Friday, February 25, 2011

Lindsey Baum, This Friday

Okay, so the beans were delicious.  The fish was also good, though I surprised myself by doing an olive oil poach.  Robotic cooking.

It's been bugging me that I no longer do weekly updates about Lindsey Baum.  I think of her every day.  Most days.  Often.

I thought it would be over by now.  I have been ready to move on.

Fridays are for clean-up in my world.  The house, the blog, occasionally the heart.  I dutifully plug in "Lindsey Baum" and instruct my search engine to give me the latest news, maybe even just what's been written in the last 24 hours.

[There are days when I suddenly get a whole bunch of hits about Lindsey and I rush to the news outlets, knowing that she's been found... only to find that the sudden spike in interest is as inexplicable as anything else.]

This evening I found something resonant, out of Olympia, Washington, from Sarah's Blog, maintained at * (We are the media...).

First you hear the choppers (Where is Lindsey Baum?)
Mon, 02/21/2011 - 1:34pm — Sarah

First you hear the choppers. They don't sound right, they don't sound like the usual medevac to and from the local hospital. You figure out you are hearing at least one circling helicopter and you step outside.

This is loud. They, there is more than one, are flying low. Looks like media. Something is happening.

Have they found Lindsey? This is what you think. It has been days, months, over a year now since she went missing and maybe they found her. Maybe there is a search warrant being served. Maybe an arrest. Or maybe it is something else. But no, this is probably about Lindsey.

Now it is time for info share. Phone calls, web forums checked, information shared. Rumors fly and you work to mine flakes of possible truth from all the mud.

Next time, next chopper, next buzz of electricity flying through the town. You start walking and find yourself across the street as a
search warrant is processed, watching the authorities and the media and the townspeople just like you watching everything and each other.

TV news wants to talk with you, with anyone, and hey! you recognize the guy from channel whatever news. But you decline. While watching a guy who is out on his lawn chair watching the scene. Maybe next time you will bring a lawn chair. Not that any of us are relaxed about this. It's just that some of us can't physically stand and watch without quickly becoming exhausted. Which is a great metaphor or something because really.............we can't stand this. We can't handle this. This is so utterly entirely wrong that Lindsey Baum is gone.
  [Read the rest HERE.]

* is a community collaboration:
"OlyBlog is devoted to citizen journalism, including hyperlocal news and discussion specifically about Olympia, Washington. If you care about this community and are tired of corporate media, then this is the place for you."

To read the various entries from elle est belle la seine la seine elle est belle about Lindsey, click HERE.

Stop! Step away from that nerve... Hands in the air!

Hullo out there.  It's time to pass on more information from newly published research on CRPS/RSD (Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy).  If you want to learn more about the disorder, I just found a pretty good summary written for nurses that you can access HERE

I am gonna have to call on the expertise of my degrees in French literature, once again, because I have "issues" with this first article.  We all know that advanced degrees in foreign languages trump any and all medical training, IF and WHEN the wielder of said degrees has suffered with CRPS longer than a week (in the Northern Hemisphere, at least).

In short, and I am known for my brevity, there's a definite penchant for endoscopic thoracic sympathectomy going on... However, it is generally accepted that most sympathectomy is really just a crap shoot, given the high likelihood that pain/disability will recur, and often with a vengeance.

My understanding about this particular procedure (amplified by my ability to correctly intersperse the passé composé with the imparfait) has been that it is most effective as a treatment for hyperhidrosis (and blushing!) and is not some sort of global pain remedy.  In general, interventions/surgeries/procedures all risk aggravating CRPS and the wisdom of the ages says to try and avoid them.  Yes, this is the same person who will be trying to get into a subanesthetic ketamine treatment program next week... Obviously, endoscopic thoracic sympathectomy can be a useful small surgery, but as I said -- for a very limited type of problem. 

Because CRPS is so challenging to treat and so resistant to extant therapies, there is sometimes a surge in promotion of procedures that really have questionable use.  Again, please apply the caveat of my expertise -- derived solely from having the disease and researching it with an avid eye for anything that seems to help AND which can also mount a logical scientific explanation of its utility.

