Saturday, February 6, 2010
Whatever. Sometimes I need a Mna Mna.
And if anyone knows what a Mna Mna really is, kindly do leave word.
And just for fun, the most downloaded of all the Muppet Vids, Bohemian Rhapsody:
Friday, February 5, 2010
God bless him, and God bless the United States.
Always remember and never forget: When it comes to proofreading, the red penis is your friend. Spank you.
That they are related is clear. Marmy is Dobby's mother and Uncle Kitty Big Balls' sister. We took Marmy in when she and UKBB were both strays, and she was about as hugely pregnant without bursting as possible.
She had a litter of five, of which we kept the runt, Dobby. Marmy remained almost completely feral for another year, but this past year she turned some mental corner and became a very loving and sociable cat. She's not particularly bright, but she seems happy. She has become a real girly girl lately, and demands more one-on-one time than any of them. Very, very coy is she.
Dobby, you've met.
Uncle Kitty Big Balls. What a guy. He remained on the street for another year or so, although he came to visit now and again. The visits were becoming fewer and he began showing up with wounds, loosing hair, etcetera. There was a long stretch where he seemed to have disappeared and we feared the worst. I had put my foot down after three cats, but felt horribly guilty.
Last April, I was in ICU on a ventilator (just hanging out), and Fred came into my room looking terribly distraught. He said there was something he needed to talk to me about.
"Oh, my God, he's leaving me. He can't handle this anymore."
"Uh-oh. Maybe he wants to disconnect the respirator, the bastard!"
So I wasn't exactly the Reigning Queen of The Cogent!
He informed me that UKBB had turned up just as he was leaving to come to the hospital to be with me, and he was very sorry, but he simply was going to have to take him in. He looked to be near death, and was holding a rear leg off the ground, and clearly had abscesses all over another leg. He barely had any fur left and he was almost skeletal.
How wonderful that acquiescing to such an easy request could make someone so happy. So he left me there in ICU, and ran home to trap this wild and dying cat.
UKBB and I recuperated in syncopated time. Both of us needed a long convalescence. Sadly, part of a rear foot had to be amputated, and he battled severe infections post-op. We dutifully downed our antibiotics together, though it was clear from the beginning that I was just some girl... whereas Fred? Fred was his saviour! He still suffers something akin to a feline panic attack when he cannot locate Fred within the bazillions of rooms and acres of land here at Marlinspike Hall, deep deep in the Tête de Hergé (très décédé, d'ailleurs).
He has become our first overweight cat, though if The Castafiore and Fred are to be believed, no one is feeding him little treats shaped like fishes, tasting of eggy tuna, and designed to prevent furballs -- because his fur! His fur is thick and beautiful, the softest thing we have ever felt, our friends have ever felt, even the parish priest is astonished by the silky nothingness of his mane...
So, he's fat and we are not to blame. It is perversely pleasing to see him eat to his heart's content, after all his time hungry and cold on the street.
I cannot keep from laughing out loud when he looks at me. He looks like a Wise Guy, a mafioso. All banged up, eyes crossed. When we're not around, he likes a good stogie. We don't promote smoking but somehow his humidor is ridiculously well stocked with the best cuban cigars. That Bianca!
He has a very sweet and sensitive spirit. He spent almost no time acting ridiculously feral like his sister Marmy had done. No, he took to domestication as if he were the original housecat.
Here is his mugshot:
Our fourth cat, the awesome Sam-I-Am is the eldest now, which is a shock to him, and to us, as he spent many years in the position of postulant. Dobby has been a new life force to him, and I catch them playing like maniacs, Sammy behaving like he was but a few months old, and not a decade into this affair.
But this post seemed more dedicated to The Family: Marmy Fluffy Butt and her valiant brother Uncle Kitty Big Balls, and The Dobster.
Thursday, February 4, 2010
Those old eyes and wizened face were what won us over to begin with -- and how, in almost every photo, however grouped, whomever served as photographer, his sweet little face came shining through like a slightly bored nebula.
I will give you a moment to ponder what a "slightly bored nebula" might look like.
In fact, I will sit here with you, and ponder in tandem. Hope you don't mind Ponder Company!
Today, Dobby is my buddy, my pal. He also figures in my very first resolution of the new year, now not old, but no longer new, either. But because Dobby is part of the wording, I find myself remembering my pledge more often than not.
What is it, you ask?
Just joshing. I will divulge the Dobby Part, and try to explain it, too.
It goes: yadda yadda yadda and remember that Dobby is very wise.
How is he wise, and more importantly, how the heck do I translate that into some real form of behavioral change in myself? Well, in large part, it can all be summarized by The Dobster's Way Of Asking For What He Wants.
