Autoimmunity and CRPS

The passive transfer of immunoglobulin G serum antibodies from patients with longstanding Complex Regional Pain Syndrome

Andreas Goebel, Mar Liete, Li Yang, Robert Deacon, Cruz M. Cendan, Andrew Fox-Lewis, Angela Vincent

European Journal of Pain
Volume 15, Issue 5, Pages 504.e1-504.e6

May 2011

ABSTRACT

Background
The aetiology of Complex Regional Pain Syndrome (CRPS) is unknown. Recent evidence suggests that there may be autoantibodies directed against peripheral nerves, but it is unclear whether such autoantibodies are merely biomarkers or whether they cause or contribute to the underlying pathology. The transfer of disease after injection of a patient’s serum or IgG fraction into mice (‘passive transfer’) is the classic way to demonstrate a functional role of autoantibodies.

Aims
Based on previous preliminary results, we wished to investigate whether the transfer of IgG antibodies affected mouse behaviour or produced signs of CRPS.

Methods
We injected purified serum-IgG from 12 patients and 12 controls into groups of 6–10 mice (∼17mg/mouse intraperitoneally) on 2 consecutive days and looked for any evidence for altered behaviour or signs of CRPS. The observer, blinded as to test or control group, measured behaviour in the open field, stimulus-evoked pain and motor coordination, and inspected limbs for autonomic CRPS signs.

Results
Stimulus-evoked pain and autonomic signs were not detected, but CRPS-IgG induced significant depression of rearing behaviour (17.9 rears/3min (n=84) vs. 22.1 rears/3min (n=83), p=0.0004), confirming previous observations in a single case study. Moreover, motor impairment, one of the four cardinal signs of CRPS, was evident in the three CRPS-IgG injected groups tested with a sensitive rota-rod protocol (p<0.0001 vs. control-IgG injected groups).

Conclusions
These results lend support to a pathophysiological role for IgG autoantibodies in CRPS.

REFERENCES:
1.Abrahamsen B, Zhao J, Asante CO, Cendan CM, Marsh S, Martinez-Barbera JP, et al. The cell and molecular basis of mechanical, cold, and inflammatory pain. Science. 2008;321:702–705

2.Birklein F. Complex regional pain syndrome. J Neurol. 2005;252:131–138

3.Blackburn-Munro G. Pain-like behaviours in animals – how human are they?. Trends Pharmacol Sci. 2004;25:299–305

4.Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, et al. Autoimmune etiology of complex regional pain syndrome (M. Sudeck). Neurology. 2004;63:1734–1736

5.Buckley C, Vincent A. Autoimmune channelopathies. Nat Clin Pract Neurol. 2005;1:22–33

6.Cerbone A, Sadile AG. Behavioral habituation to spatial novelty: interference and noninterference studies. Neurosci Biobehav Rev. 1994;18:497–518

7.Contet C, Rawlins JN, Deacon RM. A comparison of 129S2/SvHsd and C57BL/6JOlaHsd mice on a test battery assessing sensorimotor, affective and cognitive behaviours: implications for the study of genetically modified mice. Behav Brain Res. 2001;124:33–46

8.Dalakas M. IVIG in other autoimmune neurological disorders: current status and future prospects. J Neurol. 2008;255(Suppl. 3):12–16

9.Deacon RM, Croucher A, Rawlins JN. Hippocampal cytotoxic lesion effects on species-typical behaviours in mice. Behav Brain Res. 2002;132:203–213

10.Goebel A, Baranowski AP, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of complex regional pain syndrome: a randomized trial. Ann Int Med. 2010;152:152–158

11.Goebel A, Stock M, Deacon R, Sprotte G, Vincent A. Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1. Ann Neurol. 2005;57:463–464

12.Goebel A, Vogel H, Caneris O, Bajwa Z, Clover L, Roewer N, et al. Immune responses to Campylobacter and serum autoantibodies in patients with complex regional pain syndrome. J Neuroimmunol. 2005;162:184–189

