Monday, February 15, 2010

the one where i break my leg...

hi there, sports fans! as usual, you will just have to trust that i have scintillating posts in the works for My Dear Readers.

in fact, on my list of sixteen things to do this week, item number sixteen reads: "kindly finish the two scintillating blog posts that you have on deck" -- {that'd be the requisite sporting terminology}.

la bonne et belle bianca castafiore is driving me and fred nigh unto insanity due to her obsession with all things "Jeux-O." last night, we caught her chatting online claiming to be québécoise, d'une vieille famille acadienne. she is a riot, though, when she affects the accent, when she really puts her prodigious nose into it.

plus, it is fashion week here at Marlinspike Hall, just as it is in the greater world of haute couture. for The Castafiore, though, its purpose serves a greater urgency, that of preparing her outfits for March Madness and College Basketball viewing. sports and fashion go hand-in-hand.

[you may recall "The ACC Semis," from last March:

"La Bonne et Belle Bianca Castafiore is decked out in a bold, strapless, beaded animal print (specifically, leopard), her considerable self poured into the sweetheart neckline whose décolletage is set off by rhinestones, the fitted silhouette amply accenting her curves, the mid-thigh slit in the front allowing the bright orange lining to flash like a stroboscopic lamp. She is plopped next to me on the bed, rounding out her come hither look with a pair of orthopedic alpaca fuzzy slippers.

During the first semi-final, she kept up a steady effff-ah you! effff-ah you! -- despite my efforts to turn that into the more accurate chant of FSU! FSU! Eventually, The Castafiore burst out of the lace-up corset that constituted the back of that safari prom dress. She's been pretty quiet since."]


you sweet folks deserve an explanation for the dearth of original posting here at elle est belle la seine la seine elle est belle. lacking that, here is what i ranted just a bit ago to some acquaintances at my favored fetish site:

good morning! i am frustrated. that's the extent of the rant, really.

oh, why am i frustrated?

in a previous rant, i explained that i have crps in all 4 limbs + the lower part of my face -- i also have severe avascular necrosis pretty much everwhere thanks to years of steroids for lupus -- plus there is that pesky osteomyelitis in my shoulders (and probably one knee, too). are you up to speed? basically, my bones suck. sometimes they rot. sometimes they fester. and... very often! they break.

i fractured my tibia saturday morning. it was a brilliant moment. i am wheelchair bound (sniff, sniff) -- it's a power chair because i cannot use my shoulders, i mean, my fake shoulders, to self-propel. i was already doing what i am not supposed to do --i was rotating our mattress.

now, i keep the thermostat very low -- as in 58 degrees. so we don sweatshirts and sweaters and are just generally swathed in layers of fabric. i try to keep the various sleeves carefully rolled up, so as to avoid accidents.

what kind of accidents? ohhhhh, the kind where your sleeve catches on the "joystick" of your power chair and drives you willy-nilly at high speed into the METAL bedframe. not possessing intelligence, the chair continues to push, push, push until the idiot driver manages to smash the OFF button in between screams.

i love the various sounds of the erupting zit: schlurp! pa-pa-pop-splat!

i HATE the sound of a bone breaking: ccccc-r-aaaa-ccccc-k.

given that it was, of course, my right leg, the one my doctor suggested amputating back in november (?), the increase in pain is practically meaningless. going from a steady pain score of 8/10 to 9/10 just doesn't mean crap, y'know? i mean, what am i going to do, take more pain medication? i don't think so.

before crps, when my bones broke, i'd surround the offending skeleton with ice. after crps, ice is contraindicated.

so we sat around and watched it swell and change colors. more fun than a movie and popcorn.

and we discussed how annoying it was that my health insurance is no more. yes, i called the medic and my doc wanted it splinted right away. i knew he was going to say that, so we had already launched an expedition into our Orthopedic Supply Closet, crammed full of boots, splints (cloth and metal as well as air), velcro, exercise bands, a collection of walkers, canes, and wheelchair batteries. thanks to dislike of organization, there were also bedpans, tennis rackets, gallons of biofreeze and betadine, bendy shoelaces (back in the day, i used to wear shoes), and a few embarrassing romance novels.

my leg, though, had decided to swell quickly, too fast for the application of a splint.

PRAISE THE LORD, because if i cannot wear a sock on my feet due to pain? i surely can no longer tolerate the pressure, touch, and weight of a booted splint.

so, no weight-bearing is the rule, also the joke, as i cannot abuse that left leg either, and cannot use any type of crutch -- for those exciting trips of 15-20 feet to get from bed or chair to the bathroom.

whew. okay, thanks, y'all. i feel better. everytime i think, "oh, fuck, i *cannot* do this..."? it works itself out. not to say that i don't sometimes look forward to the day when i truly will give up! no time soon, no time soon.


wow, heavy-duty self-pity.

the good news is that having vented, i do indeed feel better.

news that you may or may not consider "good," i think i have it in me to write again. the problem is finishing. getting it to the point where it won't be a total embarrassment if viewed by others.

you dig?

Re-post -- Medical Bloggers: Touche Pas A Mon Pote!

J'ai passé une nuit blanche... during which I found myself missing Nurse K and her now defunct blog, CrassPollination. I hope that it, like the Phoenix, will rise from the ashes, or at least become available in some other format. Ummm, like a book -- that'd be cool.

Anyway, that led to laughing at my various references to her fine anecdotes, and my virgin shock at the âpre, biting depictions of the dread Problem Patients and the manner in which the well-raised, polite ED nurse reacts to them.

I don't know exactly why my dander was all up, back in November of 2008. By then, I had had the second of six surgeries, was not able to sleep at all (to the point of true toxicity), and was in the kind of pain that births dreams of loaded guns. I also had really just started to read medical blogs with any sort of attention. Okay, yes, I also had begun to hear the dreaded "ewww, you're a complicated patient, aren't you?" Add to that that I was a licensed, charter member of the Annoying Chronic Paineurs, and yeah, I might have been a tad bit touchy.


A hard time, to be sure, but I'm not the kind of person to project my issues onto someone else.

Cough.

Anyway, when I am feeling all righteous and stern, these medicos piss me off. When I am thinking straight? I am oh-so-grateful for each and every one.

*In deference to my broken leg, I am not going to make my damned fingers waltz around to see if the links in this repost remain in effect, and accurate. Do it your own self!

Cough.
Sniff.




"Touche pas..." has long been a favorite saying (and message) of mine. Indeed, I've always wanted the T-shirt. But how to explain to someone unfamiliar with both the situation and the language what it means? I had never googled it -- oh, the amazing act of googling! Anyway, I found this short passage, which does a pretty nice job of it (though the lack of an accent puzzles me -- why get something almost right?):

A Powerful Political/Social Sign: "touche pas a mon pote"
One of my favorite social-change campaigns of all time came to my attention recently when I saw it in the background of a film shot in Paris.

It's the ubiquitous yellow hand of the French anti-racisim organization SOS Racisme, which travels the French visual landscape coupled with the phrase "touche pas a mon pote," which translates roughly as "don't mess with my buddy."

The straight-ahead everyday slang of the phrase in French --- it's literally what one would say in a street confrontation --- and the powerful yellow hand have always been a model for me of really understanding both the potential audience for a social change initiative and the moment of decision the designer/strategist is trying to influence. This is what you say to protect a friend, and the implied strength-in-numbers and the sense that "we are watching you" and holding you up to social shame makes the slogan an absolutely brilliant piece of writing.

In an earlier post I quoted science writer Daniel Goleman on research showing that the more someone is perceived to be "like me" the more our empathic brain circuits are activated.



My name is Retired Educator, and I am addicted to medical blogs. (Hi, Retired Educator!)



I am one of those barely-there people. If you sneak a peek behind La Belle Bianca Castafiore's considerable operatic girth, there I am, ensconced in this drafty, ancient manor with my darling, but essentially clueless, Fred, and with the real brains behind the outfit -- the Felines.








Once upon a time, I was -- sniff -- a rising star; More importantly, I had considerable fame as a clothes hound and shoe afficianado. Chronic illness and pretty severe daily pain has reduced me to unknown status, and my wardrobe to oversized organic cottons, with the occasional silk and linen blend, all bearing the satanic marks of elastic and screeching velcro closures.









