of its casualties:

The End of PRN
To: The Pain Relief Network Community
From: Siobhan Reynolds
Dec 29, 2010

The Members of the Board of Directors and I have decided to shut down PRN as an activist organization because pressure from the US Department of Justice has made it impossible for us to function. I have fought back against the attack on me and PRN but have received no redress in the federal courts; so, the board and I have concluded that we simply cannot continue.

It is important to note that PRN has been refused standing in federal court to sue the federal government in defense of the patients’ Constitutional rights; this, when the Sierra Club has been given leave to sue powerful entities on behalf of insects. Even after changing tactics by suing under the names of persons directly injured both materially and Constitutionally, the federal courts in the 9th Circuit denied standing to a doctor and a group of his oppressed patients; preventing them from suing the State of Washington for their dangerous and lawless attack on the rights and personal welfare of Washington doctors and patients.

It certainly appears that the legal deck is stacked against pain patients and doctors. Despite this, others will keep trying because so very much is at stake. A group of us may bring another action in the Western District of Washington in the near future; but exactly how that will be framed is not yet clear. In any event, the action will not be undertaken under the auspices of PRN.

People in pain are still being abused, neglected, and left to die by the entire system. Physicians brave enough to treat chronic pain continue to be intimidated and prosecuted. It breaks my heart that we have to stop, but there is simply no way forward for PRN.

With the dissolution of PRN, I will be bowing out, but a group of former PRN leaders are going to keep the web site up (minus the donation page), as a resource for information. Members are free to set up their own talking area elsewhere. I suggest the PRN community put together a Facebook page where the conversation might continue. I would be happy to put the word out about any separate patient efforts. We will also continue to update the news on the site as a public service.

We are proud of all we have accomplished given how little funding we received. The Drug War is a beast. I believe the only legislative efforts that have a chance at changing the current state of affairs are those supported by Congressman Ron Paul. He and many of the groups he supports are aware of what patients suffer. If you want to continue to push for a change in the drug laws, I suggest you do what you can to support their efforts.

Siobhan Reynolds

Some background reading from Cato @ Liberty and Adam Liptak's NYT Sidebar.

To learn more about pain, I suggest visiting the site of the American Pain Foundation.

Mala Fortuna: Stanford Stops the Streak

The jinx lives on.

Shortly after having this thought, I decided to search my blog for previous uses of the word jinx.  Having written about both college basketball and professional tennis, there was no doubt that my deleterious impact upon the success rates of my favored teams and players would be documented here.  I have been more true to my jinx attribute than to any other character trait.

In an aptly titled entry, Blather, I explained the genesis of the curse, as engineered, and then painstakingly nurtured, by Brother-Unit Grader Boob.*  Begun as a common-sensical remedy to my native curse, the jinx method expanded to encompass our mutual academic pursuits, something that would otherwise be inexplicable:
Good morning. It is lovely here: warm, sunny, clear -- you know, when the whites of the sky are opalescent, surrounded by true blue. I am tempted to say "Carolina blue," out of fondness for an alma mater... but as we approach March Madness, I cannot lend support to UNC, or even to little Davidson, despite last year's excitement and the incredible Stephen Curry-- no, I am obliged, academically, to prefer the much deeper blue hue of the Devil. I can't wait for the ACC Tournament, then that inconsequential old NCAA tourney thang... It's my favorite time of year, despite the fact that my brother-unit, the Grader Boob (who owes no allegiance to the Gothic Wonderland), long ago convinced me that I am a bona fide jinx, making a rule that when Duke, or whoever, is in a tight spot -- the fault being me and the bad luck I bring by my proximity to the television set -- I must retreat out of the viewing room and not cross the plane of the doorway. So he would end up munching on Malted Milk Balls, stretched out on his bed, blocking the screen, while I jumped up and down trying to see over him from my position in the hallway. Brother-Units are such fun.

Of course, he is jealous that I planned my academic career by the sporting accomplishments of the various universities I attended. It is a little known fact that admission to graduate programs is contingent upon one's knowledge of the money sports -- basketball and football. I went to every interview in full regalia -- the appropriate jersey, face paint, the giant finger. This and only this can explain my success.

As we promptly noted and celebrated in this space, on Tuesday, December 21, 2010, the UConn Women Huskies broke John Wooden's 88-game streak record for Division I college hoops.  They extended the record to 90 games, an awesome feat, but then ran smack dab into the Stanford Cardinals last night.

I had nothing to do with it.

I swear.

Stanford 71, UConn 59
Stanford Beats UConn to Halt Streak at 90

Published: December 30, 2010

PALO ALTO, Calif. — The Connecticut Huskies had been undefeated during the Obama administration, untouched by the great recession, undeterred by the fiercest obstruction from any opponent in women’s college basketball.

No more.

Just as top-ranked UConn had feared, ninth-ranked Stanford was too big, too deep and too thorough inside and out on Thursday, defeating the Huskies by 71-59 at sold-out Maples Pavilion and ending Division I college basketball’s longest winning streak at 90 games.

UConn, which won by an average of 33 points during its streak and won all but two games by double figures, did not lead for a single second, falling to its first defeat since it lost to Stanford by 82-73 in the N.C.A.A. semifinals on April 6, 2008.

Just as Notre Dame bookended the U.C.L.A. men’s 88-game winning streak set from 1971 to 1974, so has Stanford bracketed the Huskies’ streak.

* I am pleased to announce that, on January 15, Grader Boob will be flying into the regional Tête-de-Hergéen supersonic transport hub -- a challenging landing on the southwestern slope of The Alp.  The Brother-Unit and I envision a leisurely manoral weekend with Fred, La Bonne et Belle Bianca, and the three extant Marlinspike felines.  G.B. has a longstanding and unrequited love for The Castafiore (and, truth be told, for the cats) -- I don't delude myself into thinking that filial love is behind this sudden need for a mini-vacation.  Anyway, great plans for great fun are in the works, thus far mostly involving food, flannel pyjamas, and U.S. American college basketball (with jinx provisions).

Oh God, Bianca is getting riled-up in anticipation of both Grader Boob's arrival and her chance to cheer on her favorite teams, an activity that includes dressing to the nines (elevensies and fourths) and operatic productions to beat the band.  As Spectator Athletes of the highest non-professional calibre, we take our Viewing Fashions seriously and can only wish that the athletes we visually support would likewise expend some money on appropriate couture.  Like words, it mattersDo you recall the incalculably noxious impact of Caroline Wozniacki's tennis dress back in September of '09?  I barely survived that Fashion Sentinel Event...

[...] I became somewhat upset earlier in the evening, after watching the Clijsters/Williams match. [Aside: Please note that my customary role as jinx and source of mala fortuna did not come into play; That is, my favored athlete did manage to win, albeit not in a way she, or anyone, liked overly much.]

Actually, I was babbling even before Serena was subjected to that IDIOTIC foot-fault call by The Timid and Conniving LinesWoman. No, the smashing of her racket at the end of the first set didn't set me off -- surprising, I know, given my reaction to Gonzalez yesterday.

No... it was Wozniacki's tennis dress. She is the second woman in the tournament to be a fashion disaster in what can only be described as a Failed Dropped-Waist Contraption. And it was beige. Ecru, if you like. Sand. Café con leche. Whatever.

All that beige really brought out Caroline's pale visage and blond hair.

Yes, I know that the dress is from the new fall/winter Adidas line by Stella McCartney. It certainly does not look bad on Wozniacki, a beautiful girl. But imagine it on your average woman. Imagine it on La Bonne et Belle Bianca Castafiore, for instance.

