Grosses Bises/Re-posting as an Object Lesson

Wow.  It's amazing how some things do not change.


I was browsing old entries, looking for something that dated from the summer of 2008.  I have never been a good tagger or key-worder of posts, and many from that time period were left essentially undescribed.  The one that I am republishing now, for instance, bears this label:  "a partridge in a pear tree." Cute, maybe.  Helpful?  Not in the least.


Reading it should have made me laugh, but given how it highlights that inefficiency has been alive and well chez MDVIP Go-To-Guy's office for quite some time, I am not even cracking a small smile.  It's even less amusing since it marks the actual beginning of the Shoulder Infection Saga.  At this point in the ridiculous tale, I had two prosthetic shoulders that had both begun to hurt, accompanied by infamous malaise and fevers.


I may have to give this conspiracy angle more thought, because it looks more and more like things were screwy from the very get-go.


This post is in the form of an email to a then dear friend, who is, remarkably, still a dear friend.  Like everyone at a physical remove, she echos frequent consternation and disbelief at my tales of labs gone missing, labs ruined, doctors out of the country, and health professionals behaving as boors.  I'm sure she thinks this is all an elaborate invention...  Especially after she gets today's email explaining why the wildly anticipated culture results from last week's sampling will not come to anything resembling fruition.


So it is [*poof*] July of 2008 and apparently, I've begun to make serious noise about the state of my shoulders.  After a frustrating few days, I vent to my friend, thusly:








Hullo --

Don't worry, it's not you -- I need some slow-speaking here on my end, too. The quality of the deliberate. Or... I need an analyst's couch.

I can't remember what I wrote to you! The blood work showed an elevated white blood cell count, a very high platelet count, high liver function tests/enzymes -- That's all she told me -- And I didn't want to hear any more. It is, I believe, all very vague. My white counts are usually very stable and hover at the 11,000 mark -- mostly because of my "normal" inflammatory state. (Touche pas à ma phrase...) When I saw him last, I had already started having the fevers and general misery (quelle malaise, cette falaise...) and that white blood cell count was elevated, too, but only to 13,000, I think. It's now 17,000 sumpin' sumpin'.

I need to vent -- which will hardly interfere with the innate logic of my presentation. You know this from innumerable past attempts to plumb the depths of the chaos of my language. My languages.

Where is La Belle Bianca? you ask, voice a-quiver. She is firmly ELSEWHERE today. En vacances, disons. Resting her voice.

So -- Today being Wednesday, we naturally begin from the début of the work week: Monday.(Please recall that Monday marks six days from the blood draw, and six days from the steep clamber up Prednisone Mountain.) I call dear Dr. Go-to-Guy's office and leave a message at about 2 pm. I am feeling like warmed over, tepid crap.

No, of course that is not the essence of my message! What do you take me for, and for whom, too? Also! The message was that I remained febrile, that the stress-dose of steroids had helped with much of the bone and joint pain, but that there was an intensifying, well-localized pain in my right shoulder -- which, by the way, was basically unusable. I did not share la malaise de ma falaise, because who wants to encourage these medical types, these diagnostiqeurs, in their disgust of people with generalized pain and an excess of adjectives? Dear Dr. Go-to-Guy is not your average bear, of course, but I still don't wish to open myself to ridicule, now that the medico blogging world has dared to air its fatigue and discontent. (There has been an adroit movement to shift the blame for the cynicism squarely onto the shoulders of the barrister. Ooooo, smooth-and-wholly-unanticipated!)

There is no call back.

Monday night becomes emotionally bad as well as physically bad because I am just so tired of hanging on. The violins begin to play. Yes, the world's smallest! Bianca warbles in an effort to cheer me up; Dobby plays leapfrog on the very shoulder in question; Marmy offers an exquisite hair ball; Sammy makes goo-goo eyes; and Fred? Well, Fred goes shopping. He is very kind and I try not to overwhelm him with ridiculousness. Good man, that Fred. Well, except for his recent executive decision to use chicken feed as cat litter. Very absorbent, but the house smells like a barn.

