Thursday, May 26, 2011

Changing the Channel: Court TV and Two Abstracts

I've never been a Court TV junky -- mostly because, you know, I've been busy being some other kind of junky -- Mwa ha ha ha!  Sorry, Beloved Readers, that's Street Drug Humor, something at which I am fantastically adept but have kept hidden as an attribute.  Now, though, I've decided not to hide my light under a basket. A bushel.  A bushel basket. Or whatever.

No, I am not suffering from Hinky Methadone Withdrawal.  What I am suffering from is this twit of a woman, this Casey Anthony person upon whom we are wasting such incredible resources of money, time, and emotion.  Yes, my television is tuned to her first-degree murder trial in Florida, where she is accused of having killed her two year old daughter back in 2008.   

Change the channel, you say?

Oh.  Right!

If I can redirect the miscued energy of a kitten, surely I can train myself to change the television channel -- even {gasp} turn the machine off.  Let's do that, then, and see what happens.

Why, look!  Here are some CRPS updates that I've failed to pass on.  Oh, and there is a Pink Elephant hanging from the ceiling fan!  (Just let me know when you've had enough Hinky Methadone Withdrawal humor.  Why are the lights blinking?)

This first research paper has a very specific target audience -- so, attention all orthopods!

The use of beta-tricalcium phosphate bone graft substitute in dorsally plated, comminuted distal radius fractures.Journal of Orthopaedic Surgery and Research

Michael G Jakubietz , Joerg G Gruenert and Rafael G Jakubietz
2011, 6:24

Published:  22 May 2011

Abstract (provisional)

Background:  Intraarticular distal radius fractures can be treated with many methods. While internal fixation with angle stable implants has become increasingly popular, the use of bone graft substitutes has also been recommended to address comminution zones and thus increase stability. Whether a combination of both methods will improve clinical outcomes was the purpose of the study

Methods:  The study was thus conducted as a prospective randomized clinical trial. 39 patients with unilateral, intraarticular fractures of the distal radius were included and randomized to 2 groups, one being treated with internal fixation only, while the second group received an additional bone graft substitute.

Results:  There was no statistical significance between both groups in functional and radiological results. The occurrence of complications did also not show statistical significance.

Conclusions:  No advantage of additional granular bone graft substitutes could be seen in this study. Granular bone graft substitutes do not seem to provide extra stability if dorsal angle stable implants are used. Dorsal plates have considerable complication rates such as extensor tendon ruptures and development of CRPS.
I know, I know -- where did that last line of the conclusion come from?  Is it really there or am I imagining things again?  Like I said, this has a definite target -- orthopedic surgeons -- and, well, I hope it doesn't keep any of them up at night!

Mwa ha ha ha!


Okay, on to something more "relatable," though not less specialized -- fixed dystonia in CRPS.  Just a few observations:  Classical dystonia is mobile;  Fixed dystonia is usually classified as part of functional movement disorders and is often labelled a contracture -- (though I think a better descriptor is fixed flexion postures)All of that is code for "psychogenic."  Most studies will make quick mention that fixed dystonia happens mostly in females, many of whom suffer from dissociative and affective disorders


(Please note that I am sighing as I look down at my twisted and distorted foot... as I recall the initial days of CRPS, when my left hand looked like the infamous psychogenic claw!  I'm also flashing on some really cool concerts from back in the day, but that could be the DTs.  Mwa ha ha!)

So... once again, if you're a CRPS patient experiencing dystonia, be sure to see someone who is not going to automatically categorize you as a nut.  The authors of the study below are searching for an explanation beyond the easy and lazy classification of "functional," and posit that the neurotransmitters used by interneurons are misfiring or dysfunctional (he he).  If you are like me, you might want to start with this quick intro to interneurons!

Fixed Dystonia in Complex Regional Pain Syndrome: a Descriptive and Computational Modeling Approach

Alexander G. Munts, Winfred Mugge, Thomas S. Meurs, Alfred C. Schouten, Johan Marinus, G. LORIMER Moseley, Frans C.T. van der Helm and Jacobus J. van Hilten

BMC Neurology 2011, 11:53

Published: 24 May 2011

Abstract (provisional)

Background: Complex regional pain syndrome (CRPS) may occur after trauma, usually to one limb, and is characterized by pain and disturbed blood flow, temperature regulation and motor control. Approximately 25% of cases develop fixed dystonia. Involvement of dysfunctional GABAergic interneurons has been suggested, however the mechanisms that underpin fixed dystonia are still unknown. We hypothesized that dystonia could be the result of aberrant proprioceptive reflex strengths of position, velocity or force feedback.

