Saturday, October 19, 2013

molten lava over a clenched fist::une larme de pluie

in lieu of trying to restate one of the oldest feelings in the world, i'm just going to steal someone else's contemporaneous treatment of it, far better than i could ever do, and in translation from italian, which also fits this old, old feeling like a glove, like molten lava poured over a clenched fist.  
yeah, like that. sort of.

some of you may understand why a poem, originally italian, then translated by its italian author into good french, and then, of course, presented to you in a blog that is written in bad american by someone completely unrelated to the production... feels so *right* -- and then again, some of you may not.

the author, here a poet, is giovanni merloni and this poem is available in his work, stella, poèmes 1972-1974which figures as part of his blog, his blog being, in its entirety, a piece of art that i've come to admire quite a lot, sometimes envy, and, occasionally, need:  le portrait inconscient.

i am feeling beat up by a combination of ronsard, du bellay, and petrarch, were each of these great ones a jug of milk an hour away from turning rancid.

is love supposed to be so lonely, so fiercely unrequited that it mirrors an act of hatred?  the only pictorial element to add to such a borrowed and out-of-time post as this one, une larme, seule, une larme, une larme seule.  and not even mine, or even human, but une larme de pluie.



Quand on croit voir l’amour s’éloigner (1974-2013)
Quand on croit voir l’amour s’éloigner
c’est alors qu’ils affleurent
les souvenirs les plus reculés :
un souffle sur ton front plissé,
une coupure nette qui était capable
de débrouiller n’importe quel écheveau,
ton pas près de moi, inattendu
notre étreinte soudaine.
Quand l’amour se replie, condamné,
on désire jusqu’au désespoir
que le temps sera infini,
qu’une vie sera deux vies,
qu’une promenade en hiver
dans le brouillard
sera aussi un plongeon
dans un amas de feuilles sèches et de boue,
que l’on pourra à nouveau se tenir par la main,
dans un bref voyage invisible,
vers les nuages suspendus
au-dessus du calme et du vent.
Quand l’amour près de nous se termine,
on ne cesse pourtant de chercher un ailleurs
où nos voix les plus égarées se retrouvent,
un point lointain
où nos pensées les plus figées se perdent.
Quand l’amour se perd,
nous apprenons à nous distraire, à nous renier,
à nous engager dans la bonne cause.
Quand l’amour lointain soudainement s’approche,
ils sont simples et très beaux les souvenirs
d’où jaillit ton sourire, facilement
(il me semble),
et que toi, tu deviens comme une vague :
la vague des pensées les plus affectueuses,
la vague des cheveux qui entourent toute chose,
la vague de caresses et murmures,
la vague d’une mer nouvelle,
la vague d’une terre au bout de notre bout,
la vague d’un vent sombre,
sibilante dans son tour dans le ciel et les toits.
Giovanni Merloni

Quando l’amore sembra allontanarsi (1974)
Quando l’amore sembra allontanarsi
proprio allora affiorano
i ricordi più remoti :
un soffio sulla tua fronte corrugata
un taglio netto che era capace
di sgrovigliare qualsiasi matassa
il tuo passo vicino e inatteso
il nostro abbraccio improvviso.

Quando l’amore sembra condannato
si desidera disperatamente
che il tempo sia infinito
che una vita sia due vite
che una passeggiata in inverno
nella nebbia
sia anche un tuffo
tra le foglie secche e il fango
sia tenersi di nuovo per mano
verso nuvole sospese
tra la calma e il vento.

Quando l’amore vicino finisce,
c’è sempre un altrove
dove le nostre voci si intrecciano,
un punto lontano
dove i nostri pensieri fissi si perdono.

Quando l’amore si perde
impariamo a pensare ad altro
a rinnegarci, a farci impegnati.

Quando l’amore lontano
diventa vicino, anche i ricordi
son semplici e belli
e sgorga facile il tuo sorriso
(così mi sembra)
e tu ti fai onda di pensieri affettuosi
onda di capelli che cingono
onda di carezze e sussurri
onda di un mare nuovo,
onda di una terra che è la nostra meta
onda di un vento cupo, sibilante
che avvolge il cielo dei tetti.