Yesterday, Tuesday, I called as soon as they opened, ticked off by then, thinking that my message might have purposely been derailed, thanks to all the bad blood going on between the doctors, nurses, and staff that are leaving to form the new practice, and the ones that are staying behind. Worked myself into a lather, lots of suds! While not normally a conspiracy theorist, I will run with one when tired and dehydrated.

When Darling Nurse does finally call, she does so in order to tell me that she got Monday's message and that she was (profusely) sorry. She lost my chart Monday, and can't do a thing without it and blah blah blah and could she call me back because she needed to consult with dear Dr. Go-to-Guy about a few things? In the inimitable language of Marmy: Ack! Ack! At least, all things are back to normal, and Lee Harvey Oswald did, indeed, act alone.

Darling Nurse's second call: She is kind of scaring me, although I suspect it is more an effort to impress me with references to quick, decisive action -- all brought about by her dedication to my health, and by, of course, the recovery of my chart. Doc is on the phone right now with your orthopedic surgeon (henceforth to be known as ShoulderMan) and he wants an x-ray stat, and probably a bone scan, and so on and so on. Inside, I am a tad bit pissed by all the stat-ness, after having been so desperate for help.

Also, I know that a bone scan would be a massive waste of time, money, and resources.

Third call: We figured out where I could go for the x-ray (to a hospital about 40 minutes from us, but we also would be in bad traffic, very bad traffic) and then she said I needed to call her right before I left the house because she would have "additional instructions" from dear Dr. Go-to-Guy.

Time came for us to leave, at least I think so -- Le Fred is dragging his feet, suddenly has to make a trip to Walmart, suddenly there is an online auction he simply must witness, but overall? He is being a total studmuffin! What no one takes into consideration is that *his* day is being ruined because he has to chauffeur me everywhere. Like I said, a studmuffin.

Anyway, per instructions, I called the office and asked for my good nurse.

-- "Your nurse is on another line, would you like to leave a voice mail?"
-- "No, she told me to speak directly to her."
-- [major put-upon sigh] "Well, i will have to put you on hold."
-- "Okie-dokie!"
-- DISCONNECTED.
-- Repeat performance, the only difference? "Your nurse has taken a patient into a room and won't be available for a while."
-- [major put-upon sigh from MY end!]
-- "Okie-dokie, there, then! We will call her from the hospital's outpatient radiology department. We're leaving. please let her know we are on our way. Thanks!"

I was very proud of my telephone skills, as I am usually nearly phobic. I don't like telephones. Part of the supreme irony of all this? The hospital we were going to is -- literally -- a straight shot across the street from Go-toGuy's office. Why couldn't this all have been: swing by the office on the way to radiology and make sure you have everything you might need?

Shut up, you! Yes, I realize that such a common sensical move was also mine to simply make. One somehow gets caught up in a frenzy of following orders. And yes, of course, if we would just join the rest of the human race and snag some cell phones, some of this ridiculousness might be alleviated.

Anyway, we get there -- We're an hour late but still in the windowof opportunity she outlined for me. I smile a toothy smile at the receptionist because I remember and like her. I give her my full and complete name, get out my picture ID and insurance card, and while she is frowning at her computer monitor and leafing through piles of paper, I make smart chit-chat with The Fredster. (I keep wanting to call him "studmuffin" now, but if he found out, he would be pissed, like he was about the whole "Cabana Boy" snafu! Now *that* was a fine misunderstanding, I must say!)

You're probably ahead of the curve of this story: Right! NO ORDERS. NO PAPERWORK. No outstretched hands to take my proffered proofs of coverage and identity.

Unbelievably, I have a conversation with dear Dr. Go-to-Guy's office staff that is eerily reminiscent of the last one before we left the house, in that 'My nurse isn't available, would I like to... '

"No," I erupted. "I would not like to... What I *need* are some x-ray orders..."

The nice X-ray lady gives me the fax number and I relay it. Then Go-to-Guy's office lady says, "And what is the number if we just want to talk to them some more?"

This is a huge, major hospital that is right across the street from where her little pin head sits. Of course they have the phone numbers.

Still, in the interests of world peace, I ask the nice X-ray lady, who promptly furrows her considerable brow and shakes her head "No. No. No." They just need a number, I beg... and RELUCTANTLY, she gives me a number for their back office. What is the issue about giving out a sacré phone number? Incredible...