13.Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–331

14.Inoue I, Yanai K, Kitamura D, Taniuchi I, Kobayashi T, Niimura K, et al. Impaired locomotor activity and exploratory behavior in mice lacking histamine H1 receptors. Proc Natl Acad Sci USA. 1996;93:13316–13320

15.Jones BJ, Roberts DJ. A rotarod suitable for quantitative measurements of motor incoordination in naive mice. N-S Arch Exp Pathol Pharmakol. 1968;259:211

16.Kohr D, Tschernatsch M, Schmitz K, Singh P, Kaps M, Schafer KH, et al. Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen. Pain. 2009;143:246–251

17.Maihofner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007;130:2671–2687

18.Mense S, Schiltenwolf M. Fatigue and pain; what is the connection?. Pain. 2010;148:177–178

19.Mills CD, Grady JJ, Hulsebosch CE. Changes in exploratory behavior as a measure of chronic central pain following spinal cord injury. J Neurotrauma. 2001;18:1091–1105

20.Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain. 2004;108:192–198

21.Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol Today. 1993;14:426–430

22.Teeling JL, Felton LM, Deacon RM, Cunningham C, Rawlins JN, Perry VH. Sub-pyrogenic systemic inflammation impacts on brain and behavior, independent of cytokines. Brain Behav Immun. 2007;21:836–850

23.Toyka KV, Brachman DB, Pestronk A, Kao I. Myasthenia gravis: passive transfer from man to mouse. Science. 1975;190:397–399

24.Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342:1012–1016

25.Zimmermann K, Leffler A, Babes A, Cendan CM, Carr RW, Kobayashi J, et al. Sensory neuron sodium channel Nav1.8 is essential for pain at low temperatures. Nature. 2007;447:855–858

26.Zlomuzica A, Viggiano D, De Souza Silva MA, Ishizuka T, Gironi Carnevale UA, Ruocco LA, et al. The histamine H1-receptor mediates the motivational effects of novelty. Eur J Neurosci. 2008;27:1461–1474

A Good Day For Kate ♥

Psssst!  Kate had good scan results today!  See the journal entry over at CaringBridge...

*kate*
Thanks to CaringBridge and the Tiny Sparrow Foundation *

* The Tiny Sparrow Foundation:  "a non-profit organization dedicated to providing lasting memories through the art of photography to families whose children are facing life threatening illnesses."

And Now for Something Completely Different: [clop clop]

I was going to reference a roller coaster, implying redemptive ups and promising downs -- being taken on a ride, yes, but always well worth it!  Eye on the prize and all that, eh, wot?

But I can't pull it off.  I didn't sleep last night for fretting.  Also for all the hilarious feline antics that seemed to inevitably end somewhere on my body -- Marmy would chase Dobby and so, of course, the only place possible for them to both end up was... on my hip, my knee, my chest.  Anywhere on me.  The FuzzBall Kitten played ferociously with his collection of stuffed mice, batting them around the bed until he'd lose them... somewhere under me -- under my arm, my feet, my head.  Anywhere on me.  This required that he dig, and Buddy Boy hasn't learned the meaning of modulation.  He knows one speed and one intensity, and he loosed both on.... me.

Interspersed with all that running, sliding, and digging were bursts of laughter from Fred's workroom.  I still don't know what he was doing back there -- likely watching videos or a film -- but he clearly couldn't help himself. 

So at about 3 AM, I quit trying and surrendered to the fates.  Twelve hours later, I feel like I have Saran Wrap on my eyeballs.

This Philly Thang?  It's not going to happen.

No, no one has told me it's off.  But the incredible disinterest in making it happen sends a clear message. 

The Party Line hasn't changed:  Dr. Schwartzman is booked through 2013 and the offer of an "expedited appointment" seems to have been a meaningless one.  Like some kind of coupon given out to all comers but never redeemed.

Carol said to me, in a mildly scolding tone, that "she's working on it" but right now there is no way to schedule an expedited appointment.  It feels more and more like I've been caught with my pants down in the middle of a Monty Python skit. 

Maybe this one:

Host: With me now is Norman St. John Polevaulter, who for the last few years has been contradicting people. St. John Polevaulter, why do you contradict people?

Polevaulter: I don't!

Host: But you... you told me that you did.

