i cannot forget her

Two nights in a row of bitch-slapping is excessive.  But my anger at the leg and arm choppers from last night has been reignited this evening over the renewal of a memory I'd much much rather forget.

When Andrea Gianopoulos died in Mexico after her second ketamine coma treatment, I wrote rashly about it, and I hurt and angered her family.  I cared, and their feelings and anger mattered, but so much was wrong with both the German wing (then suspended) and the Mexican wing of the ketamine coma "trials" that I cared more about getting the word out.

I just ran across another blogger's post from January 2012 that was written with the approval of Andrea's mom Leslie.  It is to be noted that the blogger, Nancy Cotterman, had her attention drawn to Andrea's death by these words of Leslie's posted at my favorite place, Facebook {shudder}:

 "My daughter died from the Ketamine coma treatment"

I don't want to reinvent the wheel, hurt the Gianopoulos family even more.  I have the same intentions to which Ms. Cotterman lays claim:

Andrea, I hope that your story will cause people to stop and think about all of the risks before they make the decision to go to a foreign country with a less sophisticated health care system than that of the US.  Again, I'm not saying that we shouldn't go.  I'm saying that we all need to do our homework and know everything that we can about the treatment, the facility, the doctor, the risks, etc. before going to have the treatment. You need to weigh the quality of life that you currently have against the potential risks of the treatments.  Ultimately it is your decision and it should be an informed decision.

Perhaps when Leslie and Gus are feeling stronger, they can join us in our fight to get all insurance companies... to cover Ketamine here in the US.  Had Andrea's insurance company covered her outpatient follow up Ketamine after her trip to Germany PERHAPS (of course there is no way to be sure) it could have held her coma treatment. If, like Jon Haag, coma treatment were available here in the US PERHAPS (again there is no way to know because people die here in the US too) coma Ketamine would be safer.  At least, we wouldn't have the expense of paying out of pocket, travel and treatment would be available to more people.  The more a procedure is done, the safer it becomes.

There's no claim on my part or anyone's that the liaison folks in Tampa or the "trial" supervisors in Mexico did anything wrong.

There's loads of evidence that it is pure nonsense to call this activity a "clinical trial" or to claim that strict protocols are being observed.  That's where the bitch-slap comes in... again.

Andrea had already had one coma treatment, in 2002.  It failed to work, one supposes, because she had no access, financially, to the booster treatments that are supposed to be so crucial to the continued success of the coma.  Huge,.freaking break in protocol, right there.

That she went on to get so much worse, I regret, and regretfully, understand.  But what continues to freaking escape me is how, after heart surgery for a bad valve -- adding a significant comorbid condition -- she flies to the top of the list again for Germany.  But those "clinical trials" having been shut down due to Laura Becket's MRSA and paralysis (which could have happened anywhere, to anyone), somehow Andrea again rose to the top of the list for Mexico.

There are doctors and administrators who have made a lot of money on this compassionate outreach, and that is why protocols matter, that is why a tragic story should not have put a young woman's life at risk, and that is, perhaps, why this needs to stop.

There is enough evidence now that ketamine helps some handpicked patients (only of Dr. Kirkpatrick? only of Dr. Schwartzman?) that the trials, properly set up, strictly supervised, and sufficiently cold-hearted to be fair in their provision of access need to be brought to the U.S.

People are told there is a two year wait to see these CRPS gurus -- and they are the disease wizards -- but if you happen to also be monied and all that goes with, my how those limits disappear, the other waiting lists for the coma trials magically shrink.

I know this is the way of the world.  I bitch-slap the world, then.

My previous writing -- very raw -- about this topic can be found HERE. But not much has changed since I banged a different keyboard back in 2009:


How dare I intrude on the death of this lovely girl? Why can't I leave it -- her -- alone, in peace? In part, it is because of the evident lack.

There is nothing but silence around this death, hardly anything beyond the barest of acknowledgements.

Or the most private of them. The nearest and the dearest. And to them, I apologize -- no, rather I beg pardon, for this prurient interest -- not in Andrea, but in what happened *to* Andrea.

The ketamine coma trials... that is what we are made to say, you know -- "the trials."

How many other legitimate "trials" cost well over $50-60,000? How many other legitimate trials cost ANYTHING? 

How many other legitimate "trials" suffer a death and allow it to pass into silence, unexplained?
There has also been a high incidence of infection, particularly respiratory -- aspiration pneumonias.

Oh, and how many "trials" make way for someone to repeat the treatment, the benefits of the first time around apparently not having lasted? How was that expressed in the data collection of the second coma? Was the first treatment before the days of the "trials"? You know, back when a person basically only had to produce the money, and be sufficiently young and healthy (beyond having CRPS)? Wait... am I getting it all confused? Because it sure seems like today's requirements are eerily... no, *exactly* the same -- young, otherwise healthy, cash in hand.

My prurient interest has its roots in anger and envy -- as well as in a more legitimate need for information that was not forthcoming from those running the programs.


I cannot forget Andrea.  I cannot forgive the shortcuts that cut her short.  I cannot believe it has been so successfully buried, the truth.

Premonition of Civil War

Salvador Dali, Soft Construction with Boiled Beans (Premonition of Civil War)

Okay.  This is where things stand:  After considerable confusion about names, addresses, phone numbers, and staffing... I was able to call the interventional pain center that is reportedly doing low dose ketamine infusions for CRPS/RSD.  That was about 3 on Friday afternoon.  The office was open until 4:30 pm but my call went to voice mail and I left a message. 

Then, of course, I started cooking something fantastically difficult.  I was also in serious pain, thanks to being over-emotional and moving around more than normal.  I don't know if I have mentioned that my right hip replacement, soon to have its 10-year anniversary, is, well, messed up and very painful -- the belief is that there's a post-replacement BooBoo.  Very painful.  Making sitting a nightmare.  It's called a periprosthetic femoral fracture.  (Turns out I did mention it.  What are the odds?)

The point being that I have to limit my time in the wheelchair and maximize my time with legs [carefully] elevated. 

So going full-speed ahead for four hours in the kitchen is kind of contraindicated.  If you've ever wondered why I cook so many things in stages, that's why!  I can rest while a dough rises.  I can rest while a protein marinates.  While something bakes, I'm in bed.

Not this past Friday.  In lieu of doing what I should have, I made ridiculous side dishes, each preceded by an intricate mise en place.  I made a sauce for everything on my menu, damn the calories, damn the weirdness.  I washed, dried, and put away every dish.  I washed things that weren't dirty. 