Giovanni Merloni

Thursday, October 17, 2013

Honor the Fred, or else.

Fred tried to make me jealous.  He failed, miserably.          
by glittergirl

Ah, the benefits for spouses, sidekicks, and dear friends of mild short-term memory loss in those we love!

Fred is joyfully planning a coup.  Not a seizure of power, he insists, but more a revolution of celebration. He's always been ill at ease with the word "fun." It ties him in a knot, almost immediately.  You tell Fred, ":Let's have some fun!" and you'll witness facial contortions indicative of pure panic.  But if you work at it, and find some convoluted way to say it, like:  "Let's make today a better day than yesterday!" -- he's with you, he's ready, he has a referent. He almost jumps for... well, not "joy," of course, but perhaps "ascending hopefulness."

So he has volunteered to lead the Service at his place of, well, worship, on 22 December 2013.  He, uh, worships at a Unitarian Universalist affiliated congregation of militant existentialist lesbian feminists.  There has been a decline in the lesbian demographic of this exciting group, and their commitment to existentialism has always been questionable, as a majority of the membership cannot string enough defining words together to form a sentence about the post-World War II philosophy.  Which leaves militant feminists as the predominant ongoing influence.

Hank self-identifies as a Christian.  As far as I know, he's straight -- although he and I, and several friends, used to enjoy allowing others to assume we were, basically, a jaunty gay gang.  I wrote a poem about that, I think, over at AllPoetry, but don't know if I snagged a copy when I left that enterprise.  Let me see.  Be right back...

Damn, that was exciting.  I found a .zip file of my writerly "stuff," many things too personal to find posting here, but that may change according to shifts in courage, should they come.  Anyway, it's long and full of allusion but it does tell the story of our "jaunty gay gang," out to convince people at post-worship Sunday potluck picnics that yes, they did, indeed, know a gay person!  The rumors of invasion are, indeed, real! You're surrounded and we are eating your potato salad!

I'll get back to Fred's current initiative on the other side of the poem and its "Author Note."

"Peasants, Indian Nobles, and the Decline of the Tlaxcalan-Spanish Alliance"



as i write this, the defense of marriage
act seems to be circling the sucking
drain,

whether counter the clock 
or with it, i cannot tell,
though what else will determine the hemisphere?

i read the article behind these poems; fatigue set
in, i circled the drain. actually, it's better said
that i dove right in, sieve bound, no curvature, no wasted motion;

i am that sick of it.
surely there is nothing
left to say, only the abiding strength of what we know?

but i felt this way twenty years ago, as well,
when we were almost always together, all four of us,
at some point in any potato salad, fried catfish 

and slaw gathering: me and fred and ramak and alejandro.
our solution was that, together or apart,
we were all gay -- for the asking.

it was fred's idea, after his gazillionth whispered, crooked
fingered (halting and prepared-to-be-apologetic)
"fred, are you gay?"

he decided to always answer "yes," figuring and theorizing,
hoping and praying that then, at least, that person
would think they knew, at least, one gay person.

he had epidemiological visions of a spreading virus,
shedding little viral progenies, emptying the now vapid host,
having sucked and eaten its innards, free and bounding away

to spread the word: i know someone who is gay; i have a friend
who is gay.  fred hums "imagine" as he sands the frets of his guitars.
pleased, eased, now there were the four of us in the game -- but

back when there were two, when it was just me and fred,
we had the comfort of knowing others knowing
we lived together and seemed suspiciously, knowingly intimate

or, at least, weirdly close, not that we needed or required
or needed or required that knowing knowing at all, at all,
and then there came ramak --

for whom none of it was light as air, pretty as a feather, pithy
as a cold beer teachable moment, but she played.  the obsidian glint in her eye,
however, kept many a potential postulant from leading with the required question.