Sleeping became difficult, and it is not an exaggeration to say that the rising sun became an emblem of survival. The computer, and its incredible access to almost anything one can dream up, was a great tool to wield in the middle of those long nights. I was a member of several online communities of people who were also in pain, who were suffering from the same acronyms. Boy... was that depressing.









One 3 am (apparently, the witching hour), I was searching for information on a medical test that I was about to undergo -- something that doctors just adore -- and my googling returned a hit that turned out to be transformative. I had never before ventured into the blogosphere, thinking it a "place" for only the Smarmiest of Smarty Pants. I was ill-prepared for the pleasant shock of reading this acerbic nurse's blog. It beat the hell out of the navel-gazing and shrill cheerleading of the online support groups.

And so it was that Nurse K's blog, Crass-Pollination: An ER blog (ED if you're... oh, never mind), was the first medical blog I ever read. Medical blogs helped me get through some of the long nights that were already medically oriented, anyway -- and intense. It's much better to laugh than to cry -- and infinitely better to snort-laugh than to weakly titter. Nurse K supplied lots of those snorts, although I now regularly read a good dozen other medical blogs that are equally entertaining and informing.







These medicos are intelligent and creative people, turns out. For whatever reason, blogs maintained by Other Liberal Educators proved... unsatisfying. And so, I was hooked.

I never expected to learn some of the things that I have, however -- mostly things pertaining to intense professional frustration. There are a host of other nominatives that I sometimes would like to apply but won't. Probably. Well, maybe. We'll see. As I said way back in the beginning, whose blog is it anyway? That snappy-snippy attitude, and that respect, is due every blogger. Well, not every blogger. Well, maybe. We'll see. Cela dépend.

(Please recall: I am the prof who declares that "Yes, there *are* stupid questions, just as there *are* stupid students. That said, I never doubt my own ability to salvage all students and most questions. It is called getting to the heart of the matter.)

It turns out that learning what particularly challenges [blogging] nurses, doctors, and other health-related workers has impacted my interactions with those self-same people in my life. In some ways, it has been marvelously helpful -- mostly, it encourages me not to blather on and on, as I tend to do when not feeling well. I need to be an efficient, honest, and straightforward patient, since I expect as much from the people trying to help me. I now don't provide much in the way of information that is not pertinent to whatever the specific situation might be, and I do not ask for things that I might have in the past (mostly creature comforts -- a blanket, a pillow -- but also that meal that never came, or the medication that never arrived).

Unfortunately, the thing I learned most was fear of these people. Before anyone flies into some sort of fury-driven arrhythmia, let me qualify that use of the word "fear." It is the same fear that I experience when driving near speeding, lane-hogging, long distance rigs on the highway-- and it feels like a prudent response.

These [blogging] doctors, nurses, et al, are not malevolent, and they would not purposefully hurt anyone in a lasting way. I believe, however, that a small minority *does* intentionally inflict temporary pain -- they confess it, and they confess it with a certain amount of very disturbing pride. Of course, there will be a complete disavowal -- instead, my lack of humor will be suspect, or my intellect (more likely my worldliness, or common sense, saying, "Jane, you ignorant slut," to which I can only say, "Dan, you pompous ass...") Shoot, we all recognize the urge and understand it -- but acting on it? Oh, what are the words? Hmmm. Oh, yes: wrong and amoral. Criminal?

Faced with an annoying waste of time that is a woman faking a seizure, the response is:
I head to the cabinet that holds the STAT 16 Fr Punitive Foley Catheter, and Nurse Tinkerbell heads for the cabinet that holds the STAT 16g Punitive IV Catheter.It's called a "16 Squared", and it's the first line treatment for ODs and fake seizures.

[The whole entry itself is totally hilarious, and I am a great fan of this particular blog.]

The punitive foley and i.v. catheter are tame examples, really. Maybe what is most disturbing is that I have no difficulty believing that this sort of thing, and worse, happens. I guess it is not supposed to matter because no lasting damage is done, or the patient is presumed too stupid or "crayzee" to ever know.

And, it must be said, in this election time, that there are systemic cruelties that no human can match -- the idiotic aspects of EMTALA law, the medication too expensive to be had, the follow-up care that just won't happen, the dumping that has never really stopped (go ahead, challenge me on that, I dare you. I double-dare you. I will name names!).




Abuses? Good God, I don't know how health care professionals (I am thinking primarily of the ER/ED environment) maintain any semblance of a good attitude in the face of all the social ills that masquerade as physical or mental health emergencies. I imagine that almost everyone they see is at least a dual diagnosis. Despite this terrible complexity, they are called on to treat the presenting symptoms, the presenting problem -- but the background of addiction or some other chronic disease invariably creeps in to complicate the visit. It takes a lot of disciplined skill to keep the "emergency" visit on an "emergency" track.

In the blogs about emergency medicine, you will read stories of women wanting pregnancy tests or ultrasounds at 3 am -- after arriving via ambulance, no less -- and tales of homeless people who want something to eat (a sammich) and a place to sleep. Drug-seekers are an enormous drag on the general goodwill and dealing with them daily may well be enough to tarnish even the finest of attitudes. These folks are usually allergic to all medicine except opiates, and attempt to steer their treatment straight toward the drug they desire. WhiteCoat, who rants at another insightful and entertaining blog spot, tells a story respectful of all comers: "Drug Seekers Suck." There are *countless* number of blogged posts generated by the frustration of dealing with drug-seekers -- would that that provided something beyond temporary catharsis.



Most professionals worth their salt know frustration -- if they don't, they've chosen a niche of safety, more power to them. What said professional chooses to do with that frustration, however, speaks volumes.

Moi? In the built-in cabinets of the Ivory Tower, I kept a stash of amazing weaponry to throw at students, although chalk would always do, in a pinch. I converted every departmental or university-wide insanity into a reactive act of pique, usually in the form of a scathing letter -- or, if the matter were truly weighty, a collective effort with colleagues. Maybe a sit-in, or a huffy petition. When the problems were "emergent," so was my response. When the issues were more some systemic form of illness, working toward a cure required much, required deep study, required patience. Of course, I understand that an academic or intellectual emergency does not really matter, in that grand scheme of things, in, cough, the order of things. Except for two specific instances*, life itself was never in question -- although divestiture from South Africa did seem to matter... Blogging medical professionals, par contre, exist within a world of pain walled off from the rest of us. Not unlike an abscess. (Sorry, that came unbidden! But, really, how true! A good incision and drainage might be just what a doctor might order...)



And like the whining teenager, there's no way [we] could ever understand.



It must be very wearing to deal with the people who are inappropriately demanding the considerable medical talents of an emergency department. You don't have to follow many medical blogs before the problem list is set: people on Medicaid, the uninsured, drug-seekers, people with chronic pain, fibromyalgia, headache, homeless people, alcoholics, addicts, and general dirtbags who don't appear sufficiently grateful for the ministrations received. Just looking at the list is enough to make *me* sigh with anticipated fatigue and frustration. What can I say? I am a real fan of the genre and of the brave people driving the narration.



Then, it happened. Nurse K put me on the list. Oy! There it was: reflex sympathetic dystrophy (the inaccuracy of the name continues to be perpetuated by both sufferers and medicos alike -- nevermind that sympathetically maintained pain is not necessary to the condition, or that it does not include causalgia -- because CRPS is just too unwieldy to say!)



Anyway, this is the entrapment post in question:

CRAYZEE NOS
52 y.o. female with a past medical history of something like:
Fibromyalgia, chronic pain in other conditions, anxiety, depression, panic disorder, bipolar II, hyperventilation syndrome, cyclical vomiting, restless leg syndrome, reflex sympathetic dystrophy,IBS, endometriosis, L4-L5 "bulging disk", bunionectomy
AND
CABG 6 months ago....

...presents with "chest tightening". In the last month alone, she's had five negative chest-related work-ups including a clear cardiac cath.

Geez, Crayzee, why'd you have to have that CABG on there? Now we have to treat you like a real patient.



As part of the banter that appeared in the comment section following the post, Nurse K had occasion to write: I think all crayzee, anxiety-mediated diseases and "pain out of proportion to exam" complaints should just be lumped together under this ICD-9 code.



I often wondered how people with fibromyalgia felt when they were under attack. Now I was in the same position, and it pissed me off.



For all of five minutes! For what use is anger in the face of ignorance? And since stamping and stomping ouT ignorance has been the calling of my life... surely this would qualify as one of those euphemistic "teaching opportunities"!