In about 10 minutes -- a STAT order is faxed over for a plain x-ray series of the shoulder. Surely this is abuse of the word? All the other stuff, the bone scan and whatever, is not ordered. Fine by me, I have a headache and i think (no, I *know*) we are all bozos on this bus...



So we finish. Hooray! The x-ray tech says, when sufficiently wheedled, that she thinks everything looked fine, but that my doctor will call me at home -- that night, last night, Tuesday night -- as in "shortly."

We crawl home through rush-hour NPR traffic, I feed everyone, am all wound up, very feverish, etcetera, ad museum, et ainsi de suite, and so on and so on, amen. I keep the dread phone at hand.

No phone call. I seem to recollect some involuntary weeping mixed with inchoate laughter.

No sleep -- well, some -- but I don't know how much, because I wake up with the computer on my lap and no memory of what I was doing. I have started a ridiculous little blog and it just gets weirder by the day because of insomnia and pain, plus my undeniable native weirdness -- and I see that I have made an entry into said blog -- again with no memory of it. What the heck, eh? An entry is an entry -- except that I like blogging and want a good calibre of thought and writing -- that is definitely NOT happening now.

We arrive at today, enfin. I get an early morning phone call! Hooray! It is, forgive me, from ShoulderMan's nurse, whom Fred and I call, forgive us, SuperDyke. She is extraordinarily gay, even in this city of the très gay, extremely masculine, and she acts like a drill sergeant. We have been mildly frightened of her in the past, though she is also very, very organized and straightforward, two key characteristics that have been woefully absent this past week.

SuperDyke tells me, first, that they are angry with me because back in 2005, I failed to turn up for my post-op visit with ShoulderMan. I congratulate her on her elephant-like memory and explain that I had multiple problems post-op and that her office told me that none of them were their concern, and that subsequently, I caught pneumonia, was on a ventilator in ICU, and then had to deal with fractures to my sternum from where they did CPR, etc. Screw world peace.

She sniffed.

Then, she shifts into high gear and lays out the arrangements for me to have an aspiration (guided by fluoroscope?) from the shoulder this Friday afternoon -- at yet another hospital, this one totally unaffiliated with my dear Dr. Go-to-Guy. They will culture it and see if it grows any bacteria. That will take time, apparently, and so I won't be scheduled to see ShoulderMan until next Wednesday. Yes, Wednesday, when I am simultaneously scheduled with Magic Eye Doctor to see if my pressures are responding to the glaucoma treatment... Well, cancel that! Magic Eye Doctor already thinks I am avoiding him. (Maybe I will drop off a copy of the Warren Commission Report.)

So now it is "pre-cert" time and la-di-da dealing with BCBS time... and, I figure, dear Dr.
Go-to-Guy will finally call me this afternoon. Yeah! That's the ticket! That's what will happen!

RING RING. It is Go-to-Guy's good nurse, who advises me that she is not normally this bad, it is just that she is kicking her Diet Coke habit. Uh-huh, I say. What happened yesterday with the orders and all, I dare to ask. Oh... I sent them to the wrong hospital...

She is calling to tell me that:

DR. GO-TO-GUY IS OUT OF TOWN UNTIL JULY 24, that I need to "be strong and go on auto-pilot, alternate percocets with ibuprofen around the clock..." oh -- and that SHE JUST GOT IN A TELEPHONE FIGHT WITH DR. SHOULDERMAN, himself.

Well, I know that ShoulderMan and his staff will do the right thing, and shrug it off.

Because I know that they won't take it out on me, the patient!

So that's the whole sad story, in ridiculous detail, my dear Ms. D, and clear as mud, too!

I am munching on sweet, crunchy, bad-for-me cereal, sipping strong cold coffee, burning up with fever and pain, trying to find the high road, so that I can get on it!

Hanging by the proverbial thread,

All my love,
Prof

[it was a tough call, though... which post to repost. "Calling Dr. Hackenbush" was just nosed-out at the finish line...]

Headless, and yet weeping

seeing red by halo

These are the available choices:    

Either my head is going to explode or I am going to cry.