A major red flag?  The size of the cohort.  Basically, in Tête de Hergé Land, if you cannot cobble together enough people to host a baseball game, don't count on securing my approval based on what can only be called anecdotes.

Sigh.  I was gonna cover a few more articles but my eyes are not working too well and my limbs are at war with one another.  Also, that fish is not going to cook itself and it smells suspiciously like my red beans might be overdone.  Raw fish and burnt beans.  Yum.

So I will see you later, friends.  Just try not to cut any sympathetic nerves unnecessarily, would you?

European Journal of Trauma and Emergency Surgery

Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome *
K. Demey, S. Nijs, W. Coosemans, H. Decaluwé, G. Decker, P. De Leyn, D. Van Raemdonck, A. Sermon, P. Broos and T. Lerut, et al
21 February 2011

Posttraumatic complex regional pain syndrome (CRPS) has a strongly negative impact on rehabilitation and activities of daily living. Treatment is most often unrewarding.
To analyze the efficacy of endoscopic thoracic sympathectomy (ETS) in reducing pain and disability associated with CRPS prospectively.
Patient and methods
Over a 5-year period, 12 patients (7 females and 5 males; median age 46.5 [range 34–60 years]) with posttraumatic CRPS underwent unilateral ETS. The median duration of CRPS symptoms before ETS was 3.8 months (range 1.2–19.9). The sympathetic chain was resected from the 2nd to the 5th rib, and the nerve of Kuntz was severed. Median postoperative 16 months (range 12–40). Pain was assessed, at rest (passive) and during movement (active), using a visual analogue scale (VAS) from 0 to 10.
One patient (8%) suffered a hydrothorax and 3 patients (25%) complained of contralateral compensatory hyperhydrosis. At 1 month (n = 12), 2 months (n = 7), 6 months (n = 12), and 1 year (n = 12) after ETS, there was a significant decrease in passive and active VAS (P < 0.05). Ten out of the 12 patients (83%) needed fewer analgesics after surgery, and eight (67%) did not need analgesics at all. The median sleep duration improved significantly from a preoperative value of 2 h (range 1–7) to a postoperative value of 6.25 h (range 3.5–8) (P < 0.001). Overall, patient satisfaction was 83%.
ETS is effective at decreasing pain and improving quality of life, and should therefore be considered in the treatment of CRPS.

*This paper was presented at the 10th Belgian Surgical Week, 29 April–2 May 2009, Ostend, Belgium, and at the 10th European Congress of Trauma and Emergency Surgery, 13–17 May 2009, Antalya, Turkey.

The Height of Kitty Kool

Visit Shiro's Blog for more moments of serene transcendence and video excellence.

aum  aum  aum

Wednesday, February 23, 2011

Come On: Feel the Illinoise

I love politics. 

Democratic members of the Indiana legislature have fled to Illinois:

INDIANAPOLIS — Most Democratic members of the Indiana House of Representatives have decamped for Illinois, stalling even routine legislation in the state house Wednesday in order to avoid being forced to vote on legislation that includes a bill that would allow workers in private sector unions the right to opt out of their unions and not pay dues.

The Democratic lawmakers, who are in the minority in the House, have refused to attend the chamber’s sessions in order to prevent a quorum. And despite a pledge from Gov. Mitch Daniels, a Republican, not to send state troopers after them, the Democrats said that they thought it best to secretly leave the state Tuesday night.

The Democrats, who are staying at a hotel in Urbana, Ill. — about a two hour drive across the state line from Indianapolis — say they do not plan to return until Republicans make concessions, including withdrawing several bills.

Pat Bauer, the House Democratic minority leader, said the union legislation had not been the sole reason for the Democratic exodus — rather that it had “escalated” political tensions in the chamber.

“We’d like to make peace,” Mr. Bauer said during a phone call from Urbana to reporters who had gathered in his Indianapolis office. “This is a class war that is being fought in many states.” The Democrats have mentioned 11 individual bills they say they are concerned about, including several aimed at diminishing the power of labor and others that would change elements of Indiana’s public education system.