I'm sorry. No, I'm not! It reminds me so much of a schoolgirl's jumper, deliberately ugly, with a band that bisects the wearer at precisely her widest point. Oh, and then let's amplify that impression with... RUFFLES. Quite the philosophical construction -- all business up top, very hip, spare, monosyllabic, c'est-à-dire masculine -- and all fluff down below, very flouncy, excessive, babbling, c'est-à-dire feminine. Oh, the dichotomy. Oh, my. My.

Again, put The Castafiore in it and suddenly even the umpire would be howling "Foul! Foul! Fashion fault!" Alternatively, the tennis audience would cry out, in alarming syncopation, "My eyes! My eyes!"

Oh jeez-louise.  She is really gearing up;  She's deep into her favorite basketball chant-and-step routine, which has a rhythm that Bianca also employs to lend a pleasing cadence to her housework (an equally seasonal event):

f'blasticball! f'blasticball! allez, dooook-uh! allez, dooook-uh! [shuffle shuffle]

f'blasticball! f'blasticball! allez, dooook-uh! allez, dooook-uh! [shuffle shuffle]

Thursday, December 30, 2010

Mumford and Sons: Timshel

{{800th post on elle est belle la seine la seine elle est belle :::
balloons and confetti falling all about your pointy little head :::
::: and the crowd goes wild :::}}

Cold is the water
It freezes your already cold mind
Already cold, cold mind
And death is at your doorstep
And it will steal your innocence
But it will not steal your substance

But you are not alone in this
And you are not alone in this
As brothers we will stand and we'll hold your hand
Hold your hand

And you are the mother
The mother of your baby child
The one to whom you gave life
And you have your choices
And these are what make man great
His ladder to the stars

But you are not alone in this
And you are not alone in this
As brothers we will stand and we'll hold your hand
Hold your hand

And I will tell the night
Whisper, "Lose your sight"
But I can't move the mountains for you

*with thanks to dr. smak

Saturday, December 25, 2010

Poverty of Compline: Wynken, Blynken, and Nod

Wynken, Blynken, and Nod by Mandy Moore
i hope you had a merry, warm day and a meaningful christmas, if you are a christian. 

in the course of this very busy day (for me!), something struck me hard in the chest as deeply true:

i would sleep unperturbed, and enough, were the monks to gather nightly round my bed -- say, sometime between their usual 9 pm and my normal 3 am -- and sing me off to SlumberLand with the lullaby of compline.

but let's face it, friend:  despite the cistercians just over the apple orchard wall, despite frequent visits from their runaway abbott (he jumps the wall and checks in, incognito, as a Manor Guest whenever the trials of monastery life press too close), i am in poverty of compline.

our neighboring brothers maintain a couple of websites, that we know of, mostly dedicated to the worldly business of raising money and providing for their keep.  to fit in, they also provide links to larger catholicdom, and in this way i sometimes work up a SeriousPretend, as i transport myself to dark churches in the night, the shadows pierced as much by sound as light.  the sound of a leather sandal on stone, those creaks, the sudden snap and electrical quick-sizzle click of a monk turning on the electric bulb in his choir stall. 

they enter the church from more entrances than i knew existed, though before reconvening for the next Hour, i sleuth out the newest portals, if -- that is -- i am not barred -- non-monk, woman, visitor, silent retreatant (slightly suspect, altogether forgettable).

they make loving reverence to mary, to the altar. they make a bee line right to her.

those were the only moments that risked a show of pride, if pride can exist unconsciously.

the reverence to mary.

i usually sat up in the balcony, in the back, the better to see it all, hear it, have the chance to match sandal to shadow, leather slap to sound.   there is this conceit -- that they all look alike, hooded brown, most slender, schooled even as to the angle of the head.

they might as well sport individual numbered jersies, their god names ironed-on in shiny block letters.  when they bow to the mother of god, they are ardent, yearning lovers, lost in adoration or need, and the form of their reverence is as individual as a brushstroke in burnt umber.  some of the oldest monks proffer jaunty youth, closer to their beloved than the young man just professed, young in the way they mean young: young in the life.

they bow not so much with a fluorish as with energy -- impatient energy, smooth, conserved energy, ragged i'm-gonna-burst ecstacy.  they shit on the old laws of thermodynamics and all that preservation, conservation, transfer but not creation!  when in SeriousPretend, i'm up there looking down, they're down there, looking at nothing but mary (even mary as piled up lectionaries psalms psalters liturgies...).

were i there, and huddled up there, all ready for bed except the going, my bed turned down back in my humdrum retreat house room, tans on beiges over a nightmare of neutrals, were i there, up there in the balcony, the tired happy brothers would sing and say these things (among other things) for me, tonight, and now, according to the day, the 25th of december:

Compline (Night Prayer)

O God, come to my aid.
O Lord, make haste to help me.
Glory be to the Father and to the Son and to the Holy Spirit,
as it was in the beginning, is now, and ever shall be,
world without end.
Amen. Alleluia.

Christ, thou who art the light and day,
Who chasest nightly shades away,
Thyself the Light of Light confessed,
And promiser of radiance blest:
O holy Lord, we pray to thee,
Throughout the night our guardian be;
In thee vouchsafe us to repose,
All peaceful till the night shall close.
O let our eyes due slumber take,
Our hearts to thee forever wake:
And let thy right hand from above
Shield us who turn to thee in love.
O strong defender, hear our prayers,
Repel our foes and break their snares,
And govern thou thy servants here,
Those ransomed with thy life-blood dear.
Almighty Father, this accord
Through Jesus Christ, thy Son our Lord,
Who with the Holy Ghost and thee
Doth reign through all eternity.

Canticle Nunc Dimittis

Keep us safe, Lord, while we are awake,
and guard us as we sleep,
so that we can keep watch with Christ and rest in peace.
Now, Master, you let your servant go in peace.
You have fulfilled your promise.
My own eyes have seen your salvation,
which you have prepared in the sight of all peoples.
A light to bring the Gentiles from darkness;
the glory of your people Israel.
Glory be to the Father and to the Son and to the Holy Spirit,
as it was in the beginning, is now, and ever shall be,
world without end.

Keep us safe, Lord, while we are awake, and guard us as we sleep, so that we can keep watch with Christ and rest in peace.

May the almighty Lord grant us a quiet night and a perfect end.

we should all take such care before we close our eyes at the end of day!  unconscious sleep is nothing to be entered into lightly.

ah, but they aren't here, my monastery friends. there is no twinkly-eyed brother william, forever being punished for breaking silence, for laughing, then set the unenviable task of scrubbing the flagstone on his knees. no formidable old father anthony, old arsehole monk, guestmaster, rulemeister. (arsehole anthony was bone weary and when inclined toward the virgin, clearly beseeching, clearly begging to go home.)

i have tapes, i have memory, i have worship aids galore but i cannot reproduce the loving send-off, confident of my safety, of my lasting, of my waking -- intact.  dead, possibly, but awake, intact. 

the dearth of compline, my lack of monk, is making me feel hopeless and lost, and my obéissance an absolute insult.

so i had this desperate thought that made me smile. what do you think? wynken, blynken, and nod, as lay compline?  it might not fly in rome, or even over the apple orchard wall, but it has cadence, and memory, and just as many a promise.

Wynken, Blynken, and Nod (Dutch Lullaby)

Wynken, Blynken, and Nod one night
Sailed off in a wooden shoe---
Sailed on a river of crystal light,
Into a sea of dew.
"Where are you going, and what do you wish?"
The old moon asked the three.
"We have come to fish for the herring fish
That live in this beautiful sea;
Nets of silver and gold have we!"
Said Wynken,
And Nod.

The old moon laughed and sang a song,
As they rocked in the wooden shoe,
And the wind that sped them all night long
Ruffled the waves of dew.
The little stars were the herring fish
That lived in that beautiful sea---
"Now cast your nets wherever you wish---
Never afeard are we";
So cried the stars to the fishermen three:
And Nod.