Methods: We systematically characterized the pattern of dystonia in 85 CRPS-patients with dystonia according to the posture held at each joint of the affected limb. We compared the patterns with a neuromuscular computer model simulating aberrations of proprioceptive reflexes. The computer model consists of an antagonistic muscle pair with explicit contributions of the musculotendinous system and reflex pathways originating from muscle spindles and Golgi tendon organs, with time delays reflective of neural latencies. Three scenarios were simulated with the model: (i) increased reflex sensitivity (increased sensitivity of the agonistic and antagonistic reflex loops); (ii) imbalanced reflex sensitivity (increased sensitivity of the agonistic reflex loop); (iii) imbalanced reflex offset (an offset to the reflex output of the agonistic proprioceptors).

Results: For the arm, fixed postures were present in 123 arms of 77 patients. The dominant pattern involved flexion of the fingers (116/123), the wrists (41/123) and elbows (38/123). For the leg, fixed postures were present in 114 legs of 77 patients. The dominant pattern was plantar flexion of the toes (55/114 legs), plantar flexion and inversion of the ankle (73/114) and flexion of the knee (55/114). Only the computer simulations of imbalanced reflex sensitivity to muscle force from Golgi tendon organs caused patterns that closely resembled the observed patient characteristics. In parallel experiments using robot manipulators we have shown that patients with dystonia were less able to adapt their force feedback strength.

Conclusions: Findings derived from a neuromuscular model suggest that aberrant force feedback regulation from Golgi tendon organs involving an inhibitory interneuron may underpin the typical fixed flexion postures in CRPS patients with dystonia.

In other breaking news, "Ketamine induced selective impairments in timing..."

Put that in the No Kidding File. 

Well, folks, I'd better get back to my soon-to-be "Done"-less life.  I do hope you know I'm just joshing around about the difficulties of tapering off of methadone.  I am NOT having a hard time (yet) or experiencing anything I cannot deal with.  Just don't take away my ibuprofen.

Wednesday, May 25, 2011

kind, humble, funny: spectrumom

In the course of reading commentary over at another blog, I came across an interesting one and followed the author back to her place -- this blogosphere is awash with serendipitous linkings.  We're gifted by the stylizations of the juxtaposed!

I read all of spectrumom: Getting all Buddhist and whatnot about autism.  That wasn't hard.  There are only nine posts.

On July 9, 2010, she opens her blog this way:

We have 3 kids: Sam, Nathan and Isaac.

Sam was diagnosed when he was 2year, 7mo with autism. Nathan was born 3 weeks later.

It was a stressful time.

As he grew, it became obvious that Nathan was on spectrum too and I was devastated. I had always wanted a large family and it seemed all I could obsess on was not having more children. Well, in addition to trying to fix what was wrong with my kids, it was all I could obsess on. Eventually, after 4 years, we did decide to have another. At the advanced age of 38, I had Isaac, now 4. And he is neurotypical, the outlyer in our family. The weirdo. Or the normal kid in a family of weirdos, take your pick.

Maybe because her time and spirit are likely... distilled, her prose is very lean, very clean.  Or perhaps she's a practiced writer.  Whatever.  Do I really need to justify the fact that I like her writing, and like it very much?

I won't claim that, through it, I understand autism, or people with autism, or parents with children with autism.  Thank goodness, she hasn't been taxed with my education in her reality.  But she is kind, humble, and funny -- so I am allowed what I can deal with.

Malpensa Airport, Milan 2008

I particularly like "Airport Brain."  She does a superb job of facilitating between worlds without condescending to any of them.  Give it a read, starting below and then clicking your way over to spectrumom

Have you ever been in an airport, or another busy place, but you're by yourself? So your brain decides to separate itself from it's surroundings. You feel separated from those around and there is a hum in your head. It is just an odd feeling. It's called depersonalization by the psych people. And this kind is very mild as opposed to the severe end associated with severe anxiety disorders and PTSD. But it happens to me sometimes when I'm shopping by myself or at a huge convention by myself. I can hear and talk to people and look pretty normal, but I just feel totally separated. Maybe it's just me being weird, but work with me on this idea.