the butch hair, the soft breasts unbound under thin egyptian cotton tees,
her general cold courtesy, all these kept the question under lock and key
because romy was always romy, what else, who else, could romy be?

so we three hobbled along like monopoly's shoe and hat and iron,
fred and i trying to keep the joy in it, ramak sometimes giving us
the hairy eyeball.  along came alex, part alejandro, half gringo,

and the same with being gay, he first needed to know his audience,
prepare the footlights,  his traveling troupe, his imagined dresser,
but he was not in the closet, no, or if so, not

for the usual pedestrian reasons.  it was more out of castilian courtesy.
but as a game, well, and a game, you say, that we all four would play?
well, that might work, not that i don't cry in fear at night of being alone,

you understand. (and i would secretly hold fred's hand: ramak would either
redo the hairy eye or quickly wipe the hint of a tear at alejandro's crying game.)
"welcoming" church picnics were our specialty, we ate free

but were pale, all four, from the night before, so we lost some of the original
artistry, the courtly dance of far away corners coming together to hold hands
and circle, jauntily, in the middle, by the buffet tables, queens of may.

alejandro was hung over from the peculiarity of tequila one awful sunshiny
sunday morning afternoon, and thus he "snapped" -- his word, worthy of a copper's
tyranny of interrogation under a hot bare bulb -- "i just snapped, damn it,"

said alex, alejandro temporarily in barcelona
(santiago an emergency alternate),
so the four of us piled high our paper plates,
"raised high the roofbeam," 
goose-stepped over to the roots
of an ancient southern oak,
and ate and ate and ate,
til our cheeks pooched out. 
  
we were memorialized on polaroid, and what a tale that photo told, beyond
an apparent feeding frenzy.  i wore a thin jersey top with a hood
of my favorite deepest blue, the hood up, my curls defiantly creeping

out, curls no matter what i put them through. "she was just so freaking stupid,"
whisper wailed alex, stabbing what might have been chicken, but could have been
fish, "and what was there to say but 'so what if i am?' to the mousy-brown

sweet tea idiot, so much my mother i could spit."  aha, ramak nodded to me
and i lent her a bent eyebrow in return.  alex's mother was an unrecognized
but powerful female force in live performances of los reyes the gipsy kings

never introduced, just the spanish chica who carried the trills to the apex in a peasant 
bandanna blouse and blousy skirt, while they sprayed on tans under gold chains
on hairy chests over fat bellies and excluded her from the recording studio

and its royalties.  fred was oblivious to the backstory drama, didn't see his dream
game implode between jellos studded with grapes, watermelon chunks,
frisbee golf and christian volleyball, open to all.

i suggested we switch to vaudeville,
a barbershop quartet:.
fred's bearded hawk-nosed head,
my curly round-cheeked cheery face,
romy's amazingly white teeth
and sultry exoticism --
each popping up,  in harmony,
"i'm gay-y-y" --
 "i'm gay-y-y" --
 "i'm gay-y-y" --
and then an extended
holding of the line,
with jazz hands twitching
as a waving, jerky alex
hops up behind, 
boater waving, starting us all
in a slow,
flat-crowned
chorus kick,
leading a rafter rattling
(whether rafter or no)
speed increasing, voltage volting,
(Milyen volt az előadás? How was the show?)
flabbergasting
"so.  what.  if.  i.  am...
so.  what.  if.  i.  am...
o mama!  
o papa!
so.  what.  if.  i.  am...  
i'm gay!"

what really happened is that fred's dream was killed by the obvious:
a straight couple with twisted liberal tendencies,
and guilt (the woman in love with ramak,

but not gay), and alex keeping two journals,
one a  homosexual compendium of erotica that could
make a person weep, the other private password-

protected files in a folder marked "Peasants, Indian Nobles,
and the Decline of the Tlaxcalan-Spanish Alliance" on his mac.
our plan to have everyone in the world know at least one gay person

failed, failed even if we deflated the world to continents,
those continents to a country, that country to a region,
that region into little tiny counties, with towns of plastic 

red and green monopoly houses, motels, hotels,  
and b&b accomodations, monopoly's shoe, hat,
iron, and thimble jive dancing in the corner establishment saturday

nights before sunday picnics,
arguing why a gay bar cannot be a jazz club.
who to tell -- and how to tell -- the difference.