All night long their nets they threw
To the stars in the twinkling foam---
Then down from the skies came the wooden shoe,
Bringing the fishermen home;
'T was all so pretty a sail it seemed
As if it could not be,
And some folks thought 't was a dream they 'd dreamed
Of sailing that beautiful sea---
But I shall name you the fishermen three:
And Nod.

Wynken and Blynken are two little eyes,
And Nod is a little head,
And the wooden shoe that sailed the skies
Is a wee one's trundle-bed.
So shut your eyes while mother sings
Of wonderful sights that be,
And you shall see the beautiful things
As you rock in the misty sea,
Where the old shoe rocked the fishermen three:
And Nod.

-- Eugene Field

say good night, prof...

Thursday, December 23, 2010

Crayzee Central -- v2

She seems a tad bit *off* yet but that will take care of itself, dontcha know?  She will have her Full Force Snark on in short order.

We should probably have a moment of silence for the poor soul who is going to be the first to take her on.  Will it be Happy?  Will it be WhiteCoat?  All I know is that it won't be moi.

Of course, equally endangered are the idjits who work too hard at endearing themselves to this purveyor of:

High-quality emergency nursing care, primary care, drug-seeker support services, physician handwriting interpretation, arrangement of rapid ambulance transfers to detox, bus tokens and cab vouchers, Stage 4 malignant cynicism, and concierge service.
Nurse K and Crass-Pollination are back.

There seems to have been a notable change in venue, as she mentions a "little community Montana hospital," and does NOT mention Dr. Bloody Gloves at all.  In fact, the first reference she makes of physician staff is... respectful?  Polite?  Complimentary?  (I know! I know!  It's mind boggling!)

Drug-seekers, progressive politicos, fibromyalgeurs, migraineurs (chronic paineurs of any sort), doods and sum doods, alike -- Beware. 

If you were thinking of heading to the ER (ED, if you're WhiteCoat) for a pregnancy check at 3 am...

If you characterize your pain as being a 12 on a 10 scale...

If you are allergic to all non-narcotic pain relievers and just happen to respond best to that one drug that starts with "d"...

If you are crayzee and think you might be needing a blanket, a sammich, and another pillow...

Be forewarned, Nurse K is back! *

* Please, though, avert your eyes from her Tweets (as erNurseK), as she is being a lascivious BlogWhore on that bit of social media.  SAMPLES: 

Four posts so far on Blog 2.0. Have you added me to your RSS feeds?

It's cute...lots of people are reading 20-30 pages of my archives. 9000 pageviews today :)

Tuesday, December 21, 2010

Wooden's UCLA Streak Record Broken by the UConn Women Huskies

congratulations, uconn women!

One of the biggest streaks in sports now belongs to the UConn women's basketball team.
The No. 1-ranked Huskies topped the 88-game winning streak by John Wooden's
UCLA men's team from 1971-74, beating No. 22 Florida State 93-62 on Tuesday night.

unfortunate update HERE

Monday, December 20, 2010

Ecce homo

I don't know how to describe waking up this morning without grossing you out.  And you know how much I hate grossing you out!

Yesterday was an improvement over its recent predecessors, and as I drifted off to sleep with the aid of a double dose of tizanidine and a few stray milligrams of amitriptyline, I enjoyed toying with the idea of that trend continuing indefinitely. I had visions of sugar-free "sugar" plums dancing in my poor head.

I slept way past my usual wake-up time. 

There's been a drastic change in my sleep hygiene practices. 

Yesterday, while practicing the technique portion of the Olympic Wheelchair Vaccuuming Competition, I sustained a training injury.  A deep puncture wound to my -- and if you know me, you guessed it! -- right big toe.  I did not feel it happen and it was only after growing perturbed at the strange red rasberries that seemed to be materializing behind me that I thought of blood. 

I was home alone -- sometimes, but not often, a great notion.  Thanks to the intersection of so many holidays, Fred and I negotiated an afternoon off for the Domestic Staff -- a benefit for spouses and offspring, too.  Their gratitude knew no bounds.  At least I think that's what they were saying to us as they sped over the speed bumps and down The Country Lane on the tandem bicycles Fred provided to lend their outing a cachet of Christmas cheer.

(Not to imply Christmas as the only source of holiday glee, you understand.)

You shoulda seen them peddle when Fred pulled up behind them in Ruby the Honda CR-V, giving the horn a healthy BEEPBEEP!  Oh, I love the holiday season!  It brings out the child in all of us.

The major issue with my right big toe turned out not to be pain (I felt nothing -- something a medical professional might argue is a negative, but really, you can't always rely on those over-educated ninnies) but the fact that the bleeding would not stop.  Eight hours later, even, if you removed pressure from the site, it bled on.  Dedicated l'il puncture wound.

I must have wrapped that toe in a whole roll of paper towels, then set out to sort through our eclectic supply of cleaning products.

At which point, I confess, the rites of every New Year started to become manifest and a massively long To Do List took form in my headachy head.  First item:  clear out the eclectic supply of cleaning products.

Fred is a sucker, a cute and kind sucker, but a sucker nonetheless.  He brings home some amazing concoctions, all bought from the same man.  You know, the guy who "swears this stuff works like magic."   That guy.  His products all seem to be sold from very mobile kiosks or from under counters.  Amazingly, his inventions are not required to list active ingredients on their labels, prompting him to claim that they are all non-toxic, "as safe for humans as they are safe for pets!" When they foam and smoke upon being applied to various stains and spills, well, I guess that is just unexpected entertainment -- an additional value!

Anyway, there I was, bleeding like a stuck pig all over the Haddock clan's priceless collection of oriental rugs, along with an occasional splatter flung onto the antique fabrics that upholster the Thomas Chippendale and George Hepplewhite collection housed in the 18th century Scottish Instruments Music Room.

My only hope is that some of the splatter on the gold-and-maroon striped, five-legged Hepplewhite Settee will sort of... blend in.

Photo courtesy of Southwood Furniture
Anyway, I did as much damage control as possible, then tended to the bleeding toe, which I washed and bandaged.  Pretty quickly, a new CRPS/RSD symptom presented itself.

I don't wear shoes or socks, ever.  When I go out, I sport a pair of Old Friends:

It's the best I can do. 

Still, immediately after sustaining this training injury, I began to want socks... heavy, thick, soft socks.  It was enlightening to find that, at some point in the last eight years, I had put all my socks in a red Crabtree and Evelyn shopping bag that I then stashed on the upper shelf of the closet in my office.  Right where you'd expect to find socks!

I could see the evolution of my disease, as well as my acceptance of that disease, by the assortment of socks, all of which were brand new and unworn -- except for the three pathetic pair to which I had taken a fierce pair of scissors!  Toes were cut away and any area with elastic binding had been split.  I took the largest, most forgiving-looking pairs and tried to put them on.

I could not even get past the toes on my left foot, and not anywhere near that far on the right, despite my growing need for warmth and protection.

When I sleep, I cover myself with a single layer of well-worn, much loved cotton quilt -- but my feet and lower legs are never covered because even the weight of the thinnest sheet can set off hours of pain and burning. with lower limbs instantly becoming a boiled-lobster's red.

So when Fred found me under two quilts and a heavy blanket, he about fell over in shock.  I put on some flannel pajamas, and a hooded jacket (which he did not find so surprising!). 

My teeth began to chatter, I felt such a sensation of cold.  Determined to perpetuate its reknown for paradox, my legs were that unique and weird bright red of CRPS, and they were putting out waves of... heat.

Still, the day was elevated out of the morass of former days.

Somewhere in there, Fred found organic Fuji apples on sale for a dollar and bought what can only be called a mess of them.  Fred was a Christmas baby and this year he has requested, in lieu of a birthday cake, an apple pie.  I plan on making several despite his contention that all apples taste the same when spiced for a pie, since we have three other varieties on hand, as well.