Meanwhile, back in Wisconsin... their Democratic legislators are also hanging out in Illinois, trying to avoid a vote that would drastically limit the role of unions, in part by striking down the collective bargaining process.  The legislation being considered there is the baby of Governor Scott Walker who "has warned that if the bill was not passed, layoff notices could be sent to state workers as early as next week."

To counter the governor's threat, the South Central Wisconsin Federation of Labor has announced plans for a general strike should Walker sign the bill limiting collective-bargaining rights.

Of course, what USAmericans really want to know is what the heck is going on in Illinois?  Is it more than just Democratic control of the governorship and the Legislature there that attracts politicians from other states, luring them to the high life in the Land of Lincoln?

Did you know that Lincoln came to Illinois at the age of 21 via... Indiana?

Did you know that the Illinois state motto is State Sovereignty, National Union?  That the name Illinois comes from Illini, a confederation of the Cahokia, Kaskaskia, Michigamea, Moingwena, Peoria and Tamaroa Indian tribes? 

Obviously, a bunch of subversives!

Remember that troublemaker those Illini sent to Washington as a freshman legislator -- now the 44th President of the United States, Barack Obama? 

Did anyone else notice that Rahm Emanuel took over Chicago?

Clearly, there is something going on, something like a gravity-and-democratic-legislator sucking vortex, and it is happening in Illinois.  Watch out Iowa, Missouri, Kentucky, and maybe even Michigan...

* I dunno, but someone does, and he's sayin' to me that the answer lies in a dedicated deconstruction of Sufjan Stevens' seminal album, Illinois. 

Oh great intentions
I've got the best of interventions
But when the ads come
I think about it now

In my infliction
Entrepreneurial conditions
Take us to glory
I think about it now

Cannot conversations cull united nations?
If you got the patience, celebrate the ancients
Cannot all creation call it celebration?
Or united nation. Put it to your head.

Oh great white city
I've got the adequate committee
Where have your walls gone?
I think about it now

Chicago, in fashion, the soft drinks, expansion
Oh Columbia!
From Paris, incentive, like Cream of Wheat invented,
The Ferris Wheel!

Oh great intentions
Covenant with the imitation
Have you no conscience?
I think about it now

Oh God of Progress
Have you degraded or forgot us?
Where have your laws gone?
I think about it now

Tuesday, February 22, 2011

Prayers for Christchurch, for Kirsten

Our thoughts go out to the people of Christchurch as New Zealand has once again been struck by a powerful killer quake.

I've been trying to find blogger Kirsten Bentley (New Zealand Health Care blog; Neo-Conduit) for some months now -- since the first big quake last September -- without success.   She had just had major surgery and one of her children was also having difficulties.  I continue to hope that neither health issues nor natural disaster will quiet her voice of advocacy on behalf of patients, both animal and human!

Most likely, blogging no longer seems an important activity...

REUTERS: Rescue workers search for survivors at the collapsed CTV building that housed the King's Education School in Madras Street after an earthquake in Christchurch February 22, 2011. The strong earthquake killed at least 65 people
 in New Zealand's second-biggest city of Christchurch on Tuesday, with more casualties expected as rescuers
worked into the night to find scores of people trapped inside collapsed buildings.

From Yahoo! News:

CHRISTCHURCH, New Zealand – One of New Zealand's biggest cities lay in ruins Tuesday after a powerful earthquake toppled tall buildings and churches on a busy weekday, killing at least 65 people in the country's worst natural disaster in decades.

The quake even shook a massive chunk of ice from New Zealand's biggest glacier, some 120 miles to the east of Christchurch, where most of the damage was reported.

More than 100 people, including as many as a dozen visiting Japanese students, were thought to be trapped in the rubble as darkness — and drizzling rain — fell Tuesday night. Rescue crews with sniffer dogs fanned out across the city in search of survivors, some of whom were able to send text messages or make phone calls from under the wreckage.

It was the second major quake to hit Christchurch, a city of 350,000, in five months, though Tuesday's 6.3-magnitude temblor caused far more destruction than a stronger September quake that struck before dawn on a weekend.