I even started a "kitchen" load of laundry, because God loves a clean oven mitt.

The phone rang twice.  Neither call was from the interventional pain center, confirming that they do subanesthetic ketamine treatments, that these treatments were custom-made for me, that we could start first thing Saturday morning, and that I'd be walking, dancing, twirling by Sunday evening.  Instead, I spoke with a flooring company and we agreed to a Monday morning delivery of 60 boxes of flooring, with installation scheduled for this upcoming Friday.  I told Fred that next Friday was *perfect* for me, as I would be cured of CRPS by then.  Unfortunately, I added, the installation schedule was going to interfere with my plan to win the Australian Open.  I was going to have to let Na Li take my place in challenging Kim Clijsters and allow the tournament to finish up a week early.

Luckily, changing my plans for swimming the English Channel (scheduled for the 7 - 8:30 Saturday morning activity block) didn't inconvenience anyone beyond the captains and stewards of Captain Haddock's private jet.  Clearly, I need to schedule more individual sporting championships -- out of simple courtesy to family, friends, fans, and support personnel.

So they didn't call.  So I served a many-coursed, complicated dinner that no one really wanted.  So I became terminally crabby, as well as, it sometimes seems, eternally depressed.  So Fred seemed not to be able to reference ketamine without also saying "horse tranquillizer." The first time he neighs, his ass is grass...

My go-to guy of MDVIP fame finally answered my middle-of-the-night email from Thursday.  Do you wonder why I trust this man as much as I do (never mind that he has saved my life a couple o'times)?

No worries. I agree with you about making the consultation visit and really seeing for yourself what it is all about. You are well read and educated on much of this stuff and you are very astute and I believe you will get a feeling one way ot the other whether this is right for you or not. I do know that group and I do have a few patients that I've shared with them and I personally have never had an issue. Give it a try...

That went a long way toward helping me to calm down.

I'm a stute!

In addition to being freaked out over the prospect of entering ketamine treatment, I failed to anticipate one of the more interesting things that happen when I am on the antibiotic regimen... my blood sugars, high from the impact of infection, DROP dramatically.  That's one of the reasons we're doing it, in fact.

An intelligent person, someone who was really A Stute, would have refrained from injecting herself with her usual 70/30 insulin.

It's just that the first two times on the antibiotic, the change in blood sugars happened on the second or third day. My numbers, this time, did not plummet so soon... it took a week. Still, I should have switched over to regular insulin only, and stayed away from the long acting stuff. Live and learn. And learn again. Then, in my case, relearn.

I have spent many hours reading... reading about the original protocols from Dr. Harbut, reading Dr. Schwartzman's studies, reading patient stories. Every so often, I make myself read something from the anti-ketamine crowd, a crowd that is not unsubstantial.

I can't ignore those who think it is too dangerous, too untested, too much of a question mark... because, though he doesn't press the point right now, that's Fred's opinion. {whinny::whinny::neigh::neigh}  Also, it turns out, the opinion of my half-sister, though she knows little about the technical, medical side of things. She said she did not want to have to come here to hurt someone. I'm still not sure whether she was referencing moi, The Stute, or the ketamine-wielding doctor in question.

I cannot seem to rein in [sorry] my wild hopes, though. What if my new insurance coverage won't recognize it as a valid treatment? What if my mind goes on a hike during the infusion, and doesn't come back? What if I am one of those who does not respond? What if I respond, but the pain comes back within a few days?

There is one poor man who worked hard to raise the $30,000+ for a trip to Germany and the ketamine coma treatment.  It was difficult and he had a slow recovery, but he was pain free for the first time in a decade.  He and his family travelled a bit around Europe afterward, and life was suddenly, amazingly, full of promise.  They boarded a plane a few weeks post-treatment and flew into JFK in New York.  He collected his luggage, a simple thing that he couldn't have done before ketamine, and headed out to find a van for the trip home.

He stubbed his toe.

Within minutes, his CRPS/RSD was active again, his foot and leg already changing color, becoming cold, the burning, burning, burning was back.  The stabs, the shooting pain.

True story.  A story I am trying to sit with for a few minutes each day.  Something has to keep me grounded.

American RSDHope, a website/organization that I have never much liked, has an entire section online dedicated to Patient Stories about ketamine treatment -- both the coma therapy and the subanesthetic version.  I think that I may have mellowed since the last time I visited American RSDHope, or they have become more responsibly cautious.  Whatever -- if you are looking for experiential reports, go there.

Below is a list of what I have read so far, the content of which is often redundant -- a redundancy that is both reassuring and frustrating.  Virtually all of it is available over at RSDSA, the site that remains, in my opinion, the most trustworthy of CRPS organizations. Excuse me for not giving the full citations.

Overview of Ketamine Infusion Therapy

Multiday Low Dose Ketamine Infusion for Treatment of CRPS

Use of  oral ketamine in chronic pain management

Ketamine in Chronic Pain Management:  An Evidence Based Review

The neurocognitive effects of 5 day anesthetic ketamine for treatment of refractory CRPS

Safety and Efficacy of Prolonged Outpatient Ketamine Infusions for Neuropathic Pain

Two Approaches to Ketamine Move Forward for Complex Regional Pain

Ketamine Treatment for Intractable Pain in a Patient with Severe Refractory Complex Regional Pain Syndrome:  A Case Report

Ketamine Provides Effective and Long Term Pain Relief in Patients with CRPS Type I

Efficacy of Ketamine in Anesthetic Dosage for the Treatment of Refractory CRPS: An Open Label Phase II Study

Ketamine:  Does Life Begin at 40?

Gambling on experimental treatment for pain

Glutamate and the Neural Basis of the Subjective Effects of Ketamine

Intravenous Ketamine for CRPS: Making Too Much of Too Little?

Outpatient Intravenous Ketamine for the Treatment of CRPS: A Double Blind Placebo Controlled Study

Effect of low dose intranasal (s)-ketamine in patients with neuropathic pain

Trapped in a Medical Nightmare: NJ woman travels to Germany for banned medical treatment, ends up fighting for her life

Update on CRPS (Johns Hopkins 2004 Annual Pain Meeting)

Update on low dose ketamine infusions
 
CASE REPORT:  Complete Recovery From Intractable CRPS Type I Following Anesthetic Ketamine and Midazolam
 
Relief for Worst RSD May Lie With Ketamine Coma


What if I get the call tomorrow, and what if they say they aren't doing ketamine infusions?  What if I get turned away because of co-morbidities?  What if it is inaccessible due to cost?
 