Christmas birthday pie!

After spending so much time on Manor Decor, showing our diversity and the Haddock commitment to inclusiveness by fêting every religious or spiritual tradition known (or suspected) to human kind, we decorated our wing in a pretty traditional, straightforward Christian-y sort of way.  Angels, potted rosemary plants shaped like aromatic trees, bits of holly and pine (the cones spray-painted a naturally distressed gold), hand blown ornaments gathered in pretty glass pieces, to catch the light.  Years ago, we bought what must be the world's smallest crèche, made of soapstone by Vietnamese artisans and contained in a tiny basket that doubles as the manger when stood up.

I know I should be ashamed, and keep this to myself, but whenever confronted with the scene, no matter the grandeur of the subject or the design, I always think:  Ecce homo.

But that is almost a whole other topic!

We have made good eats, and abundantly.  We have done what good works we can, and made private accusatory lists of all we did not do.  We are cognizant of the reasons for the season we purport to celebrate.  We laugh.  We ponder.

So, yes, things are looking up, even with hospital stays and surgeries, illnesses and handicaps.  Even with relatives gone missing, and relatives denied.  Our animals are safe and happy, our cars and house insured.

We have an abundance of apples and I am a whiz with a food processor.

The President and Congress dismantled DADT, and we are glad.  A child of the American military, I know how hard a step, and how considered a change, this is.  Change does not come easy to that way of life, even when mandated, but unmandated?  We'd be not asking and not telling forever.  The demise of DADT merits a celebration, too!

I briefly considered beginning a Gratitude Journal.

Then I woke up. 

I was up and down during the night, mostly because of Crud Remnants in the lungs.  Well, okay, once because of some delicious, thick (nonfat) yogurt that was calling my name very loudly.  And once more for one of the much ballyhooed apples.  (They are big and round, firm and perfumed, these amazing apples!)

I slept, for the second day in a row, much later and longer than usual.  It was 8:30 am when the pitter::patter of feline feet woke me.  Except that the feet appeared to be on my chest (again) and not on the more acoustic floor.

It wasn't exactly feet I was hearing, or their motion, but rather mouths and paws.  One mouth, really, and its accompanying two front paws.

Someone had eaten a mess of kibble.
And lost it.
On me.  On my quilts.  On my blanket.
And Dobby was eating it.

I decided, invoking the wisdom of Solomon, to close my eyes again, and wait for the end.  Surely there would be an end to the chewing-purring concert my cats were orchestrating? (Marmy Fluffy Butt, Dobby's mother, and Uncle Kitty Big Balls, his uncle, were both looking on with parental pride.)

If that isn't gross, I don't know what is.
Except maybe the time when, as a kitten, Sammy pooped on me. 
Different blanket, different bed, same phenomenon.
Fred almost busted a gut laughing because I grabbed "it" as I was waking up, and discovered myself holding what appeared to be some version of a Tootsie Roll.

Ecce homo, indeed.

*  I am NOT going to do any research among the numerous online cat resource sites.  Somehow, they will trace my computer address, they will know -- this is that woman who has been both vomitted on and pooped on by her cats.  This is where she lives.  This is what she is wearing today.  This is her phone number.

Fiat lux

There is for sure a Christmas post in it.  Or maybe, more rightly, a Solstice... reflection.

Fred and I were discussing the lunar eclipse coming tonight, and tomorrow's Winter Solstice, a holy night.  I was in bed, wrapped in quilts, because I'm cold. 

Don't laugh, because the doings of CRPS are mysterious, but ever since sustaining a fairly deep puncture wound to my right big toe yesterday, I have been unable to get warm!  I cannot figure it out and even with fleece on, and a hoody, under two quilts topped by a thick blanket?  I am chilled to the bone.  The ultimate proof is that I upped the thermostat two degrees -- something that I am loathe to do under most any circumstances because that's a bill that always bites...

So we are talking dark, and light, and cold, and night, and I am shivering.

"Ring-a-ling-a-ling" from the delivery door -- the one just *under* the drawbridge, hardly noticeable to most visitors but a real boon to UPS and mail carriers, as it cuts their time spent dealing with Manor deliveries way down.  It's actually a smallish dutch-doored entryway into a former winesap cellar that has been converted into a mailroom that Captain Haddock insists be fully staffed (even on weekends and holidays). I guess that privilege has its reasons, or vice-versa, and no obligation to explain itself to me, but I have recently decided to divert the staff dedicated to sitting in receipt of the odd package or two, and installed a chime to notify us of arrivals.  This has freed up an extra pair of hands for use in wassail-making, fire-tending, nog-spiking, and so on.

But it also means that Fred has to set off at a fast-paced jog in answer to any broadcasted ring-a-ling-ling or risk incurring the wrath of various men and women in uniform, all in an incredible rush at this time of year.

We get very little personal mail and even fewer unexpected boxes.

So it was kind of neat to see Fred so laden down, to tell the truth!  He unceremoniously dumped the surprising armful on the bed -- ignoring the red and white FRAGILE labels.

Three huge, overstuffed manilla envelopes, two medium-sized boxes, all with return addresses like Davidson Lighting, Crystal Clear Images, Lucca...

I was perplexed, not able to match up these names and addresses, wanting to master them even in this season where the sudden and unexpected are most likely to be joys.  Fred watched my frustration with a growing version of his own and wordlessly handed me a pair of scissors, urging me to get on with it.  He hasn't had his coffee yet. 

Do you remember The Boxes that my brother TW and I agreed to send each other?  He sent me several and you can read about them here, and also here.  Oh, and here as well!  It all began a year ago:
A few weeks back, thinking it would be a way to save money and be a marvelous gift, I asked my two brother-units for used copies of the two books that had been the most formative to the person they each have become.

Grader Boob declined.

Tumbleweed, a stranger to me, took on the task with more compassion, generosity, and insight than I could ever deserve.  Three such Gifts he sent me, each box laden with small things imbued with larger meaning from his life.  Three occasions of grace.

This year, I changed the rules... I reverted.  I failed to grow.  I went backward.  Down with The Crud and using it as an excuse, I sent him a gift card.  I knew he would be disappointed in me, despite my honoring his atheism with a card celebrating the more natural, the more believable, the equally magical solstice.  I almost hoped he would forget about me this year.

Instead, he's put the light back in my eyes.

Prisms.  He sent me prisms, and prisms, and more prisms.  Small ones, medium, large ones.  Simple ones and endlessly facetted ones.  Seventeen of them.  (Seventeen as of now, anyway!)

The last time a total lunar eclipse fell on the winter solstice was in 1638 but there has never been a brother so in tune with a sister's dark nights, so confident in the power of the simple and the true.  It makes me happy to know, and I do know it, that my obsidian hours do not trouble his heart.

I am continually humbled by TW, a wonderful thing.  I have several deals ongoing with the Lord  of the Universe, all pertaining to humility.  In general, I am to be richly rewarded once I achieve Total Humility (and yes, I do find myself laughable!).  Who knew that all I needed was the return of this long lost boy and the complete submergence of my confidence that he was the one who needed finding?

TW, I love you.

fiat lux

Image from crystalinks: Pairs of Crystal Prisms of Consciousness Create Harmonic Grids

Tuesday, December 14, 2010

Standing in the Gap: Activated Glia and Neuropathic Pain

graphic from Principles & Practice of Palliative Care
 & Supportive Oncology, 3rd Edition

Difficult Pain Syndromes: Bone Pain, Visceral Pain, Neuropathic Pain

The good folks at the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) recently hosted a discussion about research on the role of activated glia in the context of neuropathic pain. Experts in neuroimmunology, neuropharmacology, neuroimaging, neurophysiology, and pain medicine gathered in early October 2010 for an international workshop.  Thanks, as always, to Jim Broatch for keeping everyone apprised of the goings-on...