Now imagine you are in an airport in a foreign country and there is the hum of Chinese or an Indian dialect, not an American voice to be heard. Your brain spaces out more as it seeks the familiarity of your thoughts. [CLICK HERE TO CONTINUE]

14 Minutes

image courtesy of addiction search

I'm having great dreams.  My last flirtation with sleep had me at the White House in tennis togs, running up and down a lovely, wide, red-carpeted staircase, happy as a clam.  The President and First Lady were scheduled to renew their wedding vows, and I was serving, of course, as a bridesmaid (a word and concept that makes me cringe).  People were reputed to be lined up outside, dressed to the nines, and upset that the wedding party had spent the afternoon on the courts instead of primping -- we had delayed the festivities when our mixed doubles required a third set.  So President Obama made a charming statement, promising that we'd all be downstairs and completely suitable within 14 minutes.  He repeats the 14 minute reference several times and it seems to be an inside joke, as the press and all the gathered beautiful people are snickering.

What can I say?  It was a dream.  14 minutes.  *These* are the dream details, Dear Sigmund, that I'd love to understand!

Clearly, there is nothing profound going on between the ears.  My brain is simply a little less inebriated than usual:  About ten days ago, I decided to try and be off of methadone and Percocet before the next Ketamine treatments.  If we are going to try and approximate the protocol used by Dr. Schwartzman, and if that's part of what he recommends, well, that's that. 

From a beginning dosage of 40 mg a day, I am down to 15 mg of methadone.  From a usual four pills a day of Percocet, I am down to three. 

I may need to pause here for a few more days, though, and I'm thinking it looks "iffy" that I will make the deadline of "no opiates" by June 13.  Why?  Well, most of all, methadone has a long half life and it surely won't be completely out of my system. 

And as for Percocet -- it helps too much for me to imagine not having to take it.  Judicious use of Percocet and ibuprofen has saved many a day.

I will do what I can do.  Any reduction is good.

In an effort to make it easier, and to control symptoms while attempting this crazy thang, I'm relying more than usual on non-addictive adjunct meds -- amitriptyline, baclofen, Cymbalta. Mostly, though, I am just trying to see the "absolute value" of taking as little narcotics as possible.  A clearer head, a happier gut, and maybe, given the infamous rebound potential of these drugs, less of a certain type of pain.

I can report that I'm not having as much of the burning so much a defining element of neuropathic pain -- but that might be due to the higher dose of amitriptyline (I hate amitriptyline and won't maintain this higher dose much longer).  The rest of my pain is unchanged and if you forced me to pick a number on the Pain Scale, it would be an eight, which is about as high as I ever will claim. 

Let's put it this way:  At my current level of pain, it sometimes takes me up to 10 or 15 minutes to just get out of the wheelchair, and I am likely to be crying by the time I am on my feet.  This morning I had to go without coffee because my shoulders, arms, and hands couldn't tolerate the weight of water.  I'm not suffering any delusions about having a pain free life.

There are whole communities on the internet of people trying to stop taking methadone, and after perusing the goings-on within them, I got really scared.  Weeks and months, even, of withdrawal?  Going through a literal hell? (Also, shouldn't I be referencing "percs" and "dones" so as to better perfect my Addict Persona?)

Among these conversants, though, there are very few who are taking methadone to treat pain.  Most are part of a methadone maintenance therapy that enables them to resist the cravings for other drugs, usually heroin.  It really is awful to contemplate -- to be hooked on heroin, then to be put on another drug to which one invariably becomes dependant?  I get the argument -- it's cheap, it's controlled, it doesn't require a life of crime or victimhood to sustain... Still.  How awful.  

The constant theme is withdrawal, and at what point to consider "jumping off" and going cold turkey.  It is generally agreed that it's nuts to do it above 30 milligrams.  Obviously, the lower the dose at which one jumps off, the better. (And then there is the constant motif of suboxone!) If I had more time, I'd do it all by taper, but I will have to choose a jump-off dose as well, with the expectation of about a week of withdrawal symptoms, probably beginning on the fourth or fifth day.