"It is just a scene of utter devastation," Prime Minister John Key said after rushing to the city within hours of the quake. He said the death toll was 65, and may rise. "We may well be witnessing New Zealand's darkest day."

The spire of the city's well-known stone cathedral toppled into a central square, while multistory buildings collapsed in on themselves and streets were strewn with bricks and shattered concrete.

Sidewalks and roads were cracked and split, while thousands of dazed, screaming and crying residents wandered through the streets as sirens and car alarms blared. Ambulance services were quickly overwhelmed, and some victims clutching bleedings wounds were carried to private vehicles in makeshift stretchers fashioned from rugs or bits of debris.... [CONT.]

Monday, February 21, 2011

my feet my feet oh my feet my feet: video as dirge

i am having a high pain day in my legs and hands. 

captain haddock got fred one of those flip cameras as a winter solstice "longest night" token, though we usually just say it was a "christmas gift."  you know, to avoid perplexity.  and stuff.

anyway, i hurt.  a lot.  and i have been losing my temper a bit because of it.  i am sorry, but no matter how sorry i am, i keep blowing up.  there is no one who really constitutes the object of my anger;  they are just there. 

that they're there by choice is what is truly mind-boggling.

and oh-so-appreciated.

so i was reading an email from a friend who was bitching about how her feet throb at the end of the day and i about puked.  what she knows about throbbing would fit into the disintegrating window of what used to be my big right toenail.

er, my right big toenail?  (somehow, that makes my toenail sound like landed british gentry)

so i made my first film.

of my feet.

also... i forgot that my hands are now showing their temperature and pain gradations by means of color, too.  it is kind of freaky looking, the split on my left hand.  on my right hand, busy holding the camera and trying not to shake, the purple "line" extends almost all the way up my forearm, but on a diagonal.

to be precise, and why not? -- there is a line on the right hand that matches, exactly, the placement of the line on the left hand.  this is typical of me, and, i assume, of bilateral crps/rsd (the disease process in question, plus a scosh of avascular necrosis, for good measure).  but because the damage is more extensive on the right, the area past that line is just a step-down from the first splotch of purple.  that second area extends up the forearm, on a diagonal.

to be precise.

my legs are on fire.  that would be the famous "burning" neuropathic pain.
they also throb, deeply -- i assume from the bone and tissue damage.  and oh, is the bone damaged.
there is a superficial annoying pain that stems just from contact with... air.  and -- almost, as you will see, one cat.  that was dobby.

he knows better than to sniff my feet.  that was enough to send me into orbit.

maybe i will set up a "footcam."

anyway, here's my first flip vid:

FDA Recalls Medtronic’s SynchroMed II and SynchroMed EL Implantable Infusion Pumps/Refill Kits

The following is a copy of an eAlert sent out by the American Pain Foundation:

Safety Alert: Urgent Medical Device Correction and Recall

FDA issued a class I recall of Medtronic’s SynchroMed II and SynchroMed EL implantable infusion pumps and refills kits. Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of the recalled product will cause serious adverse health consequences or death. These pumps and refill kits have been recalled because pocket fills — the unintended injection of drugs or fluids into the tissue under the skin at the pump pocket site — have occurred and may result in patient harm, serious injury, and/or death due to drug overdose or underdose.

Medtronic, which manufactures these pumps for the long-term infusion of pain, cancer treatment and anti-spasm medications, issued a “Urgent: Medical Device Correction” letter to health care providers on January 14, 2011. The letter reminded health care providers to check needle placement within the pump septum during the drug refill procedure — the needle must be inserted through the refill septum until it has reached the needle stop in the pump reservoir. Health care providers should review the signs and symptoms of drug overdose, underdose, and withdrawal with their patients and caregivers at EVERY refill.

The manuals for these pump and refill kits do include warnings related to the potential for improper injection; however, Medtronic is currently updating the labeling for the SynchroMed II and EL pumps and associated refill kits with more information for avoiding pocket fills and managing patients as recommended in the January 2011 letter to health care professionals.

