Mur pourrit, trou s'y fit, rat s'y mit; chat l'y vit, rat s'enfuit; chat suivit, rat fut pris.

i'm doing a little (a very little) retail therapy online. 

this is an actual item description. try repeating it 3 times:

"sheer crinkle gauze hoodie over a adjustable lingerie strap opaque cami."

The Checklist: Pause and Reflection... FAIL!

As part of the eternal quest to identify the nasty pathogen causing infection and inflammation in my left shoulder (and hip), I underwent an aspiration of that shoulder joint last Monday.  The hospital radiologist used dye and a fluoroscope to guide the insertion of the needle.  A nurse and a radiology tech were there to assist him, as there were beaucoup bottles and slides that needed to be prepared once he managed to get a sample.

So there we were, the four of us.

Before getting started, we participated in a strange and wonderful ritual -- a Procedure Pause and Verification of Site Ceremony.  For short:  The Checklist, an adventure in Pause and Reflection.

Essentially, the head medico calls out for everyone's attention, then tediously goes over who the patient is and what procedure is to be performed and on what body part.  The site is marked and signed by the doc, and everyone is in accord about whether it is the north leg or the south toenail of the eastern ankle that is to be poked, cut, or otherwise handled and abused.

In my case, despite a desperate attempt on my part to shave a decade off of my date of birth, we all concurred that we were there to stick a large-bore needle into my left shoulder in an attempt to draw off some nasty fluid from which we hoped to farm some identifiable nasty bugs.  The radiologist signed my shoulder with a flourish, and we were off!

Having experienced the impact of medical errors, I did not find the Pause or the List or the Purposeful Redundancy to be any kind of imposition.  Quite the contrary -- I was impressed.  I even told a few people about it... Folks who know the extent to which I have suffered due to medical errors, and the attempt to cover up those errors.

Of course, I spoke with  Brother-Unit Grader Boob -- at some point in the 1990s, he supplemented his teaching salary by working at a hospital near his university -- a hospital most known for its surgical errors, by which I mean the amputation of THE WRONG LEG.  In the lingo:  wrong-side surgery.

What a horrible thing to happen!  And how upsetting when it happened again!  Yes, that was the reigning attitude -- the mistakes just somehow "happened." In my sad experience, I learned much about verbs in the passive, about hospital-acquired booboos.  [In one of the more sinister conversations Fred and I enjoyed during a riotous stay at Saint Joseph's Hospital of Atlanta back in 2002, the retort to our query regarding what, if anything, the orthopods planned to do about my "hospital-acquired" tibia fracture was:  "Oh.  So you know about that?" {with a beautifully arched eyebrow} It just made us mildly curious as to what we might NOT know, you know?  Beyond the initial medication owie, concussion, internal bleeding, and fractured ankle -- with CRPS onset within hours -- had we missed anything besides this tibial oopsie?]

As a Gimp, the attitude in play in these instances horrifies and pisses me off no end:  Well, this person already knows pain and disability, so it is no big deal that a little more pain and disability might be added to their lot.  They probably won't even notice!  Of that 1995 BooBoo, a NYTimes article noted:

"Some doctors who appeared as witnesses said that the leg Dr. Sanchez removed was in such poor shape that it would probably have been amputated in the future." 

What a pompous, convoluted, ass-saving and totally deflective (better than Teflon!) attitude! 

Okay, so I may have given some considerable prior thought to the impact such attitudes can have.

Back to our story!

Yes, it was an impressive display, last Monday, inside a tiny radiology suite.  So simple a thing as a pause and basic review of identities and of left or of right -- what a marvelous idea! 

So there I was this afternoon, getting an incredible amount of Face Time with a noted Infectious Disease Specialist, and we were reviewing the goings-on of the last few years.  Given the back-and-forth rhythm of the orthopedic surgeries I underwent, it was difficult to stay on top of which shoulder did what, when -- even in a fairly ordered conversation.  The ID Dood and I chuckled over the note sent by my Go-To-Guy, which clearly stated that the present culprit, in terms of pain and diminishing range o' motion... was my RIGHT arm. 

Chuckle, chuckle.

Good-natured guffaw!

He said, "Well, with so many shoulder surgeries, it is easy to get confused."  Spurfle!

Then ID Dood called the lab to check on culture growth from last week's aspiration.  So he's on the phone, all Chatty-Kathy, with some minion when his eyes go into Serious Squint.  He had asked for the results of my "left shoulder aspirate," identifying me by name and date of birth.  Lab Minion, however, informed him that there was no left shoulder aspirate being cultured.  There was, however, a sample from...

