Tuesday, May 7, 2013

"show your work"

it's been so long since i've messed around in french.
however you choose to take that...
i dared give it another go this afternoon, and was surprised at the story that wanted telling.
there was a theme to the contest, which set it all a-twirlin' -- "la roue tourne."


la première fois qu'on m'a permis
d'enseigner un peu de littérature
française, juste avant chaque réunion
de classe, j'ai vomi, violemment.

j'étais en train d'essayer
de tomber profondémment amoureuse
d'un mec quelconque --
et oui, c'était un de mes étudiants
{pour ainsi dire}
mais pas de littérature
française, non, pas du tout.

lui, il faisait un effort
de lier les pronoms personnels sujets aux formes
appropriées des verbes, de comprendre
le sexe féminin d'une "porte,"
et la masculinité évidente d'un "stylo."

nous sommes allés prendre un verre
et écouter un peu de jazz, comme on trouve
dans quelques trous encore à oakland,
où le verre est sale, et le vin

il avait 24 ans, faisait
des études graduées,
{quand même}
j'avais tort, alors
on attendait la fin de semestre,
les notes finales,
avant de trouver ensemble un appartement,
un endroit sacré, des salles pleines
de musique
poètes maudits.

c'était bien rare, le vomissement
avant sa classe de grammaire.

mais ces êtres bizarres
qui me suivaient de près
dans la lecture
de littérature

parmi eux figurait une jeune femme
énormément sérieuse
{et belle}
et que je n'ai jamais vue
sourire même une fois,
qui raidît visiblement
devant beckett, devant ionesco,
devant sartre, et même camus.

un jour j'ai conquis la nausée
et en donnant les devoirs
à la fin de classe, a inventé
un sujet sur le coup:

"Sarte dit qu'il est impossible d'imaginer sa propre mort.
Je veux que vous essayiez,
{malgré lui}
 et comme on dit en maths -- 'show your work.''"

cet après-midi-là, mon amant, l'écrivain
toujours en train d'arriver,
a fait l'amour dans notre lit
{que j'ai acheté}
commun, notre nid
de tendresse,
avec une femme
qui a gagné l'or
dans les jeux olympiques
{patinage artistique}
et moi, enceinte, lourde,
sans médailles
d'aucune couleur.

le jour prochain, les yeux
rougeâtres, le nez coulant,
avec des centains de maux
dans ma tête?

cette jeune femme
énormément sérieuse
{et belle}
et que je n'ai jamais vue
sourire même une fois?

quand je lui ai demandé son devoir,
elle a dit, à très haute voix:

"je ne l'ai pas fait.
au lieu de le faire,
j'ai passé deux heures
en prière pour mon professeur
{on dit}
de français, qui avait l'audace
de donner un sujet
à écrire
tellement grossier,
si offensif
{envers le bon dieu}."

TW, calling TW...

hey you,

would you please contact this woman and tell her where the mmmhmm to mail your b'day package?
i've now screwed up the address three times. i must have copied it wrong into the 2013 Red Book of addresses and contact info because your local PO claims your addy does not exist (probably your dream come true).

i know you could care less about "stuff." do this because i want to give you this gift.

you should not deny the little sister.  ever.

besides, it is beautiful -- she's a great artist.  you deserve beautiful art.  and more.

i love you,

Stuff I Stole From The Social Good Project / Ignite.Me

TO JOIN:  click HERE

Radical Self-expression: Radical self-expression arises from the unique gifts of the individual. No one other than the individual or a collaborating group can determine its content. It is offered as a gift to others. In this spirit, the giver should respect the rights and liberties of the recipient.

is he not, at this moment, the most beautiful man in the world?

well, okay, this is a little along the lines of "find your happy place and let roots grow out your ass,
reaching down to the rich loam of the earth" but it's tuesday and we've all got to get to wednesday, and so on
and so forth.  i once paind a woman $350 dollars to wave sage over my body and make a crystal bowl sing.
 i had wine glasses which, if filled with a good wine, would have sung better, and cigarettes,
which would have smelled better and not made me cough.

dr. seuss is god-like. in tête de hergé?  he is god.