Well, no. I don't have the energy or -- after that terribly uncomfortable aforementioned five minutes -- the desire. No, once again I come away convinced that these people are dangerous (and I hear the explanatory retort of 'we are just venting... we're professionals but we are also only human... we'd never say these things to patients or act on them...').



How much do you think it would blow these med bloggers minds to learn that they are teaching the public to second guess and seriously doubt their capacity for satisfactory treatment and diagnosis?



Of course it must be reiterated that the offending, offensive bloggers are a small minority, and I wish I were less thin-skinned, more able to "consider the source." Shoot -- it is illuminating just to remember the traits likely to a blogger to begin with! There is a need to be right, a desire to pontificate, a hope to be known -- just as there is knowledge to share, experiences to detail, and much fun to be had. And so it is that I remain enamoured of these talented people and the incredible tales of humanity they have to share, and wish the medical bloggers the best.



But always remember, and never forget: Touche pas à mon pote!



*Two students of mine, both Freshmen, turned in suicide notes as homework, and in so doing, cemented my rapid-turnover grading habit forever. Thankfully, both students lived; Sadly, they both had to drop out of college, though I am sure they returned -- both were phenomenally gifted.

Tuesday, February 9, 2010

Palin: Are Her Bumpits Too Tight?


After spending considerable time trying to understand what so many claim to see in Sarah Palin, I transitioned to wasting more of that time devising a plausible explanation for both her positive reception and her remarkable idiocy.

You know, tryin' not to infer too doggone much!

Eureka, my friends, eureka. Thanks to @Tweetin4Palin, it became clear to me that blood flow is being restricted and inappropriately diverted by these Bumpits that Palin clearly is never without -- and she must have spawned a Bumpits Craze among already off-kilter supporters. Goin' rogue with them Bumpits!


I know, I know. How to explain the masculine connection? I haven't noticed too many Bumpits among the men, though maybe I am not lookin' in the right places.


Oh, puh-leeze! Piece of cake, cuppa tea! The Bumpits Women are crafty and able. Simple lead poisoning can induce cognitive dysfunction for a good 50 years. Careful dosing with carbon monoxide provides that episodic kind of confusion that makes politics an absolute riot! And, of course, you cannot go wrong with heavy metals, though it might be good to take a class at the community college first -- especially if you're hoping to reverse whatever encephalopathy you cook up for hubby, hijo, and pawpaw.


Glad I could bring a little clarity to the situation. Again, if you are trying to understand Ms. Palin, as well as Ms. Palin as a phenomenon, the explanation is a two-parter:


1. Bumpits (Sarah and her militant mavens, women all) and


2. Subsequent poisoning (CO, lead, heavy metals ingested/inhaled by Palin Patriarchsl note that we did not even *begin* to discuss the possibilities for poisonous plants!)

Monday, February 8, 2010

Repost: Lessons in Existentialism, Wedgies, and Trolls

originally posted 9/14/2009


It may well be that Retired Educator is going to go to ground and allow La Bonne et Belle Bianca Castafiore free reign of this blog. It could happen.

Be afraid, be very afraid.


Aw, shucks, who am I kidding? I monitor everything That Chica does, and love y'all just a little too much to allow her indiscriminate and total control of what gets written here.


It's not just Sisyphe that you must imagine happy. When the "boulder" is an audio clip of L'air des bijoux, more specifically a single line from the aria, sung over and over -- à haute voix, à voix haute, et très, très fort -- you'll more than likely want to give Camus a wedgie.


Yes, there is a French word for "wedgie." I just spent a few moments in wild laughter at the discussion over at the WordReference Forums. I do appreciate polite people, even in an incongruous moment:

Bonjour,

Qu'est-ce qu'on dit quand les culottes deviennent coincés entre les fesses?

Merci


I even flashed on Allen Ludden, the long-ago host of the gameshow Password. I can hear the announcer make his loud whisper: "The password is... wedgie."


Anyway, the first responders on the scene at WordReference provide faithful word-by-word translation, not helping matters one whit. Finally, someone arrives with the helpful suggestion of: "j'ai les rideaux coincés dans la fenêtre." I like that one; That would definitely soar over my head were I not in the loop, in the know, hip, and happening. Chouette...


Three months after the initial post, Benoit arrives to clarify things, and announces that the wedgie phenomenon is "faire un Luigi," at least in the north of France and in Belgium.** This, of course, begs the question: Who was the original Luigi, hmm?

Since only the good die young, and bad things often happen to good people, Walkyrie is next to come along. Evil, evil Walkyrie!


Vous le savez peut-être, mais l'anglais a aussi un mot pour désigner une culotte (ou un pantalon) coincée non pas derrière, mais devant, chez une femme. Je laisserai à un natif le soin de vous le divulguer, au cas où vous ne le connaîtriez pas. Ça a rapport avec le pied d'un animal, et là encore, je ne pense pas qu'il y ait d'équivalent en français, à part une traduction directe.


And my taxed brain flashes on the great CamelToe SNL skit!

The last hilarity? Two years after the deep thinking began, a Senior Member of the Forum suggests "un string" as a good translation for "wedgie," and that would surely work -- if it did not mean "thong"!


Even among the faithful, commentary often strays, and this is true of the Wedgie Work being done by these dedicated linguists. In the middle of it all, Quake3 demands to know how to translate the following pith: "My fondest desire? To give you a wedgie with your own lungs."


Hmm. It takes all kinds. That's what makes the world go 'round. And it's a small world, after all. People, people who need people, are the luckiest people in the world. Right-o.


No one really questions the impulse to want to commit a wedgie on someone's lungs. No, they go straight to work. Junior Member Kwaw submits the following:

wedgie = something (usually underwear) pulled up through the cleft of the buttocks

= to pull your guts / innards / lungs out through your arse?

Mon plus grand souhait / désir ?:

Tirez-vous les viscères (par l'intermédiaire de votre anus)?

Se retirer vos poumons sortir (par l'intermédiaire de votre cul)?

De prendre vos viscères par le biais de votre cul?

De faire une lanière de vos poumons?

À faire pour vous une lanière de vos poumons?

de faire un string (entre vos fesses) de vos poumons?

Se retirer votre poumons entre vos fesses?

kwaw



Kwaw later opines, after the suggestion that his French is not up to par: "The one that manages to sound violent while making least sense is probably the most accurate..." I know that's the rule by which I try to live.

"Why, Retired Educator, friend to animals, children, and several adults from around the world, whatever is so wrong with you today? Goodness, gracious, girl! You are frothing at the mouth, caught up in a tirade about... wedgies! Surely something is amiss in Marlinspike Hall, deep, deep in the Tête de Hergé!"

Thanks for asking, Sweet, Darling Reader. {snarl} I would eventually have made my point, limpide comme l'eau, le diamant, le crystal. Since you're rushing me, though, I'll segue to the issue -- bring matters to a head, as it were.

"Certain troubling aspects of a too rich situation..." wrote Simone de B, about "consoling ethics"
-- those entities, often mammoth and institutional, that cannot live with or within the "ethics of ambiguity." The ethics of ambiguity? Believe it or not, but Simone de B has, as central reference for the concept of Bad Faith -- Our Beloved Flaubert's Emma Bovary. [see the remarkable
How I introduced a NYT editorial by comparing President Obama to Gustave Flaubert for more Flaubert antics.]
Emma, Emma, Emma -- how I have always loved Emma! She grates on the nerves, though, and I could use a break from the Emmas that seem to be surrounding me.

Actually, the institutional mammoths of which I'm thinking are more within the order of internet trolls than Emmas. Specifically, internet trolls who skulk in the pus-filled corridors of PopThatZit.com.

Yes, I am enamoured of zit videos. The neat thing? I am so not alone!

En tout cas, mes amis... read here, here, and lastly, here to get a vague sense of my unrest when in the profderien incarnation. Such retardation is -- thank God -- rare. In my better moments, I imagine the harping phenomenon as the work of one small, pin-headed individual that happens to go by four or five different names. Of course, the whole situation is rendered manageable by the capable management of one Emilbus, the site owner and all around good egg.


And it must be said that it's a question of a very vocal minority suffering from a narcissistic sense of entitlement. For the most part, everyone is quite nice, very sharp, and not interested in the dramas -- dramas that can, as you know, turn me into a rubber-necker, gaping at all the accidents on the side of the road.

