Friday, August 6, 2010

Friday Favorite Repost: It happened *again*

Last weekend, at the grocery store: "Excuse me, do you know Melissa? She's in a wheelchair, too!"

Yes, we *all* know each other.

Don't forget -- Potluck tomorrow @ 1 pm by the Koi Pond.
La Bonne et Belle Bianca Castafiore would like you to remember:
No cripples on the front lawn.
Who is bringing the endive?

Thursday, August 5, 2010

Three Months Later: José Ochoa, *Still* A Big, Fat Turd

Do you remember the couple of posts wherein I called José Ochoa a turd?  No?  Well, you can read up on this poor excuse for a hackjob doctor here and here

Or you can keep reading this post, as I am about to call José Ochoa a turd one more time.  He's co-authored an eight-page article painting people diagnosed with CRPS as malingerers, as suffering from conversion disorder, or -- now isn't this kind of him to allow? -- as harboring "unrecognized pathology (lesions) of the nervous system."

He has built a lucrative career testifying about his [now very lonely] contention that CRPS does not exist. His forensic testimony has less and less influence as hard science advances, but his path remains littered with broken lives -- lives financially ruined, physically and emotionally devastated by his self-enrichment campaign.

Am I questioning the data he reports?  Not at all.

Do I propose canonization of people with CRPS, an affliction that only strikes the angelic, a syndrome often caused by work-related injuries, associated with legal action, and therefore never feigned by lazy dipshits? Nope!

I do protest the authors' simultaneous display of contempt for "the label" CRPS and their ready glee to paint all those diagnosed with CRPS with the same brush as those identified as malingerers.  In lieu of identifying the defects in the diagnosis process, they have assumed a character defect in the vast majority of real sufferers. 

It's tiresome, it's disgusting, and Ochoa needs to find a new way to invent scientific support for his true calling:  his own enrichment.

I am almost completely out of line in writing this blog post, but I really don't care.  I have not read the article I am maligning, would not spend the money to buy it or to subscribe to the journal, and have no basis for attacking the study results.

I am just mad that Ochoa has been published again, that he has found another means of advancing his loathesome small-mindedness and greed.

Don't get me wrong, I know that many doctors and most researchers are fully cognizant of his malicious intent. It's just that his energies would be better used -- and actually appreciated! -- were he to channel them toward, say, working with the IASP and their efforts to produce workable, effective diagnostic criteria for CRPS.  The data he is producing does nothing but make that endeavor even more worthwhile.  The better the diagnostic criteria, the fewer malingerers abusing the justice and health systems.

I am the last person to contest legitimate dissent, no matter the subject matter. But neither am I going to assert the rights of an academic who might, for example, publish work after work about the Holocaust as a fiction, no matter how well-documented. (I am not trying to aggrandize CRPS as a topic, that is just the first instance that came to mind. So let me add that neither would I debate The Texas School Board on textbook choice or history and science curricula!)

In the years 1997-2009, Dr. Ochoa has earned, according to his own testimony, between $300,000 and $400,000 a year -- over a 12-year period, he has made between 3.6 and 4.8 million dollars by denying the existence of CRPS. Given that there is no research that legitimizes his claim, it makes sense that he needs to publish something, periodically, that he can use to maintain his claim to be an expert. There simply is NO currently valid research to which he can point, beyond what he manages to publish.

God help the poor patient with CRPS whose unsuspecting family doctor refers him to The Oregon Nerve Center, to Dr. Ochoa. Hoping for treatment, these patients will instead be subjected to his pre-suppositions about their physical symptoms and psychological makeup.

The worst crime of all?  The delay in treatment -- which can obviate the possibility of a fairly easy cure -- that may result from Dr. Ochoa and his campaign against the existence of CRPS.

Neuropathic Pain Syndrome Displayed by Malingerers
José L. Ochoa, M.D., Ph.D., D.Sc. and Renato J. Verdugo, M.D., M.Sc.
J Neuropsychiatry Clin Neurosci.2010; 22: 278-286

Received October 27, 2009; accepted April 1, 2010. The authors are affiliated with The Oregon Nerve Center at Legacy Health Systems and the Departments of Neurology and Neurosurgery at Oregon Health and Science University in Portland, Oregon; Dr. Verdugo is also affiliated with the Department of Neurology, Faculty of Medicine, Universidad de Chile, in Santiago, Chile. Address correspondence to José L. Ochoa, M.D., Ph.D., D.Sc., The Oregon Nerve Center, Good Samaritan Medical Center, 1040 NW 22nd Ave., Suite 600, Portland, OR 97210; (e-mail).

Among 237 patients communicating chronic pain, associated with sensory-motor and "autonomic" displays, qualifying taxonomically for neuropathic pain, there were 16 shown through surveillance to be malingerers. When analyzed through neurological methods, their profile was characteristically atypical. There were no objective equivalents of peripheral or central processes impairing nerve impulse transmission. In absence of medical explanation, all 16 had been adjudicated, by default, the label complex regional pain syndrome (CRPS). The authors emphasize that CRPS patients may not only harbor unrecognized pathology ("lesion") of the nervous system (CRPS II), hypothetical central neuronal "dysfunction" (CRPS I), or conversion disorder, but may display a recognizable simulated illness without neuropsychiatric pathology.
[You may read more HERE]

NOTE: The law firm had to take down this illustrious video because Ochoa sued them, saying it cost him revenue.  What a turd.  There's an excellent unbiased summation of the non-board certified Doctor Ochoa by the Third Circuit Louisiana State of Appeals Court HERE. As for what you would have seen in the video -- the patient being examined by The Turd asks him to be aware of the severe allodynia she has in her hand.  He proceeds to blow on it and also to pinch it -- saying, in what can only be the cutest SCOTUS reference of all time, that he was just removing the "pubic hair" that was somehow on her hand.  I say again:  turd, turd, turd.