Author notes

A contest entry for: Nobody's Gay by T.H. 

This poem's title is taken from a Grinnell College Latin American Studies research paper written by Eliot Spencer in 2005, a Senior Paper requirement for certification in Latin American Studies.
It tickles me that people want to see the picture under the tree.  I am a poet, or trying. It does exist, but without Alex.  I'm staring at one of the huge tree roots, Fred is staring at me, and Ramak is glaring at the woman taking the picture -- who was in (very unrequited) love with her. Alejandro would never, ever play the game and was, at this period, I believe, having mooched all of us to death, mooching his way around South America, Spain, and Portugal.  Ramak telegraphed so well that even her willingness to play was pointless, plus she was always the same to all she met that... well, Romy was just above it all.  
So it was just me and Fred, really.  That's what I get for writing narrative stuff, I suppose, and making it plausible.
All I know is that the plausible picture of the four of us, the game, itself, driven by "welcoming" Christians and their curiosity, was all about wanting to be loved, wanting to love, and desperately needing to be able to relax into the truth and just chow down on free fried food.  We simply found a way to so structure our discomfort that we could pretend the strictures of hate, prejudice, and damnation did not exist.

Really, I should call these posts "performance art," though to call this "art" is an aggrandizement. It is such an accurate representation of the flightiness of my poor brain...

So... before that terrible poetic interlude, I was telling you about Fred's Christianity.  It emerges most often when he's hurt by some change among his friends at the existentialist congregation -- he clothes his concern and pain in feisty battle readiness, in condemning their condemnation of organized religions, especially Christianity.  

Basically, the congregation, about 30 years old now, has historically been made up of people marginalized by organized religious groups, sometimes in childhood, sometimes in young adulthood and on occasions such as coming out as gay, lesbian, or transgender.  Their faith, they say, went the way of their trust and love of the institutions that had sworn them an allegiance of support, guidance, and acceptance.  Not always, but often, the end result is a stunted thought process and a continual aggravation of wounds that never healed.

Fred says it was not always like this, not always this bitter, repulsed response to notions large and small, from stringent anti-Christian stances to degradation of men, because men are behind every bad thing that has ever occurred in human history.  Yes, the anti-male hysteria is real, and yes, I do characterize it as a "small" notion.  The men in the group are among the most liberally compassionate, pacifist, and open-minded guys you'll ever meet -- and the militant existentialist lesbian feminists all know it.  They'll even admit it in the span of a lightening strike.

Fred wields Christianity as a bat to hit the high-powered, stinging pitches that are hurled toward his strike zone, by which I mean that he is hurt and using ideology to fight back.

Hmm.  Do you hear bells ringing?

There used to be a solid core of existential philosophy study going on there, and, odd as it may sound, that study was full of fun.  Gatherings were fun, even if sometimes necessarily "deep." Now?  Existentialism is being not-so-gently shoved off the altar, left undiscussed, considered arcane -- and most members couldn't provide the sketchiest sketch of its history, meaning, or significance.

The happiness of the place (it is, after all, where I met Fred) hinged on fun, on a miraculous conjunction of existential ideas and theories for action with the lives that congregated around them.

Fred now often leaves for the 11 am service at 11:25 am.  He also sometimes goes early for a meeting or out of excitement for a scheduled speaker and ends up home at 11:15 am.  He comes home pale and sweaty, sad and angry.

He was born on Christmas Day, was Fred.  Raised in the Catholic Church, educated by nuns, he got over that abuse with the help of single malt scotches and beautiful women in Ethiopia.  He experimented with naturalism as a faith, and considered himself a modern druid for a bit.  The way he sometimes eyes certain trees, I suspect he still might.  But for several years now, he speaks with more and more respect of Christianity.