In other words -- any day now.  I have June 1 in mind. It would be lovely to be at a comfortable 10 mg a day in the next week.  We'll see.  Again, if I cannot do it, I won't see that as a failure, but it will mean going into the upcoming Ketamine treatments under less than ideal circumstances.

For me, this is a fairly straightforward case of diminishing returns.  Higher doses of pain medications that are not terribly effective anyway make no sense.  Finding the lowest, most effective dose seems logical, and along with that, testing the validity of that dose from time to time (I believe in drug holidays).

My poor brain is trying hard to keep up.

The increased sleep is helping.  Who would not enjoy mixed doubles with Michelle and Barack Obama?  Finally, too, I get to wear a bridesmaid dress that is not a gauzy, goopy pastel but instead is a copper-colored raw silk with a clean, clean line.

And I'll figure that 14 minutes reference out one day...

Tuesday, May 24, 2011

To Blog Visitor From Spain (guardamar del segura)

I could not find information specific to DSR/SDRC (RSD/CRPS).  You might find what you need here:

Valencia University General Hospital
Multidisciplinary Pain Management Department
Valencia, Spain

You might also consider calling/writing these doctors for more information:

Dr. José De Andrés
Associate Professor of Anesthesia,
Valencia University Medical School
Chairman, Department of Anesthesiology and Critical Care
Director of the Multidisciplinary Pain Management Center
Valencia University General Hospital
Tres Cruces s/n, 46014-Valencia. Spain

Prof. Carmen Gomar
Professor of Anesthesia,
Barcelona University Medical School
Department of Anesthesiology and Reanimation
Hospital Clinic i Provincial
Villarroel 170, 08036-Barcelona. Spain

Monday, May 23, 2011

FAQ For My Students: The Rapture

Brother-Unit Grader Boob forwarded this recent department-approved addendum to his syllabus for English Comp classes at Good Old University, where he quietly and courageously attacks the lethargy and heightened sense of entitlement afflicting today's youth. He must have begun the first summer session, because just a few weeks back he was getting misty-eyed over the end of spring semester:

Just wanted to drop you a line as the grading/cursing here comes near an end.
Have had one student say that I "fucked [her]" and that "[she didn't] care one bit for this shitty class." My response: a bland "Have a nice summer."
I just wished I'd said it sarcastically!
Where's Swift when you need him?
Mucho amore to all.
Grader Boob

From UC-Berkeley's Landscape Heritage Plan
Sather Gate, Wheeler Hall, and the Campanile beyond (ca. 1945). Note that at this time, the Gate
defined the campus entrance, and the adjacent Sproul Plaza was a city block.

FAQ for my Students: The Rapture
Q: With the rapture coming, should I bother working on my final paper?
A: Yes. The odds are you will not be judged worthy of ascent to heaven, in which case your grades will still be a basis of judgment for rewards in this earthly sphere.
Q: What if my instructor is raptured?
A: None of our instructors bear much chance of being judged worthy. However, on the off chance your instructor is chosen, an army of unemployed secular Marxists is waiting to take his/her place.
Q: If my mother/father/grandfather/grandmother/favorite aunt/etc. is chosen, will I be excused from the final so that I may mourn his/her loss?
A: No. They have not died, but been granted eternal life, thus this does not count as a case of a death in the family.
Q: If my instructor is not raptured, is he really fit to judge me?
A: Yes, seeing as you were not raptured, you are still subject to the earthly judgment of the unsaved. If/when you are redeemed, a change of grade form will be automatically processed by heavenly authorities if they decide your grade was unfairly given by one of the damned.
Q: If my computer crashes and my printer breaks and there is no email on account of the rapture, will I be able to get an extension on the paper?
A: Everyone in tech and IT departments is of Satan’s party, so the internet, your computer, and your printer should continue to work the way they always have: sporadically.
Q: How will the rapture affect your curving, particularly if raptured students are exempt from final tests/papers?
A: Final grades are not curved, but students who are taken up in the rapture will be given incompletes, just in case.