Saturday, January 5, 2013

Maniacal Laughter: "these patients' quality of life remains amongst the lowest reported in medical conditions"

Autoimmun Rev. 2012 Dec 6.

Complex regional pain syndrome, prototype of a novel kind of autoimmune disease.

Goebel A, Blaes F.

Pain Research Institute, Department of Translational Medicine, Liverpool University, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK. Electronic address:

Complex regional pain syndrome (CRPS) is a painful condition, which arises in a limb after trauma. CRPS can profoundly affect patients' quality of life, and there is no cure. CRPS is associated with limb-confined sensory, motor, skin, bone and autonomic abnormalities. Recent research has shown that some patients respond to treatment with immunoglobulins, and that a majority have IgG serum-autoantibodies directed against, and activating autonomic receptors. CRPS serum-IgG, when transferred to mice elicits abnormal behaviour. These results suggest that CRPS is associated with an autoantibody-mediated autoimmune process in some cases. CRPS has unusual features, including a non-destructive, and regionally-confined course. We propose that CRPS constitutes a prototype of a new kind of autoimmunity, which we term 'IRAM' (injury-triggered, regionally-restricted autoantibody-mediated autoimmune disorder with minimally-destructive course). Understanding autoimmune contribution to CRPS should allow the exploration of novel treatment modalities in the future. Additional 'functional' disorders, painful or painless may be autoimmune in nature.

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The article is available in full text HERE.  Here's the début:

1. Introduction
Around the time when Paul Ehrlich described ‘horror autotoxicus’, the postulate that our body does not tolerate an immune reaction against itself, Paul Sudeck reported on a peculiar painful post-traumatic condition [1] and [2] (Weir Mitchell had first described in 1864, what was later recognized as a post-nerve injury form of the same condition; this rare subgroup is now classified as ‘CRPS II’; Mitchell had termed the condition ‘causalgia’ after the reported peculiar, burning pain). In 1900, Sudeck portrayed five patients admitted to the General Hospital in Hamburg, Germany, who had sustained peripheral limb trauma and developed disproportionate, un-abiding limb pain, associated with limb-confined swelling, sweating and reddening. He initially considered that these signs and symptoms were caused by a particular inflammatory reaction. He identified localized osteoporosis on X-ray and thus assigned the term ‘acute, entzuendliche Knochenatrophy’ (acute inflammatory bone atrophy). This syndrome subsequently received a number of additional names including ‘Sudeck's atrophy’ and ‘Reflex Sympathetic Dystrophy’, until in 1994 ‘complex regional pain syndrome’ (CRPS) was accepted [3]. The diagnostic ‘Budapest’ criteria are based on the presence of pain and certain limb abnormalities including sensory, autonomic, trophic and motor changes [4]. CRPS is costly to both the healthcare system and society. Only few patients with un-abiding CRPS return to work [5]. There are only few treatments, and there is no cure [6] and [7]. The condition has continued to puzzle investigators. Bizarre aspects of its presentation have continued to emerge over the past 110 years, and although we now understand that CRPS is indeed associated with an initial local inflammatory response – without reported neutrophil invasion or overt tissue destruction [8] – the underlying cause has remained elusive. Over the course of the disease, initial limb signs generally mellow [9], however about 15% of patients continue to have unrelenting pain [5]; these patients' quality of life remains amongst the lowest reported in medical conditions [6].

We propose that in some cases CRPS is autoimmune-mediated, caused by a novel kind of autoimmunity, which has unusual features. One important feature is, that CRPS is post-traumatic, and that certain parts of the body – the peripheral limbs – are susceptible [10]. Stable regional restriction of autoimmunity within a larger organ is rare; it occurs, for example in ophiasis, an occipital form of alopecia areata, which is T-cell mediated [11]. A ‘two-hit’ process may explain a regional restriction. Pre-existing circulating autoantibodies (the ‘first hit’) may become pathogenic only in the context, and around the area of regional trauma (the second hit, Fig. 1A). Peripheral limbs may provide a facilitating environment. One additional unusual CRPS feature is minimal tissue destruction, even after many years disease duration. Other CRPS characteristics accord with a ‘classical’ autoimmune presentation. CRPS is usually of adult onset [12]. There are HLA associations, although most studies have been small [13]. A number of investigators have described cases following viral and bacterial infections [14] and [15]; further we have provided preliminary serological evidence for antecedent infections with chlamydia, parvovirus and campylobacter [16], [17] and [18].


Back on December 16, 2012, Daisy's Dad tweeted: "Scan results are in & apart from God's supernatural intervention Daisy’s prognosis is bleak."