The recalled products were manufactured from June 1998 to January 2003 and distributed from April 1999 to January 2011. They are:

  • SynchroMed II (Model No: 8637)
  • SynchroMed EL (Model No: 8626 and 8627)
  • Refill Kits (Model No: 8551, 8555, 8561, 8562, 8564, 8565, and 8566)

For individuals who have an implantable infusion pump, the manufacturer’s make and model number can be found on your medical device information card. If you are have either a SyndroMed II or EL implantable infusion pump model listed above, notify the health care provider who is managing your infusion care for further instructions.

  • Contact the FDA and report if you have had any adverse reactions such as pain, swelling or redness at the injection/refill site after a recent pump reservoir refill; loss of pain or spasm control; or excessive sleepiness, difficulty breathing, nausea, vomiting or itching. Adverse reactions or quality problems experienced with the use of this product should be reported to the FDA's MedWatch Adverse Event Reporting program online at; by regular mail to 5600 Fishers Lane, Rockville, MD 20852-9787; or by fax to (800) FDA-0178.

Consumers with questions may contact Medtronic Patient Services at (800) 510-6735, Monday - Friday, 8 a.m. to 5 p.m., central time for more information.

Health care professionals with medical questions related to this issue or Medtronic therapies should contact at Medtronic at (800) 328-0810, Monday - Friday, 8 a.m. to 5 p.m., central time.

From MEDPAGE TODAY, 17 FEB 2011:
According to Medtronic, from May 1996 to September 2010, there were eight deaths, 270 events requiring medical intervention, 58 events not requiring intervention, and 15 events of unknown severity related to pocket fills.

That works out to a rate as high as 1 per 10,000 refills, assuming pumps are refilled six times a year, the company said.

The recall affects model numbers 8637 (for SynchroMed II), 8626 and 8627 (for SynchroMed EL), and 8551, 8555, 8561, 8562, 8564, 8565, and 8566 (for the refill kits).

The products were manufactured from June 1998 to January 2003 and were distributed from April 1999 to January 2011.


obscenities compounded

Texas is preparing to give college students and professors the right to carry guns on campus, adding momentum to a national campaign to open this part of society to firearms.

More than half of the members of the Texas House are co-authors
of a measure directing universities to allow concealed handguns.

The Senate passed a similar bill in 2009 and is expected to do so

Republican Gov. Rick Perry, who sometimes packs a pistol when he
jogs, says he supports the idea.

Texas is one of about a dozen states considering the idea and
has become a prime battleground because of its gun culture and

It would become the second state, following Utah, to pass such a broad-based law.

Colorado gives colleges the option, and several allow handguns.

Here is a photo of one of Charles Whitman's sixteen dead victims. Not one of the thirty-two wounded. One of the sixteen dead.

"Charles Joseph Whitman (June 24, 1941 – Aug. 1, 1966) was a student at the University of Texas at Austin and a former Marine who killed 16 people and wounded 32 others during a shooting rampage on and around the university's campus on Aug. 1, 1966."

Governor Rick Perry of Texas has fun with guns!

Hmmm.  Somewhere near Texas, recently.  Something unpleasant.  What was it? Hmmm...

A syllabus revision I never thought would be necessary: No guns allowed in class.

Sunday, February 20, 2011

it's 6:15 am where you are, qaddafi. have a good day.

not thanks to any great insight, just a quick read of the headlines before bed, but i am lead to think of tripoli, and all of libya, while we on this edge of the world may sleep.  i rise into waking every 40 minutes or so, and will rise into thoughts of liberty, as the libyan people -- "its tribes, clans, and loyalties" -- may deign to construct that notion.

beware, qaddafi.  it's 6:15 am where you are.  have a good day.

WSJA(2/21): Libya Death Toll Surges In Crackdown
Monday, Feb 21, 2011
By Charles Levinson and Tahani Karrar-Lewsley
CAIRO -- Libyan security forces fired live ammunition and rocket-propelled grenades at demonstrators in the eastern city of Benghazi on Sunday, pressing a bloody crackdown on snowballing protests demanding the ouster of leader Moammar Gadhafi that has doubled the death toll to at least 173.
Protests consumed at least six other cities in eastern Libya, according to reports from residents and a warning from the U.S. Embassy in Tripoli. In many of the cities, residents said government security forces had withdrawn from the streets to their bases, ceding whole cities to protesters, at least for now.