Studied detachment remains the ideal virtual comportment -- and, normally, I can achieve it. These days, though? Daily fevers are now over 101 -- CRPS has kicked into high gear -- and infection continues to reek havok. [C-RP is 86, WBC over
15,000, sed rate of over 70-something]. When I spike over 100, it's not that I give up free will in order to make little girly whining noises, for I am overwhelmed with physical lassitude -- no, I fall into a strangely frenetic state of just-not-caring, just-not-giving-a-royal-shit.


A hell of a formula! My rude febrile inertia + all the rude PTZ Emmas = absurd, rude goings-on! Thank goodness for the overwhelming majority of stable people (who just happen to share one slightly fetishistic interest in zits).


I know that when a crowd arrays against me, my own conduct must be examined.


I have done this and conclude that I am perfect in every way! Ar ar ar! No, seriously. I know my faults, and they are legion.

However, I'll not be maligned as a pedophile and murderer.

We all have our limits, those tired lines in sand, and mine appear to be pedophilia and murder. I'm strange that way.


Oh, the humanity!


It's a little known fact that Sartre's eye deformity was the result of constant and unrelenting hazing by de Beauvoir, most often in the form of the wedgie. Yes, she kept putting a Luigi on him, until his eyes went haywire. Pity I don't have the supporting evidence -- as soon as I make some up, I'll post it.


L'oeil de Sartre. A rich source to punsters. We giggle to speak of his "trompe-l'oeil," throw the elbow, say, "Get it? Get it?" Much as kids will call out, "Mom! The television just said 'heinous'!"
Fred still snickers during the tedious introduction to the ubiquitous television show Law and Order.

"We can guess at the efforts he must have made to plaster a smile onto that hideous face, to forget and make sure others forgot the image of the marsh, to control that one eye that said shit to the other, the excess of the flesh, the erratic proliferation of the features." Bernard Henri Lévy -- what a card.


The words of a true friend.

Those of you in the know may take my mention of letting La Bonne et Belle Bianca Castafiore have Head Author status at elle est belle la seine la seine elle est belle as a threat. Of course, those of you in the know are not the stupid, provincial, assinine, dirty-minded, acephalic -- and just plain *rude* -- denizens of whom I speak.

Marx and Engels might rethink their whole concept if they knew some of The Workers I've met in the last 72 hours or so.

But then, I might be guilty of perpetrating noise pollution on your lent ears -- a crime that carries quite the penalty:

It is an offence under the EP Act to emit objectionable noise. A maximum penalty of over $250,000 may apply, while for a continuing offence a daily penalty of over $125,000 may be imposed.

You may also be liable under health legislation for noise emissions which are considered dangerous to health or offensive.





**In Québec: avoir la strap prise dans la poulie

Saturday, February 6, 2010

Mna Mna

Okay, so maybe it harkens back to the days of marijuana and Courvoisier, or maybe it was those brilliant performances for the 'rents from the backseat of the Cadillac, designed to make them pull over at the earliest opportunity. Maybe it was what kept me from killing my stepsister when we were saddled with cleaning up the kitchen.

Whatever. Sometimes I need a Mna Mna.

And if anyone knows what a Mna Mna really is, kindly do leave word.









And just for fun, the most downloaded of all the Muppet Vids, Bohemian Rhapsody:


Repost: War and Peace: I Have the Power When I'm in the Shower

originally posted 11/15/2009
Good morning, Fearless and Beloved Readers! I've missed you, I really have. Give yourselves a hug.

Have a seat on the red horsehair loveseat over yonder. It's one of the few Victorian Pieces in The Manor. {guffawandsnicker} Go figure, huh? Captain Haddock's more recent ancestors were a wily people, a sang froid of common sense running in their blue, blue veins.
The space that we are in today served them as Reception Hall during the American Civil War, and for roughly 60 years afterward. Back then, it was worth their Snooty While to allow a more plebian sort of individual to attend the legendary Marlinspike Hall Afternoon Teas.


But a few changes were necessary, so as to honor their actual intent.

Horsehair furniture. Horsehair as stuffing, horsehair as "fabric." *Small* furniture of unwieldy proportion, shape, and style. American furniture! To provide the necessary Provenance of Snoot, most of it was purchased from a small dealer specializing in the paraphernalia and artefacts of Abraham Lincoln.

We're talking austere. And sturdy.

But mostly? We're talking un-freaking-comfortable! Somehow, some way, the earthier visitors to The Manor found that the rich folks' furniture variously pinched their derrières, squeezed their oversized working class thighs, and often made them break out in an itchy rash. Slowly but surely, word spread, and the afternoon receptions thinned out, freeing up The Haddocks for their beloved Tea Time Mahjongg Tournaments.

Oh, yeah. They also switched from what most people in this region of Tête de Hergé (Très Décédée, D'ailleurs) prefer to drink, a strong polyvalant coffee, to thinly brewed and overly sweetened English teas.

That's the succinct version of why there is such a massive collection of Bone China Coffee Cups, Mugs, and Saucers -- and of why it is hidden from Common View. It must be said, doggone it, that must also be the reason for the chintzy, stained tea cups and the dented, tarnished silver tea sets.

It's not that Haddock Stock disapproved of tea, per se. There are over three dozen delightful tea pots in the working kitchens in the East Wing, alone.

But today, we chose to greet you here in La Recepción! Yes, we are planning a surprise renovation for this space -- from Lincolnesque austerity to teeming, busy Spanish Colonial. Coffee reigns supreme again! I know, it will be a striking change, yes? From itty-bitty loveseats to massive, in-your-face stuff!

My! I do go on. The words seems to have built up over the past few weeks. Explosive posting.

Anyway, please pour yourself a cup of this fine, winey yirgacheffe. It is Fred's favorite from the years he lived in Ethiopia. And why not, let's use the Imported Fine English Bone China Coffee Accoutrements!

Here, look in the bottom of the china cabinet -- note the paw foot, the curved glass -- no, the bottom, there you go! Smart Reader!

If you're a strict, unyielding traditionalist, use one of those Royal Crown Derby Posies-patterned coffee cups and saucers -- a very fine bone china, with both gilded rims and handle bands! Stop! Right there! Very good, Sweet Reader.

It's part of Captain Haddock's extensive Imported Post War Bone China Collection.

Now that everyone is seated, all comfy (how is that horsehair treating your various tushes?),
the inmates here at Marlinspike Hall would also like to extend a Warm Welcome to My Two Cyber Stalkers. I think I spotted them sprinting between haystacks earlier this morning, as dew lay on the Manor Holdings. I'm unclear as to how the Second Cyber Stalker came to be on scene, but I surmise that she is basically an unbalanced woman fallen under The Spell of The Primary Cyber Stalker. Maybe, if I am good, one of them will leave a comment explaining the exponential growth of my fan base. But until such time as the two of you begin to focus on each other -- the absolutely predictable ending to your saga -- please, make yourselves at home.

Just don't touch anything.

This morning, for the first time in about two months, I woke up feeling pretty darned okay (I don't want to jinx it with excessive exuberance).

The cows are giving sweet frothy warm milk again, sparing us another morning of nasty "non-dairy creamer," and providing The Castafiore and Her Denizens with the raw material for yogurts, various creams, and cheeses. We are thinking of reopening The Manor Dairy.

Marmy and her Fluffy Butt has made peace with Sam-I-Am, thereby helping Uncle Kitty Big Balls to de-escalate his frenetic efforts at a military-style feline coup d'état. Sammy is finally able to doze with both eyes shut. In other Cat ChitChat News, Dobby has learned how to wink when prompted. As we tell him with great frequency, Dobby is a very good boy.

La Bonne et Belle Bianca and Fred have had several run-on and amorphous spats, but today? Both have tweeted at me asking for my version of how and why their internescine battle began. I pretended to have a broken tweeter, thereby encouraging them to give up their fruitless efforts to justify the Recent Unpleasantness. Last I saw? They were off to town in Ruby the Honda CRV, laughing and carefree.

I gotta say, if you will permit me to wander just a little from my tight prose, that this household tweeting has become a real thorn in my imaginary side. How much trouble is it to get off one's lazy arse, leave one's quarters, cross over to the Central Ballroom, and take the Checkered Spiral Staircase to the Former Cloak Room, recently converted into My Reference Room Slash Office?