Activated Glia: Targets for the Treatment of Neuropathic Pain

Summary of the Workshop Proceedings

The role of activated glia in the neuronal mechanisms of chronic pain was the focus of the workshop, Activated Glia: Targets for the Treatment of Neuropathic Pain, held October 8-9, 2010 and sponsored by the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA). Goals for this workshop included approaching neuropathic pain disorders, complex regional pain syndrome (CRPS), and other chronic pain conditions from a new perspective; bringing together experts in glial cell biology and function, imaging, patient advocacy organizations, clinicians, and industry representatives to challenge current concepts of chronic pain; and, ultimately, developing a knowledge consortium to further the work of this workshop.

Presentations focused on the biology of glia, imaging of activated glia, new ways to attenuate the deleterious actions of glia. Donald Manning, MD, PhD, set the stage with an overview of glial activation and its implications in neuropathic pain disorders. Glia, which until recently were thought to be passive support cells for the neurons, now are considered an important link between the immune and nervous systems in inflammation and trauma. Therapies directed at activated glia hold promise for a new approach to intractable pain. To expedite the goal of developing new diagnostic tools and new therapies for intractable pain, it is important to allow the cross-fertilization of ideas to occur between preclinical and clinical researchers in venues such as this workshop. Dr. Manning cautioned, however, that any new developments in the treatment of chronic pain must also begin and end with the patient. If animal models do not hold up to patients’ experiences, their value in furthering clinical development is questionable.

Joyce DeLeo, PhD, described the evolving model of the synapse, the junction across which a nerve impulse, such as a pain signal, travels from one nerve cell to another nerve cell, muscle, or gland. Glial cells, including microglia, astrocytes, and oligodendrocytes, constitute more than 70% of the total cell population in the brain and spinal cord. Microglia are the macrophages of the brain and are the first responders to central nervous system (CNS) injury, but exactly which signal triggers microglial reactivity is not fully understood. The activating signals may include changes in neuronal transmission, or the appearance of nitric oxide or proinflammatory cytokines.

Glial Activation and Modulation
In neuropathic pain, damage to the peripheral nerves shifts the glia to an activated state within the spinal cord. This occurs as a consequence of signals released by stressed and damaged neurons, including factors that activate the “endogenous danger signal” receptor, toll-like receptor 4 (TLR4). Once activated, the microglia release proinflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF); later, anti-inflammatory cytokines are generated to help dampen the injury response.

Several pharmacologic targets have been proposed that modulate specific glial function and the immune response, including inhibition of glial proliferation and migration, modulation of astrocyte components, and interference with proinflammatory interactions between glial cells and immune cells. Moreover, glial cells block the analgesia induced by morphine, as opioids induce glia to increase the release of IL-1. If we can block the action of glia, we can increase the efficacy of opioids.

Opioids and Chronic Pain
The use of opioids in chronic pain is often limited by hyperalgesia and tolerance. Glia play a key role in the formation and maintenance of morphine tolerance, as chronic morphine treatment has been shown to increase microglial reactivity. Studies by Dr. DeLeo and others in animal models have shown that minocycline, an antibiotic in the tetracycline class, and propentofylline, a glial modulator that decreases mechanical allodynia (an enhanced pain response to touch), can inhibit spinal microglial reactivity and attenuate the development of morphine tolerance. In vitro studies have confirmed that these agents can attenuate microglial migration. Dr. DeLeo and her group hypothesize that morphine enhances microglial reactivity by inducing the release of proinflammatory cytokines and chemokines, as well as through direct signaling between microglia and nociceptive neurons.

Potential Therapies Under Development
Several therapeutic approaches to target the negative consequences of glial activation are currently under investigation. Kirk Johnson, PhD, Chief Scientific Officer at MediciNova, described research on ibudilast, a nonselective phosphodiesterase (PDE) inhibitor that also suppresses glial-cell activation. Ibudilast, also known as MN-166 and AV411, has been available in Japan for 20 years for the treatment of bronchial asthma and poststroke dizziness, and shows promise for its antineuroinflammatory and neuroprotective action, attenuation of activated glia, and inhibition of the molecular targets macrophage migratory inhibitory factor (MIF) and PDE.

Efficacy in animal models as well as positive pharmacologic characteristics has moved ibudilast into human studies. Preclinical studies have shown several actions that can be attributed to attenuation of microglial activation, including attenuation of proinflammatory processes, inhibition of TLR4 signaling, and stimulation of neurotrophic and anti-inflammatory factors. A phase 1b/2a trial in diabetic peripheral neuropathy patients showed efficacy in pain reduction and a reduction in opioid use in those taking ibudilast. In a study of progressive multiple sclerosis (MS), ibudilast showed significant reduction in brain atrophy and reduction in persistent black holes seen in MRI studies.

Dr. Johnson cautioned that the concept of glial modulation, though appealing, has not yet been clinically validated and there are some concerns about the long-term effects of chronic suppression of glial reactivity/activation. However, ibudilast may have the ability to impact several aspects of chronic neuropathic pain or MS, including pain, depression, cognition, and neurodegeneration.

In contrast to the broad-strokes approach to controlling neuroinflammation with ibudilast, Linda Watkins, PhD, posited that by targeting specific receptors, it is possible to provide polypharmacy in a single molecule. According to Dr. Watkins, research in the last 18 years has shown that glia are activated in every clinically relevant model of enhanced pain. Suppressing glial activity and its proinflammatory products suppresses the pain and returns the patient to normal. This concept extends beyond pain—the same uprise of proinflammatory cytokines that begets pain may also be a risk factor for abuse of opioids and other pharmacologic agents.

Strategies for controlling glial proinflammatory responses include targeting specific receptors that are already very well understood: adenosine 2A, interleukin-10 (IL-10), and TLR-4. ATL313 (Adenosine Therapeutics/PGxHealth) is an adenosine 2A agonist (A2A) that suppresses proinflammatory cytokines while enhancing the anti-inflammatory cytokine IL-10. A single injection given intrathecally has been shown to reverse neuropathic pain for 4 to 6 weeks in animal models of chronic constriction nerve injury, peripheral neuropathy, spinal cord injury, and central neuropathic pain.

XT101 (Xalud Therapeutics) is an IL-10 nonviral gene therapy tested in models of peripheral and chemotherapy-induced pain as well as central damage similar to that seen in MS. Following injection, this treatment is microparticle-delivered and slowly degrades into natural products of metabolism, releasing gene therapy for IL-10. A single intrathecal injection of XT101 inhibits the proinflammatory cytokines that are causing pain and paralysis, in turn reversing this pain and paralysis.

Orally deliverable TLR4 antagonists, such as naloxone, also offer a targeted approach to treating neuropathic pain and increasing the efficacy of opiates, such as morphine. Studies have shown that morphine and (+)naloxone administered together produce an increase in analgesia, and repeated dosing prevents the dependence and withdrawal effects that commonly occur with morphine. These effects also extend to the side effect of morphine; studies have shown that the TLR4 antagonist action of (+)naloxone blocks the dose-limiting effects of constipation and respiratory depression...

The entire proceeds of the workshop are summarized HERE.

A few reading recommendations if, like me, you're not quite up to speed on glial research and its potential applications to neuropathic pain syndromes like CRPS:

Nature Reviews Drug Discovery 2, 973-985 (December 2003)
GLIA: A novel drug discovery target for clinical pain
Linda R. Watkins & Steven F. Maier
available as pdf file from Univ. of Colorado
The Journal of Pharmacology and Experimental Therapeutics, vol. 297 no. 3 1210-1217 (June 1, 2001) 

Propentofylline, a Glial Modulating Agent, Exhibits Antiallodynic Properties in a Rat Model of Neuropathic Pain

S. M. Sweitzer, P. Schubert and J. A. DeLeo

Neuroimmunologic approaches to the understanding and potential treatment of CRPS
Donald C. Manning, MD, PhD
RSDSA Education Section  [2005?]