Protests also sprung up on the outskirts of Libya's capital of Tripoli, according to residents in the city and opposition activists. Though they were quickly quashed by security forces, the spread of protests from the country's more isolated eastern half to Mr. Gadhafi's center of power was a sign that calls for Mr. Gadhafi's ouster appeared to be gaining momentum.

The U.S. Embassy in Tripoli warned in a statement of violent clashes between protesters and security forces in at least six other cities in eastern Libya.

There were widely varying casualty figures. Human Rights Watch said they had confirmed 173 deaths in protests so far. Those numbers were limited to confirmed deaths reported by hospitals and the real toll was likely much higher, according to Human Rights Watch's Heba Morayef and doctors at Libyan hospitals.

Libyan state TV broadcast images of burning buildings and blamed the "acts of sabotage and burning" on "foreign agents," echoing the attempts made by other Arab leaders in Egypt, Tunisia, Bahrain and Yemen to dismiss the unrest.

Residents said it was the first time government media had acknowledged the growing unrest, suggesting the violence was spreading to the point that the government had no choice but to address it directly.

Residents said they received text messages from the Libyana mobile network urging calm. "People and youth of Benghazi, the civilians and police killed are all the sons of Libya so stop what is happening and stop the bloodshed," the text read, according to residents.

Reports of the fiercest fighting came from the city of Benghazi, Libya's second-largest city, which lies on the country's northeast coast, according to reports from people inside the country and Libyan activists monitoring the situation abroad.

Residents said government control of Benghazi and other cities in eastern Libya appeared to be slipping, at least for now, with police and army forces disappearing from the streets and retreating to their bases. Residents said tens of thousands of people had gathered to protests outside Benghazi's courthouse on Saturday.

They said parts of Benghazi had been consumed by full-fledged urban warfare between protesters and pro-government forces. Residents said pro-Gadhafi loyalists were firing rocket-propelled grenades at civilians and driving in cars randomly shooting down civilians.

"There are some criminals driving cars shooting at people, and they are using antitank weapons such as rocket-propelled grenades, the bullets are the size of my hand," said a Benghazi resident whose wife works as a doctor at a local hospital.

The Internet remained down in most of the country after the government shut down servers early Saturday, according to Renesys, an Internet access watchdog. Journalists were banned from entering the country or reporting on events, making it impossible to confirm reports.

Residents reached by telephone were gripped by fear, unwilling to give their names over the telephone for fear the government was monitoring calls and would arrest them for relaying details of the unrest to journalists outside the country.

A Libyan journalist in Tripoli said some journalists who had spoken with Arab television stations had been arrested within minutes of speaking on air.

Amid the information blackout, a sense of panic and mayhem in Benghazi was fueled by rumors sweeping the city, including unsubstantiated rumors that the government had poisoned the city's drinking supply and was flying planes full of mercenaries into the city.

It was unclear just how much real estate protesters controlled and how much remained in the hands of the government.

"Neither side has complete control of Benghazi," said a student in Benghazi who would identify himself only as Abdullah for fear of his safety.

Amateur video footage from Al Bayda, a smaller city east of Benghazi, showed thousands of chanting protesters demonstrating in front of the city's central mosque.

(END) Dow Jones Newswires

Those Fool Folks

**please do not copy or reproduce these photos**

So it turns out both of my brothers are shutterbugs.  Grader Boob, still trying to ingratiate himself after failing to show up for his scheduled visit last month, proffers these photos as a means of assuaging his wild, wild guilt.  (We'll be looking for him in a few weeks!)

He took these at the beach that now serves as the front yard to my Dad and stepMom.  I know this beach, I know those dunes, I know that pier -- though I've not seen them for many a year.  Not the beach, not the dunes, not that pier.  Not the 'rents.