It is, of course, The Purity of The Dobster's Way that holds the secret and contains the magic. He never invests his askings with too much desire, and hardly ever with any personalization of intent. Above all, he wastes no time conniving, planning the best approach, fussing over timing or appropriate ambience.
He's too happy a soul to be manipulative. Something occurs to him, bells chime, his eyes light up, and meow, there he is, request ready. No wasted motion or emotion.
His synapses don't burn up with worry.
He doesn't get pissed off when his desires aren't met. He did his damnedest, he asked, and thems is the breaks, as I used to say. (And apparently still do.)
Somehow, this trust that he proffers makes the creatures that he meets all want to try very hard to give him just what he has asked for.
He is good natured and willing to be wholeheartedly a fool. That's pretty much it. I strive to be as good natured and wholeheartedly, unabashedly foolish as my cat, Dobby, seen here at a very young age with his brother, Speckle Belly White Foot, who is apparently trying to commit
As final and further evidence of his "slightly bored nebula" shining star face, here's a group shot. I wish you could experience him. He never fails to make me laugh but can also serve as a soft, warm comfort.
He just brought me his yarn ball, asking to play fetch.
How did he know that's just what I wanted to do?
Did you know that Fred practically birthed this little guy? Dobby was the last kitten to arrive. Marmy Fluffy Butt, not exactly firing on all her Mother cylinders, decided she'd had enough, and just QUIT. Laid her wacky head down for a snooze, leaving Dobby in the precarious position of being not quite delivered!
Already the smallest, he lagged in all the stages of development, behind his confrères by a good 2-3 days. We worried that he was blind and deaf for the longest time.
Then there were the mystifying behaviors -- most notably, he preferred gamely climbing his mother to the joy of nursing, and in this manner missed a lot of meals! But he did get to some imaginary, secret mountaintop. He appeared at the bottom of most piles, was poked, bitten, and smacked with exuberant regularity. Luckily, he came out of it with stupendous smarts and the patience of Job.
This is my favorite picture of Dobby. He has unusual staying power and focus. Fred was at his computer, and offered Dobby a very small box to sit in. Twenty minutes or so went by, and Fred began to feel that feeling of "someone is staring at me." Yes, shock of all shocks, it was our prodigious cat. Doggedly determined to stay in his box until acknowledged by the Alpha, Fred.
(Fred was a psych major and specialized in neuropsychology. He believes that the phenomenon of *feeling* a gaze is not just some fluke or conditioned response. He thinks that there is transfer of energy involved, as well as a sense that we've yet to discover -- we simply lack the ability to render the experience tangible.)
Wednesday, February 3, 2010
What probably is news is that whenever I prepare to click on the summarizing email, my lungs, my mind, my heart, all fill with hope. Once I see what news awaits, that hope normally fizzles and fades, losing all its precious buoyancy.
I have an appointment with Dr. PainDude in a little under two hours. It has been a long while since I showed up with papers in hand, with hope. I just printed the following article, and almost miss the days of toner smell, mimeograph fumes. Today, the paper gives nothing away.
It blurs my eyes, these words: The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks.
O Christ, O God Almighty: Let it be true.
The text in its entirety below. I will do further research this afternoon.
Scientists at the University of Liverpool have discovered that treating the immune system of patients with Complex Regional Pain Syndrome (CPRS) leads to a significant reduction in pain.
CRPS is an unexplained chronic pain condition that usually develops after an injury or trauma to a limb, and continues after the injury has healed. CPRS I - formerly called Reflex Sympathetic Dystrophy - can arise after any type of injury. CRPS II, previously called causalgia (a term coined in the American Civil War when it was first diagnosed), follows partial damage to a nerve. In some cases the pain can be so severe that patients request amputation, only to find that the pain returns in the stump.
CRPS pain can improve within one year after the injury, but if it is still unchanged after 12 months (longstanding CRPS), then it will often not improve at all. Longstanding CRPS affects about 1 in 5,000 people in the UK.
The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks. The results of this study may change the future treatment of patients with CRPS, and have an impact on research in other severe chronic pain areas. Intravenous immunoglobulin treatment for CRPS is currently not available on the NHS.
Although the cause of the syndrome is unknown, precipitating factors include injury or damage to the body's tissue. Changes in the way nerves send messages to the brain about pain may occur at the injury site. These changes may then lead to more changes in the nerves of the spinal chord and brain. All these changes are thought to play a role in causing and prolonging the condition. Conventional pain drugs either don't work, or have considerable side effects.
Dr Goebel, Senior Lecturer in Pain Medicine, explains: "In CRPS, the real effect of this treatment in clinic may turn out to be even greater than what we have already seen, because IVIG can be given in higher doses, and repeated treatment may have additional effects. IVIG is normally repeated every four weeks and we are working to develop ways which would allow patients to administer the treatment in their own home."
"The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions; if one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond."