I am thinking that both will happen, as I've no control over one and the other will probably help me feel better.  If a burst head has any propensity for spawning hot fires -- you know, maybe in the corners of the room, where a stray bit of flaming cranium might land on our ancient brittle-dry silk tapestries -- then it could be that the wetness of my flailing tears might extinguish that dangerous spark.

Hmm?  Oh, well.  The doctor's office just called.  You know, the doctor and his team that I jovially designate as my MDVIP Go-To-Guy et al?  Remember the culture we arranged last Thursday from the fistula that developed near my left shoulder surgery sites, the same left shoulder now "suspected" of being reinfected, such that removal of the shoulder prosthesis looks probable before year's end?

The source of the constant pounding in my head, my daily fevers, the stabbing pain, once confined to deep within the ersatz joint, now traveling down the shaft of the humerus?

Yes, the fistula that delivered unto the nurse's culture swab a respectful quantity of yellowish pus... that in the days since has assumed the quality, in my mind, of thick molten gold, source of epidemiological enlightenment and an informed antibiotic choice.  I even thought, somewhat dramatically, that this opportunity might save my life.

I expected to hear a lot of things but not this as a conversational opening:

"It's all my fault."

The lab refused to run the cultures.  She sent the two swabs in for analysis using expired tubes.  She said she begged them to run it, but that they responded with some lame excuse.

Oh, what was it?  Oh, yeah:  "We could lose our accreditation as a lab..."

Fred informed me that the next time I called him "paranoid," he would remind me of today.

I think I was supposed to feel sympathy for the nurse.  Excuse me if I fail that expectation.  I would entertain the idea of seeing red were not the pressure inside my skull mounting at an alarming rate.

Is there some plot afoot in the universe that wants this infection to rage on, unabated?  That wants me to be left infected, headless -- and yet weeping?

I bet we don't even have any ice cream.

crps, in living color

I hate to contradict the evidence, but the visible CRPS-afflicted parts of my body are undergoing the usual seasonal shift from red CRPS to blue CRPS.  Though you are not likely to notice, this stuff not being the center of your umbilical vantage point, this also entails a move from a highly edematous state to one that is... well, less so.  Shoot, on very cold days, my hands and feet will be nothing short of shriveled.  My rings will fall off my fingers, that sort of change.

Speaking of rings, a nurse asked recently why I wore rings and a bracelet, given the pain and ultra-sensitivity in my hands and lower arms.  I don't always -- a few times per day, I will divest myself of all jewelry and hold my freed hands up into the air, provided the air is cool and calm.

I suppose I persist in wearing some jewelry for the same reasons that I continue to do dishes, use knives, and pet animals:  these are useful ways to claim occupational/physical therapy credits.  In fact, there is a standing order in our kitchen that I am to wash all of the dirty dishes, unless I specifically beg off.  [Begging off being on my mind due to the change in temperatures.  There is nothing quite so unpleasant, first thing in the morning, as the freezing, greasy water found in a sink full of dishes left "to soak" overnight.]

Early on in my experiences with physical therapy (the treatment modality with the most success in modifying CRPS, at least if begun in a timely fashion), I was introduced to the concept of stress loading, which incorporates the activities of scrubbing and carrying.  Beyond that, there were horrific attempts at desensitization, failures all.  It soon became something of a joke to me that we were paying actual money so that someone could supervise me while I scrubbed, and give hilariously imperious nods of approval over my carrying techniques.

Besides, with all of Marlinspike Hall standing at the ready, actual scrubbing and real carrying tasks were bountiful.

In other words, it isn't at all difficult to make daily tasks sufficiently mindful that they assume the place of physical and occupational therapy.  With every setback, strengthening, dexterity, and coordination work moved to the forefront.

Being a fairly simple-minded person, I succeed in tricking myself pretty easily.  For instance, Dobby the Runt and Buddy the Freakishly Large Kitten both thoroughly enjoy opening my closet door and climbing the shelves so as to shed on my clean clothes.  To keep them out, we could add a simple latch to the door... or I could artfully pile various hand weights at the bottom, on which humans and pets, alike, could trip, causing an ongoing collection of paint chips and ill will.  It's good for my arms to do the bending and lifting now required just to put away clean underwear.