{YOU GUESSED IT!}

...a RIGHT shoulder aspiration!

So congratulations on the Careful Checklist, the Procedure Pause,the Reflection and the Verification of Site and all -- but if you are going to then mislabel your biopsy or culture samples, you are still chopping yourself off at the knees.

So to speak.

I was  making light of it as Fred and I climbed into Ruby, the Honda CRV, and loaded the power chair on Bruno's Lift, when he said:  "Yeah, but imagine...  you are brought into the ED unconscious and all they get is your name.  They plug that in and see that you have had a shitload of tests done on your RIGHT shoulder.  They can tell you have a raging infection somewhere... and that must be it -- your RIGHT freaking shoulder.  So they amputate..." Okay, so his scenario kind of fell apart at that point, but you get his drift.

The possibilities running through my mind were less extreme but equally catastrophic.  What if such an error had occurred before, but without such an obliging lab technician on the other end of the telephone?  What if, say, following one of the five surgeries on my right shoulder, SuperShoulderMan rang up to inquire about intraoperative cultures from said shoulder, only to be told something slippery like "no report of growth," when in actuality there was growth, but in a specimen mislabeled as left?  Hmm?  Before you get all pissy and dismissive, ask yourself if it could happen...

I still feel they are to be congratulated for these steps to stop medical error.  They just need to tweak a few straggling details -- like somehow including a review of labels on lab forms on the checklist.  Or something.

Marmy and the Elven Wood Smurf

For the Cat Lovers among you Fearless Readers, this is the first decent photograph -- ever -- of Ms. Marmy Fluffy Butt.

She has undergone a Personality Transplant since Sam-I-Am left us in early July.  Part of that process includes Severe Persistent Lovability and Charming Chirps -- and now, her first Posed Photo Shoot, with suitable Classic Prissy Paws.

World, allow me to present Your Queen, The Marmy. 

These were my Wee Hours -- I was in Desperate Pain and Worried about the ID consult.  In response, this Girly-Girl Cat posed The Stations of The Marmy and promised me Measured,Passionless Devotion.

Yes, I had the dreaded Infectious Disease Consult today, and wish to retract my statement describing the good doctor as an ancient Pillsbury Dough Boy with Liver Spots.  He was more of an Elven Wood Smurf.

More importantly, he has Ideas.  Based on those Ideas, we drew Blood, although not enough to get all the desired tests done.  When I left, they were still going round and round about whether 5 ml. of blood were sufficient for Immuno Goblins, or some such thang.  He's pretty convinced my Immune System is shot all to hell.

I was touched by how he understood my state -- how he said I probably cannot remember what it feels like to feel good -- by how he said "Oh my, oh my" when examining my legs.  I needed Sympathy, Empathy, Compassion and all in Ridiculous Measure... I was quite the Needy Bitch, baking along merrily at 101 degrees. 

He completely won me over when he said he would, at least, like to make me more comfortable, bring the fevers down, and convince my heart to beat at a rate below 128.

I think I am in love.

The Charles Prize for Poetry, 2010

The worst part of failing at blogging is the inevitable failure to keep one's promises.  I got you all hot and bothered about Dr. Charles' Contest and then went adrift before the deadline.

Here, belatedly, is the link to The Examining Room of Dr. Charles, and to his announcement of the winners in his wonderful poetry contest -- winning and notable poems included. Go give them a read, as there are some very talented folk telling truths in remarkable ways!  Then spend some time wandering around the archives -- An enjoyable prospect for a Sunday afternoon.

The Charles Prize for Poetry, 2010
September 12, 2010


It is with great pleasure that I announce the winner of the poetry contest. Over 125 poems were received with a general theme of medicine or science. 7 judges were consulted, representing a diversity of training in medicine, science, and the humanities. A few of the judges were moved to tears at times, and all expressed their wonder at the quality of writing.


What makes art, poetry, or literature special? Perhaps it is a combination of graceful observation and hopeful creation which lends light, perspective, and meaning to our existence. We know it’s good when a certain hum of neuro-electricity splashes brilliant colors across our satisfied brains, soothing ills, making us want more.  [Read the rest HERE.]

"I felt like he made me undress for fun."

You know those websites that "rate" or "evaluate" physicians? 

I landed on one while trying to find the address of the new Infectious Disease Dood I see tomorrow.  There were seven reviews, but only one person felt moved to leave a comment:

Pompous with a god complex! Hates women! I found him to be completely boorish while talking to me---talked to me like I was a little girl!! I felt like he made me undress for fun. He's a perv.