There's not a bit of evangelical fervor flying around backward in our suites here in The Manor, nor have we held Wednesday night Bible Studies (though I LOVE Bible Studies!).  Sometimes I insult Fred, hopefully without it showing, by thinking that this new faith-based man must be punking my ass.  Other times, I wish he would allow me into that precious space in his heart.

I started by saying Fred was trying to evoke my jealousy.  Little does he know that he does that every day, but we won't go down Self Pity Alley on this journey.  He got up early, as in well before noon, and as he handed me a wonderful jug of coffee, chirped "I have a lunch date." Then he stood up and grinned at me, feeling all superior and stuff.  This as I pictured the leftovers that I am counting on him (and Sven, and Bianca, and the Cabana Boy) to dispose of, while trying to appear unconcerned, and definitely not jealous.
He'd already told me about his plans over the weekend, but forgot -- so, ha!  I don't mind finishing off the incredible and perfectly spiced Spanish Omelet, complemented by a side of superior vegetarian chili.

The luncheon today is dedicated to a small group of revolutionaries plotting the goings-on for the upcoming pre-Christmas service on 22 December.  They are planning... a fun celebration of Christmas, free from any heavy wrapping in ideology, desire for conversion, or even contemplation of the lunacy of a Virgin Birth. This is more about a Jesus child, touched by God, running around nekkid as a jay bird and rejoicing in life lived well, finding the space and the spirit to befriend the frowning and judgmental, to soothe the injured.

A tree, small presents, maybe even a living tableau.  Jingle-Bells by the Ukulele Band.  Themes of love and hope, peace and good acts.  Sugar cookies.

That's my Fred.

He is excited but also, like me, tending toward "borrowing trouble." What if people refuse to come?  What if someone tries to openly denigrate Christmas?  What if he will be required to deliver a cogent thesis to explain Christianity itself?  (This is not a crazy worry.  The congregants are a hyper-educated bunch, full of professors and degreed fine arts practitioners 'n such.)

My job, I've decided, is to try and correct the course should the Christmas Celebration Cruise Ship veer from following the twinkling star.

But they'd better get with the program, those militant existentialist lesbian feminists or I won't be sending along any more savory tarts or rich mushroom polentas to those famed Wednesday night suppers and ukulele band practices.

Honor the Fred, or else.  A new commandment.

© 2013 L. Ryan

CRPS Update: The Things at the End of My Legs

Some people with CRPS undergo seasonal shifts.  For instance, I change from a reddish warm weather version of the disease marked by massive edema to a thinner blue that heralds colder weather.

Remember the Flip video camera that I dropped in the sink full of sudsy water while documenting the care and general abuse of a PICC line?  Well, the camera has come back to life.  Sort of.  It sometimes works perfectly but not when I use it with a purpose in mind.

For instance, wanting to document the beginning shift from red edematous skin to purplish shades of Fall, the camera began to record as it should but then refused, flat out REFUSED, to allow me to end the recording, short of simply powering it down.

I was hoping that weirdness wouldn't be noticeable but, of course, it is.  Nonetheless, here's the result.  I''m also documenting the excellent, fast healing of my toe and the lower right leg gouge from a few weeks back. As usual, despite the visual ickiness of the right leg -- at least in comparison to the left -- it is the left that leaves me screaming in the night. Weird stuff.

The music is The Beast in Me, sung by Nick Lowe.  Appropriate, I think.


video




© 2013 L. Ryan

" Admit it. You want a white Republican president again."

Strange that it is not a celebratory mood descending tonight, given that Congress has managed to -- or will soon manage to -- pass a clean Continuing Resolution just as our national credit rating was about to bite the dust.

Not so strange, really.  We are going to have to dance this dance again, and it appears that those players who delight in inflammatory falsehoods about everything from the Affordable Care Act, unfettered access to birth control, the deficit, and -- let's face it -- the black man and his family who somehow wandered into the mansion on 1600 Pennsylvania Avenue a few years back, illegal squatters, all of them, including the two dogs.