Anyway... yes, rings, watches, bracelets all serve a therapeutic purpose, most days.  They're my secret desensitizers.  The warm sudsy water in the kitchen sink is my aquatic therapy.  General cleaning encompasses a well-thought out stress-loading program, in which scrubbing and carrying are accomplished by... scrubbing and carrying.

This morning's video update just seemed to cry out for some contrasting color, so I grabbed things at hand:  one of Hiroshige's sudden showers; a favorite glass vase (favored for its blue); rope; and a needle point placemat that Brother-Unit TW included as filler in one of his marvelous gift boxes (ergo, I mistakenly imbued the placemat with magic powers).  Like I said, though quite purplish/red right now, the extremities have begun the annual pilgrimage to the blue, cold, shriveled side of things.

For such is CRPS.

the first mole (poblano)

it's been a weekend of high fevers, pain, and cooking.  looking at the sunday looming large before me, i foresee much of the same, with the exciting addition of some mopping and bathroom scrubbing.

i made my first mole sauce yesterday, an undertaking that probably has fever as a prerequisite.  a mole poblano, to be precise.  it never would have happened had not fred made several trips to the store, and had i not weaseled one or two more ingredients out of each journey.  a stickler for accuracy, he was going back to straighten out some check-out discrepancies.  anyway, it was my lucky break.

the thing is, i don't know if my mole sauce turned out as it ought to have -- not having ever tasted a mole sauce, myself -- though i suspect i've had it in such things as chicken enchiladas.

ah, but no matter, for i've surely entered the pantheon of cooking deities, never having heard of anyone else  using their first ever mole poblano as the base for a beef stew!  

that's right, about a cup of the mole sauce, along with a half-cup of brewed coffee, and some hits of nice cold fresh water.  the stew was finished with a splash of balsamic vinegar.  

this was maybe the third or fourth time i've ever used the slow cooker thingy and it proved ideal, that slow-and-low style.  

i was afraid it would turn out too sweet but instead the result was complex, smooth, and fruity, with a really cool viscosity, a bodacious body -- the criticism would be that it was too strong and almost overpowered the many tasty vegetables in the dish.  it was, though, a perfect pairing for the tender cubes of beef.  

of course, cooking beef is not something i am used to, either, since i've been a vegetarian most of my life.  when i began to eat meat, beef and pork were, and are, difficult to accomodate without major nose-wrinkling.  i cannot touch raw beef or pork -- i use utensils as i work with them.  it's a near phobia.  

so... to my untrained beef palate, it tasted rich, very detailed, peppery, spicy, smooth, with a final salvo of chocolate.

a whole lot of work for something that disappeared so quickly!

my hands went numb pretty early on in all the roasting, mincing, chopping, measuring, reconstituting, and mixing -- but after clearing the immediate area of cats, divas, and sleepy partners, i just forged ahead, approximating grips that seemed fierce and unbreakable.  i only dropped knives twice, and didn't cut myself even once.  ha!

fred behaved wonderfully well -- so very red-blooded, so very archetypal.  he settled in the bed, managing his resource of pouffy pillows with aplomb.  he scarfed down two big bowls of stew, grunting things that sounded approving, and watched ufc 138 (yawn).  as he was drifting off to his happy sleepy place, he had the nerve to inquire whether i had made an apple pie...

it's difficult to say, but i think he snickered right before falling into the dream arms of one of the octagon girls -- arianny, if his goofy mutterings are to be believed.  (the only thing i've ever admired about the octagon women?  they wear sneakers.)

anyway... one day?  i'd love to tackle rick bayless' oaxacan black mole -- check out how thick it looks, how smooth, how shiny, how beautiful!

is there an apple pie in fred's somnolent future?  

maybe.

probably.

okay, yes.  yes, i am gonna bake the man a pie.  

you wanna make something of it?  huh, do ya? 

(seriously, would you like to be in charge of pastry?  i don't think i can manage much dough-rolling today.  it's either go "rustic" or go "frozen pie shell.")  

most likely, it's jacques pépin to the rescue.   so stop back by late this afternoon and have a piece with us.  we can watch the sun set over the moat...

Feckless Fabiform Fistula, Batman!