I stole the three images above from a come-hither advertisement to join the Ignite movement.  That's just the kind of mood I am in... So sue me!  Here's some other stuff I stole.

Decommodification: In order to preserve the spirit of gifting, our community seeks to create social environments that are unmediated by commercial sponsorships, transactions, or advertising. We stand ready to protect our culture from such exploitation. We resist the substitution of consumption for participatory experience.

i dunno.  do you?

Participation: Our community is committed to a radically participatory ethic
 We believe that transformative change, whether in the individual or in society, 
can occur only through the medium of deeply personal participation. 
We achieve being through doing. Everyone is invited to work. 
Everyone is invited to play. 
We make the world real through actions that open the heart.

What Can I Expect From The Ignite.Me Movement?
Nothing is sold to you, ever. This is a completely altruistic effort to introduce millions more people into a new, more inclusive, sustainable and wholesome way of life;Expand your own horizons through pictures, videos, documentaries, online forums, live events and festivals dedicated to these principles, which you may not have known about;Find out about spur-of-the-moment opportunities to get outdoors and do exciting things with amazing people everywhere;See if a daily dose of exhilaration and motivation from fellow enthusiasts for life is what you need to get out of a rut.

TO JOIN:  click HERE

Update on Hannah

It's been a while since I've updated my Dear Readers on Ms. Hannah and her progress.

To briefly skim her story:

Hannah was diagnosed with osteosarcoma that involved an area just below her knee.  The standard treatment is chemotherapy, radiation, and amputation.  Hannah made the courageous decision to go with another option that is slowly gaining in popularity, despite its seemingly radical nature.
She opted to have a rotationplasty, in which the cancerous area is, indeed, amputated, but the foot is reattached, backward, essentially to the knee.  It's much more complicated than that but what it allows is for the later fitting of some awesome prosthetics that permit people to remain very athletic and active.

She had the chemo and radiation.  She had the radical surgery.  She worked like a true champ in Physical Therapy and was doing very well.

Do you know what one of the side effects of the chemotherapy is?  One of the leukemias.  And yes, Hannah has developed leukemia.  She also was found to have a nodule in her lung that was a spread of the original osteosarcoma.

So she has had to change horses midstream, as they say.  She is now undergoing the preparatory chemotherapy to set the stage for a bone marrow transplant -- a European man is a perfect match, "except" for a few compatibility issues in typing.  I know, I know... so he's not a perfect match.  Near perfect!

At the moment, while her counts are down so low, she's been hit with some viruses, precisely at the time when she has NO immune system with which to fight back.  Her Mom is feeling low, too, because she thinks that she is now catching a cold, which means she cannot be a bedside cheerleader until she's well.

So... give a thought to Hannah tonight, and her family, particularly her Mom.

She is one plucky kid, and she is my hero.  When I get all slobbery pitiful about missing a shoulder and not being able to move a leg... I think of this girl in her heroic "crane" pose, in her quest to get back on the soccer field, and in the pool, and I read about her doing the very hard PT work without a word of complaint... and am so humbled.

From Caringbridge:

FEBRUARY 7:  Please forgive my tardiness in updating you all on how our Hannah is doing. It has definitely been a crazy week since she got her new diagnosis last Wednesday.

Hannah is still recovering from lung surgery. As of today they still are NOT going to remove her chest tube. There is a bubble in there and it has to be gone before they can take it out. First prayer is that the bubble goes away and she can get that tube out. It is terribly uncomfortable and painful for her when she moves around.

As soon as she is cleared from her surgeon, she will go straight to the 9th floor to begin chemotherapy treatments for her AML (Acute Myeloid Leukemia). She will be in the hospital anywhere from 4-6 weeks straight depending on how fast her numbers go back up after treatment. She cannot leave the hospital until her numbers are cleared...then after a couple of days at home, she will go back in for another round of chemo with the same parameters. After that she will have to have a bone marrow transplant. This is as far as we know for her treatment. Once she's past the transplant, we will see where we are going from there to get her in remission.