Exercise your stubby legs, get some bloodflow to that congested brain, enjoy some energizing endorphins!

Fill your lungs with bracing fresh air! [We have ongoing draft issues in that Manor Sector... but that is a Tale of Frustration better suited to another time.] If you absolutely cannot make the trip and the message is of real import? Go low tech and give Dobby a note (on letterhead, of course, for verification of authenticity). He always knows where I am. He is a very good boy.

Well, darn. I seem to be the only Responsible Adult left in The Manor at the moment and some children from a neighboring village have asked to tour The Petting Zoo. Now I've no time to edit, to spellcheck, to render the dull, lackluster phrase more witty.

I had planned for this clear but slightly chatty introduction to lead into a wickedly clever, oh-so-subtle excoriation of right wing conservative assholes. Remember, please, that that is just a stream of adjectives so as to particularize "assholes." In and of themselves, those who are "right wing" or "conservative," let's even add "republican" and the slightly deceptive "libertarian" -- those good folk are not necessarily also nominative assholes.


Now I've only time for a rough esquisse and pompous use of easily translated foreign words.

It seems that some of the less able assholes referenced above have chosen to claim a certain photo of President Obama, his family, and some military officials -- situated on a dais -- to be a snap taken on Veterans Day, reflective of the President's lack of respect for the military, even for the war dead. This, because while everyone else in the photo has either hand to heart or arm raised in salute, the President is just standing there, presumably like an ignorant, superior, snotty dolt.


Something, praise Heaven, made me go to Snopes.com in hopes of a thorough debunking of this obviously manipulated photograph -- I thought perhaps it had been PhotoShopped.


It turns out to be something more insidious. In a way, I am glad to not have time to reproduce the hateful email and blog posts written as illustrative introductions to the photo, which turns out to be an unretouched one, taken not on Veterans Day or at the recent Fort Hood memorial, but considerably earlier, on Memorial Day, at Arlington's Memorial Amphitheatre. It was a ceremony held as adjunct to one held at the Tomb of the Unknowns -- this one honoring blacks who fought in the Civil War.


So President Obama had to travel from one honored site to another. He was slipping into the amphitheatre... Well, I guess presidents don't really get to "slip in" -- quiet and unnoticed -- anywhere. No, they are introduced by that pesky toe-tapper, Hail to the Chief.


The deference being displayed was intended to honor him, as required by Department of Defense bylaws, which dictate that the same gesticulations and do-da shown during The Star-Spangled Banner, another American masterpiece, are to be gesticulated and do-da-ed during Hail to the Chief. Therefore, I am a little glad he is not sticking out his tongue, jumping up and down, beating his chest, and acting the insolent fool that the aforementioned assholes apparently envisioned.


He looks, to me, a mite embarrassed and shy.


No. That's not right.


I just momentarily forgot, is all, in the midst of renewing my relationship with my Beloved Readers, wallowing like a happy pig in the squishy mud of what looks to be a great day.


I know that look. So do you.


That's the look of sad. A weary-to-the-bone sadness that, at one time or another, can be seen on all leaders of good heart. Clearer than a precision-tooled 140-charactered tweet. More expressive than the best of mots justes.


It's nice to be back with you, Reader. Thank you for waiting for me to catch back up.


Shit. Now I can't get that "alternate" version of Hail to the Chief from the movie Dave out of my pointy head.


"Hail to the chief, he's the one we all say hail to! I have the power when I am in the shower!"


I gotta get down to the zoo. Y'all feel free to roam around. Someone keep an eye on the two reprobates, would you?




Friday, February 5, 2010

Anal Community Colleague: The Impotence of Proofreading

The following thought piece, by Taylor Mali, is featured today in honor of Dearest Brother-Unit Grader Boob. The Boob just informed me "I've graded 28 with 80 more to go, so the weekend will be hectic. But, as is evident by this email, I look for any opportunity to avoid direct contact with student papers."

God bless him, and God bless the United States.

Always remember and never forget: When it comes to proofreading, the red penis is your friend. Spank you.

The Family

Fred snapped this a few hours ago -- finally, these three together in a photograph. In order from the left: Marmy Fluffy Butt, Dobby, and our newest addition, Uncle Kitty Big Balls.

That they are related is clear. Marmy is Dobby's mother and Uncle Kitty Big Balls' sister. We took Marmy in when she and UKBB were both strays, and she was about as hugely pregnant without bursting as possible.

She had a litter of five, of which we kept the runt, Dobby. Marmy remained almost completely feral for another year, but this past year she turned some mental corner and became a very loving and sociable cat. She's not particularly bright, but she seems happy. She has become a real girly girl lately, and demands more one-on-one time than any of them. Very, very coy is she.

Dobby, you've met.

Uncle Kitty Big Balls. What a guy. He remained on the street for another year or so, although he came to visit now and again. The visits were becoming fewer and he began showing up with wounds, loosing hair, etcetera. There was a long stretch where he seemed to have disappeared and we feared the worst. I had put my foot down after three cats, but felt horribly guilty.

Last April, I was in ICU on a ventilator (just hanging out), and Fred came into my room looking terribly distraught. He said there was something he needed to talk to me about.

"Oh, my God, he's leaving me. He can't handle this anymore."

"Uh-oh. Maybe he wants to disconnect the respirator, the bastard!"

So I wasn't exactly the Reigning Queen of The Cogent!

He informed me that UKBB had turned up just as he was leaving to come to the hospital to be with me, and he was very sorry, but he simply was going to have to take him in. He looked to be near death, and was holding a rear leg off the ground, and clearly had abscesses all over another leg. He barely had any fur left and he was almost skeletal.

How wonderful that acquiescing to such an easy request could make someone so happy. So he left me there in ICU, and ran home to trap this wild and dying cat.

UKBB and I recuperated in syncopated time. Both of us needed a long convalescence. Sadly, part of a rear foot had to be amputated, and he battled severe infections post-op. We dutifully downed our antibiotics together, though it was clear from the beginning that I was just some girl... whereas Fred? Fred was his saviour! He still suffers something akin to a feline panic attack when he cannot locate Fred within the bazillions of rooms and acres of land here at Marlinspike Hall, deep deep in the Tête de Hergé (très décédé, d'ailleurs).

He has become our first overweight cat, though if The Castafiore and Fred are to be believed, no one is feeding him little treats shaped like fishes, tasting of eggy tuna, and designed to prevent furballs -- because his fur! His fur is thick and beautiful, the softest thing we have ever felt, our friends have ever felt, even the parish priest is astonished by the silky nothingness of his mane...

So, he's fat and we are not to blame. It is perversely pleasing to see him eat to his heart's content, after all his time hungry and cold on the street.

I cannot keep from laughing out loud when he looks at me. He looks like a Wise Guy, a mafioso. All banged up, eyes crossed. When we're not around, he likes a good stogie. We don't promote smoking but somehow his humidor is ridiculously well stocked with the best cuban cigars. That Bianca!

He has a very sweet and sensitive spirit. He spent almost no time acting ridiculously feral like his sister Marmy had done. No, he took to domestication as if he were the original housecat.

Here is his mugshot:




Our fourth cat, the awesome Sam-I-Am is the eldest now, which is a shock to him, and to us, as he spent many years in the position of postulant. Dobby has been a new life force to him, and I catch them playing like maniacs, Sammy behaving like he was but a few months old, and not a decade into this affair.

But this post seemed more dedicated to The Family: Marmy Fluffy Butt and her valiant brother Uncle Kitty Big Balls, and The Dobster.

Thursday, February 4, 2010

Dobby: His Wisdom, My New Year's Resolution

In an effort to cheer moi up, The Fredster went a-diggin' through some old photographs of Our Little Idiot, Dobby the Runt, back when he was an otherworldly kitten.

Those old eyes and wizened face were what won us over to begin with -- and how, in almost every photo, however grouped, whomever served as photographer, his sweet little face came shining through like a slightly bored nebula.

I will give you a moment to ponder what a "slightly bored nebula" might look like.

In fact, I will sit here with you, and ponder in tandem. Hope you don't mind Ponder Company!

Done?

Today, Dobby is my buddy, my pal. He also figures in my very first resolution of the new year, now not old, but no longer new, either. But because Dobby is part of the wording, I find myself remembering my pledge more often than not.