Polevaulter: I most certainly did not!

Host: Oh. I see. I'll start again.

Polevaulter: No you won't!

Host: Ssh! I understand you don't contradict people.

Polevaulter: Yes I do!

Host: And when didn't you start contradicting them?

Polevaulter: I did! In 1952!

Host: 1952.

Polevaulter: 1947!

Host: 23 years ago.

Polevaulter: No!

(GONG!)

-- The Man Who Contradicts People from  Monty Python's Previous Record

It's equally possible that my role is just to call out a reminder now and then: "I'm not dead [yet!]."

MORTICIAN: Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

[clang]

Bring out your dead!

CUSTOMER: Here's one -- nine pence.

DEAD PERSON: I'm not dead!

MORTICIAN: What?

CUSTOMER: Nothing -- here's your nine pence.

DEAD PERSON: I'm not dead!

MORTICIAN: Here -- he says he's not dead!

CUSTOMER: Yes, he is.

DEAD PERSON: I'm not!

MORTICIAN: He isn't.

CUSTOMER: Well, he will be soon, he's very ill.

DEAD PERSON: I'm getting better!

CUSTOMER: No, you're not -- you'll be stone dead in a moment.

MORTICIAN: Oh, I can't take him like that -- it's against regulations.

DEAD PERSON: I don't want to go in the cart!

CUSTOMER: Oh, don't be such a baby.

MORTICIAN: I can't take him...

DEAD PERSON: I feel fine!

CUSTOMER: Oh, do us a favor...

MORTICIAN: I can't.

CUSTOMER: Well, can you hang around a couple of minutes? He won't

be long.

MORTICIAN: Naaah, I got to go on to Robinson's -- they've lost nine

today.

CUSTOMER: Well, when is your next round?

MORTICIAN: Thursday.

DEAD PERSON: I think I'll go for a walk.

CUSTOMER: You're not fooling anyone y'know. Look, isn't there

something you can do?

DEAD PERSON: I feel happy... I feel happy.

[whop]

CUSTOMER: Ah, thanks very much.

MORTICIAN: Not at all. See you on Thursday.

CUSTOMER: Right.

[clop clop]

-- Monty Python and the Holy Grail

For further dissonance, I've got Seinfeld's Soup Nazi between the ears, shouting "No Philly for you!"

Search Words for 5/16/2011

It's so much more than just a list of terms plugged into Google Search by people I will never know.  It's how they got to me, to us, to Marlinspike Hall, and somewhere in the intervening space is a story, are many stories.  It's about how they got here from there, proving not just that you *can* get here but that you come different ways for different reasons -- detours, bridges, toll roads, backseat drivers, and that rare bird of a map reader who interprets west as a left turn (I'm just sayin').

periwinkles and driftwood::This is the way we went to the beach when I was a kid. 

As soon as you hit Kinston, you could smell it. We would stop at the grocery store that sits right there when you come off the bridge from Morehead City to Atlantic Beach -- for bleach and ammonia, hot dogs, and Maxwell House in the big can. We ate Wonderbread at the beach and whole wheat the rest of our lives. Setting the indoor picnic table sometimes just meant spreading out newsprint and big platters of boiled shrimp, salad, and loaves of decent crusty bread.  Garlic butter.  Melons for breakfast, and toast.  No one in the ocean before 9 AM, curfew starts at 9:30 PM, remember to tie a flipflop to the umbrella in case you get lost.  They sent out a search party for me one night after I fell into a huge sand dune and just stayed there, mute, trying to decipher constellations and my Mother, both. I'd just had my appendix out;  Chiggers crawled on my legs, ate me up, I scratched myself raw..  Not chiggers, sand fleas.  My aunt chaperoned a bunch of us for Junior/Senior Weekend -- a boy fell off of someone's porch -- he was perched (backward) on the railing that jutted out over a concrete driveway.  Lois made us all godawful sloe gin fizzes; He died.  He wasn't from our school but was good friends with the Bennetts.  My cousin and I made a chowder out of periwinkles and all the grownups actually ate it.  (It was full of sand.)We spelled it "perrywinkle," wrote out an official recipe in pencil on a lined index card that we stuck in the middle drawer of that old-fashioned enamel table in the kitchen.  I went to the cottage one winter, alone, and sat on the porch, right on the stormy ocean.  They called that The Front Porch.  Visiting the cemetery in Beaufort was important but I couldn't begin to tell you why.  After my summer months there found a rhythm, time fell into bayside days and oceanside days, interrupted by stormy afternoons when we'd pile into the drugstore, where everyone got to buy one paperback, just one.  Dusk.  The running lights on shrimp boats.  The pay phone on the pier.  Swimming past the breakers. Knowing who was boss when the undertow took you twisting down.  Yogurt on sunburn.  Ice clinking, bourbon, scotch, beer.  Hearts, spades, bridge, Scrabble and crossword puzzles.  Turning into the wind.  The stories about my sister Copper being born smack dab in the middle of Hurricane Hazel.  Driftwood fires, sparking.