The research is published in the journal Annals of Internal Medicine.
The research was carried out in collaboration with University College London.
Research activities on the role of the immune system in chronic pain are the focus of the newly created 'Centre for Immune Studies in Pain' (CISP) at the University of Liverpool, led by Dr. Goebel. For further details visit www.liv.ac.ukpricisp. Support for these and other research activities aimed at relieving chronic pain comes from the Pain Relief Foundation in Liverpool.
University of Liverpool
Aha! A better article,* of course, is available at RSDSA.org -- from The Annals of Internal Medicine (cutting to the chase, "results... limitation... conclusion"):
Results: 13 eligible participants were randomly assigned between
November 2005 and May 2008; 12 completed the trial. The average
pain intensity was 1.55 units lower after IVIG treatment than
after saline (95% CI, 1.29 to 1.82; P 0.001). In 3 patients, pain
intensity after IVIG was less than after saline by 50% or more. No
serious adverse reactions were reported.
Limitation: The trial was small, and recruitment bias and chance
variation could have influenced results and their interpretation.
Conclusion: IVIG, 0.5 g/kg, can reduce pain in refractory CRPS.
Studies are required to determine the best immunoglobulin dose,
the duration of effect, and when repeated treatments are needed.
*yes, it is a bit of cold water... damn it.
later... in an email to my sister-in-law, this brief but exciting episode was summarized thusly:
i got all excited this morning by a news report that i.v. immunoglobulin had been found to "significantly" reduce pain in CRPS. an hour later, i found out that the big study had all of 13 people in it, one of whom dropped out. "just under 50%" of the participants had positive results. let's see. putting on my thinking cap. half of 12, six. okay, "just under" must mean... FIVE. then hank did his "statistics" speech: there must be at least a cohort of 30 to be statistically relevant... sometimes, i wish he would keep all that book learnin' to himself. i should have known that when something sounds too good to be true, it probably is.
Friday, 5 February 2010:
Further tidbits keep popping up. An editorial accompanied the published research. It sought to temper impulsive enthusiasm as a response to this study, emphasizing caution and the tremendous need for more work. In case you've not kept up with the exciting times in CRPS/RSD research, the authors give a quick gloss at the beginning of their editorial -- and I am resolved to place my hope in that steady progress. It's just that when severe chronic pain and disability roll on unabated for eight years? Well, it can be difficult to be positive. So I tend to grab and latch on to any research that makes sense. I don't mean to mislead anyone by these occasional bursts of unwarranted optimism; Please pardon me if I inadvertently played upon your heartstrings. Also, my case of CRPS is pretty awful and I sometimes forget that most cases are not this bad. I shouldn't be dragging you into my freak show!
Editorial: Intravenous Immunoglobulin to Fight Complex Regional Pain Syndromes: Hopes and Doubts
Frank Birklein, MD, PhD; and Claudia Sommer, MD, PhD
From University of Mainz, Mainz 55131, Germany; and University of Würzburg, Würzburg 97080, Germany.
Chronic pain is multifaceted. It involves changes in somatosensory processing from the primary afferent neurons to the brain; it induces negative emotions, such as fear and depression; and it often entails serious consequences for working ability and personal life. Long-standing complex regional pain syndrome (CRPS) has all of these features and may be associated with substantial reduction of limb function, leading to physical impairment.
In recent years, we have made progress in understanding CRPS. Studies of the acute phase of posttraumatic CRPS show the importance of cytokines and growth factors for pain and hyperalgesia; the involvement of peptides in changes in skin perfusion, edema, and sweating; and the effect of sympathetic neurotransmission on pain in selected patients. We have learned that in long-standing CRPS, cortical reorganization of sensory, motor, and autonomic function might underlie the profound disturbances of the body reference scheme. Although acute CRPS can be challenging to treat, the outcome is often favorable. Treatment of chronic CRPS, when central neuroplastic changes are fully established, is especially difficult.
And so concludes a pretty accurate, if embarrassing, example of my emotional ups-and-downs as I follow the thread of medical news, in real time [as real as it gets at Marlinspike Hall, deep, deep in the Tête de Hergé (très décédé, d'ailleurs)]. Despite my initial over-reaction, all the subsequent information did not cause too much grief -- it simply served as a reminder that this is serious business, for serious people, and that one mustn't let hope get out of hand.
2/15/2010: I was definitively told, via bullhorn, to "step away from the study... toss your hope on the ground and step away from ridiculous hope." Yes, the Hope Police came down on me like the proverbial ton of bricks. My case is extreme; My case is refractory; My course is "complicated." And then there was this surprise statement from Dr. Go-To Guy: "Bianca, ma belle, this is old news."
As soon as I get my breath back, lobbying will begin for a little offlabel use of immunoglobulin. Shhhhh!