The Fredster and I made an incredible team today:

• We left the Manor on time for an 11:30 appointment to have my port flushed (still a questionable sounding activity, in my opinion... I hear someone hiding in an alley, wrapped in a trench coat, hissing, "Wanna get yer port flushed, Lady?"); 

• Traversing the entire length and most of the width of the hospital campus, we scored a quick, if over-priced, spicy chicken sandwich which we ate in record time under the atrium sky, all whilst recounting amusing anecdotes, Steve Jobs' last words, and providing reconnaissance for one very confused old woman in search of her wayward nephew ("He's my ride!");

• We arrived for the second appointment early, an integral part of the plot to make the office manager feel guilty, and therefore I was seen at 1:10 rather than 1:30;

• After some minor difficulties remembering where we parked Ruby, the Honda CR-V, we loaded the wheelchair and zipped down the road about half a mile, pulled into some primo gimp parking, then made nice with Paindood's Evil PA, who was, as anticipated, her usual bitch self;

• I grabbed the Rx, Fred called for the elevator, and we finessed the pharmacy's minefield such that I owed nothing for meds (and scored free parking, too!).

There were some perplexing moments, like the three identical compliments I received for an ugly toxic lime scarf -- chosen to conceal part of the old lady embroidery on my "wearable art" old lady sweater.  Oh, and the homicidal looks we got from our fellow waiting room denizens as we incessantly commented on the CNN closed captioning.  Hmm, and that smart remark by the PA about "admiring [my] spunk." 

Spunk?  I have spunk?

What is she trying to do, confuse me?

image from microscopesblog.com

The most perplexing of moments, though, may be the one to come.

The only appointment that really mattered to me was the second one, at the pleasant and efficient office of my MDVIP Go-To-Guy.  I cannot remember if I shared the excitement over the development of a FISTULA (woo hoo!) on the inside of my left upper arm... If I didn't, please feign excitement: now!

Look, you would be excited, too, if the only other way to culture the stuff growing in your shoulder joint and humerus were to let the orthopedic surgeon yank your prosthesis in exchange for an antibiotic-laced surgical cement spacer.  (Say that 10 times without taking a breath;  Think that once without abject weeping.)

Because the filthy low-down pathogen in my shoulders has thus far refused to grow in the laboratory, and has returned despite 42 weeks of intravenous antibiotic therapy using potent gorillacillens, despite seven major surgeries, heck yes, I hope that a clear culprit might emerge from today's relatively painless procedure!  My surgeon would love to have an advantage for once, before he has to give the reverse replacement a try -- something that's likely to happen before the end of the year.  If we identified the bacteria and found the correct antibiotic therapy to zap it?  Before the surgery? Happy dances of profound joy!  (Now with actual arm movements, too!)

But.

However...

My MDVIP Go-To-Guy's nurse may not have used the best of techniques when she swabbed the thick, yellow pus (with occasional bloody streaks... What?  You're trying to eat?).  For instance, she may have set one of the swabs down such that the tip was on the counter top. If there is growth in the lab, how can I trust that it isn't a contaminant... and do I bring that possibility up with anyone?  What if it comes back staph?  I have a MRSA history and spent most of ShoulderMan's hospitalizations in strict isolation.  Medical settings are purportedly rife with bugs...

I just went blank while it was going on.  She had to do a fair amount of physical cajoling and basically bullied the thing to get the samples she wanted, so I was sort of lost in Biofeedback Land.  As she was packing up the samples, my shocked mind replayed the images.  Is there a 15 second rule for bacterial culture swabs?

I must add that she's the best nurse I've ever encountered, that I respect her immensely, and even more appreciate the many ways she helps me -- over the phone, in person, and with an awesome and unerring eye for veins-that-will-give-blood.  For all I know, she had scrubbed that counter top just prior to my arrival such that it harbored not a single microbe.

So anyway... we did it, we made it to every appointment, and *early*, too.  I made a kick-ass roasted red pepper soup last night -- meant for the usual Wednesday Festivities that Fred enjoys with the Militant Lesbian Existential Feminists, except that only one of The Gang showed up, and she had to leave early for a dance class... so the soup came home with Fred.  Or that's the story the boy told, anyway.  