Posted to YouTube by LawlorWinston | September 21, 2009, with this comment:

Here we see Dr. Jose L. Ochoa, a defense-retained expert, in a portion of his examination of a woman whom six other physicians, including another defense-retained expert have diagnosed with RSD/CRPS-1. The Plaintiff, who suffers from crippling neurological pain, has requested Dr. Ochoa not blow air on her affected extremities.

RSD is an abbreviation for "Relex Sympathetic Dystrophy", also referred to as "Complex Regional Pain Syndrome" (CRPS).

Dr. Ochoa has become one of the foremost experts used by Defendants in lawsuits involving RSD/CRPS by denying that this condition is an actual "diagnosis". His opinions have been stricken or otherwise disallowed as unscientific in at least three States.
[Trust me, I'd much rather be watching a video over at PTZ.  I keep waiting for Ochoa to be featured over there, but I guess Emilbus only has room for so many explosive pilonidal cysts.]

Wednesday, August 4, 2010

Diva: Memory Lane

Guess what I just finished watching... for the first time in ten years, at least. 

This is, of course, the scene of the great crime, the déception, le viol -- Jules tapes Cynthia Hawkins (Wilhelmenia Wiggins Fernandez), who has never allowed recording of her performances; His tape will come to mirror the other recording at the heart of the movie, the one of a murdered prostitute whose disembodied voice exposes Saporta --a  fiend of a crooked cop.

In my initial relationship with this film, I fell in love with Serge Gorodish and Alba -- I mean, really -- they *are* super-cool.  There will always be a place in my heart for Alba -- she reminds me of someone very dear -- but my admiration for Serge is now more of a nod in the direction of what makes the movie move.

Though I confess that I covet his various digs.

A lot!

I further confess that were I bleeding to death in a phone booth, assassins on my heels, I would want the singsong lilt of Alba to take me home.

I've never read the book from which Diva was adapted -- by Daniel Odier (Delacorta).  Reminder to self. 

Perilously close to schmaltz, the Promenade Sentimentale (Cosma) scene either almost makes me weep or successfully pisses me off.  There is no in between.  The music, of course, is perfection itself.

Vladimir Cosma

Tuesday, August 3, 2010

Cleveland Clinic Study Posits CRPS "Systemic Disease of Autonomic Nervous System"

Cleveland Clinic Journal of Medicine July 9, 2010
Volume 77, Supplement 3

Bakken Heart-Brain Institute-Funded Research ABSTRACT

Complex Regional Pain Syndrome (CRPS I):
A Systemic Disease of the Autonomic Nervous System

Kamal Chemali, MD; Robert Shields, MD; Lan Zhou, MD, PhD;
Salim Hayek, MD, PhD; and Thomas Chelimsky, MD
Cleveland Clinic and University Hospitals Case Medical Center, Cleveland, OH

Our study aims to assess the extent of systemic autonomic dysfunction in the autonomic pain syndrome known as complex regional pain syndrome type I (CRPS I). This condition, formerly known as reflex sympathetic dystrophy (RSD), is notorious for its pathophysiological complexity. On one hand, it occurs in only certain people after a minor trauma or insignificant trigger and behaves like a focalized pain syndrome to one limb with prominent local autonomic manifestations, such as edema, vasomotor changes, trophic changes, pain, and allodynia. A more recent theory speaks about somatic-autonomic coupling as an explanation for the above, and the most recent consensus seems to be that CRPS I is a disease of the central nervous system that manifests peripherally. Through this study we would like to investigate further the possibility that the autonomic nervous system involvement in this disorder is generalized rather than localized to the painful limb and, in a more general way, to try to open new windows on the role of the autonomic nervous system in generating and maintaining pain.

The study is a bicenter research project at Cleveland Clinic and University Hospitals of Cleveland that will include 20 patients with CRPS I. The control group will consist of 10 patients with small fiber neuropathy (a neuropathic pain condition similar in certain aspects to CRPS I), 10 patients with limb pain due to osteoarthritis of the knee (a nonneuropathic pain), and 10 healthy volunteers. All subjects will undergo comprehensive autonomic testing, skin biopsies, pupillometry, and Doppler flowmetry to assess the autonomic nervous system at various levels of the body. Results will be compared between the patients with CRPS I and the control group and subgroups.

To date, one patient has been enrolled, a 27-year-old female with CRPS I of the left foot following a traumatic injury. After consenting to the research protocol, the patient underwent a washout from all medications known to affect the autonomic nervous system for 5 half-lives prior to testing. She then underwent a series of tests of the autonomic nervous system and a skin biopsy.

Preliminary data revealed the following:

1. Decreased cardiac response to deep breathing, suggesting a
cardiovagal abnormality
2. Abnormal vasomotor sympathetic response characterized by postural tachycardia, consistent with the diagnosis of postural orthostatic tachycardia syndrome (POTS)
3. Abnormal quantitative sudomotor axon reflex test (QSART) results consistent with an underlying small fiber neuropathy
4. A 35% reduction of small fiber at the left distal leg (symptomatic)
compared to the contralateral asymptomatic leg
5. Abnormal pupillary response to light in constriction parameters
in the right eye, consistent with a parasympathetic pupillary

These data, from a single patient, are consistent with our hypothesis that CRPS I is a generalized (systemic) disorder of the autonomic nervous system.