topiary and gingerbread::I like this road because of that house, the one with all the wild flowers.

I turn left a good half mile before I have to just to see it.  There's the wire form for a bear topiary -- kind of a Pooh -- that sits in the middle of one patch, and they decorate him for the least little holiday.  National Teachers Day, Cinco de Mayo.  Canada Day, Bastille Day, big football Saturdays.  Past Sterling and Oakdale, but before Clifton Road.  One year the yard was overgrown and the bear undecorated.  I mean, he stayed in his Santa duds until they just wore off him.  I think a baby died.  Then, like nothing, the bear grew rich, thick, and green again and there were raised beds of every kind of flower, as if from nowhere.  Can't even recall the house now -- brick, compact.  One of the gingerbreads, big slants to the roof, dark masonry.  Everyone felt special, peeking at those flowers, that bear, like it was a private kiss you'd sneak.  I thought, What if they move?  What will I do then?  Who will change the bear?

 waffle cones and cockapoos::There used to be a Dairy Queen right there.

I would pick up my parents' Saturday evening dinner order on the way home from a day of tennis in the park:  a pound of barbeque, a pound of slaw, and hushpuppies.  Then I'd cut through the dirt lot, through the heady smoke from the pit, and drive on up to the DQ in my 1965 baby blue Cadillac.  It was a minor revolution, delaying that vinegar-heavy chopped pork for a vanilla shake.  That's right, I was every bit as exciting as they were, me and my vanilla shakes.  The vet we liked was right across the highway, on the westbound side of Hwy 70, heading back into town.  I hated going home once they lit the downtown courts -- I could have picked up games all evening, and if Teresa didn't have to babysit, we could play doubles with the country clubbers who forgot to make a reservation.  It'd be okay at home for a little while -- setting sun on the lake, the attack of pastels, the dog chasing geese. I'd follow him down to the water, turn 'round and look back at the house, their dream house, but you could tell just by looking that nobody lived there.  Mom made me a big salad  so that I could keep company while they ate their pound of barbecue, pound of slaw, and hushpuppies.  I stayed a vegetarian for 25 years.  Sometimes she'd ask me to stop at the Dairy Queen and bring home hot fudge sundaes.  I always told her I forgot and kept the extra money for gas, always planning to get in that car, pick east or west, and go, go, go.

We generally find what we're looking for.  My "stats" page says these are the words that brought folks here today after being plugged into Google Search.  These aren't the only pathways and story lines, of course, but they are all I have as clues tonight, and they suffice.

ina mae oxendine
serena williams catsuit
pesach 
venus williams ass
canned peaches al swearengen 
dame marjorie charden 
dr schwartzman rsd 
ketamine coma february 2009
"andrea gianopoulos"
mike vermeer tennis
3 invisible dicks
picture of bouillabaisse 
pollyanna woodward naked
cushingoid
serena williams catsuit
serena williams cat suit 43
serena williams underpants 
lindsey baum 
taiji dolphins
monopoly game pieces 
taiji
focaccia di recco 
anna kournikova tennis skirt
taiji japan
kamasutra 
dr schwartz rsd puzzles
sequential frame spinning back fist
rebecca allwine
dolphin killing
andrea gianopoulos

carrara marble quarry

and

((pfizer or wyeth or johnson&johnson or j&j or "johnson & johnson" or "johnson&johnson" or "j & j" or hoffmannlaroche or "hoffmann la roche" or roche or novartis or glaxosmithkline) and (tsunami or earthquake or erdbeben or quake or japan or japanese)) and (donation or donate or donates or spende or spenden or spendet)

New Nurse

Though I am tempted to insist that she appear at the same time and in the same place with Nurse K, I enjoy reading New Nurse In The Hood's blog.  It's... scrappy.