Soup with dark rye toast.  A bed.  Purple, swollen legs.  Purple swollen fingers.  A good book with just enough vision left to read it. The satisfaction of having made a dent in my "to do" list.  The hope of something identifiable and treatable growing in the lab.  The hope that nothing grows in the lab except what is in *me*!

Fred was heroic.  Fred is always heroic.

***   **   ***   **   ***   **   ***   **   ***   **   ***   **   ***   **   ***   **   ***

Oops.  Almost forgot.  Something did happen that I am working hard to forget but probably should work to understand:  Before we acquiesced to the sexiness of the spicy chicken sandwiches and the hard benches under the hospital atrium sky, we went to the cafeteria.  It was my suggestion, even, born of a fond recollection of their fine frozen yogurt.  Surrounded by medicos in uniform, covered in badges and stethoscopes, with pen lights and bandage scissors peeking out of huge utilitarian pockets... I kinda freaked out.

First, it was incredibly loud and busy.  Remember that I stay in the protective confines of the Haddock family's ancestral home, Marlinspike Hall, except for these exciting blitzkrieg-type forays into the Metro Lone Alp area in central Tête de Hergé.

Remember, also, that this is the hospital where the Sentinel Event (that pretty much ended life as I knew it) occured back in May, 2002.  Yes, it does seem ridiculous to say a Sentinel Event of such magnitude "occured." I never thought I'd lend it a passive voice.  Progress?  Regression?  Denial?  Basic bad grammar?

When I dress Fred in the adjective "heroic," this is what I mean:  He was ahead of me in the cafeteria, carrying two of everything without being asked, when I veered my chair to the one vacant area (by the salad bar, of course).  He must have sensed my distress.  That, or he heard the clunka-clunka of my defective left front wheel stray from his plotted course.  In just a couple of short, well-constructed sentences, he diagnosed my malaise and recommended an immediate exit -- which, I am convinced, saved both the day and my sanity.

I've long suspected that I have PTSD, as embarrassing as that is, given that what I went through is precisely nothing in comparison to the terrors behind the disorder in military and rescue personnel, in people who have been traumatized by real violence.  It was much worse early on -- back in the summer of 2002, I would relive the fall in the hospital ICU every time Erin, my physical therapist, tried to help me stand up beside the hospital bed we had to rent.  I was left with a huge fear of standing -- exactly what I had been trying to do when I went down in May.  Then, until my courage and physical strength was reestablished, I lived with unexpected fears, too -- of fire, of being trapped, of being alone.  It was truly ridiculous.  Let us say that to declare Fred heroic will never be an overstatement, so long as the memory of those awful days persists.

Now my "episodes" are restricted to actual visits to that hospital, seeing one of the guilty doctors or nurses, although sometimes just a memory or a dream can do it.

What must have really primed the pump?  Being hospitalized there last month.  Talk about rebirth of terror, rebroadcast of the ridiculous before, during, and after of the Sentinel Event... But explain to me how that brief visit to the cafeteria eclipsed even the admission as a PTSD trigger?

Therapy?  I don't need no stinking therapy... Besides, we'd have to travel outside the confines of Tête de Hergé, as there are no mental health disorders in the native population here.  Well, none they'll admit to, you know?  There is a huge substance abuse problem, in my opinion, but having the new treatment center located in our barn may influence my conclusions.  Most of the residents continue to be carnies and circus folk from beyond these borders.

Anyway, just this brief exposition has helped me put things back into a more proper perspective.  So thanks for allowing me, O Interwebs, to jettison that mental debris...

Therefore:  Good night to all, and sweet dreams!

*the first reading of the cultures, i am told, will be reported late monday or tuesday... 