As for the tumor they took out on Monday, it was confirmed as Osteosarcoma. While we are all disappointed that it recurred so quickly (only 2 months), the good news is they did get all of the tumor and because the margin around the tumor was healthy cells, we know they got all of it. That means, at this point, there are no plans to put her through treatments for Osteosarcoma. We are so grateful for this "silver lining" in our very dark cloud.

We are so grateful for all of the prayers and positive thoughts coming our way. Hannah is in wonderful spirits, as always, and is ready to fight this monster called cancer. I will update you when I know more.

APRIL 19:  Just had another big informational meeting about Hannah's bone marrow transplant at St. Louis Children's Hospital. We know that Hannah's donor is a man from Europe and that he is a perfect match based on the criteria however there are a few things that could be a potential problem. It's a lot of medical terms so rather than go into a long explanation I'll just say she will have a heightened risk for GVHD (graft vs host disease) as well as CMV. His blood type is A+ and Hannah's is O+ so initially there could be issue despite them taking out the red blood cells. There are also lots of meds she's going to take for prep for the actual transplant. Also they pushed back her transplant date to June 12. Sooo many hurdles yet to jump. Please pray everything goes as planned with no rejection or problems. I feel so overwhelmed with all of this...soooooo overwhelmed! :'(

TONIGHT:  Hannah's still feeling rotten. Her ANC is back down to 0, but that's to be expected. These viruses (rotovirus is one of them) are kicking her tail. Still coughing and runny nose. Had to have 2 units of blood today b/c her hemoglobin was WAYYY low. Had platelets yesterday. She's really getting frustrated and down about it all... she told me today "I just want to be done!" Translation: Ive had enough of hospitals and medicine and doctors and all of this. She and I had a bit of a cry together, which I think helped her. Another hurdle for me (I know I never post about myself so please forgive me) is I feel myself getting sick too. If I'm sick, I can't be on the floor, meaning I can't be with Hannah. This is all so overwhelming! I can't be sick! My Hannah needs me! :'( 

Uploaded to YouTube by mayoclinic on Sep 3, 2010:  "This is a pre-surgical video which describes rotationplasty, who the procedure is appropriate for and possible complications. This video depicts the process of being fitted for a prosthesis and learning to use it. The patient describes her active and satisfying life after rotationplasty, her emotions and the process of adjusting to living with a prosthesis."

Monday, May 6, 2013

An Anniversary Repost: Little Green Apples

I'm having trouble using my hands today... and then there's this pesky newly broken ankle.  O, Woe and Alas, and Poobah!  So I wondered what I was writing about on May 6, 2009.  Yes, that's right, an anniversary repost.  It's bittersweet, as it turns out, being a memory of one our now lost pets, the one, the only Uncle Kitty Big Balls, shortened to an affectionate "Little Boy." Fred loved him so... he was totally Fred's best buddy.  Me, I was good for putting out the kibble and for a good scratch and grooming session -- but for pure love, Fred and Little Boy, all the way.  There are other things to commemorate on May 6th, so happy birthday to those things, too.  Really. I mean it.  Sorry.  Did you ever notice that bitterness leaks?


 The one day we had open for this week -- Thursday -- has now been filled with yet another visit to the Infectious Disease office, as they want a higher vancomycin trough level. We went by yesterday to pick up the antibiotics-in-a-ball to learn that we are going to dosing every 12 hours.

Today I see Bob for my first post-op visit; The Fredster has dinner with the Existentialists; and we proceed with... The Taming of Uncle Kitty Big Nuts, our newly rescued cat!

Yes... last Wednesday, as I lay dying in ICU, Fred delivered quite the performance.

The male cat, formerly known as Little Boy, is brother to the last cat we rescued, Little Girl, now officially known as Marmy. We took her in off the mean streets of Tête de Hergé so pregnant that she was sway-backed; Her humongous belly almost touched the floor; She waddled around, miserable, swishing her swishy tail. Of her five kitten litter, we kept the runt, known to us as Dobby. Dobby is our little idiot.