I can't allow myself to entertain this not happening.  I deserve a shot, a chance.  Oh, please, please, please... let this happen, let me try, let me at least try.
 
In the meantime, The Manor needs cleaning and straightening.  Fred is defrosting a couple of Wild Beast Loins.  It is a beautiful sunny day, and if the yeast will proof, I see deliciously fragrant homemade bread in our near future. 

club drug as antidepressant

Good morning. I would like to expose myself. No, wait, there's more!

I would like to expose myself as a person who knows and understands things scientific in a very limited and prejudicial manner. It's just the truth --my capacity is in the realm of the pseudo-, of pretense.

Of course, this being my blog, and this blog representing my real interests, when I present medical information pertaining to CRPS/RSD, I try to educate myself enough that I am not, at the least, being irresponsible.

Okay, okay, except perhaps as pertains to Jose Ochoa, who is clearly a turd but I don't see passing that fact on to my few readers as even remotely irresponsible. It's more like a Public Service Announcement.

I am trying to say that I am more humble than you might think when I set about to read and digest medical studies/announcements.

Even so, sometimes I just want to scream, and possibly shake someone silly.

On the off chance that some CRPS-related information is listed under the search term ketamine, one of my medical feeds checks for daily references to the drug. Most studies relate either to abuse of ketamine, its deleterious side effects, or to proposals of novel uses for the anesthetic.

Today? Well, there is something on the harmful effects of ketamine on the urinary tract ("a new radiological challenge"!), a bit about partial tripolar cochlear implant stimulation in ketamine/xylazine anesthetized guinea pigs, a veterinary medicine label update for KETAMINE HYDROCHLORIDE injection,/solution ("for Intramuscular Use in Cats and Subhuman Primates Only"!), and something about how ketamine can reverse "the expression of tolerance to the anticonvulsant effects of morphine."

Not stuff terribly applicable to CRPS;  Not stuff terribly accessible to a non-medico such as myself.

But then there was this -- An article in Nature, titled Neuroscience: Quick mood lift, with this come-hither statement serving as tantalizing abstract:  Patients taking traditional antidepressants have to wait several weeks for the drugs to kick in. However, a few severely depressed patients taking ketamine, an anaesthetic and recreational drug, have shown improvement within hours.

Okay, so I don't have a subscription to Nature... and cannot access the current edition without forking over $32.  By a search of the terms ketamine and antidepressants, limited to the past week, I feel pretty confident that I understand the claims of the Yale researchers.

A quick search of the journal finds this Nature article -- from 2006, about another study (at the National Institute of Mental Health) that revealed the exact same results and engendered the same excitement:

Club drug finds use as antidepressant:  Psychedelic ketamine hits the blues surprisingly fast

The 'club drug' ketamine may be the fastest-acting antidepressant ever tested, researchers report today.

A team based at the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, studied ketamine in 17 people with major depression. All the subjects had failed to respond to treatment with standard antidepressant drugs or more drastic methods, such as electroshock therapy. But 71% felt better the day after taking ketamine, and 35% still felt better a week later. None improved when dosed with a placebo.

Most striking, the scientists say, was that some patients felt better less than 2 hours after taking ketamine. Currently approved drugs can take weeks to remedy depression. The work is published in the Archives of General Psychiatry.

"It's almost like there's a sound barrier for those us who do depression research, and we have not been able to break it," says Carlos Zarate, chief of the mood and anxiety disorders research unit at the NIMH, and first author of the study. "That's the exciting part of this — now there is evidence that we can."

Zarate and his colleagues are not advocating that doctors start giving depressed patients ketamine right away. Large doses of the drug can cause brain damage in rodents, and its long-term health effects have not been studied in people.

"We don't want to give anyone the message to run out on the street and use ketamine," says Nuri Farber, a psychiatrist at Washington University in St Louis, who was not involved with the work. "It makes you crazy — that's why it's a banned drug."

Scientists are currently testing a wide range of recreationally used-and-abused drugs, including ecstasy (MDMA; see 'The ups and downs of ecstasy') and psilocybin, the active ingredient of magic mushrooms, as potential therapeutics.

Ketamine, invented in 1962 as an anaesthetic, is chemically related to phencyclidine (PCP), also known as angel dust. Both induce hallucinations and out-of-body experiences, hence their use as illegal psychedelics.

Ketamine has milder psychotic effects than PCP and is therefore also used as a legal anesthetic and horse tranquillizer. Scientists are studying whether it can be used to treat alcoholism and chronic pain, as well as depression.

Ketamine targets a brain protein called the N-methyl-D-aspartate (NMDA) receptor. Existing antidepressants target brain chemicals such as serotonin, but there is growing evidence that these drugs eventually affect NMDA receptors. Ketamine may work so quickly because it takes a short-cut straight to this part of the brain.

The psychotic effects of ketamine, such as euphoria, wore off before the antidepressant effects kicked in, Zarate's team found, suggesting that the drug's psychotic and antidepressant effects are separate. One surprising aspect is that other drugs that induce euphoria, such as cocaine, usually lead to a depressive crash once the high wears off.

Zarate's group is looking for substances with some of the chemical properties of ketamine, such as the ability to target NMDA, without the psychedelic effects.

Oh, well, good.

Worried about, ummm, side effects?  No sweat!

Other scientists, including Farber, have developed drugs that can be taken with ketamine to damp its side effects. Giving these drugs together might help patients feel better without getting high.

Of course, in the same issue, there's an article about "what it means to be an ant."

"It's like a magic drug — one dose can work rapidly and last for seven to 10 days," said Dr. Ronald Duman, professor of psychiatry and pharmacology at Yale University, who led the study.

Oh, dear Lord.

One final admonition -- to myself. Keep an open mind. The Ketamine Coma protocol for intractable CRPS has actually allowed some people to mumble the C-word -- cure.

Remember, too, though, that there have been deaths and other bad outcomes in both the Mexican and German research sites.

That ought to attest to the horrors of this disease, that people are willing to be injected with ketamine in an amount sufficient to maintain a coma for 5-7 days, risking their lives to have a chance at lessening the pain of CRPS.

Hmmm.  Here's a thought:  Maybe I should try putting myself in the place of someone so depressed, clinically, that they, too, would choose ketamine...

But I would still find this research more bother than boon.

