Topical Rubs

One of my CRPS MedWorm RSS feeds delivered the following non-news news to my inbox this morning -- an announcement that the targeted enrollment number for a Phase 2b trial of a topical cream has been reached. Yes, I know. Kind of a meh-moment.

The meh-moments have been accumulating around here.

The Internet's medical router -- "over 6000 authoritative RSS feeds go in, hundreds of new RSS feeds by category come out" -- MedWorm is a terrific tool for the lazy researcher. Check it out if you try to stay on top of breaking medical news. You know, like for topical creams...

Before addressing that pressing news, though, I must report that Ivan Ljubicic, now in a tied fifth set with American (and ultra-cool dresser) Mardy Fish, needs emergency fashion advice.

Actually, the situation is not an emergent one, as Looby has long defied dictates of color, fit, and the remotely chic. He is a tall, pale man sporting a shaved head (almost always adorned with a *white* headband). His height is undeniably 6'4" but I refuse to believe that he weighs in at the reported 200 pounds.

I further deduce that the sun did not shine in the Serbian-dominated part of Bosnia of his childhood -- nor, apparently, are there opportunities for tanning in his current home of cloudy-dowdy Monaco. He looks positively jaundiced in a bright yellow shirt that fades rapidly to white, ballooning over white shorts, white socks, white shoes. Badly stained white, of course, as this is the terre battue of Roland Garros, after all.

My eyes! My eyes! Ljubo just treated the viewing audience to an around-the-world hip rock, hoping, I think, to approximate Elvis, but... well, failing. Next up for The Lube-Meister? Brazil's Bellucci, and more bad white clothing. I mean, at least wear *bright* white in lieu of the dirty-white, dishwater look.

Ljubicic is actually signed with designer Li Ning... a fact which begs more questions than it answers. Li Ning is one of the leading sports brand enterprises in the PRC. I know when I think of tennis fashion, the PRC fairly leaps to mind. Jelena Jankovic is also sporting their clothing/shoe line.

In the interests of full disclosure, let it be known that I'm a fan of "the war child." Only a fan would care about the nefarious effect of red clay on His Whiteness.

What am I wearing? An oversized, longitudinally-striped night shirt and dark grey chinos. My stripes are pastels, my fabrics all very worn, soft cotton. Turquoise earrings. [No bra, no underwear of any sort, no socks, no shoes -- I cannot tolerate any of them against my skin, or pulling on my shoulders. That's a bit of trivia I bet you wish you had not read.]

In other meh-news, when did Baghdatis achieve a 25th ranking? No offense, but he's basically a country club sort of player. I enjoy watching him, and root for him because he has always seemed to represent the good local player whose level of game rises against better players, making for some exciting points before he eventually winds down to his actual level of proficiency.

He tends to respond in kind... that is, if he is given a fast, flat ball, his return will be faster and flatter. He is a counterpuncher but lacks the speed and placement capabilities required to win majors.

I might feel differently were I sporting undies or red stilletos.

Maybe if I get ahold of some of EpiCept Corporation's analgesic topical cream, I would be able to once again wear proper foundational garments. How's that for a segue?!

Targeted Patient Enrollment Reached In Phase IIb Clinical Trial For Epicept™ NP-1 In Chemotherapy-Induced Peripheral Neuropathy

EpiCept Corporation (Nasdaq and Nasdaq OMX Stockholm Exchange: EPCT) today announced that the targeted enrollment in a Phase IIb trial for EpiCept™ NP-1 in chemotherapy-induced peripheral neuropathy (CPN) has been attained. The trial is being conducted by National Cancer Institute (NCI)-funded Community Clinical Oncology Program. EpiCept™ NP-1 is a patented topical cream formulation of two FDA- approved drugs, 4% amitriptyline and 2% ketamine, and is intended to provide long-term relief from the pain of peripheral neuropathies. CPN may affect 50% of women undergoing treatment for breast cancer.

The double-blind, randomized placebo-controlled study has enrolled more than 400 patients suffering from painful CPN for at least 28 days following the conclusion of chemotherapy. The primary endpoint of the 6-week trial is change in average daily neuropathy intensity scores from baseline to the endpoint. Secondary endpoints include the percentage of patients whose neuropathy intensity decreases at least 30% from baseline as well as various other measures. Topline data is expected to become available by year end.

About EpiCept™ NP-1

EpiCept™ NP-1 is a prescription topical analgesic cream designed to provide effective, long-term relief from the pain of peripheral neuropathies. Peripheral neuropathies are medical conditions caused by damage to the nerves in the peripheral nervous system. The peripheral nervous system includes nerves that run from the brain and spinal cord to the rest of the body. Peripheral neuropathies are associated with conditions that injure peripheral nerves, including herpes zoster, or shingles, diabetes, chemotherapy, HIV and other diseases. Peripheral neuropathies can also be caused by trauma or may result from surgical procedures. EpiCept™ NP-1 Cream is a patented formulation containing two FDA-approved drugs, amitriptyline (a widely-used antidepressant) and ketamine (an NMDA antagonist that is used as an anesthetic).