Sam-I-Am, the elder spokesman for the group, was born in a Walmart -- hence we named him for what's-his-face... Sam Walton, with a deeper, more appreciative nod to Dr. Seuss. Known to his friends as Stinky Boy, Sammy's life is filled with neuroses. I love him bunches. What can I say? He likes to kiss me.

When I was little, I wanted to be a vet and had a fairly active veterinary hospital that specialized, it seemed, in rehabilitating birds. My grandfather and a neighbor of his down the curvaceous country lane kept me supplied with injured blue jays and carrier pigeons. I raised a blue jay that had been tossed from the nest by one of *those* types of mothers -- he was a small ball of wrinkled skin with a huge gaping mouth and wirey neck -- eyes closed. I fed him purée of bugs with vitamins. I taught him to fly. Neither of us thought much about the details of first flight -- he fluttered, dipping and rising, his path almost plotted out by slow, huge dashes in the air -- "landing" with a complaining screech amid the branches of the crabapple tree next to Granddaddy's back porch. We had no exit strategy, and he almost spent the night in that crab apple tree. Usually, Squawky flew about the neighborhood during the day, coming into the house just a few times, and usually to hide his catches of bugs under the cushions of my grandmother's old-timey loveseat. She hated that bird. At night, Squawky came inside. He was killed by a hawk the next summer -- having lived only a little over a year.

Fred had me in tears as he pitched the notion of adopting Marmy's brother, "the sweetest cat in the world." I felt like the big bad meanie -- not wanting him near the others if he had anything infectious, not wanting to have to clean up after another long-hair.

Still, I made it out of ICU and meant to keep my promise. Little Boy, or Uncle Kitty Big Nuts, was delivered to our vet for a complete overhaul on Monday -- he had a large leg wound that they cleaned and packed with a drain, large nuts that they snipped, ear mites that they smote, plus worming, flea treatment, and a very punk whole body shave, as his long white and grey fur was matted beyond hope of repair by brush or comb. All his shots, too.

Amazingly, Uncle Kitty of the Former Big Nuts is disease-free. I just knew that The Fredster would come home Monday night sobbing, because the little guy just looked so very rough and haggard, limping and way skinny.

Yesterday, we set out to see The Boutiqueur, so punchy already that we sat giggling in the waiting room, sipping gourmet coffee. I had a fever and couldn't breathe. Saw Boutiqueur and got my first and best piece of practical advice. Should my lungs shut down again, and if I am alone, COUGH. Cough as hard as I can. The thing is, my brain seemed to be the first thing to stop working!

Anyway, we got lost in the parking deck, and by the time we found Ruby and loaded me -- they wanted $5 for the privilege of spending an hour and two minutes in the doctor's building.

Then we got lost on the highway, then we were found, and proceeded to the damned Infectious Disease group o'peeps. After that? Speed-demon Fred floored it across town to the vet's office, where we picked up a cross-eyed and bewildered Little Boy.

He is ravenous and has gulped down three cans of food. His sister and the rest of the feline crowd huddle outside the bedroom door -- Sammy is growling, Marmy is "ack-ack-acking" away and seems very happy, and Our Little Idiot, Dobby, is the most affected, surprisingly.

We are planning a family reunion and low key meet-and-greet for this afternoon, before we haul ass to see even more white coats.

CRPS research, the latest...

As usual, fellow CRPSers, the offerings range from titillating in potential to near-angering regurgitation of things we've known for, oh, decades.  But we must read what comes, must encourage all the efforts.

On the one hand, they are helping those who contract the syndrome in the future, and maybe we can help in the clinical trials (big toothy grin!);  On that other hand, if it's working for you, we have to hope the slower researchers/fields will catch up with the rest of the research world.

First up is a disappointment:

Interventions for treating pain and disability in adults with complex regional pain syndrome.


Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, UK, UB8 3PH.