I still want to shake someone silly.

CRPS / RSD and the Ketamine Coma Study

"Your Turn" with Kathy Fountain from Fox 13 Tampa, FL. Discusses CRPS/RSD and the Ketamine coma study. Features Dr. Anthony Kirkpatrick -- one of the world's foremost CRPS/RSD researchers:

After nearly twenty years of dedicated service to the University of South Florida College of Medicine in Tampa, Anthony F. Kirkpatrick, MD, PhD, left to establish the RSD / CRPS Treatment Center and Research Institute, the world's first institute of its kind, dedicated exclusively to RSD / CRPS. The Institute opened its Ambulatory Surgical Center in February 2008 and is headquartered in Tampa.

Ketamine Coma live broadcast Fox 13 Tampa

Voice of Frustration

This is the text of an email from Anthony F. Kirkpatrick MD PhD (via Tony Tobin):

FDA approval of ketamine coma therapy
From: Anthony Kirkpatrick MD, PhD
Sent: 13 October 2009 14:37:54
To:

Today, a physician in Australia wrote the following:

"I hope the FDA sees the light and approves the Ketamine coma therapy in the U.S before too long...good luck and keep up the great work."

My reply:

"In my opinion, the FDA will never approve a disease specific indication for ketamine such as CRPS because there is no patent protection and, therefore, no money to be made by a drug company in going through the FDA approval process for a specific disease state / diagnosis.

There is little financial incentive for the FDA to approve ketamine for a specific pain diagnosis without a drug company supporting the New Drug Application (NDA). More than 60% of FDA's budget comes from drug companies. Check this site out:

http://www.rsdfoundation.org/en/research.html

Thirty years ago, the FDA approved ketamine for a specific route of administration (IV) and dosage range up to and including general anesthesia to treat breakthrough pain regardless of the underlying disease state / diagnosis.

Forget about the FDA ----- it is not the solution. Third party payers (e.g., Australian, US Governments) are likely to reimburse patients for ketamine treatments with the publication control studies like those found here:

http://rsdhealthcare.org/PatientInfo/outpatient_ketamine.htm

It is unlikely that a study with an active placebo control (e.g. midazolam, fentanyl) conducted in the ICU will ever take place from an ethical standpoint given that ketamine has already been proven effective at a low dose for treating CRPS on an outpatient basis. Under this circumstance, how many patients with CRPS would volunteer to be intubated and mechanically ventilated for 5 days in the ICU with an active placebo instead of ketamine?"

A. Kirkpatrick, MD, PhD

www.rsdfoundation.org
www.rsdhealthcare.org

XXX Porn! Live, Totally Naked Women! XXX Porn!

Now that I have your attention...

One of the top ten subject searches that brings Virgin Readers to elle est belle la seine la seine elle est belle is "Laura Beckett."

Please note that she has nothing whatsoever to do with pornography!

In case you did not know, it's easy as pie to accumulate information about how, when, and from where people access an internet site, even such a humble one as this. The search information provides the occasional hint as to "why" you are here, too! So if you don't want me to know that it is you popping in, que c'est bien toi que est arrivé -- oh, just relax! I'm clueless and your anonymity is assured.

Really. I mean it!

I'll never tell.

Unless they beat it out of me. But even then, I'm not likely to remember.

Honest!

Anyway, I got to thinking [it happens, now and then]:

The last I "heard" -- through my own searching -- Laura Beckett remains paralyzed after her struggle with MRSA that began while she was in Germany pursuing the Ketamine coma treatment for CRPS/RSD. I seem to recall that she is currently in a rehab -- a situation that I hope is temporary. I believe she continues to require assistance breathing -- but I am not completely, reliably sure.

Indeed, we all send out hopeful, curative thoughts into the universe on her behalf.

There is a danger in the "I-read-it-somewhere" proliferation of information. Yes, I know I am participating in that danger -- I may even have a proprietary involvement, at this rate. But the serious searches that lead people to this blog most often pertain to some form of ketamine research, whether it be in Mexico, Germany, or in booster form within the United States, or to CRPS clinical trials.

I am sometimes moved to tears by the search terms -- the descriptive terms for the pain, most often expressed as burning, or as fire, itself; the unanswerable questions, safely posed when alone with a computer, usually about mobility, the loss of a job, of friends, of family, of sanity.

So if you get here by accident, by some haphazard search for new information about CRPS/RSD, please know that you are not alone, and that, as weird as this blog likely seems to you, it is the evidence of my effort to defy this disorder in as major a way as I can. I encourage you to curb your incessant searching and to turn, instead, to creation. You can safely trust that RSDSA, among other organizations, is more up to speed than you or I could ever be, alone.

And didn't Your Mama ever tell you not to trust strangers?

EDIT: My memory is not too messed up. The source of my tidbits of information regarding Mrs. Beckett turns out to be the August 10, 2009 issue of People magazine:

In October 2008, RSD patient and mother of three Laura Beckett, 47, of Magnolia, N.J., developed pneumonia while in a coma in Germany and was kept under for three weeks as doctors fought to save her. She woke up paralyzed from the neck down and now lives at a rehabilitation center. "It's an understatement to say things went wrong," says husband Karl, though he adds his wife's pain was so unbearable they would likely choose the coma again. Says Schwartzman: 'We've had tragic outcomes. But this is only attempted after every other treatment has been tried."

And that reminds me of two other thing I wish to stress:

**My profound respect for Dr. Robert J. Schwartzman, neurology chairman at Philadelphia's Drexel University College of Medicine -- and my gratitude on a personal level for his dedication to helping those living with CRPS.

**My belief that experiences with MRSA (and variations) can be had at any hospital in the world, no matter how clean, no matter how excellent. I do not know the particulars of Laura Beckett's infection. I understand, and am sympathetic to, the desire to blame some person, place, or thing -- but there is nothing good in that, beyond correcting whatever may need correcting. MRSA is a monster of our own creation.

Photo credit for Kitty Porn: Let's Talk Politics

More On Ketamine (Courtesy of the StudMuffin)

Courtesy of Jim Broatch, the StudMuffin of RSDSA (Reflex Sympathetic Dystrophy Syndrome Association -- an organization in need of a new name, if ever there was one...). Jim and His Fellow StudMuffins at RSDSA do phenomenal work for those mired in suffering now, all the while keeping their heads above water, their eyes on the prize of future therapies and happenin' research.