Ten Articles, No Abstracts

This morning, I received a list of ten articles recently published about CRPS / RSD.  Unfortunately, I have no access to any of them, as they were published without abstracts and I am currently unwilling to buy articles or give in to any subscription strong-arming.  Still, here are the bare bones of the information for your reference.

from deviant art dot com

Chronic postsurgical pain after nonarthroplasty orthopedic surgery - July 1, 2011 Sugantha Ganapathy, FRCA, FRCPC Jonathan Brookes, FRCA (Techniques in Regional Anesthesia and Pain Management)

Chronic postsurgical pain (CPSP) following nonarthroplasty orthopedic surgery has a variable incidence and results in significant morbidity in patients. The etiology of this persisting pain could be because of a variety of insults during surgery including injuries to nerves and release of inflammatory mediators. Trauma is well known to result in complex regional pain syndrome (CRPS). Phantom limb pain frequently follows both traumatic and ischemic amputations. Both these conditions are well known to result in debilitating pain. Management of CPSP is not only dependent on careful planning of acute pain management but also the treatment of established pain. Preventive strategies include use of multimodal analgesia, preventing opioid-induced hyperalgesia, and use of regional blocks. Treatment of established CPSP will depend on its etiology. Phantom pain and CRPS can be difficult to treat once established. Many therapeutic interventions have been tried with variable success.

Article references are available HERE.

The remaining citations are all from the Supplements to the European Journal of Pain.  Supplements, unfortunately, do not have abstracts provided, but each article/communication can be purchased and then downloaded.  Of course, individual and institutional journal subscriptions are available, too!

Supplements to the European Journal of Pain (ISSN 1090-3801) are published under the title European Journal of Pain Supplements (ISSN 1754-3207). All subscribers to European Journal of Pain automatically receive this publication.

The European Journal of Pain Supplements is an official journal of the European Federation of Chapters of the International Association for the Study of Pain®.
The publication of supplements is subject to the approval of the Editor-in-Chief. All contributions for the European Journal of Pain Supplements are commissioned and no unsolicited material is accepted. Rapid publication is a feature of all supplements.

24 HOW POSTTRAUMATIC INFLAMMATION TURNS INTO WARM AND COLD CRPS F. Birklein  - September 1, 2011(European Journal of Pain Supplements)

T239 HOME TREATMENT OF CRPS WITH REPEATED DOSE SUBCUTANEOUS IMMUNOGLOBULIN OVER ONE YEAR: A CASE STUDY H. Poole B. Frank L. Haynes L. Wyatt A. Goebel - September 1, 2011 (European Journal of Pain Supplements)

T240 FOLLOW-UP OF PAIN EXPOSURE PHYSICAL THERAPY FOR CRPS-1 J. van Egmond C. Koen

J.W. Ek R. van Dongen H. Samwel F. Klomp E. Draaijer  - September 1, 2011 (European Journal of Pain Supplements)

F237 THE CLINIMETRIC PROPERTIES OF THE RADBOUD SKILLS QUESTIONNAIRE AND THE HUMAN ACTIVITY PROFILE FOR ADULT UPPER LIMB CRPS-1  A. Daly A. Bialocerkowski J. McGinley C. Martin

- September 1, 2011 (European Journal of Pain Supplements)

F239 SPINAL CORD STIMULATION FOR CRPS-1 PATIENTS WITH DYSTONIA, RESISTANT TO ANESTHETIC BLOCKS: A CASE REPORT  C. Voet B. le Polain de Waroux P. Forget E. Masquelier

- September 1, 2011 (European Journal of Pain Supplements)

F240 ELECTRICAL SENSORY DISCRIMINATION THERAPY IN COMPLEX REGIONAL PAIN SYNDROME (CRPS) C. McCabe N. Harris S. Grieve - September 1, 2011 (European Journal of Pain Supplements)

F241 COMPLEX REGIONAL PAIN SYNDROME (CRPS): THE EFFECTS OF THE CHOLINESTERASE INHIBITOR PYRIDOSTIGMINE; A PILOT STUDY  S.G.L. Fischer W.W.A. Zuurmond D.L. Knol S.A. Loer

R.S.G.M. Perez - September 1, 2011 (European Journal of Pain Supplements)

S239 EPIDURAL CLONIDINE FOR TREATMENT OF COMPLEX REGIONAL PAIN SYNDROME (CRPS) TYPE II R. Fernandes C. Costa L. Agualusa - September 1, 2011 (European Journal of Pain Supplements)

S241 CRPS-1 IN CHILDREN AND ADOLESCENTS – A RETROSPECTIVE STUDY 1984–2010 - September 1, 2011 (European Journal of Pain Supplements)