There is currently no strong consensus regarding the optimal management of complex regional pain syndrome although a multitude of interventions have been described and are commonly used.


To summarise the evidence from Cochrane and non-Cochrane systematic reviews of the effectiveness of any therapeutic intervention used to reduce pain, disability or both in adults with complex regional pain syndrome (CRPS).


We identified Cochrane reviews and non-Cochrane reviews through a systematic search of the following databases: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Ovid MEDLINE, Ovid EMBASE, CINAHL, LILACS and PEDro. We included non-Cochrane systematic reviews where they contained evidence not covered by identified Cochrane reviews. The methodological quality of reviews was assessed using the AMSTAR tool.We extracted data for the primary outcomes pain, disability and adverse events, and the secondary outcomes of quality of life, emotional well being and participants' ratings of satisfaction or improvement. Only evidence arising from randomised controlled trials was considered. We used the GRADE system to assess the quality of evidence.


We included six Cochrane reviews and 13 non-Cochrane systematic reviews. Cochrane reviews demonstrated better methodological quality than non-Cochrane reviews. Trials were typically small and the quality variable.There is moderate quality evidence that intravenous regional blockade with guanethidine is not effective in CRPS and that the procedure appears to be associated with the risk of significant adverse events.There is low quality evidence that bisphosphonates, calcitonin or a daily course of intravenous ketamine may be effective for pain when compared with placebo; graded motor imagery may be effective for pain and function when compared with usual care; and that mirror therapy may be effective for pain in post-stroke CRPS compared with a 'covered mirror' control. This evidence should be interpreted with caution. There is low quality evidence that local anaesthetic sympathetic blockade is not effective. Low quality evidence suggests that physiotherapy or occupational therapy are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control.For a wide range of other interventions, there is either no evidence or very low quality evidence available from which no conclusions should be drawn.


There is a critical lack of high quality evidence for the effectiveness of most therapies for CRPS. Until further larger trials are undertaken, formulating an evidence-based approach to managing CRPS will remain difficult.


Next up is a case study.  Never overlook reading case studies.  The whole investigation into the Ketamine protocols derived from one case study of a woman who happened to receive ketamine for anesthesia purposes following a bad auto accident.  She also had CRPS and improvement was noted in her involved limb while she was in the medically induced coma.  So read those case studies!

 2013 Apr;26(2):164-8. doi: 10.3344/kjp.2013.26.2.164. Epub 2013 Apr 3.

Searching for hidden, painful osteochondral lesions of the ankle in patients with chronic lower limb pain - two case reports -.


Department of Anesthesiology and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.


It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.


ankle, cementoplasty, complex regional pain syndrome, osteochondritis dissecans, thromboangiitis obliterans
[PubMed - in process] 
Free PMC Article

Lastly, a rare occurence, worth noting:

 2013 Apr;26(2):160-3. doi: 10.3344/kjp.2013.26.2.160. Epub 2013 Apr 3.

Concurrence of malignant peripheral nerve sheath tumor at the site of complex regional pain syndrome type 1 - a case report -.


Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.


Malignant peripheral nerve sheath tumors (MPNSTs) are very rare sarcomas derived from various cells in the peripheral nerve sheath. Malignant peripheral nerve sheath tumors have a known association with neurofibromatosis type 1. Diagnosis of MPNSTs is difficult in patients with chronic pain, when MPNST occurs at an overlapping area of chronic pain. Therefore, the diagnosis can be missed unless clinicians pay attention to the possibility of this disease. Here in, we report a case of concurrent malignant peripheral nerve sheath tumor with complex regional pain syndrome type 1. A 44-year female patient, who was diagnosed with complex regional pain syndrome (CRPS) type 1 in her left ankle, visited our clinic because of aggravated pain. The cause of the aggravated pain was revealed as concurrent MPNST in the left common peroneal nerve territory, which overlapped the site of pain from CRPS.


complex regional pain syndrome, nerve sheath neoplasm, neurofibromatosis
[PubMed - in process] 
Free PMC Article