What is it, you ask?


Like I would tell you!


Just joshing. I will divulge the Dobby Part, and try to explain it, too.

It goes: yadda yadda yadda and remember that Dobby is very wise.

How is he wise, and more importantly, how the heck do I translate that into some real form of behavioral change in myself? Well, in large part, it can all be summarized by The Dobster's Way Of Asking For What He Wants.

It is, of course, The Purity of The Dobster's Way that holds the secret and contains the magic. He never invests his askings with too much desire, and hardly ever with any personalization of intent. Above all, he wastes no time conniving, planning the best approach, fussing over timing or appropriate ambience.

He's too happy a soul to be manipulative. Something occurs to him, bells chime, his eyes light up, and meow, there he is, request ready. No wasted motion or emotion.

His synapses don't burn up with worry.

He doesn't get pissed off when his desires aren't met. He did his damnedest, he asked, and thems is the breaks, as I used to say. (And apparently still do.)


His requests might be turned aside all day but it never occurs to him that anyone would not give him what he wants out of any kind of spite or wicked intention.

Somehow, this trust that he proffers makes the creatures that he meets all want to try very hard to give him just what he has asked for.

He is good natured and willing to be wholeheartedly a fool. That's pretty much it. I strive to be as good natured and wholeheartedly, unabashedly foolish as my cat, Dobby, seen here at a very young age with his brother, Speckle Belly White Foot, who is apparently trying to commit

[c]atricide. Actually, I think that might have been Fuzz Bucket diving for his jugular.


(All his siblings found great homes, by the way.)







As final and further evidence of his "slightly bored nebula" shining star face, here's a group shot. I wish you could experience him. He never fails to make me laugh but can also serve as a soft, warm comfort.


He just brought me his yarn ball, asking to play fetch.

How did he know that's just what I wanted to do?

Did you know that Fred practically birthed this little guy? Dobby was the last kitten to arrive. Marmy Fluffy Butt, not exactly firing on all her Mother cylinders, decided she'd had enough, and just QUIT. Laid her wacky head down for a snooze, leaving Dobby in the precarious position of being not quite delivered!

Already the smallest, he lagged in all the stages of development, behind his confrères by a good 2-3 days. We worried that he was blind and deaf for the longest time.


Then there were the mystifying behaviors -- most notably, he preferred gamely climbing his mother to the joy of nursing, and in this manner missed a lot of meals! But he did get to some imaginary, secret mountaintop. He appeared at the bottom of most piles, was poked, bitten, and smacked with exuberant regularity. Luckily, he came out of it with stupendous smarts and the patience of Job.


This is my favorite picture of Dobby. He has unusual staying power and focus. Fred was at his computer, and offered Dobby a very small box to sit in. Twenty minutes or so went by, and Fred began to feel that feeling of "someone is staring at me." Yes, shock of all shocks, it was our prodigious cat. Doggedly determined to stay in his box until acknowledged by the Alpha, Fred.


(Fred was a psych major and specialized in neuropsychology. He believes that the phenomenon of *feeling* a gaze is not just some fluke or conditioned response. He thinks that there is transfer of energy involved, as well as a sense that we've yet to discover -- we simply lack the ability to render the experience tangible.)



Wednesday, February 3, 2010

I cannot help it, I am full of hope...

One of the numerous feeds to which I subscribe channels news about CRPS -- that's not likely a shock to you!

What probably is news is that whenever I prepare to click on the summarizing email, my lungs, my mind, my heart, all fill with hope. Once I see what news awaits, that hope normally fizzles and fades, losing all its precious buoyancy.

I have an appointment with Dr. PainDude in a little under two hours. It has been a long while since I showed up with papers in hand, with hope. I just printed the following article, and almost miss the days of toner smell, mimeograph fumes. Today, the paper gives nothing away.

It blurs my eyes, these words: The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks.

O Christ, O God Almighty: Let it be true.

The text in its entirety below. I will do further research this afternoon.


Scientists at the University of Liverpool have discovered that treating the immune system of patients with Complex Regional Pain Syndrome (CPRS) leads to a significant reduction in pain.

CRPS is an unexplained chronic pain condition that usually develops after an injury or trauma to a limb, and continues after the injury has healed. CPRS I - formerly called Reflex Sympathetic Dystrophy - can arise after any type of injury. CRPS II, previously called causalgia (a term coined in the American Civil War when it was first diagnosed), follows partial damage to a nerve. In some cases the pain can be so severe that patients request amputation, only to find that the pain returns in the stump.

CRPS pain can improve within one year after the injury, but if it is still unchanged after 12 months (longstanding CRPS), then it will often not improve at all. Longstanding CRPS affects about 1 in 5,000 people in the UK.

The team at the Pain Research Institute discovered that a single, low dose infusion of intravenous immunoglobin (IVIG) significantly reduced pain in just under 50 per cent of patients treated, with few adverse effects. The pain relief lasted on average 5 weeks. The results of this study may change the future treatment of patients with CRPS, and have an impact on research in other severe chronic pain areas. Intravenous immunoglobulin treatment for CRPS is currently not available on the NHS.

Although the cause of the syndrome is unknown, precipitating factors include injury or damage to the body's tissue. Changes in the way nerves send messages to the brain about pain may occur at the injury site. These changes may then lead to more changes in the nerves of the spinal chord and brain. All these changes are thought to play a role in causing and prolonging the condition. Conventional pain drugs either don't work, or have considerable side effects.

Dr Goebel, Senior Lecturer in Pain Medicine, explains: "In CRPS, the real effect of this treatment in clinic may turn out to be even greater than what we have already seen, because IVIG can be given in higher doses, and repeated treatment may have additional effects. IVIG is normally repeated every four weeks and we are working to develop ways which would allow patients to administer the treatment in their own home."

"The discovery is expected to have a real impact on the treatment of other unexplained chronic pain conditions; if one pain condition can be effectively treated with an immune drug, then it is possible that other types will also respond."

The research is published in the journal Annals of Internal Medicine.

Notes: [....]
The research was carried out in collaboration with University College London.
Research activities on the role of the immune system in chronic pain are the focus of the newly created 'Centre for Immune Studies in Pain' (CISP) at the University of Liverpool, led by Dr. Goebel. For further details visit www.liv.ac.ukpricisp. Support for these and other research activities aimed at relieving chronic pain comes from the Pain Relief Foundation in Liverpool.

Source:
Sarah Stamper
University of Liverpool



Aha! A better article,* of course, is available at RSDSA.org -- from The Annals of Internal Medicine (cutting to the chase, "results... limitation... conclusion"):



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.

*yes, it is a bit of cold water... damn it.

**************************************************************************************************
later... in an email to my sister-in-law, this brief but exciting episode was summarized thusly:

i got all excited this morning by a news report that i.v. immunoglobulin had been found to "significantly" reduce pain in CRPS. an hour later, i found out that the big study had all of 13 people in it, one of whom dropped out. "just under 50%" of the participants had positive results. let's see. putting on my thinking cap. half of 12, six. okay, "just under" must mean... FIVE. then hank did his "statistics" speech: there must be at least a cohort of 30 to be statistically relevant... sometimes, i wish he would keep all that book learnin' to himself. i should have known that when something sounds too good to be true, it probably is.

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


Friday, 5 February 2010:

Further tidbits keep popping up. An editorial accompanied the published research. It sought to temper impulsive enthusiasm as a response to this study, emphasizing caution and the tremendous need for more work. In case you've not kept up with the exciting times in CRPS/RSD research, the authors give a quick gloss at the beginning of their editorial -- and I am resolved to place my hope in that steady progress. It's just that when severe chronic pain and disability roll on unabated for eight years? Well, it can be difficult to be positive. So I tend to grab and latch on to any research that makes sense. I don't mean to mislead anyone by these occasional bursts of unwarranted optimism; Please pardon me if I inadvertently played upon your heartstrings. Also, my case of CRPS is pretty awful and I sometimes forget that most cases are not this bad. I shouldn't be dragging you into my freak show!

Editorial: Intravenous Immunoglobulin to Fight Complex Regional Pain Syndromes: Hopes and Doubts
Frank Birklein, MD, PhD; and Claudia Sommer, MD, PhD

From University of Mainz, Mainz 55131, Germany; and University of Würzburg, Würzburg 97080, Germany.