Do you remember Joe "The Plumber" Wurzelbacher who achieved an odd but familiar sort of fame during the 2008 presidential election?  He subsequently ran for Congress but lost, finally affiliated himself with the Republican Party (a true shocker), and began doing what all of us frustrated political junkies do by launching a blog.

A patriot.  A symbol.  A man with a computer.

He crossposted a piece to Joe for America.com from The Black Sphere, written by Kevin Jackson, that begins with smooth subtlety:

Admit it. You want a white Republican president again.
Now before you start feeling like you’re a racist, understand you are not.
Wanting a white Republican president doesn’t make you racist, it just makes you American.
Proving that he can dogpaddle even in the shifting tides of white water, Wurzelbacher responded to the responses to his borrowed tirade by posting this to his Facebook account:
'Let no chance to find a boogey man in a non-racist's closet go by without first taking time to blame a white guy for repeating something a black guy said...about a black guy.'
Attribution for his blog postings is sometimes murky, though after perusing a fair number of them, the tenor is crystal clear.  For example, just prior to the aforementioned liberation from racism, he published another chef d'oeuvre entitled "Does Barbara Boxer Need A Good Beating?"  It appears to be his own work, a conclusion I reach from my time spent diddling around in Comparative Literature (subcategory: acephalic anathema):

Normally this would be an inappropriate question to ask, but rules have exceptions. Senator Barbara Boxer recently compared Tea Partiers to “domestic abusers.” In her world, trying to restore fiscal sanity and prevent America from going broke is equivalent to engaging in physical violence. 
What the hell would this (insert curse words here) know about domestic abuse? Any man who married her would have to be so emasculated that he would not raise his hand without permission. Normally I am against domestic violence but she really could use a good beating to knock the stupidity out of her. Her existence is an act of abuse because the rest of us have to suffer from her feminist yapping. Even a government shutdown can’t shut her leftist trap. Her crybaby victim routine is an insult to real victims. She is the third worst Barbara in America behind Streisand and Mikulski. To all fake feminists everywhere, please shut the Sandra Fluke up.

Do I think Joe's site to be a source of influence?  No.  Do I worry about his impact on the quality of our national discourse?  Sadly, no, as it is actually an improvement over some of those congressional delegates who were, unlike Joe, duly elected.  I think I will steal from John McCain, who responded to Texas Rep. Gohmert's assertion that he consorts with Al Qaeda terrorists on a regular basis by telling NBC's Brian Williams:

On that particular issue, sometimes comments like that are made out of malice.  But if someone has no intelligence, I don’t view it as being a malicious statement. You can’t respond to that kind of thing.
Yes, I am aware that the frequent lack of response to my own various tirades might be shaded by this same Umbrella For Dolts.  I am also aware, however, that my superior insight into my own shortcomings places me at least a few ladder rungs above Brother Joe as we scale the heights of our Fool's Errand.

Where I probably top The Plumber in unnecessary rhetoric is in moments like this one -- where I cannot help but wonder why the hell this John McCain was not the John McCain who showed up under the guise of a presidential candidate.  Such an effective debater, steered by what seems an unerring sense of right and wrong, is terribly at odds with the man who tapped Sarah Palin into service and hummed out that catchy parody of "Barbara Ann" --  Bomb, bomb, bomb, bomb, bomb, bomb Iran...

Could it be that I am secretly a very forgiving person, almost Christ-like in the depth of my compassion? Nearly surgical in the precision of my dissections?

Wurzelbacher goes after Megyn Kelly for calling him racist for reproducing Kevin Jackson's wondrous journalistic crap with this pithy bitch slap:

So where is the racism? The way I got it figured, is since I’m a “white” guy and you labeled me a racist for publishing his article, Seems to me you could be implying that Kevin is an Uncle Tom? See what I did there Kelly? I didn’t mean it, just making a point.
Hmm.  Maybe I'd best put myself on a closer watch.  A shorter leash?  Hire an editor?  Consider a sabbatical?  Have my knees removed in an effort to cure the automatic jerk?  Cook a large pot of red beans and rice, liberally peppered with serranos?