Also, like the always aforementioned Nurse K, New Nurse reminds me of why you will never find me in an Emergency Room/Department unless my ACTUAL emergency involves lots of blood (and gore, lots of gore) that cannot be resolved by applying feminine pads to my shin. (Please try to keep up.) And even then, I might not go.  I mean, who knows, Dr. Schwartzman's Office Staff might try and call me with a free hair appointment.  Or a gift card for a shopping spree at Amputations R Us.

I'm fine.  Really!

Anyway... New Nurse is good.  And if only 10% of what she relates as happening in her ER/ED (screw WhiteCoat!) actually happens?  Then she is a far better person than I would be under similar circumstances.  Some of these folks qualify for Group Memberships on my List of People Who Need Killing.

Would you HUSH, please?  I said, "I'm fine," and that's what I meant: I'M FINE.

So... New Nurse gives us the run-down in this post entitled "Just an overall poor effort" -- from last Wednesday.  An optional title?  One girl, no brain.  Or something like that. 

It's an old tale, really, as old as time.  Shakespearean in its ridiculousness. 

Yes! Pregnancy games!  How to waste precious medical resources, in human as well as monetary terms!

From reading many an excellent medical blog, I get the feeling that a good version of New Nurse's "poor effort" post could be written weekly by each of them, and from fresh, actual material, too!  That's sad and pitiful.

Without further ado... why not start her post here and then finish it over there at her place?

Just an overall poor effort

Chick checks in last night for nausea x 5 days, with positive pregnancy test at home. Let me pop that in the hood hospital translator for you right quick:
I want a sonogram, and maybe another pregnancy test. Starts going into an in depth discussion with the triage nurse about when she started having sex with this dude that is with her currently. Listen sister, this isn't Maury, we just asked your LMP, next please.
So it was utter pandemonium and fuckery up until about 4 am last night, people were forming human pyramids in the waiting room because there were no more chairs, the line to check in wrapped around the building and everyone had chest pain. I had two dudes who fell off of roofs, like, really actually fell off of them, check in within 5 minutes of one another. One had a broken C2. So, uh, obviously this young woman's complaint was not of immediate concern. So she and baby daddy leave and do some shit at Walmart or whatever and then come back...

Begging and Beseeching, Entreating and Imploring

  “Hope” is the thing with feathers -

That perches in the soul -

Emily Dickinson 1830–1886

Okay, so I'm STILL waiting for a call back from Philly about an appointment with the illustrious Dr. Schwartzman (see previous gush).

After days of some sort of Stupid Attack, I am finally remembering my well-earned expert opinion on... Experts.  Correction!  Make that: I know whereof I speak concerning those experts celebrated by a cult-of-personality-based community.  I've lots of unfortunate experience in this arena -- Derrida, Fish, Foucault, Jameson -- but not near enough, apparently, since here I sit in Marlinspike Manor's Computer Turret instead of the nearest Ivory Tower.

It's really more the Middling Players who are the actual offenders, anyway -- Bersani, Hollier, Lentricchia, Most Poets.  You learn the most from this moderate and scruffy crowd but you also accept more [unwarranted] abuse than is wise.  The accumulated angst and stress of simply sharing a town with them eventually detracts from the information received.

Note to other bloggers contemplating making their own Lists of Four:  Alphabetize.  That's the only solution to the Order Problem.  Well, I suppose you can also opt for a Living versus Dead construction, further subordered by Date of Death.

I am reminded of a conversation with Grader Boob from a few years back.