That's where I went, straight from every graduation I've attended.  That's where I got burned.  That's where we watched John Wayne movies when it rained.  That's where I read Harriett the Spy.  That's where I confessed my transgressions.  That's where I took friends who could not decide to wed. 

That's where boiled shrimp on newspaper, a green salad, and crusty bread was a regular feast, and spaghetti for throngs.  That's where I fell in a hole.  That's where I first got drunk.

That's the ocean I watched my brother swim, and drift, in.  That's where we played submarine.  That's where the undertow is wicked.  That's where we saw the world as stripes, broad colors of land, and sea, and sky.  That's where those fool folks have gone to die.

please come close, for i long for you to hear, hear the sound, that will rid you of your fears

When the music's not forgotten (Deadman)

Please come close, for I long for you to hear
Hear the sound
That will rid you of your fears
In a land, where no water can be found
In a place, where there is no fertile ground
Longing for, yearning not to be forgotten
In an age, when the music is forgotten
In an age, when the music is forgotten

In the truth (in the truth)
Speaks of great and mighty things
Teaching us (teaching us)
What the peace of heaven brings
We must give (we must give)
We must give to all the others, to those in need (those in need)
Who we fear to call our brothers

Reaching out (reaching out)
So that we are not forgotten
In a time (in a time)
When the music is forgotten
In a time (in a time)
When the music is forgotten

If we stand on a hill and do not touch
How can we do good?
If we wash our hands with all our friends
Where change can really come
If we hide our fears and don't draw near
Have we really lived?
Or are we all just standing here
Hoping there is grace?

In a dream (in a dream)
That I had not long ago
Visions of (visions of)
In a city made of gold
And a sound (and a sound)
That I never heard before
Such a sound (such a sound)
Saturating to the core
Such a sound (such a sound)
One that cannot be forgotten

In a time (in a time)
When the music's not forgotten

Absalom! Absalom! (Deadman)

absalom absalom where have you gone?
are you running out of fear out of hate?
ashamed to move toward a precious reward
afraid that you're lacking in faith?
that's okay boy no one's counting and no one is keeping score
you're burning down houses
because it arouses the depth of love from the core
and your heart opens wide the demons you fight
they still haunt you
someone told me of revolution
with a cause that is worth fighting for
and when i arrived on the terrible fight
the revolution was no more
and so many had paid the price
so many didn't even know why
i can't even see how it ever came to this
i can't even remember why we tried
and the heart opens wide
the demons you fight
they still haunt you
so much more you've seen it
so much more between us between us
there is peace peace that flows like a river
and just like rivers flow to the sea we move on we forgive one another
absalom absalom golden boy don't bring me no terrible news
it took us so long to sing the victory song
even though we've got the blues
and the heart opens wide the demons have died
and kingdom come your work here is done
not in vain not in vain not in vain

Rotator Cuffs and Intrathecal Baclofen

After posting such a spaz attack as today's earlier contribution, I thought I'd offer up something cut, dry, and relatively boring.  Er... a few infinitely fascinating new studies referencing CRPS/RSD.

The first involves rotator cuff tears and CRPS, and that just makes me chortle. Er... chuckle. Smile. A little.

After my left shoulder "collapsed" from AVN secondary to lupus in 2002, I had it replaced. That hospitalization -- giggle::giggle -- did not go well and the prosthesis never did quite meet my Stringent Standards for Shoulder Membership. Fast forward to 2008 and the Search for the Guilty Pathogen Infecting My Shoulder Hardware... Over the next two years, that left prosthesis was removed, a spacer put in. That spacer was removed... but there was still infection, so a second spacer was put in that had a specially made antibiotic-laced cement ball. All surgeries were followed by at least 6 weeks of intravenous antibiotic via PICC line. Unfortunately, the handcrafted spacer proved highly irritating to the joint, was removed, and I was gifted with a new prosthesis... because no one knew what else to do. I was to live with the pain until I couldn't, then we'd see what limited options remained. I reached that point last Fall, underwent my fifth unsuccessful aspiration under fluoroscopy, and then cried "uncle" in October and went in to see the orthopedic wizard. He snapped some x-rays. His verdict? My rotator cuff was gone!