I shouldn't make fun -- EpiCept's idea of compounding amitriptyline and ketamine for relief of neuropathic pain is well-founded, logically, and I am glad to see it in the pipeline. I don't know enough about the various types of neuropathic pain to say whether the CRPS incarnation is truly comparable to this focus group of chemotherapy patients, but I would imagine some applicable correlation. Besides, it is virtually impossible to have meaningful test results if the cohort is limited to CRPS patients -- I tire of reading about results involving all of 4 or 13 subjects, 3 or 12 of whom have dropped out due to side effects...

In the Supportive Care in Cancer journal (ISSN: 0941-4355 Print; 1433-7339 Online), a similar study announced its results on 24 May 2010. The topical gel used here has the addition of baclofen in its compounded form: baclofen 10 mg, amitriptyline HCL 40 mg, and ketamine 20 mg in a pluronic lecithin organogel.

Again, from a lay point of view, the combination makes beaucoup sense. It's ironic that I can't use topical meds -- I cannot tolerate lotions, creams, gels. Still, it sure sounds like a good idea!

Abstract

Background
Chemotherapy-induced peripheral neuropathy (CIPN) is a troublesome chronic symptom that has no proven pharmacologic treatment. The purpose of this double-blind randomized placebo-controlled trial was to evaluate a novel compounded topical gel for this problem.

Methods
Patients with CIPN were randomized to baclofen 10 mg, amitriptyline HCL 40 mg, and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) versus placebo (PLO) to determine its effect on numbness, tingling, pain, and function. The primary endpoint was the baseline-adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks.

Results
Data in 208 patients reveal a trend for improvement that is greater in the BAK-PLO arm over placebo in both the sensory (p = 0.053) and motor subscales (p = 0.021). The greatest improvements were related to the symptoms of tingling, cramping, and shooting/burning pain in the hands as well as difficulty in holding a pen. There were no undesirable toxicities associated with the BAK-PLO and no evidence of systemic toxicity.

Conclusion
Topical treatment with BAK-PLO appears to somewhat improve symptoms of CIPN. This topical gel was well tolerated, without evident systemic toxicity. Further research is needed with increased doses to better clarify the clinical role of this treatment in CIPN.

In the women's draw, Serena is looking very good, Venus, also. As I've consistently noted, I am not a fan of the Williams sisters. It's a snooty attitude and I try to revise it every year.

First impressions do endure: I was a non-fan from the beginning. Initially, they seemed to be cobbling together victories with novelty shots and spurts-and-bursts of brilliant power that alternated with amateurish errors.

Venus can thrill me at times, when she moves well to the ball, and executes once she gets there. I am frustrated on her behalf when she hustles to get there, then seems unable to convert the hustle into a point. Another hold-over of my hypercritical past (I am downright magnanimous now) because she is, of course, awesome in her court presence.

The sisters sometimes smother my potential enthusiasm by their attitude -- conveyed as much by a lazy overhead as by a blistering verbal outburst. Then, too, I think they've both sometimes made excuses for poor play that was inexcusable, and have failed to adequately respect their opponents off court.

Okay, okay, none of that is true. It all comes down, really, to fashion sense, to The Togs. They are both accredited designers but who can forget Serena's Klingon industrial black affair from that long ago U. S. Open? One piece, of oh-so-breathable spandex, it is the iconic image conjured whenever I hear her name. Ridiculous and unfair, as it has been eight years now, but that's the way it goes.

It must have been meant to convey the trend toward unrepentant female strength and power, but as Robin Givhan noted back then, it came off as "trash talk," and was a "disservice" to Serena. There was a brief attempt to make it a "teachable moment," during which White America was to confess its discomfort with the Black Female Butt. Clearly, there is truth to the notion that eurocentric white standards continue to dominate, and clearly, Serena and Venus have both enjoyed providing an in-your-face response. I promise, though, if Anna Kournikova were to sport the rubbery unitard? I would have been equally disapproving. Less disappointed, perhaps, because I've not the visceral connection with Kournikova that I share with the American Williams, but no less turned off by it.

It is late-coming, but I might turn the corner as a Serena fan. I like that she is now so fit and that her form is consistent. I'm sure she's very relieved that I am coming around...

I may have to let the catsuit issue die a natural death.

As for Venus, whose heart didn't stall when her skirt flew up to reveal... flesh colored tennis underpants? Actually, my heart didn't skip a beat but I understand much of Paris required resusscitation. I even like the corsetted red "bustier," and if she can tolerate the feel of all that lace, well... cool.