Three days ago, the Pray For Daisy website blog reported:

Difficult day
Today is a difficult day for Daisy… with large tumors in her abdomen and trying to recover from two weeks of chemotherapy, her body is struggling. She is extremely fragile and weak.
[followed by an invitation to prayer and fast]
Tyler Morgan
Executive Director
The Daisy Merrick Trust

Daisy and her father Britt

Last night I dreamed about surfing, and, trust me, surfing is not in my repertoire, not even in my impressive and intrepid athletic Days of Yore.  Daisy comes from a surfing family, a surfing heritage. Her grandfather, Al Merrick, is a famed "shaper."

Professionals and amateurs alike have "paddled for Daisy" all over the world...  And so my dreams and my heart are telling me to tell you that and to show you Daisy, and other similar souls, rocking on the water.

Maui, HI
Launiupoko, Maui, HI

Honolulu, HI
Diamond head side of the Hilton Hawaiian pier

North Shore, HI
Ehukai Beach Park and paddle to Waimea Bay

Pacifica, CA
Linda Mar Beach (South side of the beach)

Santa Cruz, CA
Location: Cowells Beach
(north side of the pier in front of the Dream Inn)

Carmel Beach, CA
Bottom of 13th St at Carmel Beach

Pismo Beach, CA
South Side of the Pismo Beach Pier

Santa Barbara, CA
Santa Claus Lane Beach (southside)

Oxnard, CA
Oxnard Shores – 5th St.

South Bay, CA
EL Porto (45th St)

Huntington Beach, CA
HB Pier (South Side)

Newport Beach, CA
Newport Beach Pier (South Side)

San Clemente, CA
The San Clemente Pier

Oceanside, CA
Oceanside Pier, South Side (200 The Strand)

Encinitas, CA
Moonlight Beach

Minneapolis, MN
Lake Calhoun North Beach West Lake Street

Rockaway Beach, NY
Rockaway Beach 90th St, NY

Manasquan/ Spring Lake, NJ
Ocean Ave and Pitney Ave (by the Arches)

Virginia Beach, VA
1st street jetty

Avon, NC
Avon Pier

Surf City, NC
Kinston Street Beach Access next to the pier

Emerald Isle, NC
Bogue Inlet Pier

Wrightsville Beach, NC
Oceanic Street (Access #28)

Carolina Beach, NC
Hamlet Ave Access

North Myrtle Beach, SC
Cherry Grove Pier, 3500 North Ocean Boulevard

Myrtle Beach, SC
Myrtle Beach State Park
4401 South Kings Hwy Myrtle Beach, SC

Charleston, SC
The Washout

Jacksonville, FL
Jacksonville Pier

St. Augustine, FL
FA’s at the North side of St. Augustine Pier

Ormond Beach, FL
Granada approach, A1A at Granada Bvd. (SR-40)

New Smyrna Beach, FL
Flagler Ave. Beach ramp(on the beach)

Flagler Beach, FL
South Sixth St.

Melbourne Beach, FL
Ocean Avenue (beach access)

Deerfield Beach, FL
Deerfield Beach Pier

Panama City, FL
Panama City Beach Pier

daisy surfing

Fort Worth, TX

Kuta Bali
Pantai Kuta, Jl. Pantai Kuta, Kuta 80361

All photos are property of Al Merrick, Daisy's grandfather, from his company website, Channel Islands Surfboards by Al Merrick.  I have a feeling there's no finer place to satisfy your surfing needs...

FLOW from Koastal Media on Vimeo.

"The story focuses on Channel Islands Surfboards founder and world-renowned surfboard craftsman Al Merrick and his special relationships with the team of world champion Channel Islands Team riders and arguably the two best and most influential surfers ever: Kelly Slater (6 time world champion) and Tom Curren (3 time world champion)."

we do it everyday

Brett Dennen - Ain't No Reason (Official Single Video)

There ain't no reason things are this way.
It's how they always been and they intend to stay.
I can't explain why we live this way.
We do it every day.

Preachers on the podium speaking of saints.
Prophets on the sidewalk begging for change.
Old ladies laughing from the fire escape,
Cursing my name.

I gotta a basket full of lemons and they all taste the same,
A window and a pigeon with a broken wing,
You can spend your whole life working for something,
Just to have it taken away.

People walk around pushing back their debts,
Wearing paychecks like necklaces and bracelets,
Talking about nothing, not thinking about death,
Every little heartbeat, every little breath.

People walk a tightrope on a razors edge.
Carrying their hurt and hatred and weapons.
It could be a bomb, or a bullet, or a pen,
Or a thought, or a word, or a sentence.

There ain't no reason things are this way.
Its how they've always been and they intend to stay.
I don't know why I say the things I say,
But I say them anyway.

But love will come set me free.
Love will come set me free, I do believe.
Love will come set me free, I know it will.
Love will come set me free, yes.

Prison walls still standing tall.
Some things never change at all.
Keep on building prisons, gonna fill them all.
Keep on building bombs, gonna drop them all.

Working your fingers bare to the bone.
Breaking' your back, make you sell your soul.
Like a lung, it's filled with coal,
Suffocating slow.