Guilt's Stain

Mark Madoff was remembered fondly by former classmates Monday...

Doreen Hebron said Madoff was 'very popular,' dressed well and had a good attitude.

Bernard Madoff's sons, according to their family's legal representatives, were whistleblowers and not co-conspirators in the Ponzi scheme that defrauded investors of 65 billion dollars, and for which, in large part, their father is serving a hefty prison sentence of 150 years.

The story goes that immediately upon being informed by dear old Dad that he had lost the life savings of thousands of investors, Mark and Andrew Madoff contacted the FBI, and Bernard Madoff was arrested the next day, December 11, 2008, on a single count of securities fraud.

That was an amazingly swift reaction.

(I'm just sayin'.)

As the 2-year anniversary approached, there were apparently a good many legal issues that needed attention -- most having to do with the filing deadline for lawsuits seeking recovery of lost assets -- and the attention of the press and general public was again at a peak.

Mark Madoff hung himself this past Saturday, December 11, using a dog leash. He was married and had four children. His father's lawyer states that Bernard Madoff won't seek to attend the funeral out of "consideration" for his son's immediate family.

Despite the fact that investigators still cannot fathom how Madoff pulled off his securities fraud or how he laundered such large amounts of money for so long without the assistance of others, particularly of his brother or sons, all of whom worked at Madoff Investment Securities, authorities now deny that any new criminal charges were imminent.

In his article about the suicide, AP journalist Larry Neumeister interviewed another of Mark Madoff's childhood friends, Lev Seltzer:

[R]eached by telephone in Israel, where he now lives, [Seltzer] recalled working with Madoff on a sixth-grade assignment at a Long Island school to create a fake television commercial. He said the ad mocked a long-running Life cereal commercial that featured a boy named Mikey who hated everything else but liked the cereal.

"Instead of Mikey, we had Marky," Seltzer said.

Monday, December 13, 2010


funny pictures-meh.
see more Lolcats and funny pictures

"ai concurz." *

*I completely forgot, in the previous post, to extol the virtues of LOLcats and Funny Pictures when fending off The Crud.



Pharmacies, Penguins, and Richard Russo (to the tune of "plop, plop, fizz, fizz...")

O, to be a screaming ninny, O!  a screaming ninny, O, to be!

This is what I have been reduced to, after spending the day in such worthwhile endeavors as establishing The Manor as a No Call Zone for the American Heart Association.  You'd think that those ne'er-do-wells would not waste time by canvassing Tête de Hergé (très décédé, d'ailleurs) territory, as there is no heart disease here.

Let's see, what other important tasks has this hypoxic and huffing hunk o'humanity been up to?  Mostly trying to have all my medications that are currently being mangled by local retail pharmacies transferred to Medco's mail service, where they can mangle them, in turn, but for an extended, 3-month period.  It seemed an easy enough thing to do when I thought of it -- and I thought of it precisely when Fred announced his intention to murder a local retail pharmacy employee.  We have been playing "who called whom?" and "who has the prescription but not the medication?" since December 8.  This morning, we switched to a new game called "who has the prescription filled... CORRECTLY?" 

What Fred wants to know from his growing list of Pharmacy Friends, it seems, is:  Why the hell do I have to be present in person for you to confess your pharmaceutical failures and inadequacies?  Isn't that exactly why you have our phone number and email addresses?  Hmmm?  And then, as I said, he dreams of the quick garrote.  O, that boy and his piano wire!

When he finally appeared with my drug in hand, five days after it was prescribed and probably ten days since it was first needed, Fred was triumphant.  But since he, like I, still struggles to breathe after being ill with The Crud, his victory was celebrated by a weak, trembling fist in the air, followed by total collapse.

Would you believe... they gave me extra pills?!  It's a trap, I know it must be a trap.  They are waiting by the phone, ready to impugn my honesty as I have repeatedly impugned theirs (before understanding that it was competency in question, not character...).

I pity my Go-To DoctorGuy.  He is part of the inimitable MDVIP organization, a medical delivery system designed to privilege prevention of illness and maintenance of health.  How he ended up with me as a client is something he must ponder at least several times a week.


We email regularly.  I actually saw him for a fairly extensive visit last Monday.  Two days later, of course, I was deathly ill.  That's the rhythm of our relationship:  I see him; He tries to kill me, I survive but launch a defensive email campaign.


Somewhere in there, I started amusing myself with animal videos on YouTube.  God bless YouTube.  Really, I mean it. 

Well, God bless Richard Russo, also.
Specifically, God bless his novel Straight Man.

If you are, or if you know, a frustrated academic, Straight Man will bring you as close to hilarity as anything can at this point in the university calendar.  By page 19, I had logged two episodes of uncontrollable mirth, bed-shaking mirth.  Indeed, pant-wetting mirth, were I the type, which I'm not.

I'm NOT, I said.

I did, however, end up with the entire domestic staff, Fred, The Castafiore (distressingly déshabillée), and all three extant Manor Felines trying to squeeze through our bedroom door like an implausible number of overfed circus employees leaving an imploded clown car.  I sounded, according to them, as if I were in distress.  With the advent of bronchial pneumonia, my harsh laughter apparently approximated the bark of a California sea lion

I hate those moments.  You so want to have the people (and felines) peering at you on your side, you know?  They look so distraught, you think.  If only they, too, could experience the joy of this rambunctious prose!  That's when you hatch the worst idea conceivable:  I will read them a passage!  Then we will all be {giggle::giggle} on the same page!

I chose to share the bit about William Henry Devereaux Jr's dog and his propensity for head-butting people in the groin as an expression of pure joy.  It was what was on the page.  I thought it could stand the exposure. 

Yeah, so that was about the time when animal videos from YouTube gained preeminence over any type of reading... at the suggestion, precisely, of the domestic staff, Fred, The Castafiore, and all three extant Manor Felines.  Fred allows me a half hour of Richard Russo at bedtime, on condition that I not wake the Cistercians down the road with my verbal shenanigans.  It's a glorious 30 minutes.

There is something reassuring about what we, as a species, tend to find funny.  Particularly (and precisely), I am reassured by what we find hilarious in the exploits of the animals with whom we share the planet. 

One of Fred's Militant Existential Feminist Lesbians condescended that these poor animals were exploited by our raging egocentrism as humans.  "Nuh-uh," I countered.  "It only makes sense that we interpret the actions of another species through the actions of our own, because, heck, we really are the center, object, and norm of all experience!  C'mon cutie, give us a smile!"


Take penguins, for instance.  (Any reader out there who periodically shouts "Or she!" gets brownie points)
I resemble these birds and the many human feelings they evoke.

All statements and claims of humor and/or interspecies resemblance will be subject to reevaluation upon our return to baseline ill health.

Sunday, December 12, 2010

Oh, that bothersome bot!

graphic by creativeNERDS
Good evening, Friends of The Manor, Minions of Marlinspike!  

I am doing my darnedest to breathe. Fred has passed along his illness, and as is my wont, I am taking it to new heights. As in flirting with, if not in the actual throes of, pneumonia.

Lacking that, I have at least achieved a striking bronchitis.  Marmy Fluffy Butt and I have been performing *ack*-*ack* duets, our pink noses in air.
This self-limiting respiratory virus will serve as my latest excuse, the raison du jour for my absence from the virtual realm.

In such a condition, with its predictable accompanying mood, I decided to check email before gathering with Fred and The Castafiore to sing, all in a jumble, our nightly rendition (in the round) of "plop, plop, fizz, fizz... oh, what a relief it is..."  Marmy scats her *acks* as a sort of background vocal.