Not helpful.  Nope. No.  Not at all.

Plus he looks like an Expired Pillsbury Dough Boy with Liver Spots.

Oh, relax!  I employ sufficient discernment to realize that, were this woman's numerical evaluations taken away from the whole, Dough Boy would have near perfect marks.

(But how dare any doctor demand that she get nekkid!)

the::people::around::me

Henri Cartier-Bresson, La Villette, Paris 1929

New-nurse-in-the-hood describes herself this way:

Baby nurse in the ED surrounded by nursing homes in the worst part of a big city. Consequentially, I get sworn at A LOT, and I'm growing up fast.

I've been meaning to recommend her, but as you know, I'm not blogging much of late. It was on my list.

Then the girl went and wrote this, impinging on my doggone hiatus. She calls it Compassion Deficit:

I think everyone has their type of patient that they just can't get over the feeling of wanting to kick. I've been a little surprised at myself lately at who it's been. I've always known that I can't deal with the entitled patients. I know why, and I've learned how to deal with them. But lately another sort of pet peeve- I hate to even call it that, because it's a little stronger than that- has crept over me for our addicts.

This may seem like a given to a lot of nurses, especially those that work in ER. But it sort of bothers me. I've always sort of felt deep inside that the reason I always end up with so many high drama psych patients is that God knows I know how to deal with them. I always thought that I would feel sort of a kinship or at least a deep empathy for addicts because of my own past. I was never a substance abuser, but I've dealt my whole life with a lot of unhealthy tendencies. When I was about 13 or 14, I started cutting myself. A couple years later, I also started dieting to a ridiculous degree even though I was already underweight. When I slipped up, I would make myself throw up. I didn't tell anyone. For a long time. When my family found out, and I realized how much it hurt them to see me this way, I worked very hard to stop. I had my setbacks, and I still have the tendency to do these things. I always will. The thoughts still run through my head, but I have it in me to stop myself because I think about how it hurts the people around me.

I think this is where I struggle. I hurt for our depressed patients. I hurt for the type of people who rely on some self destructive behavior to escape all the bad things they feel. But I hurt even more for their families.

I took care of a lady with liver failure and esophageal varices the other day. I remembered her face. I knew why she was here. Drank herself sick again. This time, though, her son was with her. I knew I would have remembered him. He was a big cherubic looking kid. Really quiet. Really young, about 21. He never asked us for a thing. He sat there and stroked his mom's hair and held her hand while we tried to start an IV on her scarred-up shit veins. I don't think she even really acknowledged his presence. She did demand Dilaudid from us while he sat outside the room and cried. He asked one of the nurses how much it would cost to get his mother a liver transplant. That was enough to make me cry, too.

And my patient last night. Came in via EMS for approximately the 50th time this year. Took 9 Vicodin at once for whatever bullshit pain complaint she made up at that particular moment. Her tooth...nope. Maybe her back. And/or neuropathy. Wherever the pain was, she wasn't trying to kill herself or get high. She was just trying to make the pain better. In fact, the pain was still there, could she get some more pain medicine? Yeah. No. So her husband came back. Apparently this was a pretty regular little routine for them. By the way, she'd also been popping Xanax all day like they were sweet tarts. She does this and passes out, he says, so he just calls the ambulance as soon as she does it. Take her meds away, we tell him. Nope. Can't do it. Supposedly if he takes her meds she throws boiling water on him. Why he stayed with her I have no clue. But he did. The whole night he hugged and kissed her while she drooled. He cleaned and changed her when she peed on herself. This is my wife, he said. I married her because I love her. The EMTs who ran on her knew her by name. They said he would run down the block and use the pay phone to call 911 because she got so irate and abusive when he did it, so he would call from outside the house and pretend it wasn't him. I felt so awful for him. He clearly loved his wife so much, and there was absolutely nothing he could do for her.

I looked into both of these people's faces trying to find what it was that made these people love them. I could not figure it out for the life of me. Who had they been? And what happened? I can understand trying and failing. But I cannot understand looking into the eyes of your loved one and seeing the desperation I saw in both of these men and not wanting to change at all. The selfishness in them made me sick. It didn't change the way I cared for them but it just felt... bad. Like there was an anger in me for them that I really felt uncomfortable with. Chances are that these women will both kill themselves with their behavior one of these days. An awful part of me felt like it would be better for their loved ones if they went ahead and did it.