Chronic pain is multifaceted. It involves changes in somatosensory processing from the primary afferent neurons to the brain; it induces negative emotions, such as fear and depression; and it often entails serious consequences for working ability and personal life. Long-standing complex regional pain syndrome (CRPS) has all of these features and may be associated with substantial reduction of limb function, leading to physical impairment.

In recent years, we have made progress in understanding CRPS. Studies of the acute phase of posttraumatic CRPS show the importance of cytokines and growth factors for pain and hyperalgesia; the involvement of peptides in changes in skin perfusion, edema, and sweating; and the effect of sympathetic neurotransmission on pain in selected patients. We have learned that in long-standing CRPS, cortical reorganization of sensory, motor, and autonomic function might underlie the profound disturbances of the body reference scheme. Although acute CRPS can be challenging to treat, the outcome is often favorable. Treatment of chronic CRPS, when central neuroplastic changes are fully established, is especially difficult.


And so concludes a pretty accurate, if embarrassing, example of my emotional ups-and-downs as I follow the thread of medical news, in real time [as real as it gets at Marlinspike Hall, deep, deep in the Tête de Hergé (très décédé, d'ailleurs)]. Despite my initial over-reaction, all the subsequent information did not cause too much grief -- it simply served as a reminder that this is serious business, for serious people, and that one mustn't let hope get out of hand.

Right?



2/15/2010: I was definitively told, via bullhorn, to "step away from the study... toss your hope on the ground and step away from ridiculous hope." Yes, the Hope Police came down on me like the proverbial ton of bricks. My case is extreme; My case is refractory; My course is "complicated." And then there was this surprise statement from Dr. Go-To Guy: "Bianca, ma belle, this is old news."

As soon as I get my breath back, lobbying will begin for a little offlabel use of immunoglobulin. Shhhhh!


photo credit


Saturday, January 30, 2010

$20, 000


The only update I can find this week in the case of missing 11-year-old Lindsey Baum? The reward for information has doubled to $20,000. Read all associated posts from this blog: here.

FBI ramping up search for missing McCleary girl
By Keith Eldridge & KOMO Staff

McCLEARY, Wash. -- Officials have announced a larger reward for information in the disappearance of a young girl missing since last summer, and investigators are planning a renewed search effort.

Grays Harbor County Undersheriff Rick Scott on Wednesday said a reward of $20,000 is available for anyone who helps find Lindsey Baum, who vanished June 26 after leaving a friend's house to walk home.

"I want to reinforce to the community that we're not going anywhere," Scott said. "This case is a long ways from being at a dead end. We have continued to make this case a priority."

The new money, which ups the reward from the previous offer of $10,000, is being provided by the Federal Bureau of Investigation, Scott said.

Lindsey was 10 years old when she vanished; now she'd be 11, and her family is holding out hope that someone will come forward with information.

"Our world is standing still," said Lindsey's mom, Melissa Baum. "It's hard to stand here and watch the entire world keep going on when we're just frozen in time waiting for her to come home.

"If there's anybody who knows anything, even if you suspect something, if you would just please call law enforcement."

Investigators have received hundreds of tips, but no substantial leads. Volunteer searches have turned up nothing but frustration.

Over the last six months, Lindsey's mother and the police chief appeared on a national TV programs to urge anyone with information to call investigators, and Lindsey was even featured on the cover of People Magazine.

FBI Assistant Special Agent in Charge Ron Twersky said a new group of investigators has been looking at the case to provide an outside review and offer suggestions on how to re-start the search for Lindsey.

"Because Lindsey's missing, we felt it was right to take a 'fresh eyes' approach and simply look at what's been done," Twersky said.

"The work has been extensive, but we just need that break. We know that break is out there, and so that's what this review and this effort is all about."

Twersky said agents will be going over old ground, searching many of the areas they looked at before and talking with many of the people who have already been interviewed.

The FBI will also be employing several new tactics, Twersky said, but he would not detail what those efforts would entail.

Lindsey's mom, meanwhile, is not giving up.

"Lindsey if you can hear me, I love you and I'm not going to stop looking for you, I swear," she said. "I will bring you home."

---

Anyone with information is asked to call 866-915-8299

Brush-evoked allodynia as a predictor of SCS success in CRPS

European Journal of Pain, Volume 14, Issue 2, Pages 164-169 (February 2010)

Brush-evoked allodynia predicts outcome of spinal cord stimulation in Complex Regional Pain Syndrome type 1

Frank van Eijs, Helwin Smits, José W. Geurts, Alfons G.H. Kessels, Marius A. Kemler, Maarten van Kleef, Elbert A.J. Joosten, Catharina G. Faber

ABSTRACT

Background
Spinal cord stimulation (SCS) has proven to be an effective however an invasive and relatively expensive treatment of chronic Complex Regional Pain Syndrome type 1(CRPS-1). Furthermore, in one third of CRPS-1 patients, SCS treatment fails to give significant pain relief and 32–38% of treated patients experience complications. The aim of the current study was to develop effective prognostic factors for prediction of successful outcome of SCS.

Methods and results
The study population consisted of 36 chronic CRPS patients enrolled in a randomized controlled trial of SCS efficacy. We analyzed various prognostic factors in the group of patients treated with SCS and compared baseline values of possible predictors of outcome in the successfully treated and the not successfully treated group. Success was defined as Patient Global Perceived Impression of Change score of at least “much improved” and pain reduction of at least 2.5 on a visual-analogue scale (VAS score 0–10). Univariate analyses showed that patient age, duration of the disease, localization of the disease, intensity of the pain, and the presence of mechanical hypoesthesia did not predict SCS success. The mean and maximum value of brush-evoked allodynia proved to be statistically significant predictors of outcome. Using Receiver-Operating Characteristic (ROC) curve analyses of maximum allodynia values, the diagnostic sensitivity for successful SCS was 0.75 and the specificity 0.81.

Conclusion
Brush-evoked allodynia may be a significant negative prognostic factor of SCS treatment outcome after 1 year in chronic CRPS-1.

Keywords: Spinal cord stimulation (SCS), Complex Regional Pain Syndrome type 1 (CRPS-1), Brush-evoked allodynia, Mechanical hypoesthesia, Prognostic factors

Corresponding author -- Address: Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Mail Box 5800, 6202 AZ Maastricht, The Netherlands. Tel.: +31 043 3877673.

STUPID QUESTION TIME: Why the insistence on CRPS Type *One* in this study, and most others, too? Is there a possibility that there exist different results for CRPS Type 2?

Sunday, January 24, 2010

The Birthday Gift

Tumbleweed has done it again.

It was pouring rain Friday when the postman plopped the package down on the drawbridge. I thought about letting it sit there and get rained on, thought about how much my gut hurt and how I really wanted to stay curled up, warm, and dry.

And then I thought: "Ah, but what if it is a birthday gift?" I loves my birthday gifties!

However, my Brother-Units had both been sent strict instructions earlier in the week, on January 18. This is the email to Brother Tumbleweed, who goes by "TW":

hullo tw --

i'm in a low, low place, and waving at you from down here, hoping you're much better than "well."

sam-i-am (a cat) is helping me write this. he has become jealous of the keyboard, jealous of the other felines, just downright jealous.

here's the deal: i am still (and will be for a while) sated from your christmas gift... but i DO have a birthday coming up. that would be the 24th, next sunday.

ever following the lead of miss manners, i am writing to tell you that you had better send me a god-damned birthday card/letter. there will be consequences should you fail to do so. timeliness is not an issue, however. indeed, brother bob has been known to mail my b'day cards in july, calling them "early."

should you, however, try to gift me? big trouble, big problems, you're likely to wish you'd never been born. ha!

and so, dear one, in conclusion: always remember -- and never forget -- that a birthday card is de rigueur, oh so de rigueur.

i shall be waiting by the mailbox.

all my love, and hope --
Retired Educator, prof-de-rien

fred would say "hey," but after deftly tossing a huge bowl of popcorn into the air while performing fancy footwork in an effort not to fall and go boom (he tripped over a wire)? he was banished from the bedroom for saying, "fuck you, shut up!" when i attempted to be of assistance. his banishment will end... shortly. he'd probably say nice things -- he likes you, remember -- but you'll just have to do without until the apology-angel lights upon his shoulder, and gives him an everloving clue...