Unfortunately, I got pissed off by the very first piece of electronic mail. It was my MedWorm feed report for the term CRPS -- all the news on that funkylpated addlemucked crap of a disease that is fit to spread around like fresh, pungent manure.

The vast majority of the time, the Medworm CRPS feed turns up research just published within the confines of academia. It is remarkable when what pops up derives more from the personal, as in a blog.

And it is regrettable when the singularly personal blog merits reportage for an offhanded and uninformed remark. That's when you remember that it is not so much intelligence that is at work as it is the intestinal contents of a bot.  *

Anyway, you know me (and, again, I'm sorry about that!), I have to read it all. So I dutifully click on the link provided, tap my heels and toes together like a spastic Nazi, and arrive at:
(B)e(LO)n(G), OT -- the blog that the bot bit.

Under the title, blogger Karen appends this description:

I recently made the transition from occupational therapy student to occupational therapy PRACTITIONER. That's right, I am an occupational therapist now, dum dum dum. This blog is having a hard time following me in the transition so bear with me!
Reading this, I am already thinking that turning the computer on at all was a mistake.  My phlegm confirms it, but I figure I'm halfway home, maybe this neophyte has an insight that'll take me to school...

I read on -- it doesn't take long -- and discover that the following passage is what has so commended this woman's blog to the CRPS Medworm bot:
We had a lady come in today, 3 months post carpal tunnel surgery, who is still having a LOT of pain in her L hand and is babying it (her non-dominant hand). She doesn't move it much because it hurts. Her scar is healing well although hypersensitive, and her hand isn't swollen or red, so it doesn't seem like its CRPS/RSD, but something along those lines. To me CRPS/RSD seems like it is directly correlated to the level of depression/anxiety a person has. The more depression/anxiety a person has, the more likely they end up with CRPS [my anecdotal experience]. I was trying to think of ways to handle her pain and I wish I had more of my OT resources here. Oh well.
The unknown but now fully vested OT Julie has managed to offend me which is, of course, ridiculous, as her blog is just another blog, ho hum.  But this blog met the bot and therefore pretends (in the French sense of prétendre, and no, I am not being snobbish, I really cannot find the equal phrase in English), therefore lays claim to a sort of research nobility which its actual bastardized nature cannot support.

Do I need to chase down and reiterate... Do I need to be the counterweight, countering voice?  Do I have to care?

You ought to be able to deduce the answer from the fact that I am writing this while wheezing and bulbous-nosed, head aching and face raw.  Yes, damn it, I have to care.  I did a little reading of Karen's blog and she's definitely talented, definitely dedicated... but she blew it with this broadened (haphazard and unsought) publication.  Because for her every mention of prostheses, I've got mine (both the mentions and the prostheses themselves, eh wot?!) and for her doomed reference to anecdotal experience... well, en garde, chica, en garde

No, in all seriousness, it sound like Karen is dedicated and immersed in helping people obtain and acclimate to prosthetic limbs and the various sundries that go with disability.  And yes, I am sure that is an understatement of all that must be involved.

As long as the truth is going to be contained in winked-out citations of [not-much] experience, people with diseases like CRPS will remain disadvantaged by health care professionals who prefer their truths watered down.  It doesn't matter what you know, wink::wink, it only matters what you KNOW, if you get my heavy handed drift...

In sum, as I need to go evacuate my lungs, please, young professional, newly minted OT, bone up a bit, do some reading -- but just know that how you choose to deal with the psychosocial factors associated with any disease process... well, it shows, and not just in your blogging, and it can serve as a sort of casual litmus test for your patients.

It's funny, Karen, but as I reach the end of this ridiculous post, this rant, I find I kind of like you.  I took some time out to deal with the gastrointestinal sequelae of antibiotic therapy (yes, folks, I am now on the SECOND course of abx, the osteomyelitis experiment continues midst a budding pneumonia!) and to reflect on my personal dealings with occupational therapists, my own anecdotal evidence, of sorts.
It is not for nothing that part of the introductory packet of information sent out by Reflex Sympathetic Dystrophy Syndrome Association ( is a a fairly dense article written in 2003 by E. Daniela Hord, MD and Anne Louise Oaklander, MD, PhD -- Complex Regional Pain Syndrome:  A Review of Evidence-supported Treatment Options.

Because of the discrepancy between the subjective complaints
of pain of patients with CRPS and the limited
objective evidence of underlying pathology, some authors
in the past have suggested that psychiatric factors are a
major cause of CRPS. Although many patients with longterm
CRPS battle depression and anxiety, these conditions
usually are a consequence, rather than a cause, of their pain
[18]. It is clear that experiencing significant ongoing pain is
a major adverse life event that will challenge the coping
skills of even the most well-adjusted patient. Clinicians
should be aware of the high rate of secondary psychiatric
problems in CRPS and refer patients for counseling and
medical treatment as needed.

Bottom line!  (And good luck in what I know will be an awesome career helping people, OT Karen!)

*****     *****     *****     *****     *****     *****     *****

*  What is a bot?  Well, first of all, it is not a botfly, fascinating as those creatures can be.  If you are into botflies, you might enjoy this "compilation," much treasured over at Pop That Zit.

Sometimes a bot (or zombie) refers to a type of malware.

But what I am referencing are --
Internet bots, also known as web robots, WWW robots or simply bots... software applications that run automated tasks over the Internet. Typically, bots perform tasks that are both simple and structurally repetitive, at a much higher rate than would be possible for a human alone. The largest use of bots is in web spidering, in which an automated script fetches, analyzes and files information from web servers at many times the speed of a human.
Specifically, I'm on about RSS Bots -- "a web-crawling robot [that] collects RSS, RDF, and ATOM feeds from the internet to build a searchable index..."

Friday, December 10, 2010

Tim Minchin: White Wine in the Sun

White Wine In The Sun

I'm looking forward to Christmas
It's sentimental, I know, but I just really like it
I am hardly religious
I'd rather break bread with Dawkins than Desmond Tutu, to be honest

And yes, I have all of the usual objections to consumerism
The commercialisation of an ancient religion
And the westernisation of a dead Palestinian
Press-ganged into selling Playstations and beer
But I still really like it

I, I really like Christmas
Though I'm not expecting a visit from Jesus

I'll be seeing my dad
My brother and sisters, my gran and my mum
They'll be drinking white wine in the sun
I'll be seeing my dad
My sisters and brother, my gran and my mum
They'll be drinking white wine in the sun

I don't go for ancient wisdom
I don't believe just 'cos ideas are tenacious it means they are worthy
I get freaked out by churches
Some of the hymns that they sing have nice chords but the lyrics are dodgy

And yes I have all of the usual objections to the miseducation
Of children forced into a cult institution and taught to externalise blame
And to feel ashamed and to judge things as plain right and wrong
But I quite like the songs

I'm not expecting great presents
The old combination of socks, jocks and chocolate is just fine by me

Cos I'll be seeing my dad
My brother and sisters, my gran and my mum
They'll be drinking white wine in the sun
I'll be seeing my dad
My sisters and brother, my gran and my mum
They'll be drinking white wine in the sun

And you, my baby girl
My jetlagged infant daughter
You'll be handed round the room
Like a puppy at a primary school
And you're too young to know
But you will learn yourself one day
That wherever you are and whatever you face
These are the people who'll make you feel safe in this world
My sweet blue-eyed girl

And if, my baby girl
When you're twenty-one or thirty-one
And Christmas comes around
And you find yourself nine thousand miles from home
You'll know what ever comes
Your brother and sister and me and your
Will be waiting for you in the sun
Girl, when Christmas comes
Your brothers and sisters, your aunts and your uncles
Your grandparents, cousins and me and your mum
Will be drinking white wine in the sun
We'll be waiting for you in the sun
Baby whenever you come
We'll be waiting for you in the sun

I, I really like Christmas
It's sentimental, I know

-- Tim Minchin

Thursday, December 9, 2010

Allwine Resigns

My first post about Rebecca Allwine appeared on November 3, and was titled What are they thinking?