In fact, kiddos, the real "read" here is not this pitiful little article from People magazine (I mean, the magazine's editors *would* look at the most extreme and ill-afforded "therapy" out there -- forget the hundreds of thousands who have no access to it, or who don't believe in its claims, or who are just too far gone into misery... and co-morbidity. I rhymed!) -- no, the real read is in this link that Jim Broatch also provides, which is to legitimate information to help you make up your mind about the ketamine angle based on solid stuff.

To read up on my illegitimate posting on ketamine, much of it having to do with Laura Beckett and her sad odyssey, take a gander here. I promise it is all uninformed opinion. You're welcome.

All of that said, here's the gist of the People article, and best wishes to John Roach, its subject.

I love the title!

*** *** *** *** *** *** *** ***

This Man CHOSE to be in a Coma

After years of excruciating pain that drove him to thoughts of suicide, John Roach decided to gamble on a controversial new treatment-a ketamine-induced coma.

August 10, 2009
By Alicia Dennis
PEOPLE Magazine

John Roach looks up at wife Rosemary from his bed in room 133 at the Hospital San Jose in Monterrey, Mexico. "Don’t say goodbye," he pleads as doctors prepare to send the burly grandfather form Allentown, Pa., into unconsciousness. "It’s okay," Rosemary says. "Pleasant dreams."

Soon, deep in a coma, John descends into a frightening, topsy-turvy world. Scene: He’s in a strange house with paintings on the ceiling. Scene: He’s watching as his cat rushes into the path of an oncoming car. Scene: He’s a World War II soldier fighting on a blood-soaked battlefield. "It was weird and frightening," John recalls of his voluntary, five-day ordeal in late May. "But I needed to do something."

Suffering from a debilitating neuromuscular disorder called reflex sympathetic dystrophy (RSD) , John, 50, is one of about 100 chronic-pain patients resorting to a radical new treatment in search of relief-medically induced coma using ketamine, a surgical anesthetic and hallucinogen sold illegally as "Special K." advocates say ketamine comas can be a godsend for some. "We're giving people in excruciating pain a normal life," says Dr. Robert J. Schwartzman, neurology chairman at Philadelphia's Drexel University College of Medicine; since coma therapy isn't FDA approved, he's sent more than 60 patients to Germany and Mexico. But other experts say the treatment, which costs as much as $ 50,000 with travel, is too risky. "Vulnerable people are getting something expensive and potentially dangerous," says Dr. Norman Harden of the Rehabilitation Institute of Chicago.

Some 200,000 people suffer from RSD, in which ordinary pain escalates to crippling levels. "Think of holding a blowtorch to your skin," says John, whose entire left side was affected after he fell down rotted stairs and tore his rotator cuff in 2002. Because ketamine blocks pain receptors, Schwartzman says, very high doses can restart the nervous system, "like rebooting a computer."

Brandy Sachs, 23, of Christianburg, Va., had spent seven years in a wheelchair after a finger injury and ankle sprain spiraled into all-over agony. "I was giving her pain meds in doses that would have killed a horse," says her family doctor, Jeremy Freeman. Last fall, after undergoing a five-day coma in Germany, Brandy needed months of therapy to relearn how to walk, talk and eat. But now, she says, she's pain-free and plans to start her master's degree: "It's a miracle."

Not always. In October 2008, RSD patient and mother of three Laura Beckett, 47, of Magnolia, N.J., developed pneumonia while in a coma in Germany and was kept under for three weeks as doctors fought to save her. She woke up paralyzed from the neck down and now lives at a rehabilitation center. "It's an understatement to say things went wrong," says husband Karl, though he adds his wife's pain was so unbearable they would likely choose the coma again. Says Schwartzman: 'We've had tragic outcomes. But this is only attempted after every other treatment has been tried."

John, a jovial retired phone-company worker, had tried surgery, physical therapy and heavy doses of pain medication, including OxyContin, codeine and fentanyl. When nothing worked, he thought of ending it all. "I couldn't be touched," he says. "I couldn't hold my wife's hand or sleep next to her. It wasn't the life I wanted."

Back home now, John is amazed that he's been virtually pain-free. Getting regular ketamine booster injections (at non-coma levels) from his physicians, Schwartzman and Dr. Anthony Kirkpatrick, he has removed a protective compression sleeve he wore for years and can once again wear his watch and wedding ring. Best of all, he can walk hand in hand with Rosemary and scoop up his granddaughters for hugs. "I have been missing all the little joys in life," he says. "Now I want to live every one of them."

RSDSA: Information on Ketamine Treatment

P R U R I E N T ::: I N T E R E S T

I did not lie.

But my interest was prurient.

If I were to want a rhyme, The Oxford Dictionary of Rhymes provides me guidance:

prurient • abeyant , mayn't • ambient , circumambient • gradient , irradiant, radiant • expedient...recreant • variant • miscreant •Orient • nutrient • esurient , luxuriant, parturient, prurient • nescient , prescient •omniscient •

The meaning of "prurient interest" brings out the big guns, too, less interested in rhyming. From The Oxford Companion to the Supreme Court of the United States (2005):

Miller v. California, 413 U.S. 15 (1973), argued 18–19 Jan. and 7 Nov. 1972; PARIS ADULT THEATRE v. SLATON, 413 U.S. 49 (1973), argued 19 Oct. 1972, both decided 21 June 1973 by vote of 5 to 4; Burger for the Court, Douglas, Brennan, Stewart, and Marshall in dissent. Miller v. California articulates the test for obscenity that resolved the dilemma of First Amendment protection for allegedly obscene materials first identified in Roth v. United States (1957). Chief Justice Warren Burger's majority opinion stated that material could be obscene only if “(a) the average person, applying contemporary community standards, would find that the work, taken as a whole, appeals to the prurient interest; [and] (b) the work depicts or describes, in a patently offensive way, sexual conduct specifically defined by the applicable state law; and (c) the work, taken as a whole, lacks serious literary, artistic, political, or scientific value” (p. 25).

I did not lie. I did not tell the truth. My interest was prurient. And I don't want to make a poem with "prurient" as my major rhyming scheme.

Okay, I will tell *you* the truth.

On March 16, I sent the following email:

hello,

you don't know me -- i just saw the message you left on andrea's myspace page. i have crps, too, and had just discovered her fighting4us site when she died down in mexico. you surely don't have to answer this, and perhaps you don't even know yourself -- but what happened? i have been looking into the ketamine coma treatment -- but now that someone has died in connection with it, i don't know anymore.
can you shed any light on whether or not it was the treatment that harmed her or was this just CRPS/RSD doing its dirty work?

sincerely,
the retired educator

How dare I intrude on the death of this lovely girl? Why can't I leave it -- her -- alone, in peace? In part, it is because of the evident lack.

