Tuesday, June 17, 2014

If It Is Tuesday...

Cape May During Hurricane Sandy

If it's Tuesday, then Monday must be over.

Anyone wishing to argue about space and time continua or parallel string bikinis may simply go take a dip in the moat.

Because, damn it, Monday is over.  We start fresh.  All devices have been charged.  The Manor is pristine, the grounds are pruned, raked, and -- where absolutely necessary -- mowed.  Sven Feingold putters about giggling, so something is up with the latest ManorFest Maze design.  La Bonne et Belle Bianca Castafiore stays on her cell, when she can get reception, because she is *this* close to garnering a position as spokesperson for a major weight loss company that specializes in busty divas.  Just the exercise and muscle toning from running up and down turret stairs and sprinting around Captain Haddock's miniature submarine wormhole gateway will make her lose a few dozen dress sizes.  Should Marlinspike Hall ever successfully be enveloped in a wifi bubble, the Milanese Nightingale may well gain back all the fat she's discarded chasing a phone signal.

Our various herds and fruit orchards are all in their proper states.  The monks next door are reworking their Christmas Catalog of Wasted Calories and the Abbot, Fred, and I have been designated taste-testers.  Life is sweet.

But Monday.

The Mother-Unit that actually raised moi decided to need emergency surgery.  In a test of the emergency surgery system in the coastal backwaters of her slice of paradise, she encountered the requisite number of idiots at the local beach bum hospital over the weekend.  So, in a way, Monday was her salvation, as it brought an influx of actual medical practitioners leaking grains of sand onto the spit-shined checkerboard hallowed hospital halls.

I was a tad bit worried when I looked up her surgeon's credentials to find that he also enjoyed the practice of ophthalmology.

I've not seen her in decades but every description begins with her diminutive stature.  She has everyone and everyone's brother worried about her weight -- no busty diva, she.  I want to scream sometimes.

Oh, about what?  I need to particularize my need?

I want to scream at the "but she's so tiny," "she can't take it, she has no... reserves!"

Puh-leeze.  This is a woman who was a fierce ballerina.  I watched her employ many tricks of the dancing trade as she guarded her lithe status through the years -- as if it mattered once she was no longer expected to enter rooms via a grand jeté.  She is not anorexic in the strict definition of the malady.  Nor is she an alcoholic, nor does she abuse prescription drugs, in spite of a lifelong celebration of Happy Hours and a honking bottle of bazillions of phenobarbital kept in the last drawer of her dressing table.

Anyway, she survived the weekend, and made it through a scary surgery with style.  And got -- with us -- to Tuesday!  Yay, Mom!  Point your toes and twirl, twirl, twirl!

Equally wonderful about this day?  Grader Boob gets his first doses of chemotherapy!  His story has become so sad, beset with that ogre of physical pain and the great deceivers of the mind that pain welcomes. If you're a Dedicated Reader, you've seen me act out that drama, o'er and o'er.  Therefore, rejoice in Tuesday, for shrinking those tumors will result in less pain, and less pain will allow sleep, and sleep will further decimate the pain cycle.

All together now:  "Shrink, tumors, shrink!  Shrink, tumors, shrink! Shrink, tumors, shrink!" I have an accompanying tune in mind, but don't want to limit your creativity as you dance your way through this Tuesday, chanting, cavorting, and casting Grader Boob tumor cells into Tumor Cell Inferno.

Use any musical genre that works.  Though I have to admit that "country/western" somehow doesn't fly. Feel free to prove me wrong. Something in a Texas Two-Step, maybe?  Just be stylish.  This is my brother we are talking about.

He's simply riddled with cancer, the reprobate.  His new oncologist, who seems a very good dood, is starting the meds today whether he is admitted to the clinical trial or not.  And no, I am not stupid.  Prevailing winds, insight, what is not said -- I'm on it.

Given that it's been over 6 weeks since the official diagnosis, it is fair to say that the new oncologist's very life may have hinged on that decision, as I was gathering weaponry to bring down on his toupéed head if something were not done this week.

Would I kill to improve Grader Boob's Quality of Life?  Let me see.  Hmm. Yes, of course I would.

Wouldn't you?  If I were willing to personally extrajudicially execute Pinochet, Jesse Helms, and various other errors, an attempt on the life of someone impeding the life of Grader Boob is one of those famed "slam dunk" decisions. The weird problem with my Kill List, and this has been the case since roughly the 1970s, is that once penciled in for an extrajudicial execution, my Listees just... drop dead.  Or are taken out in the wrong fashion, a tragedy equal to the horror of their continued existence.  If you have any insight into how I might stem the tide of these unworthy deaths and promote the karma-cleansing of my efficient Kill List, the comment section is all yours.

If you're lathered in a cold sweat and thinking of calling the Interwebs Keystone Kops, relax. I was voted the Family Member Least Likely To Commit Murder.

So, it is Tuesday.  The Mother-Unit may yet gambol along the edge of her watery front yard, scotch and soda in one hand, the other arm gracefully indicating the vastness of the Atlantic.  The Brother-Unit may get to drop the F-bomb on another set of undergraduates, or he may be granted furlough to gambol alongside the Mother-Unit, leaving now and then to swim out past the breakers.

Have I told you lately, Dear Readers, that I love you?  Particularly You... That's right, You.

Instructions for Tuesday:

  • Point your toes and twirl, twirl, twirl!
  • Shrink, tumors, shrink!  Shrink, tumors, shrink! Shrink, tumors, shrink!

© 2013 L. Ryan

Sunday, June 15, 2014

Amputation for Complex Regional Pain Syndrome

photo, amputated limbs, "field day," civil war...

Informed Decision-Making Regarding Amputation for Complex Regional Pain Syndrome Type I

Marlies I. Bodde, MD; Pieter U. Dijkstra, PhD; Ernst Schrier, MSc; Jan J. van den Dungen, PhD; Wilfred F. den Dunnen, PhD; Jan H. Geertzen, PhD
J Bone Joint Surg Am, 2014 Jun 04;96(11):930-934.


Background: Literature on complex regional pain syndrome type I (CRPS-I) discussing the decision to amputate or not, the level of amputation, or the timing of the amputation is scarce. We evaluated informed decision-making regarding amputation for CRPS-I.

Methods: We describe our findings in a retrospective study of the decision-making process of thirty-six patients who underwent amputation for CRPS-I at our university medical center from 2000 to 2012. Additionally, we present the incidents preceding the CRPS-I, the reasons for and the levels of the amputation, and the outcomes after the amputations.

Results: Team members and the patient decided together whether or not to amputate and the level of amputation. Issues such as level of pain or allodynia, infection, desired length of the residual limb, joint range of motion, strength of all extremities, ability to use walking aids, and psychological “green, yellow, and red flags” were weighed in this process. There were no complications during the amputation surgery, a 22% rate of complications (infection in all but one patient) immediately postoperatively (reamputation not required), a 72% rate of phantom pain immediately after or within the first three months after the amputation, and a 77% rate of phantom pain more than one year after the amputation.

Conclusions: Informed decision-making regarding amputation for CRPS-I remains a complex process for which little evidence is available to support patient choices; patient-specific outcomes are not predictable. However, amputation should not be ignored as a treatment option for long-standing therapy-resistant CRPS-I.


Investigation performed at the Department of Rehabilitation Medicine, Center for Rehabilitation, and the Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, the Netherlands