Grader Boob: Great news. I finished that pain-in-the-ass paper for the Incomplete I got in Misogynous Medieval Literature my last year in grad school. Knocked that sucker out over the weekend.


Me: Congratulations, My Brother-Unit! So what did the prof have to say?

Grader Boob: Not much. He died six weeks ago.

Grader Boob (again): But that's not the point...

I consider myself lucky to only be at the point where my doctoral committee now consists entirely of Emeriti.  Honorifics and Soporifics, that's the name of the game!

Putting my dementia aside, and returning to the present stressor of trying to relieve this soul-destroying pain afflicting my body, and, some might argue, my cognitive powers, as well ===>>

Is it Dr. Schwartzman's fault that there's an attention-starved group of people who share a sharp interest in the pain relief he may be able to offer?  Not in the least! But I wonder if he has a sense of it, really.  Does he feel it in his bones, in his hands?  We're going crazy out here;  We're going nuts for some relief.

In other words, don't screw with me when it comes to Matters of Hope.  Don't deign or feign, just shoot from the hip, be direct, be honest.  I say again:  Don't screw with me when it comes to Matters of Hope.

Is it to Schwartzman's credit that he is equally well known for being a compassionate man, and that compassion complements intellect like no other attribute known to humankind?  Of course it is... particularly since that assessment appears to have held very true over time. He sounds like a remarkable person.  I hope to meet him.

Someday.

Does any of this mean that his Schedule Coordinator gives a royal patootey about me, sitting here in rural Tête de Hergé (très décédé, d'ailleurs), once again pondering a Do-It-Yourself Amputation, though I still haven't solved the problem of how to cut off the last arm without at least minimal assistance?  Oh sure, I could probably rig something up with pulleys and the use of my awesomely muscular lip muscles, but the whole plan goes pfffffttttttttt once I decide that I don't want to bleed out, and that tourniquets are gonna be necessary. 

Errrr, I think not.  Said Scheduling Coordinator surely has separated herself from the needy tentacles of the thousands of patients seeking an audience.  She guards the gate, keeps the dates, protects the doctor, gets it done.

If the cult-of-personality-based community of CRPS sufferers were a wealthy community, things would be different.  We'd have decent DIY Amputation Kits, already! The right vises would be included, there'd be extra hardware, sharper blades, and clean-up would be a breeze.  Appointments would be made, and made reasonably.  For instance, I confess to thinking that there MUST be someone else in the Neuro Department with at least a faithful simulacrum of Schwartzman's skills, having been trained by him -- and with whom I might have an appointment within a reasonable period of time.  I am redefining "reasonable period of time" daily.  Right now, it means "within a year." Yesterday, it meant "around six months." Last Thursday, when I made First Contact, it meant "any day now, possibly tomorrow."

Yes, so... the Gatekeeper of Appointments has laid her foundation -- I gasped, suitably, when immediately reminded that the "next available" appointment with the Famous Doctor was in 2013.  Right.  Got that.  Knew that years ago.  Part of why I never bothered.  Y'know?

But, yes, so... I gasped.  "REALLY?  YOU'RE KIDDING?" It was passable.  She seemed satisfied that I was suitably in awe.

Because, of course, The Personality has thrown me the bone of a promise of consideration, of being worked into the packed planner.  I recognized Emily Dickinson's Thang avec Feathers right off the bat.

Then it became a matter of her never having heard of my health insurance coverage, you know, that coverage initiated by My Hero, President Obama.  Of course, me yelping at her about how it is administered by "JEFE" instead of the correct "GEHA" did not promote my cause in the least.  I do this regularly, Friends.  I don't know why JEFE strikes me as the thing to yell out in the identical manner that I might scream BINGO, but it does. 

By the time I was able to mutter GEHA, it was too late, I was relegated to the Hinterlands, to a I Will Call Back Tomorrow Morning Status.  Also informing that decision was her strange assertion that "the computer won't take your insurance's 800 number." I was tempted to follow up my calls of JEFE, GEHA, and BINGO with OVERRIDE, but thought better of it.

Enter Buddy the Kitten.

Oh, hush.  You knew he was going to snake his little squirrelly self into this mess.