Mostly, I think I'll revert to my high fever coma strategy from last week so that when I wake, the sparkling clarity of this country's political purposes can wash me clean of all sin.

Cute Innocent Lamb Photo


© 2013 L. Ryan

Tuesday, October 15, 2013

Intravenous IVIG in CRPS

From Lost and Tired



Of course, the banner at the top of the PubMed page reads:

PubMed is open, however it is being maintained with minimal staffing due to the lapse in government funding. Information will be updated to the extent possible, and the agency will attempt to respond to urgent operational inquiries.
Part of the reason I've not yet posted Part Two of the latest Clinical Trials updates for CRPS is precisely because they are shut down, though the staff there is also operating on a "compassionate" basis, helping people with end stage cancers find trials to try.  There are angels everywhere.  Yes, yes, I am sure there are even some GOP members who sport halos.

Maybe.

Anyway, I'm posting the abstract for this case study about immunoglobulin infusions in treating CRPS because some wider (and much older) research studies have claimed success in reducing pain -- significantly -- with as high a success rate as 30-40%.  The usual caveat seems to hold true -- that the likelihood of IVIG being effective is greatest in that magic initial 3 to 6 month period after onset.  So many people face huge battles in getting a correct diagnosis, often for years, so hearing that "3-6 month" mantra again is a bit of a downer. But as groups like RSDSA.org continue the battle for awareness and research, maybe these promising treatments will start reaching that target demographic and there will be fewer and fewer "intractable" cases of CRPS.

I took my optimism pill this morning.  That said, please do remember that this is a case study.  But heck, it was a case study that caught someone's attention about ketamine.  And from ketamine has been extrapolated experimental uses of other drugs blocking NMDA receptors -- she said, hopefully, taking her Namenda (memantine)!


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 2013 Nov;29(11):e33-e34.
Favorable Outcome of an Acute Complex Regional Pain Syndrome With Immunoglobulin Infusions.

Medlin FZekeridou ARenaud SKuntzer T.

Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.

Abstract

OBJECTIVE::
To emphasize that complex regional pain syndrome (CRPS), a disabling disorder with the implication of aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity, might be treated with a high dose of intravenous immunoglobulin infusions (IVIG).

METHODS::
We describe a patient who presented with CRPS in the acute phase of the disease.

RESULTS::
The CRPS developed secondary to sciatic compression in a young patient and was treated within 10 days by high-dose IVIG (2 g/kg). It resolved completely within days after infusions.

DISCUSSION::
This observational study emphasizes that high-dose IVIG may be a treatment option in the acute phase of CRPS.




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Here is a slightly older study with a resounding cohort of participants -- all TWELVE of them -- who were past the "acute phase" of CRPS onset.  There was evidence of some pain reduction, but again, there were also methodological problems with the research.  I don't know that researchers will ever be able to establish "statistical relevancy" given the unlikelihood of ever achieving a decent number of subjects.  That's why we must sometimes give the hairy eyeball to those who mock CRPSers for our excitement over a case study of one patient -- we deal with what we have and try our darnedest to establish good science behind it.

Please excuse the funky layout below.  Blogger is punking me.


 2010 Feb 2;152(3):152-8. doi: 10.7326/0003-4819-152-3-201002020-00006.

Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial.

Source

University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom.

Abstract

BACKGROUND:

Treatment of long-standing complex regional pain syndrome (CRPS) is empirical and often of limited efficacy. Preliminary data suggest that the immune system is involved in sustaining this condition and that treatment with low-dose intravenous immunoglobulin (IVIG) may substantially reduce pain in some patients.

OBJECTIVE:

To evaluate the efficacy of IVIG in patients with longstanding CRPS under randomized, controlled conditions.