There is nothing but silence around this death, hardly anything beyond the barest of acknowledgements.

Or the most private of them. The nearest and the dearest. And to them, I apologize -- no, rather I beg pardon, for this prurient interest -- not in Andrea, but in what happened *to* Andrea.

The ketamine coma trials... that is what we are made to say, you know -- "the trials."

How many other legitimate "trials" cost well over $50-60,000? How many other legitimate trials cost ANYTHING?

How many other legitimate "trials" suffer a death and allow it to pass into silence, unexplained?
There has also been a high incidence of infection, particularly respiratory -- aspiration pneumonias.

Oh, and how many "trials" make way for someone to repeat the treatment, the benefits of the first time around apparently not having lasted? How was that expressed in the data collection of the second coma? Was the first treatment before the days of the "trials"? You know, back when a person basically only had to produce the money, and be sufficiently young and healthy (beyond having CRPS)? Wait... am I getting it all confused? Because it sure seems like today's requirements are eerily... no, *exactly* the same -- young, otherwise healthy, cash in hand.

My prurient interest has its roots in anger and envy -- as well as in a more legitimate need for information that was not forthcoming from those running the programs. Andrea was getting a second shot at curing or, at least, pushing into remission, her CRPS -- and at a point in time where there is a 2-year waiting list.

Anyway.

I read everything that Andrea ever published on the internet concerning CRPS. She was dedicated but had bought into the demonization of the disease -- it was an actual evil entity to her. This happens in people with CRPS -- because of deleterious effects to the limbic system of the brain? Because of simple human frustration? What can you trust when your own body systems do nothing but lie to you? She cared, and was ferocious in her caring. And she was naive. Childlike.

Her friend wrote me back just this morning.

hi, sorry it took me some time to get back to u ,, i dont check this email offten,.. ok what happend with her was,, from birth she had a bad heart, when she was younger she had surgery to fix it, but with any heart problem eovn if u fix the prob u still have to watch it,, this was her second time getting the ketamine comma treatment done... the first time was great, no probs or issues,,, this last time though, after menay years of fighting, she was 12 when she got the rsd, and died at the age of 24/25 , and all those years of fighgting and medications and the rsd itself, her heart jsut couldnt handle any more and gave out on her... so it wasnt exsactly the ketamine that killed her, it was a combo of evry thing and honestly we all belive evon if she hadnt done the ketamine, she would have died shortly ,,, most people dont realize 1, cause its sugar coated and not spoke about much, 2 doc really dont have any clue when it comes to rsd, unless u haev one that specializes in it, 3 alot of people dont want to belive it and rather live in denighel... rsd can and for the most part the longer u have had it for the more likely it is to happen... effect your internal organs. ive had my rsd for about 3 years now.,.. and its effecting my heart. ive seen the same doc she was seeing.. and he jsut said i haev very agressive and advanced rsd.. and that most likely the ketamine coma wouldnt work for me, but dosnt mean i shouldnt at lest try it.. i have 2 other friends who have done the ketamine infussions. 1 it did nothing for the other it did help almost 90% at getting ride of the pain.. but about 9 months later shes back to as if she never had the infussion... pls dont let the idea of death scare u away form any ketamine treatment...
jsut like the meds we take evryday to help treat our rsd. theres no garentee ur not gonna die form it.. jsut like rsd itself,. in the end it attacts ur own immune system form it and at that point well, its up to u and god... so pls dont let a death scare u/.. rsd isnt easy its scary and not fair and evry miss understood.. the ketamine treatments should not be taken lightly, but nore ignored becuse there have been a problem here or there. rember there were other outside sercomstance that played a role in her dying...
what i tell people who are wanting to do the ketamine treatments but are scared is
u have to stop and ask urself. r u to the point of death as far as taking ur own life in your hands, becuse u have tried evrything ealse possible and nothing has worked, and the ketamine treatments r the last thing, u have left to try.. and if ur answer is yes.. well then u have to make peace with the idea that, this may help it may not, its not 100% safe, but yet u could get hit by a car infornt of ur house in the moring.. also.. if ur about to take ur life becuse the pain is that bad and nothing has worked, really what other option do u have.. than trying ketamine treatments and hopeing for the best, knowing theres a possible risk, or jsut saying nope im giveign up not doing anything more, go into a big depression and kill ur self

2, if u have answerd no to the question., dont do the ketamine treatments, 1 there not coverd by insurance, cost a lot of money, its like a last resuslt thing. evon though it has had the best results, its still a last result. do each and evry other treatment recomende for rsd first evon more than once before trying the ketamine,, sometheing less shocking to the system is always best.. when u have done all the treatments and nothings worked, then that is when u go for the ketamine treatments,,,
i hope this has been helpfull, i dont know how long u have had ur rsd, were it is and how old u are,,, along with what u have tryed and havent for treatments, ive in a way become like a master at knowing rsd and what it dose and and wht can be fdone for it, seeing as my rsd in only almost 3 years is now infected over 50% of my body.. ( liek doc says i have very agressive rsd, apprently its more rare thann rsd, i dont know i jsut know its bad and suckslol) maybe i may beable to help u, with advice things to try, or simply just some one to talk too


this last time though, after menay years of fighting, she was 12 when she got the rsd, and died at the age of 24/25 , and all those years of fighgting and medications and the rsd itself, her heart jsut couldnt handle any more and gave out on her... so it wasnt exsactly the ketamine that killed her

Mercy. Oh, mercy me.

I wrote and thanked her, my prurient interest gone absolutely cold dead.

Fingernails on the Chalkboard

It boggles my blogging mind!

In an effort to find out how Laura Beckett was doing -- the woman who was "trapped" in Germany after contracting pneumonia and systemic MRSA infections on the second day of a week-long ketamine coma designed to treat her CRPS -- I started looking around various CRPS/pain forums. It's always disruptive to me to read the commentary of ordinary people. It scares me to death.

In an intellectually challenging discussion of the ketamine coma trials and protocols, Dylsierra writes, using a great big font and with a cute bunny and an adorable bear:

"HI Michelle,
I agree with you and Jojo!
I think that Jojo is soo right when she says that [the ketamine coma treatment] is not approved here for a reason. What the reason is, well, i don't know but it is something!!!"***

The response to Dylsierra's on-the-road-to-Damascus insight? Read on, McDuff:

"Very True!! Very good point!"