I will never forget the frilly, white, totally retarded looking tennis undies that my stepmother so wanted me to wear. There was no way not to feel stupid, no way not to be totally focused on one's own ass. They were as kryptonite to my forehand crosscourt passing shot and my blistering backhand.

Millions of women are reveling in her diss of the white ruffled bloomer and the attitude and times represented by that infantilizing bit of elastic and polyester.

As many again are thrilled by her incredible and unapologetic behind.

CNN has put together the obligatory long view of the Williams' sisters various fashion statements.

The woman I hope to see win is Justine Henin, someone who also sometimes suffers in the vagaries of body types and sexual tensions. I remember totally losing it a few years ago -- she had just won one of her four French Open titles and I was whooping it up online with fellow enthusiasts when there came a barrage of comments about the size of her breasts. She had just finished schooling the world on pristine clay court play, only to be assessed by her bra cup measurement. It was infuriating, frustrating.

Witness this "Mister Poll" and its enlightened stance:

What do you think of Justine Henin's looks?

She is so ugly I want to vomit!
She looks like a man!
She is just an average girl - not my type
She is ok I've seen better
She is nice
She is so hot she makes me hot thinkig about her!

What do you think of Justine's breasts?

She is a titless wonder - yuck!!
She has got really tiny breasts - I'm turned off..
Her breasts are really tiny and I love them!!!
I never noticed her breasts
They are just an average size pair

How would you feel if you were Justine henin and had her breasts?

My shame would be so great I would never go out
I'd be straight into surgery. Boob job please!
Padded push up bras with extra padding please!
I'd be so embarressed but I would cope somehow.
It would be ok I'd just be fine.
I would love it I'd be out topless bathing!!

Should Justine be punished for her public display of small breasts?

Yes - make her play topless and laugh at her!
Yes - bend her over and spank her bare bottom!
Yes - ban her from tennis she is ugly!
No - as long as she has a boob job!
No - She is ok.
No - She makes me hot.
No - But I still want to see her play topless!!!

Would you have sex with Justine Henin?

No way - She is an ugly dog!
No way - She is probably half man!
No way - with that titless wonder! ha!
No thanks she is not my type.
Yes - but I need lots of alcohol first!
Yes - She is so hot.
Yes - I've got to have her now!!!

It boggles the mind.

Well, I am in a shitload of discomfort and am now off to find an opiate. Maybe I will exchange my oversized, longitudinally-striped night shirt for something more appropriate to day wear. Maybe, like Venus, I can titillate the boys of The Manor by mere illusion and suggestion... because, unlike Venus, I don't have the goods to pull off a flirtation based on anything else.

Postscript: Fred and I just butt heads over... Well, over Venus' butt. I confess to having hit Shrill Tones pretty quickly. Poor Fred. He saw nothing problematic about the black-lace-over-red-corset design but became apopleptic about the tennis undies. What sent me into Shrill Land was his insistance that it was not the flesh-colored aspect of it... No! It was the "fit"! I think my eyes were bugging out. We were watching Venus play Dominika Cibulkova. Now, Dominika's tennis attire bothered me more than Venus' playful dress, mostly because it just looked so damned uncomfortable. I tire of women being uncomfortable on purpose. It's a pet peeve. Most every time I have seen her play, Cibulkova wears the same approximate thing -- a tight, bunched up sheath-type dress that is very short, over shorts that appear equally tight and bunched. I kept asking Fred if the "fit" of Cibulkova's tennis undies did not bother him, as they appeared as form-fitting (that was our chosen euphemism) as all get-out to moi! He kept muttering something about them being fine and "more like shorts." Jesus H. Christ, we do not want to tell our truthes, do we?

He dusted off his usual mumblemumble example -- doyourememberonetimewhenwehaddinneratredlobster? A large [black] woman came into the restaurant wearing see-through leggings without benefit of sufficient tunic to cover her nether regions. He apparently hasn't gotten over it. It was pretty disgusting. We were and are in total agreement on that point. What it had to do with anything, though? I dunno.

Am I NOT supposed to challenge that? Am I NOT supposed to ask what in hell that has to do with Venus Williams, a professional athlete wearing tournament-approved clothing? Am I REALLY supposed to believe that Fred's issue is with the fit of her undergarment and not the fact that she has a beautiful black butt that makes him... nervous?


To summarize: No problem with the coquettish lace and bustier... No problem with the undies virtually disappearing due to their flesh-coloration. BIG PROBLEM because they were clearly too... tight.

Well, hell.

Let's get out of this mess with something we can all be comfortable with. If you appreciate Andy Roddick like I appreciate Andy Roddick, you will appreciate this insightful analysis of his game. View it many times in succession to allow the tennis tips to meld with your Inner Athlete. If his unclad upper body bothers you? Take it up with someone else, as I am fresh out of Shrill: