Friday, September 21, 2012

Big Tall Bob Used To Reek Geek

He's a giant of a man.  When I first met him, seven years ago, he reeked "geek." He's still shy, but now he's buff, tan, wears the coolest clothes, and his spirit seems to have grown into his height, and beyond it, hovering as icy blue aura, or just making the air shimmer..  He seems to move with grace, even in clunky exam rooms overcrowded with rolling stools and tables full of tape and bandages, and those cotton swabs that top only one end of long, thin wooden sticks.

He's never been paid for his part as "assistant surgeon" in any of the eleven or twelve operations in which he has helped.  The insurance companies write that my surgeries should not require extra assistance.  If I can, and that's a huge "if," I'm going to try and leave him some money in my will.  He would die of Extreme Blushing and Embarrassment were I to do it while alive -- and I love his anti-geekness too much to put him in danger of a return to stammering and crooked glasses.

That makes an elegant segue for my tale of yesterday's appointment with Bob, Brilliant ShoulderMan's Physician's Assistant.  Unfortunately, I need to take a break, grab some frozen strawberries, cover them with fake sugar, and splashes of milk.  This concoction has comforted me several times a day over the last few weeks.  I don't know why -- except that it does cool me down, and I'm starting today's fever.  So I'll be back.  It's also a chance to give Buddy -- who is looking after me this morning -- his favorite treat of bonito flakes, fresh from the one-pound package in the freezer.  (We got the "okay" from the vet to give him as much as he wants, and he wants, and wants, and wants...)

Bob listens to me, and hears me, too.  When I'm stupid, he ignores the babbling.  When I'm glossing over something difficult, he gets very still, a hard thing for a big man to pull off.  He has crystal aquamarine eyes.

We talk cats sometimes.

There have been late-afternoon appointments, over the years, where he and Brilliant ShoulderMan's nurse would both sort of collapse onto chairs or rolling stools, even putting their heads down on the exam table.  I was like a fixture, I guess, and attuned to their fatigue.  These are some hard-working people. Once, I think we all three dozed off.  I remember the nurse shaking herself awake, handing me some pre-op paperwork to sign.  She started to go over each document, then said, "Oh, you know the drill..."  Informed consent at its best!

In the hospital, it is Bob who rounds more than anyone else, so he was the one who got to witness most of my CRPS misery.  He'd drop by between 5 and 6 AM, and I'd be doing well.  Between operations, say around 11 AM, he'd pop in to find me writhing, jerking, cussing.  He heard it all, he heard me say I was giving up, he heard me full of bravado, he saw me when I could not even speak.

When they take me into the surgery suites, I'm always lost.  I cannot see, so I tend not to speak to anyone, whereas they all feel like we're old friends, and come up and crack jokes, say sweet things, explain what is going on.  ShoulderMan and Bob usually aren't in there then, they come swooping in as I am put to sleep, I guess.  But this last time, in June (has it been that long?), there was this unmistakably tall figure moving about the surgical suite, emitting a reverberating voice.

Moving from the pre-op gurney to the operating table is always difficult.  Normally, the surgical staff would help, and the patient would be grateful.  Me?  They knew me so well that should some Newbie reach for a leg to help guide me onto the table, a whole chorus of "Don't Touch Her Legs, Let Her Do It!" rang out.  (Why the nurses up on the floor couldn't grasp the concept, I dunno!)

But this time, my legs were seizing and out of my control, mostly. My left shoulder was shot, hurt horribly with any movement (we shall not intimate that the regional block FAILED miserably!), and that left my right arm as the only available appendage to see to this transfer from gurney to operating table.  Had there been a trapeze, I might have been able to just drag myself over with that one arm, but you can imagine how incredibly crowded it already was in that area... machine after machine, lights, tables full of instruments, and people, lots of people.

I had already led some of the nurses in a sing-a-long during the trip there, and even as we all pondered how this transfer was gonna take place, we were still humming.

Finally Bob's masked face came down to about an inch from my nose.  "Hi Bob," I called out.  I think he laughed.

"We're going to pick you up and move you, and we're going to be quick and gentle."  Before I could bitch and hem and haw, it was done, but not without Bob's face coming back into the one-inch-from-my-nose range.  "Are you alright?"

It would have been one of the easiest entrances into surgery for me ever had not the anesthesiologist screwed up.  I always ask that they please give me good warning before putting me to sleep, as I like to say "thank you" to everyone in the room first.  (Tevye: "Tradition!")  I asked the guy, he said "okie-dokie."

I am difficult to intubate, so much so that they have had to break my teeth in desperation.  I guess that is what he was thinking about.  Anyway, the bleepety-bleep-bleep gave me the paralytic and then couldn't get the tube in, and I was wide awake, unable to suck air for myself, having thanked no one, and was about to come off the table in panic.

Move along, prof, move along.  I am avoiding getting to yesterday.

So... yesterday.  I had an appointment with Bob, one of the interminable "follow-ups." He asked, first thing, how it had gone with World Famous Hip Guy, who was supposed to have done an ultrasound and/or fluoroscope-guided aspiration of my hips, tracking down that wily Propionibacterium acnes.  The journey that led to me losing a shoulder was to begin with my hips.

I picked a spot on the wall behind Bob's right ear.  I told him that World Famous Hip Guy refused to operate on "someone like me" and wasn't eager, therefore, to do the diagnostics.  I told him we were kind of like oil and water.

Then I told him that I was giving up, and relayed the info from the biofilms expert, paraphrasing his "first there is a wound, then they lose a toe, a foot, a leg, and then they die." He did some fast blinking, as did I, and I risked looking at him.  He made it easy:

"So we're going to concentrate on pain control, then?"  blinkblinkblink

"Yeah, I think that is what makes the most sense..."

I was proud of Bob and proud of myself, in that I did not do that awful thing of asking:  "What do you think I should do?"

Somehow, we started cracking bad jokes, the best kind.  And we talked about the carbon footprint of sending a power wheelchair I am trying like hell to donate to someone in Haiti -- where my orthopedic team does mission work twice a year.  There is a local agency that could use it but they won't get their act together and come pick it up and we cannot deliver it for lack of a stabilizing bar for the lift.  BlahBlahBlah.

Suddenly, Bob blew it.  "You're a very special person."  Aw, damn. I, who know me, cannot let that stand, it feels like acid poured on my soul.

I made a rote denial and then managed a "Thank you, Bob, and thank you for everything you have done for me."

More blinking, and that was it.  He made some recommendations for drugs that won't make my stomach bleed, made me promise to come back in 3 months, and blinkblink, I woke the sleeping Fred in the waiting room, where people seemed to be guarding his snoring frame from disturbances.

"Awww." murmured the people, the Greek Chorus, as Fred struggled back to consciousness, cute as the dickens.

We did not speak of the appointment during the long ride home, and I was able to pretend to be bothered by the sun in my eyes.

Thursday, September 20, 2012

CRPS and Vaccines

Complex regional pain syndrome following immunization

  1. Nigel W Crawford1,4,6
-Author Affiliations
  1. 1SAEFVIC, Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
  2. 2Department of Anaesthetics and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
  3. 3Department of Paediatrics, West Suffolk Hospital NHS Trust, Suffolk, UK
  4. 4Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
  5. 5Paediatric Infectious Diseases Unit, Department of Paediatrics, Monash Children's Hospital, Southern Health, Monash University, Melbourne, Victoria, Australia
  6. 6Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence toDr Nigel W Crawford, SAEFVIC Immunisation Safety Service, Department of General Medicine, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia;
  • Accepted 26 June 2012
  • Published Online First 1 August 2012


Complex regional pain syndrome type 1 (CRPS-1) is a clinical syndrome that affects one or more extremities and is characterised by persistent pain disproportionate to any inciting event, and at least one sign of autonomic dysfunction in the affected limb(s). The pathogenesis of this syndrome is poorly understood, but its onset is often precipitated by a physical injury, such as minor trauma, fracture, infection or a surgical procedure. In the literature, there are reports of CRPS-1 following immunization with rubella and hepatitis B vaccines. Here we present a case series of CRPS-1 following immunisation in adolescents, with either diphtheria-tetanus-acellular pertussis (1 case), or human papillomavirus vaccines (4 cases). Enhanced awareness of this syndrome and its potential to occur following immunization in the paediatric population is vital to the prompt and effective management of this condition.

Okay, not the most enlightening of abstracts.  A little research, however, disclosed this 2004 case study available in its entirety in the European Journal of Pain 9 (2005) 517-521:  Complex Regional Pain Syndrome Type-1 After Rubella Vaccine.  It's available through and its impressive library of free research.

Wednesday, September 19, 2012

It's enough to be on your way...

 Uploaded by Astralionica on Dec 27, 2009

JT on

My brother Alex died in '93 on (not for) my birthday. We all went down to Florida to say goodbye. The day after we flew home (the day after his cremation) a giant mother hurricane followed us north through the Carolinas; trashing everything in its path and finally raining record rains on Martha's Vineyard (home).

In Paris, a year later I changed his character to a hippie chick named Alice and the location to Santa Fe; but my soulful older brother is still all over this song like a cheap suit.

Almost Fuck-free. 

The sun shines on this funeral
The same as on a birth
The way it shines on everything
That happens here on Earth
It rolls across the western sky
And back into the sea
And spends the day's last rays
Upon this fucked-up family
So long old pal

The last time I saw Alice
She was leaving Santa Fe
With a bunch of round-eyed Buddhists
In a killer Chevrolet
Said they turned her out of Texas
Yeah she burned 'em down back home
Now she's wild with expectation
On the edge of the unknown

Oh it's enough to be on your way

It's enough just to cover ground
It's enough to be moving on
Home, build it behind your eyes
Carry it in your heart
Safe among your own

They brought her back on a Friday night
Same day I was born
We sent her up the smoke stack
And back into the storm
She blew up over the San Juan mountains
And spent herself at last
The threat of heavy weather
That was what she knew the best

Oh it's enough to be on your way
It's enough just to cover ground
It's enough to be moving on
Home, build it behind your eyes
Carry it in your heart
Safe among your own

It woke me up on a Sunday
An hour before the sun
It had me watching the headlights
Out on highway 591
'Til I stepped into my trousers
'Til I pulled my big boots on
I walked out on the Mesa
And I stumbled on this song

Oh it's enough to be on your way
It's enough just to cover ground
It's enough to be moving on
Home, build it behind your eyes
Carry it in your heart
Safe among your own


Uploaded by LivingLegendsMusic on Apr 15, 2008
An exclusive series of Living Legends Music interviews with Livingston Taylor. Part 4 of 10. Recorded on January 12th, 2008 in Vero Beach, FL.

Tuesday, September 18, 2012

Respite from Romney: Peace is tenacious

Published on Sep 12, 2012 by 
Produced by News Channel 9 WSYR (Syracuse, NY) and Jim Dessauer.

From  [In the "Fear and Peace" section]  This documentary by Jim Dessauer of Interfaith Works of Central New York honors five people from The Syracuse Area Middle East Dialogue Group who - for 30 years - have been building bridges of understanding that affirm the dignity of all people and all faith traditions.

InterFaith Works of Central New York, through education, service and dialogue, affirms the dignity of each person and every faith community and works to create relationships and understanding among us.

Medical Biofilms, Detection, Prevention and Control: free docstoc ebook download

Medical Biofilms, Detection, Prevention and Control

Edited by:

Department of Microbiology and Immunology,
The University of Western Ontario, and
The Lawson Health Research Institute,
London, ON, Canada

London Food, Water & Environmental Microbiology Laboratory,
CPHL, London, UK

CAMR, Porton Down, Salisbury, UK


Biofilms are a complex heterogeneous consortium of microorganisms associated with surfaces and interfaces and have been shown to play an important role both in causing disease and for maintaining health.

Microorganisms growing in biofilms may cause or prolong infections through, colonisation of implants or prosthetic devices and problems resulting from dental plaque formation. Modern medical practices and implant technology have alerted clinicians to the implications of biofilmassociated infections due to their persistence and resistance to antimicrobial treatment. Biofilms are also shown to be important in maintaining health by supporting commensal microflora that may assist in preventing pathogen infectivity.

This book is the first to deal specifically with biofilms associated with different medical areas including: the contamination of medical devices such as catheters, orthopaedic prostheses, renal dialysis, shunts, pacemakers and drug delivery systems; infection of tissue surfaces as in the lungs of cystic fibrosis patients, on damaged tissue surfaces (i.e. burns and surgery), bone (osteomyelitis), cardiac tissue (endocarditis) and genitourinary tract; and dental plaque, the cause of caries and periodontal disease.

For each of these topics the book provides an overview of current research in medical biofilms focusing on detection and monitoring the problems associated with biofilm and current strategies for control and eradication. To fully understand infectious biofilms, a current summary of the basic concepts in biofilm research and future prospects are included.

The editors intend that the book be used as an aid in teaching and research. Persons with an interest in medical diseases will find this book fascinating to read and the format is aimed at complimenting many hospital teaching courses for clinicians as well as medical and dentistry students.

The publication came about due to the increased awareness of the importance of adherent microbial populations in human health and disease, yet lacking a comprehensive text on information and research investigating the problems of medical biofilms, how to detect them and ultimately how to control their presence. Industrial environments have been ahead of the medical profession on their understanding and research progress on biofilms and biofouling of surfaces by microorganisms. The companion volume ‘‘Industrial Biofouling’’ (2000) discusses biofilms as a persistent problem and how to control them in potable water systems, industrial water systems and the food industry.

Dowload the PDF book here:

Romney, "raw and unplugged": Thank you, David Corn

SECRET VIDEO: Romney Tells Millionaire Donors What He REALLY Thinks of Obama Voters

When he doesn't know a camera's rolling, the GOP candidate shows his disdain for half of America.
—By David Corn | Mon Sep. 17, 2012 1:00 PM PDT

During a private fundraiser earlier this year, Republican presidential candidate Mitt Romney told a small group of wealthy contributors what he truly thinks of all the voters who support President Barack Obama. He dismissed these Americans as freeloaders who pay no taxes, who don't assume responsibility for their lives, and who think government should take care of them. Fielding a question from a donor about how he could triumph in November, Romney replied:

There are 47 percent of the people who will vote for the president no matter what. All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it. That that's an entitlement. And the government should give it to them. And they will vote for this president no matter what…These are people who pay no income tax.

Romney went on: "[M]y job is is not to worry about those people. I'll never convince them they should take personal responsibility and care for their lives."

Mother Jones has obtained video of Romney at this intimate fundraiser—where he candidly discussed his campaign strategy and foreign policy ideas in stark terms he does not use in public—and has confirmed its authenticity. To protect the confidential source who provided the video, we have blurred some of the image, and we will not identify the date or location of the event, which occurred after Romney had clinched the Republican presidential nomination. [UPDATE: We can now report that this fundraiser was held at the Boca Raton home of controversial private equity manager Marc Leder on May 17 and we've removed the blurring from the video. See the original blurred videos here.]

Here is Romney expressing his disdain for Americans who back the president:

At the dinner, Romney often stuck to familiar talking points. But there were moments when he went beyond the familiar campaign lines. Describing his family background, he quipped about his father, "Had he been born of Mexican parents, I'd have a better shot of winning this." Contending that he is a self-made millionaire who earned his own fortune, Romney insisted, "I have inherited nothing." He remarked, "There is a perception, 'Oh, we were born with a silver spoon, he never had to earn anything and so forth.' Frankly, I was born with a silver spoon, which is the greatest gift you can have: which is to get born in America."

Romney told the contributors that "women are open to supporting me," but that "we are having a much harder time with Hispanic voters, and if the Hispanic voting bloc becomes as committed to the Democrats as the African American voting block has in the past, why, we're in trouble as a party and, I think, as a nation." When one attendee asked how this group could help Romney sell himself to others, he answered, "Frankly, what I need you to do is to raise millions of dollars." He added, "The fact that I'm either tied or close to the president…that's very interesting."

Asked why he wouldn't go full-throttle and assail Obama as corrupt, Romney explained the internal thinking of his campaign and revealed that he and his aides, in response to focus-group studies conducted by his consultants, were hesitant to hammer the president too hard out of fear of alienating independents who voted for Obama in 2008:

We speak with voters across the country about their perceptions. Those people I told you—the 5 to 6 or 7 percent that we have to bring onto our side—they all voted for Barack Obama four years ago. So, and by the way, when you say to them, "Do you think Barack Obama is a failure?" they overwhelmingly say no. They like him. But when you say, "Are you disappointed that his policies haven't worked?" they say yes. And because they voted for him, they don't want to be told that they were wrong, that he's a bad guy, that he did bad things, that he's corrupt. Those people that we have to get, they want to believe they did the right thing, but he just wasn't up to the task. They love the phrase that he's "over his head." But if we're—but we, but you see, you and I, we spend our day with Republicans. We spend our days with people who agree with us. And these people are people who voted for him and don't agree with us. And so the things that animate us are not the things that animate them. And the best success I have at speaking with those people is saying, you know, the president has been a disappointment. He told you he'd keep unemployment below 8 percent. Hasn't been below eight percent since. Fifty percent of kids coming out of school can't get a job. Fifty percent. Fifty percent of the kids in high school in our 50 largest cities won't graduate from high school. What're they gonna do? These are the kinds of things that I can say to that audience that they nod their head and say, "Yeah, I think you're right." What he's going to do, by the way, is try and vilify me as someone who's been successful, or who's, you know, closed businesses or laid people off, and is an evil bad guy. And that may work.

(Note: Obama did not promise his policies would keep unemployment under 8 percent, and 50 percent of college graduates are not unemployed.)



More from the secret Romney video. (Romney tells his donors he doesn't believe in a two-state solution for the Israeli-Palestinian conflict, that resolving this conflict is "almost unthinkable," and that he would merely "kick the ball down the field."): SECRET VIDEO: On Israel, Romney Trashes Two-State Solution 

Here is a surprising and shocking teaser to that second Corn piece:  "Palestinians have no interest whatsoever in establishing peace."  I confess that I am still not over the shock of Romney's remarks made at the end of July, during his Gaffe World Tour:

"As you come here and you see the GDP [gross domestic product] per capita, for instance, in Israel which is about $21,000, and compare that with the GDP per capita just across the areas managed by the Palestinian Authority, which is more like $10,000 per capita, you notice such a dramatically stark difference in economic vitality." Mr. Romney told a group of donors gathered at the King David Hotel in Jerusalem. He added: "And that is also between other countries that are near or next to each other: Chile and Ecuador, Mexico and the United States."  He went on to explain that the marked décalage between the GDP in Israel versus the downright pitiful laziness exhibited in the GDP of Palestine was due to "culture."   I don't understand how the Earth continued to turn on its appointed axis after that statement, but that's just me...

As for Romney's response to the release of the Boca Raton videos [that underscore what everyone already knew, but were striking in the ease and familiarity of tone the Good Guvnor exhibited], the Christian Science Monitor reports:

At an impromptu news conference Monday, Romney offered no apologies, conceding the comments were not "elegantly stated" and were spoken "off the cuff." The Republican presidential nominee said the remarks showed a contrast between President Barack Obama's "government-centered society" and his belief in a "free-market approach." 
"Of course, I want to help all Americans, all Americans, have a bright and prosperous future," Romney told reporters.

Zofran, anyone?

Monday, September 17, 2012

Occupy Posters...

"And the live show is still our main thing": HAPPY BIRTHDAY, OCCUPY!

OWS One Year Later, Time World
On Sept. 17, 2011, members of Occupy Wall Street (OWS) started camping out in Zuccotti Park in Manhattan’s financial district, and since then the movement has spread to 1,500 cities. One of its most enduring icons has been the Guy Fawkes mask, popularized by the graphic novel and film V for Vendetta and a constant presence at protests worldwide.

If we had any nerve at all, if we had any real balls as a society, or whatever you need, whatever quality you need, real character, we would make an effort to really address the wrongs in this society, righteously.

I read somewhere that 77 per cent of all the mentally ill live in poverty. Actually, I'm more intrigued by the 23 per cent who are apparently doing quite well for themselves.

Constantly choosing the lesser of two evils is still choosing evil.

Stuff that's hidden and murky and ambiguous is scary because you don't know what it does.

And the live show is still our main thing.

-- Jerry Garcia

Uploaded by  on Oct 17, 2011   Creative commons Non-Commercial, Attribution, No Derivative Works license. 
Music by: Hauschka, song "Stumm (Kein Wort)"
Music Label: Karaoke Kalk label based in Berlin