Between then and now, I've given this a lot of thought:  I might be a curmudgeon were a curmudgeon young, lithe, lighthearted and not pegged "a crusty irascible cantankerous old person full of stubborn ideas."

I'd also like a little latitude to play with alternate spellings.  I'm thinking something along the lines of "kermudjin."   
Curmudgeon that I am not, then, I still doubt that Rebecca Allwine has made what amounts to the right decision by virtue of... well, by virtue of her own virtue.
Speak plainly?
Now, there's a notion.

[One of my Brother-Units is a patient educator of 18-22+ year olds at a state university, and as such, has had occasion to offer a good many composition tips over the years.  He has, he says, "seen it all." Although he marvels at my writing, he offers me the same boring critique, year in, year out:  Too many words.] 
When elementary school teacher Rebecca Allwine graced these hallowed manor halls a few weeks back,  she had been arrested for attempting to kill her husband by poisoning his drink with a lethal dose of Ambien.  As the newspaper put it, succinct to a fault, "he survived."
[With my luck, on one of my more suicidal nights, the only thing that would likely happen after such a dosing?  A little zombie refrigerator raiding, unrecalled the next morning, as I puzzle my way through a farewell note smeared with chocolate sauce.] 
What she did is what ought to have been remarkable enough as news fodder, but you know, and I know, that it was not.  So she poisoned her husband: Well,  meh.

What moved me to mention the endearing educator in this blog was the fact that she was allowed to continue teaching there, in Coweta County, Georgia,.  Why?  Because, we are told, she had always been "a good teacher." 
Oops.  Sorry.  That's a ridiculously erroneous quote.
She was "a very good teacher."
Back in November, I did verbal gymnastics over the word turpid, as found in turpitude -- the moral sort of which the governing standards commission for teachers in Georgia determined her to be free of.  Or, at least, unconvicted.  Of. 
My grammar is dangling all over the place tonight!
Okay, so there is breaking news in Coweta County. 

Rebecca Allwine voluntarily resigned.  I think any reasoning reasonable adult would recognize that as the proper course -- that a teacher charged with such a crime not remain in the classroom (until the facts of the case are elucidated), that a teacher determined to have committed such acts never again grace the classroom.

Unfortunately, what remains a puzzlement to this kermudjin is the insistance of her school colleagues on the excellence of her character and job performance.  I suppose there is a throw-away phrase or two to which newspaper readers are not exposed -- something like "given that it was a crime of passion" or "she just must not have been in her right mind, momentarily..." There are probably even a few versions of "he had it coming..."

Well, Dear Apologists -- you are just wrong and, in your wrongness, manage to beg so many disturbing questions that we have issued writs and warnings throughout the realm of Tête de Hergé (très décédé, d'ailleurs) about the dangers of sending one's children to a school in Coweta County, Georgia. 

The fear, though, is far less about the moral fiber of Rebecca Allwine than it is about the lack of common sense of school and state education officials in that otherwise fine region.

Teacher in domestic dispute resigns
By Jeff Bishop

The Times-Herald

Facing continued questions from concerned parents and even national publicity, teacher Rebecca Allwine has resigned from her position at Willis Road Elementary School.

"We have accepted her resignation, and it was a voluntary resignation," said Coweta County School System spokesman Dean Jackson. He said he could not comment further because the matter is a personnel issue.

Allwine's last day of employment was last Friday.

The second grade Coweta County teacher allegedly attempted to poison her husband last winter. But she kept teaching at Willis Road Elementary School, even after she was arrested for the crime and later indicted by a Coweta County grand jury.

The controversial move to support Allwine made national news, with popular Headline News Channel host Nancy Grace expressing outrage and asking her viewers, "How can she not be a threat?"

"A second grade school teacher has been discovered poisoning her husband -- she's not in jail. In fact, she's back in the classroom?" said Grace on her nationally-televised cable show.

"Someone explain. She's back in the classroom with second graders. How could she not be a threat?"

As late as two weeks ago, Coweta school officials said the school system had not changed its position of support for the teacher. But parents in the meantime continued to meet with Superintendent Blake Bass and others, expressing their concern.

Newly-elected Coweta Board of Education member Amy Dees said she had problems with the school system's decision.

"I absolutely feel that she should not have been placed back in the classroom," said Dees soon after her election. "She was obviously having some emotional issues and our children were exposed to that. Whatever rules protected her need to be changed." Times-Herald reader comments also tended to be critical of the decision. One Sound Off contributor asked, "Would you let your child be in a classroom with this woman?" Another stated, "I have children at Willis Road Elementary. While I'm sorry for Allwine's personal problems, I resent the school board's attitude on this matter. She's demonstrated that she's unstable. She should not be teaching small children. She will never teach mine."

"I have a student at Willis Road Elementary School in first grade," said Sharpsburg resident Brad Gaines in a Letter to the Editor of The Times-Herald. "I am appalled the teacher accused of such a serious crime is allowed to continue to teach our kids.

"Call it what you want, but she was originally charged with attempting to murder her husband by putting something in his drink.

"I believe as parents in our community we should not just stand by quietly and allow the school board to make such a stupid decision. She has obviously proven by her actions that she is an unstable person."

Allwine so far has not responded to requests for comment.

Allwine pleaded guilty earlier this fall to disorderly conduct. A Coweta County grand jury meeting for Coweta Superior Court indicted Allwine in September for aggravated assault and battery, alleging that Allwine had attempted to poison her husband, Joshua Allwine, with Ambien and melatonin pills, court records show.

The charges arose from an incident that occurred on Jan. 31, 2010, at 2:01 a.m., following a domestic dispute, according to testimony given by Coweta County Sheriff's Office officer Trent Hastings, who arrested Allwine, according to court records.

Hastings said Mrs. Allwine did "intentionally cause physical harm to her husband" when she "struck him with her hands numerous times" in the head, "resulting in multiple lacerations," according to court records.

Allwine also "intentionally put approximately 18 melatonin and 10 Ambien in the victim's drink that he prepared for himself, and that she knew he would be consuming," said the officer. "The victim did consume the drink, resulting in a likely chance for bodily harm or death."

"The school system does not feel that she is a danger in any way, not in the least," said Jackson, speaking on behalf of the school board, after the incident became public. "If we did, we would have taken action from the beginning.

"We were made aware of the details of this incident from the start, and the school, the school system and the Professional Standards Commission were all involved. If at any time the school system has a question about whether or not a teacher should be in the classroom, that teacher is not going to be there, but there were no such concerns in this case."

The school system took the position that this was a private, domestic dispute. Mrs. Allwine filed for divorce and a temporary protective order shortly after the altercation.

The Professional Standards Commission stated that because the assault charge did not result in a conviction of a felony involving moral turpitude, Allwine's employment status was left up to the school district.

"We were continuously informed of the legal proceedings, and the issue was reviewed by the Professional Standards Commission," said Jackson. "The charges were resolved.... She has continued teaching throughout, and is a good teacher and employee."


Indifference; to be used when one simply does not care.

A: What do you want for dinner?
B: Meh.

Used in the greatest tv show of all time, The Simpsons. In the episode Hungry, Hungry Homer, Bart and Lisa respond to a Homer inquiry with "meh."

Homer: Kids, how would you like to go... to Blockoland!
Bart & Lisa: Meh.
Homer: But the TV. gave the impression that--
Bart: We said "meh".
Lisa: M-E-H. Meh.
-- The Urban Dictionary