He was apparently back at chewing wires on Friday and the phone was out most of the morning.  Therefore, I choose to believe that she tried to call me, and could not, due to the dastardly deeds of this reprobate kitten.  Still, I had the phone in my shirt pocket the rest of the day, even as I worked with doughs and slippery cold dead fowl (but never at the same time, oh no, never at the same time!).

Fine, thought I, slamming shut the oven door on the last batch of chicken carcasses.  Monday, she's gonna call Monday.  Monday is rapidly disappearing as I waste time writing this dejected post.

Why don't I call back?  Well, I am going to, thankyouverymuch.  I have established an artificial deadline of 3 PM, at which time I turn into someone with a backbone.

Unfortunately, my extensive experience with cult-of-personality situations and the gatekeepers thereof tells me that I will be dealing from a position of weakness, as I am in the position of begging and beseeching, entreating and imploring. 

That was Fred's contribution to the process thus far:  "Have you, ma chère prof, sufficiently begged, beseeched, entreated, and implored?" 
The answer is NO.  I haven't cajoled enough, haven't made my case, haven't had, in fact, the least bit of interest in going down that road. 

Am I supposed to announce that my pain score is stalled between 7 and 9 -- when I actually don't even believe in or understand the God-forsaken System of Misery Measurement?  Am I supposed to have my doctor make the call, so as to invoke preening, primping, fawning, and immeasurable posturing?  Should I weep over the telephone, sob a bit?

Well?  Yes?  No?  Never! Maybe?  It all depends?

I go back to consult with the doctor who prescribed the ketamine infusions for me here on Thursday.  It's going to be a chess match of a conversation.  Hopefully, I will have, by then, a date for evaluation in Philly, which would give me a bit of a conversational edge.  I want him to know how much I appreciate the effort he's made here but I also need him to accept that a different protocol is in order.  It's not that he is not as "good" as Dr. Schwartzman;  It's an issue of specialization and experience.

I don't feel badly about how this all got started.  In fact, I need to remember that -- all I did was email The Expert with a real question about how to get the most from these lower dose and infrequent versions of subanesthetic ketamine infusions. 

And The Expert knew compassion and said Why don't you come?  And what all of THIS is (waving my hands around in an effusively inclusive way)?  This is ME, TRYING.

Darned cat.
It's all Buddy's fault.

 

fouetté rond de jambe en tournant, avec poulpe

The Elder Brother-Unit, Tumbleweed, maintains several blogs. I only follow American Idyll with regularity. It turns out, of course, that I've been missing good stuff on the other sites.  He illustrates himself, is all I can say, and I'm hungry for each glimpse.

The video below is mesmerizing.  The best meditations skew vanishing points and horizon lines, twist sinewy, all sinewy, soft strong form, the shape of water.  If you've missed me these past few days, that's the where and what of it.  I've been contemplating dancing sea creatures.





Uploaded to YouTube by RSNOOI on Mar 31, 2009, who wrote:

This white octopus was filmed with a high-definition underwater video camera at 6600 feet depth 200 miles off the coast of Oregon in September 2005 as part of the VISIONS '05 expedition led by Professors John Delaney and Deborah Kelleyof the University of Washington. Little is known about the deep-sea octopuses that live in proximity to the hydrothermal vent fields associated with theunderwater volcanoes of the Juan de Fuca Ridge in theNortheast Pacific Ocean.


This video features the Grimpoteuthis bathynectes species. Sometimes nicknamed the Dumbo octopus, its ears are really fins that help it move through the water.


Primary sponsors of the VISIONS '05 Expedition were theNational Science Foundation,W.M. Keck Foundation, NOAA Coastal Services Center, University of Washington, and the ResearchChannel.


Special thanks to Jerome M. Paros and Elaina Jorgensen.


Music courtesy of Bryan Verhoye.


Video production by Nancy Penrose
© University of Washington, 2009

While my mind was still all wavy and without perspective, I ran into this bookend of a dance video, a production by the Moldova Ballet School:




Eugen Garnet/ Massenet. Meditation
Uploaded to YouTube by MrViorelMIRON on Apr 27, 2010

moldova ballet school