Have you ever had a day like that? You lose your rotator cuff, can't remember where you last put it?

Anyway... the pain picture is complicated because those muscles and tendons got the hell out of Dodge. Dr. ShoulderMan has since opined that a reverse replacement will be my fate... but has asked me to resume living with it until I can't. It's crazy-making.

I have my suspicions, based on some recent sneaky behavior by the right prosthesis (that underwent more surgeries than it's lefterly brother, even), that the rotator cuff on that side has fled to Mexico.

Now, we do not EVER badmouth, or allow anyone else to badmouth, Dr. ShoulderMan, Wizard Surgeon and Kindly Person. Why? Well, complicate my shoulder picture, if you will, with the addition of CRPS/RSD. See? See?!? The fact that my arms are still usable and not completely at the mercy of this neurological disorder is a testament to his abilities.

The disease has spread from one arm to another, just as it has from leg to leg. As it spread, he was busy performing major shoulder operations on both sides approximately every 9 to 12 weeks. Can you imagine what terrible shape I would be in if I hadn't lucked out by finding the best ShoulderMan in all of Tête de Herge?

So I kinda shiver and laugh when I see this in today's MedWord offering:

Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears.Koike Y, Sano H, Kinjyo T, Imamura I, Masahiro O, Goto M, Ooyama M, Kita A, Itoi E.
Upsala Journal of Medical Sciences, 2011 Feb 16
Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3, Yagiyama Honcyo, Taihaku-Ku, Sendai, Miyagi, Japan, 982-8501.

Abstract Background. Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair.
Purposes. To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods. Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera.
Results. During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05).
Conclusion. RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides.

When you've sufficiently recovered from that bit of hilarity, check out the second item caught by my little CRPS bot, as published in the 18 February issue of Pain Medicine.  Watch out, though, because it's exciting.  You might be up all night.  I'm just sayin':

The Lack of Efficacy of Different Infusion Rates of Intrathecal Baclofen in Complex Regional Pain Syndrome: A Randomized, Double-Blind, Crossover Study
Anton Adriaan van der Plas MD,  Johan Marinus PhDSam Eldabe MD,  Eric Buchser MDJacobus Johannes van Hilten MD, PhD

Objective.  Intrathecal baclofen (ITB) is effective in the treatment of dystonia related to complex regional pain syndrome (CRPS). In a previous study, we noted that the responsiveness to ITB declined in 30% of patients once drug delivery was switched from an external to an implanted device associated with a reduction of the infusion rate (IR).

Design.  In a double-blind study, we investigated the effect of varying the IR at a fixed daily dose on the efficacy and safety of ITB in patients with CRPS-related dystonia. Patients were randomized to either slower infusion rate delivery (SIRD) or four-times faster infusion rate delivery (FIRD) for 2 weeks and were crossed over after a 1-week washout period.

Patients.  Patients were eligible if they experienced no beneficial response to ITB on dystonia despite a minimum dose of 600 µg/day, or because side effects limited dose escalation.

Outcome Measures.  Primary outcome measures were changes in global dystonia and pain severity.

Results.  There were no significant differences between the FIRD and the SIRD groups for the median change of numeric rating scale dystonia (–0.3 [interquartile range {IQR} −1.1–0.5]), pain (0.1 [IQR –0.8–1.3]), and secondary outcomes, except for the frequency of adverse events, which was significantly higher during FIRD (12 vs 2). FIRD was preferred only by patients who were included because side effects to ITB prevented dose escalation.

Conclusions.  Increasing the IR at a fixed daily dose is not associated with improvement of dystonia or pain but warrants further investigation in patients in whom side effects prevent further dose escalation.
  I tried to share the preceding fascination with Bianca and Fred, but I developed a terrible lisp talking about the FIRD and SIRD groups... 

Back when I was shooting for implantation of a SCS, I also had interest in pursuing intrathecal baclofen.  Some prognosticator mentioned something, blahblahblah, about the potential for infection, and ruled me ineligible for both.  And the band played on...

I'm outta here.