DESIGN:

A randomized, double-blind, placebo-controlled crossover trial. (National Research Registry number: N0263177713; International Standard Randomised Controlled Trial Number Registry: 63918259)

SETTING:

University College London Hospitals Pain Management Centre.

PATIENTS:

Persons who had pain intensity greater than 4 on an 11-point (0 to 10) numerical rating scale and had CRPS for 6 to 30 months that was refractory to standard treatment.

INTERVENTION:

IVIG, 0.5 g/kg, and normal saline in separate treatments, divided by a washout period of at least 28 days.

MEASUREMENTS:

The primary outcome was pain intensity 6 to 19 days after the initial treatment and the crossover treatment.

RESULTS:

13 eligible participants were randomly assigned between November 2005 and May 2008; 12 completed the trial. The average pain intensity was 1.55 units lower after IVIG treatment than after saline (95% CI, 1.29 to 1.82; P < 0.001). In 3 patients, pain intensity after IVIG was less than after saline by 50% or more. No serious adverse reactions were reported.

LIMITATION:

The trial was small, and recruitment bias and chance variation could have influenced results and their interpretation.

CONCLUSION:

IVIG, 0.5 g/kg, can reduce pain in refractory CRPS. Studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeated treatments are needed.

PRIMARY FUNDING SOURCE:

Association of Anaesthetists of Great Britain and Ireland, University College London Hospitals Charity, and CSL-Behring.

Summary for patients in


Potential Conflicts of Interest: Disclosures can be viewed atwww.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-1292.
Requests for Single Reprints: Andreas Goebel, MD, PhD, Pain Research Institute, University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom; e-mail,andreasgoebel@rocketmail.com.
Current Author Addresses: Dr. Goebel: Pain Research Institute, University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom.
Dr. Baranowski and Mrs. Ghiai: Pain Management Centre, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom.
Dr. Maurer: Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Dr. McCabe: The National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, United Kingdom.
Dr. Ambler: Joint University College London Hospitals/University College London Biomedical Research Unit, Ground Floor, Rosenheim Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom.

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But what would a post be without a measure of balancing skepticism?  Here is a taste of some of the immediate reaction to this 2010 study in the form of an editorial, even -- you'll have to use your "zoom" function to enlarge it, sorry!






© 2013 L. Ryan

Sunday, October 13, 2013

Tarnished



There are always moments, moments that a writer friend of mine -- we'll call him Peaches -- names "golden moments." He's hoity-toity and thinks "golden moments" refers to a Thomas Wolfe's quotation from You Can't Go Home Again:

“This is man, who, if he can remember ten golden moments of joy and happiness out of all his years, ten moments unmarked by care, unseamed by aches or itches, has power to lift himself with his expiring breath and say: "I have lived upon this earth and known glory!”
That's Peaches.  He sees halos of glory around memories.  I peer at them, switching glasses, trying to get something, anything, to show itself in focus.

My eyes are still in acuity flux after the two surgeries in August, though I am reassured by everyone -- and everyone's siblings -- that this will settle down.  Still, I see the darnedest things.

I turned on the television, thinking to watch Meet the Press, keeping an eye on David Gregory's hair more than anything, but discovered I was an hour early.  So I stared at the blurby news, trying to read the headlines running along the bottom of our fairly large screen.

I read that the government, come Thursday, would have $308 in the Treasury.  Wow! I felt a sudden warmth of kinship with those clowns.  I, too, would have $308 in my treasury come Thursday!

By the time I'd ingested some good Colombian, albeit on the strong side, took loads of drugs, squirted my eyes with drops, and returned TV-side, they were still running the same under-headlines banner.

Now I could see that the U.S. of American Treasury would have $30B remaining on Thursday, the "B" representing that which I can never imagine -- billions.

Leaves me wondering how much false news I've passed along during the last few years -- how green are the remains of my golden moments, gleefully delivered and fundamentally flawed?


© 2013 L. Ryan