Curious to know the origin of the box sitting out in the rain, I dragged My Sorry Self down this cold, stony corridor and that gilt and glitzy ballroom, through these medieval digs and those renaissance spaces, passing the postmodern but pausing for the romantic, and retrieved the rapidly disintegrating cardboard vessel.

I discovered TW's response to my email only after I opened his gift:

birthday gal-
if my card isn't there on saturday then look for it monday instead. (the 2-3 day delivery estimate straddled sunday)
good luck trying to out-stubborn a left-handed irish taurus.
congratulations one day early and howdies to fred.
--tw


These boxes of his have come to mean the world to me.

What follows is a list of the items contained in the Birthday Gift Box 2010. They are in no particular order:

1. Ken Kesey's Sometimes A Great Notion. I've never read it. The book flops opens to page 134 which happens to contain an explanation of the many personifications of Captain Marvel.

S.H.A.Z.A.M.

On the title page:

Sometimes I live in the country,
Sometimes I live in the town;
Sometimes I get a great notion
To jump into the river...an' drown.

[From the song, Good Night, Irene by Huddie Ledbetter and John Lomax]

2. Kesey's One Flew Over The Cuckoo's Nest. I am going to go out on a limb and say that Kesey was a major influence for TW, as this is the first literary repetition of the two boxes.

I can already hear the Chief, all chatty in his mind's eye: "They're out there. Black boys in white suits up before me to commit sex acts in the hall and get it mopped up before I can catch them..."

3. Okay, so this one brought tears to my eyes. It also served as the germ of the most fascinating conversation The Fredster and I have had in a good while. What is it? The Portable Medieval Reader: The Astonishing World of the Middle Ages brought to life for the modern reader through a rich variety of writings from four centuries... I tell you, that's a work of influence! I cannot remember when I was NOT familiar with it -- which makes me wonder whether TW showed it to me before he up and ran off...

Someone named Peter S. Rich used to own, and scribble in, this book. However, I know that it was a left-handed irish taurus who laughingly flagged this page: The Character and Customs of the Irish, by Giraldus Cambrensis of the Twelfth century. Shit, that shifty irish boy is probably Giraldus' reincarnation.

"I have considered it not superfluous to give a short account of the condition of this nation, both bodily and mentally; I mean their state of cultivation, both interior and exterior. This people are not tenderly nursed from their birth, as others are; for besides the rude fare they receive from their parents, which is only just sufficient for their sustenance, as to the rest, almost all is left to nature..."

Sometimes a book is like an old friend.

4. One birthday card, as politely requested above. The front of the card is from a painting by R. W. Hedge entitled "Symphony," which you, too, can enjoy: here. The cheery inner message is: Hope everything about your day is absolutely grand! Happy Birthday! And TW says, "here's to another successful trip around the sun..."


5. Paris Journal, Volume Three, 1965-1971 by Janet Flanner (Genêt), edited by William Shawn. This is part of the "Letter from Paris" series from the New Yorker. I am very much looking forward to this and cannot imagine why it wasn't included as part of the reader for that seminar I took on 1968. You remember, the seminar in which I was the only one doing the reading? It's not hard to feel like a Grad Student Rock Star in a situation like that. Eventually, J-J took to speaking only to me. Exciting times, exciting times.



A hell of a year for the human world, 1968. I see that on my birthday that year, she notes: The Seine is at flood level. She also relates the thrill of a half hour spent watching a "special weekend TV program called Un Certain Regard, aimed at careful listeners and at minds with serious curiosities... [that featured] the so-called father of structuralist anthropology -- Professor Claude Lévi-Strauss," then at the Collège de France. [pause while I undergo waves of frissons]



She begins her journaling for 1968 with a piece on M. Ingres, who "has come to fame again." There follows wonderful details about the painterly history of Le Bain Turc. [more frissons]





Ingres, long obsessed by the visual richness of the harem, was 82 when he painted Le Bain Turc.

6. One extra-large cotton teeshirt, red, with skull, crossed knife and fork, and the words: Eat the Rich.

7. The following CDs: Pavarotti in Central Park; Daniel Barenboim, Beethoven Sonaten; J. S. Bach Orchestral Suites 3 & 4, Christopher Hogwood, The Academy of Ancient Music; Vivaldi Concerti for viola d'amore, strings, and continuo; Paris Combo; Horowitz Plays Mozart; Claude Debussy, La Mer, Images, Los Angeles Philharmonic Orchestra;

8. A guide to hiking the Inner Canyon, Grand Canyon National Park. I can tell from just the feel of it... He loved it. I am going to use it as I travel through TW's photographs over at American Idyll.

9. [And I laugh with relief, as I had almost given this as a gift to him last year!] The Lost Explorer: Finding Mallory on Mount Everest by Conrad Anker and David Roberts. Okay, so I may have to work to find my interest in mountaineering literature...

10. The Portable Dorothy Parker! Beware oncoming wit.

11. CHESS BLUES -- Chicago and Memphis recordings by Leonard and Philip Chez (americanized to Chess) -- singers and artists who performed first, probably, at The Macomba, then made their way to Leonard's Aristocrat Records. This is an incredible collection: John Lee Hooker, Howlin' Wolf, Little Walter, Etta James, Hound Dog Taylor (to whom it is all dedicated).

12. Fred is going to snag this as soon as he sees it -- Sinatra: Vegas. Recordings from The Sands, Caesar's Palace, and The Golden Nugget.

Let me restate that: Fred saw it, Fred grabbed it, Fred has found religion.

13. The Complete In A Silent Way Sessions: Miles Davis

14. Canyons of the Colorado by Joseph Holmes, with text excerpted from The Exploration of the Colorado River and Its Canyons by John Wesley Powell. A book of photography and reflection.

15. The Clifton Chenier Anthology, Zydeco Dynamite

Clifton Chenier was the undisputed King of Zydeco music. By mixing Cajun and French two-steps and waltzes with blues, R&B and rock and roll, he created the infectious sound of modern zydeco. Chenier was famous for his flashy onstage gear of cape and crown (and natty gold tooth), but it was his creation of joyful, exuberant and highly danceable zydeco music that made him a legend.



16. 4 live cassette recordings of The Grateful Dead

It isn't often I feel complete, my gaps become openings and not wounds. Thank you, Tumbleweed.

Psyche and Soma, Those Crazy Kids!

Good news!

Because I have a really rotten case of first time diverticulitis, and am flirting with a perforated colon, I think I will turn off the boob tube, stop playing bridge, set aside the book... and do some writing. If nothing gets posted, well, at least the pile of drafts will be that much taller. But if nothing EVER gets posted, well, I guess that'll mean I either imploded, or exploded, or both.

This is crazy... Apparently, I had undiagnosed diverticulosis. But I eat beaucoup fiber! Seriously, with my history of small bowel obstructions that have required surgery [4 SBOs, 3 surgeries], you can bet your sweet bippy that I aim for 60 grams of fiber a day, roughly twice the RDA. That's what the last surgeon to unknot my guts recommended, back in 1996, and until last September, I had no problems. For some reason, I developed a partial obstruction that took over a week to resolve. The x-ray studies done then didn't show any diverticulosis... or if they did, it wasn't serious enough to mention.

I finally called Super Doc yesterday afternoon, despite my plans not to bother him until Monday. He started me on antibiotics and made depressing grumbling noises about how steroids thin the intestinal wall, about how much more I am at risk by virtue of being... me.

This is rather painful, this abscessing colon business. It's not the kind of pain one cannot tolerate, though, and I certainly don't need any pain medication to deal with it, as my normal regimen just about covers it... I guess it is more... scary? Is that the word, the attribute? Just knowing that the next sharp pain might be my intestinal wall, caving in?

Psyche, meet Soma.

(Those crazy kids!)

Oh, yes. On this day mumblemumble years ago, my mother demanded some pitocin so that I might be born on her birthday. I was so looking forward to cake but am settling for celebratory broth.

Oh... one more thing. I wasn't gonna say anything, but the topic keeps coming up since Marlinspike Hall, deep, deep in the Tête de Hergé (très décédé, d' ailleurs), is a secret MMA training camp for the Miniature SaraThunderToga ThickNecks of the Third Degree. As a fellow diverticulitis sufferer, I want to distance myself from recent remarks made by Professional Ingrate and Official StupidPerson, Brock Lesnar. Way to alienate half a continent, dood.