Oh, God, take me now.

These groups are everywhere and are as promiscuous in The Willies they inspire. I used to believe that GroupThink was something to fear. And then I found its opposite, and The Truth set me free.

***The reason? The FDA does not recognize coma treatments that go beyond 3 days, and the ketamine coma requires 5-7 days for effective dosing. The agency HAS approved "awake" (subanesthetic) ketamine infusions but these have proven much less successful than the full course of coma therapy, followed by "boosters." Whether or not Mrs. Beckett's complications have caused a change in the work in Saarbrucken, I don't know. I tend to hope not, since complications from MRSA are not necessarily an indication of poor standards or more risk than one would have in any ICU the world over. Some apparently unbalanced people have written that Beckett died subsequent to her return to New Jersey -- I can find no proof of it, and these folk seemed to have an agenda that included shutting down this promising avenue of research, as well as denigrating Dr. Schwartzman and Dr. Kirkpatrick, personally and professionally.

I also cannot find any more information about the tragic death of Andrea Lynn Gianopoulos, who was to undergo her *second* ketamine coma, this time in Monterrey, Mexico.

My neurologist, a great fellow, almost begged me to not participate in online CRPS "support groups." That is like telling a toddler not to put a bean up his nose -- but it proved to be excellent advice.

Keep in your life

"Try to keep into life. Don't give up. Keep in your life.

It is destructive to give up."

-- Dr. Robert Schwartzman, re: best defense against CRPS/RSD

The Ketamine Coma Chronicles

Back on January 26, I made my initial post about Laura Beckett and her predicament, followed on February 1, by this. Beckett contracted MRSA pneumonia that apparently went systemic while undergoing the ketamine coma treatment for CRPS/RSD in Germany and then, wanting to return home to be treated for the infection, struggled to find the means. She is back and, I assume, having heard nothing attesting otherwise, is doing okay. The whole affair ended up sounding ridiculously litigious.

At the time, I was irritated by things people were writing in response to her unfortunate battle with sepsis, things that were inflammatory and needlessly critical, I thought, of this promising experimental treatment. Given that I battle MRSA myself, and have learned how pervasive it is, the uproar about the quality of care in Germany seemed directed by the lowest common denominator, that of playing meanly on people's fears. I have long been an admirer of Dr. Robert Schwartzman's work in the field and harbored an unrequited desire to undergo the protocol myself.

The only thing that bothered me, really, was a strong sense that the extensive waiting list might be driven more by financial bottom lines than by intractable pain. It is pure jealousy, I suspect. So what if some of the patients undergoing the ketamine coma are "only" afflicted in one leg or one arm and one leg... and that only for a few years. So what that they seem to be born into a family of relative means? There are also a fair number who got there by fundraisers and prayers... So what that some of the coma patients are undergoing the treatment for a SECOND time?

So what that I have been suffering since May 22, 2002, and now have this crappy, shitty syndrome in "all 4s" as well as in part of my face?

So what that I am not brave enough to take what money I do have and apply it toward a potential cure? So what that I am apparently in not enough pain to do whatever I can to alleviate it?

Now there is news of a death on the Mexican front of coma research, that of a young woman undergoing a second attempt with the regimen (her first in Germany), a young woman who spent much of her time helping others with CRPS. That doesn't make her death any more tragic, it just makes it terribly emblematic.

Informed consent lies at the heart of the whole mess, of course. No one has ever made the claim that allowing yourself to be put into a coma by use of a drug with inherent dangers is not without risk to life (I would say "limb," too -- but that's kind of ridiculous, in the case of CRPS). The risk of infection and, particularly, of pneumonia, has been explained with perfect transparency.

I am now going to write something that makes me gasp at my temerity: I believe that the work being done in Mexico is seriously flawed. Not in its science, for I am not qualified to make any such judgment. But in the way it goes about promoting itself... there is something smarmy about the slick brochure style of recruitment. I get the impression that the testimonials and videos
-- typically made by attractive young white women of means -- are there to gloss over the sense of risk and danger that might make someone definitively pause.

Still, innovators in any field tend to be charismatic and what seems questionable to me is just as likely to be simple optimism and confidence. Schwartzman and Kirkpatrick obviously care deeply about their patients, would never put them in a situation of untoward risk, and are hardly responsible for these recent negative outcomes. Even so, the fallout will not be kind and the criticisms may be impossible to answer due to their foundation outside logic. It had to happen sometime.

Andrea Gianopoulos

There seems to be a theme to these final days of February: Things that should not happen, that are not in the proper order of things -- things that weren't covered even in the small print of the contract.

Tony Tobin of the U.K. runs a Yahoo! health group that is information only about CRPS/RSD. He waxes and wanes as to when and what he posts. January saw only one message -- but February has been a flurry of activity. He doesn't judge the material he passes on although it is evident that most of it has passed through his savvy intellectual filters. He does not have CRPS/RSD but watched and learned and then became a virtual sponge for knowledge after his granddaughter was "afflicted."

So that's Tony.

He knows, it sometimes seems, everyone in the CRPS/RSD "community." He posted his 17th message this month about one of those people.

It is with deepest regret and great sorrow that I post this obituary. I have known Andrea and her family for many years and I am finding it hard to find words to express my feelings. So for now please just accept her obituary as my way of saying 'God be with you.'
Tony

Cutting through the blither-blather, here is the part that matters:

Andrea Lynn Gianopoulos

Andrea Lynn Gianopoulos, 26, of Lancaster, died unexpectedly on Wednesday, February 11, 2009 at Hospital San Jose in Monterrey, Mexico.

Andrea also moderated a Yahoo! health group, fighting fire with fire (and founded one other, of which, I think, she was the most proud --Fighting 4 Us ). In February 2008, she wrote a welcoming note:

Hey everyone out there in RSD land! I wanted to sent out the first
email of this group to get things going. I know there aren't a lot of
people in this group as of yet, but I want you guys to know that you
can invite ANYONE you want! The more people who know, talk about, and
read information on RSD, the better. So get talking people! Advice,
jokes, interesting news, WHATEVER! The more emails the better too!
Alright I'm going to get going but I will be here as your happy
moderator, ready to answer any questions or concerns. Till next time,
keep on Fighting!