The wind blows wild and I may move.
But politicians lie and I am not fooled.
You don't need no reason or a three piece suit,
To argue the truth.

The air on my skin and the world under my toes
Slavery stitched into the fabric of my clothes
Chaos and commotion wherever I go,
Love I try to follow.

Love will come set me free
Love will come set me free, I do believe
Love will come set me free, I know it will
Love will come set me free, yes

There ain't no reason things are this way.
Its how they've always been and they intend to stay.
I can't explain why we live this way.
We do it every day.

Friday, January 4, 2013

From Pete Souza, White House Photographer

The Year in Photographs 2012 by White House Photographer Pete Souza

83 Photos You Don't Want to Miss:
By all accounts it's been a historic year at the White House, and we're excited to share some of our favorite photos from behind the scenes in 2012. The White House Photo Office compiled some of the year's best, with commentary from Chief Official White House Photographer Pete Souza.

This is still my favorite, but it dates from 2009.  I just thought this the perfect moment to slip it in.

From Polichicks:  "Pat the President":

This young brother is really feeling the president's fade 
President Obama bends over to let the young son of a White House staffer touch his hair, because the child wants to see if the president's hair feels just like his own.

For the first time in our history, an African American child visiting the White House can see that someone with hair (and skin) like his (or hers) can be anything he wants to be when he grows up - even president of the United States of America.  It's amazing to see that what an Obama presidency means for African Americans - inclusion, representation, unlimited dreams and long awaited, hard fought for change - is not lost on a child this small.

More from Pete Souza:  The Rise of Barack ObamaThe Road to Kabul, Wrigley FieldPortrait of a President, Plebe Summer, President Reagan's Funeral

How Pete Souza became President Obama’s secret weaponPosted by Chris Cillizza on December 19, 2012 at 1:08 pmWashington Post 
You probably have never heard of Pete Souza. 
But, Souza, the White House official photographer, plays an absolutely critical — and often under-estimated — role in the shaping of “Barack Obama”, the image of the president presented to the public. 
And, in an election in which Obama’s likability seemed to trump policy concerns that many voters held about him, it’s not an exaggeration to say that Souza was a major cog in the machine  that got the incumbent re-elected. 
“When these eight years are done, Pete will be its most important illustrator,” said Robert Gibbs, who served as White House press secretary in Obama’s first term. [read the rest HERE].

Topical Treatments to Reduce Allodynia in Rat Models of CRPS

CREDIT: Rats have feelings too
The Journal of Pain
Volume 14, Issue 1, Pages 66-78, January 2013

Topical Combinations Aimed at Treating Microvascular Dysfunction Reduce Allodynia in Rat Models of CRPS-I and Neuropathic Pain

J. Vaigunda Ragavendran, André Laferrière, Wen Hua Xiao, Gary J. Bennett, Satyanarayana S.V. Padi, Ji Zhang, Terence J. Coderre*

*Contact for reprint requests

Growing evidence indicates that various chronic pain syndromes exhibit tissue abnormalities caused by microvasculature dysfunction in the blood vessels of skin, muscle, or nerve. We tested whether topical combinations aimed at improving microvascular function would relieve allodynia in animal models of complex regional pain syndrome type I (CRPS-I) and neuropathic pain. We hypothesized that topical administration of either α2-adrenergic (α2A) receptor agonists or nitric oxide (NO) donors combined with either phosphodiesterase (PDE) or phosphatidic acid (PA) inhibitors would effectively reduce allodynia in these animal models of chronic pain. Single topical agents produced significant dose-dependent antiallodynic effects in rats with chronic postischemia pain, and the antiallodynic dose-response curves of PDE and PA inhibitors were shifted 2.5- to 10-fold leftward when combined with nonanalgesic doses of α2A receptor agonists or NO donors. Topical combinations also produced significant antiallodynic effects in rats with sciatic nerve injury, painful diabetic neuropathy, and chemotherapy-induced painful neuropathy. These effects were shown to be produced by a local action, lasted up to 6 hours after acute treatment, and did not produce tolerance over 15 days of chronic daily dosing. The present results support the hypothesis that allodynia in animal models of CRPS-I and neuropathic pain is effectively relieved by topical combinations of α2A or NO donors with PDE or PA inhibitors. This suggests that topical treatments aimed at improving microvascular function may reduce allodynia in patients with CRPS-I and neuropathic pain.

This article presents the synergistic antiallodynic effects of combinations of α2A or NO donors with PDE or PA inhibitors in animal models of CRPS-I and neuropathic pain. The data suggest that effective clinical treatment of chronic neuropathic pain may be achieved by therapies that alleviate microvascular dysfunction in affected areas.

NOTE:  It may seem odd to publish the references without providing access to the article text, but many is the time I have found helpful background reading among footnoted/referenced sources. It takes some digging, but can pay off in greater understanding and finding your own "leads" within your particular research interests.


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