Your happy moderator

Andrea

I am not proud of it but groups like this one are as fingernails scratching on the blackboard. In general, I believe that people in the kind of diminishing-to-the-self constant pain that folks with CRPS/RSD live with should not gather in groups greater than three, and probably should be supervised. Ankle bracelets. Muzzles.

Nothing good can come of the congregation of either drugged out Pollyannas who believe in silver bullet cures (One day, they'll find the cure for this Beast, this Monster! Fight on! Rah! Buy a bracelet! Use Epsom Salts to draw out the poison! HBOT! Sign a petition! Use lots of exclamation points and emoticons!) or bitter bitter sufferers who are not yet resigned to their intractable pain. They curse a lot, threaten suicide, and emotionally blackmail everyone in the group. Eventually.

It's sad and I see it happening in almost all CRPS/RSD support groups. This may be silly, but I have some tonal and linguistic red flags to which I try to pay attention: "scripts" instead of prescriptions, "perks" instead of percocet, spread of the urban legends about the purportedly high suicide rate among "RSDers" (many doctors contribute to the myth, unfortunately, including one of the foremost experts on the disease, also the balletic and oft interviewed doyenne, Cynthia Toussaint, now predictably stricken with fibromyalgia.).

Choo choo! Toot toot tooot! Derailed train of thought, once again.

I, The Retired Educator, do hereby lay claim to the Fog of Anesthesia, in the name of Isabella and Ferdinand, Catholic Monarchs of a united Spain...

Another of Andrea's final posts is so typical of the harried sense of anxiety that chronic pain creates, as the days' sufferings accrete and fold, fold, fold over and into themselves, like air into a delicate batter. What? I can't help it... the Food Network is on.

She sounds like such a sweet young lady, determined to help anyone she can, but a bit lost, too. Her train of thought is about as clear and straightforward as mine. Her expressive style reminds me of a recent blog post by the Doc at Ten out of Ten, wherein he classifies patients by their communication acumen. Thus far, he has exaggerators, ill-depicters, stoic [doods], vagueurs, wanderers, hystericals, no/buts, and the positive-review-of-symptoms.

Choooo! Andrea paid no attention to the perils of internet overinvolvement -- perhaps she had never been burned or taken under the bridge and beaten by trolls; Could it really be that she was just unwaveringly good, unspoiled, a true optimist?

Hey everyone,

Yesturday, I got a message from a man who really wants our help. I
will not tell you his name, but I will tell you that his girl friend
is really...REALLY bad off. In the first email he just sounded
angry, and said that the local group he belong to didn't help. At
first I thought he was saying he was in pain and it was my group
that didn't help him. I sent him a rather abrasive email reminding
him that if they were saying it was my local group, that I needed to
know who was taking the name of Fighting "4" Us and just using it to
their benifit.

Well he emailed me back. He told me that it wasn't my local group,
but that it wasn't good for her. He said this was for his girl
friend and he was just trying to find help. He said her PCP has
dropped her, and for some reason her doctor won't perscribe more
scripts. She has thirty days till the script runs out and you all
know what that means. She's going to go through major withdrawl, and
is already talking about suicide. I can't tell you the man or the
woman's name, but can you all do me this: remind me where your from?
If you're close to their area maybe I can get them to talk to you.

I suggested that she join this group, but that was in an email I
just sent so I don't kow if it will help. Just tell me where you
live and I'll see what I can do. Because we want to help our fellow
RSDers...right? Thanks all and I hope to hear from you soon...

Your always fighting moderator,

Andrea

Do you remember her obituary, way up above this word mess? Do you remember where she died? Yes, that's right. At San José Hospital Technological of Monterrey, Monterrey, México.

The research being conducted on the ketamine coma is taking place primarily in two places: at the San José Hospital in Monterrey, and Saarbrueken, Germany. Recently there was a mild uproar over a patient septic from MRSA (began as a pneumonia, which is pretty common in the treatment, but -- being MRSA -- didn't respond to antibiotics, then went systemic) -- that was at the German site.

Now we have this in Monterrey.

I'm just sayin'.

Because of the infections I have developed over the past year and a half, I had to drop the notion of either getting an SCS or a "pain" pump (intrathecal pump) or going for the gold and attempting to get on the ketamine coma waiting list (word is that it is a 2-year wait at present). Now, of course, I see horror-stricken faces when I broach the topic to my doctors -- the very idea that I would want to introduce more foreign bodies that might invite bacterial colonisation appalls them.

And my rumblings about the coma? They never really took me seriously. The sepsis of one patient and the death of another may be the death knell for this research.

And I don't know how I feel about that. It has been touted as a possible cure, and I believe 14+ people have gone into longterm remission. Here's a short blurb about it that I pulled from the informed consent paperwork for folks considering hopping on an air ambulance and flying off to Mexico:

The purpose of this research is to find out if an anesthetic called Ketamine
helps in the treatment of the Complex Regional Pain Syndrome (CRPS)...

If you agree to be part of this study, you will be given two drugs: Ketamine and
Midazolam that will put you to sleep. You will be asleep during five days by
means of continuous infusions (a quantity will be given continuously but slowly)
of these drugs. At the end of the five days the drugs will be stopped and you
will wake up. After the treatment you will take several tests to see if the
treatment worked completely, partially, or not at all. You will have more tests
every certain number of months during two years in order to observe how long the
effects of the treatment last.

On January 18, 2009, Andrea wrote in her MySpace blog:
Well as many of you all know by now I will not be going to Germany in February, but I am going to be going to Mexico! I will write in here and at the Fighting "4" Us myspace site (www.fighting4us.com) about it as much as I can, and I should have wrote in this more, but there was so many feelings, so many things that had to be done, so many things to think about that I just didn't have the time or energy to come online and work through this. I was working on Fighting "4" Us stuff, however, but more behind the scenes then anyhing else. But OH how wonderful our site will be when I get back. There will be places for members to come on, it will have it's own blog....But that's just a preview of all the good things that will happen. But for now, some thoughts on going to Mexico. When I first found out that I would be going to Mexico, and when, I was overjoyed. I'm still overjoyed....but now the fear has set in. I have so many things I want to be and do...I have an entire list of them. I'd rather not take up so much room now, but when I start to check them off (and I will) you will hear about it. I'm just "a ball of nervous" as someone I know said. I guess that's all I have right now. Blessed be!

Someone has posted a banner on her MySpace page that reads: "Andrea doesn't hurt anymore."

Bless her heart.