Is this normal? Am I putting too much on them? And is it even fair for me to compare my problems with theirs? This job sneaks up on me so bad some days.

[Click HERE to read more amazing blog entries over at New Nurse, in the Hood.]

Laughing Babies, My Heroes

Anatidaephobia

What Is Anatidaephobia?

Anatidaephobia is defined as a pervasive, irrational fear that one is being watched by a duck. The anatidaephobic individual fears that no matter where they are or what they are doing, a duck watches.

Anatidaephobia is derived from the Greek word "anatidae", meaning ducks, geese or swans and "phobos" meaning fear.

What Causes Anatidaephobia?

As with all phobias, the person coping with Anatidaephobia has experienced a real-life trauma. For the anatidaephobic individual, this trauma most likely occurred during childhood.

Perhaps the individual was intensely frightened by some species of water fowl. Geese and swans are relatively well known for their aggressive tendencies and perhaps the anatidaephobic person was actually bitten or flapped at. Of course, the Far Side comics did little to minimize the fear of being watched by a duck.

While we may be tempted to smile at the memory of those comics or at the mental image of being watched by a duck, for the anatidaephobic person, that fear is uncontrollable. Whatever the cause, the anatidaephobic person can experience emotional turmoil and anxiety that is completely disruptive to daily functioning.

What Are the Symptoms of Anatidaephobia?

The symptoms of Anatidaephobia vary from person to person. Some people, when confronted with their fear, may feel slightly uncomfortable, become nauseated or begin to perspire. Others are so severely compromised by this phobia, that they experience crippling anxiety and/or panic attacks.

Other symptoms of Anatidaephobia can include:

•A Dry Mouth
•Gasping or Shortness of Breath
•Muscle Tension
•Overall Trembling
•Hyperventilation
•Feeling Out of Control
•Feeling Trapped and Unable to Escape
•Overwhelming Feeling of Impending Disaster

How Is Anatidaephobia Diagnosed?

The vast majority of cases of Anatidaephobia are self-diagnosed. The individual realizes that their fear of being watched by a duck is irrational and is severely interfering with their ability to function on a daily basis.

The anatidaephobic person may then discuss their fears with their doctor. Typically the doctor will not assign a diagnosis of Anatidaephobia based on that initial discussion. More routinely, after ruling out any physical
reasons for the phobia, the doctor will refer the individual to a mental health professional for further evaluation and assessment.

How Is Anatidaephobia Treated?

When the fear that a duck is watching becomes so intense as to disrupt an individual's daily functioning, there are a number of ways to treat Anatidaephobia. These can include:

•Talking to the primary physician who can refer the person to a therapist who specifically treats phobias.
•Traditional "talk" therapy that will assist the person to identify and control their fear.
•Self-help techniques.
•Hypnotherapy.
•Support groups with other people coping with this phobia.
•Cognitive Behavioral Therapy or Desensitization Therapy.
•Exposure Therapy.
•Relaxation techniques such as deep breathing or meditation.
•In the most extreme cases of Anatidaephobia, anti-anxiety medication can be prescribed.

Anatidaephobia is an intense, irrational fear that one is being watched by a duck. Sometimes that fear can become so intense as to completely stop a person's ability to maintain daily functioning. Unchecked, Anatidaephobia can become a debilitating condition that interferes with the person's social life, their personal life and job responsibilities. Untreated, Anatidaephobia touches every aspect of a person's life.

de colores

hullo, you cutie-pies, you!

i am taking a brief hiatus from blogging.

monday, we are attempting another aspiration under fluoroscopy, the seventh, trying to identify the little buggers still burrowing in my bones.  i am looking forward to it, as these things have gone oh-so-well in the past.  in fact, the first aspiration was inspiration for this post, back in the infancy of elle est belle la seine:  A question for nurses, techs,  doctors...

for some reason, i am rapidly cycling between the red and blue phases of CRPS.  normally, the deep cold, deep purple version rules the roost and i am glad, for the bright red edematous side of things takes allodynia and hyperalgesia to new and unimagined heights.  

the pain of being rouge.

{fade to the dulcet tones of the militant lesbian existential feminists as they belt out de colores... a-swayin' to the left, then a-swayin' to the right.}

De colores

De colores se visten los campos en la primavera

De colores

De colores son los pajarillos que vienen de afuera

De colores

De colores es el arco iris que vemos lucir

Y por eso los grandes amores

De muchos colores me gustan a mi

Y por eso los grandes amores

De muchos colores me gustan a mi

Canta el gallo

Canta el gallo con el quiri quiri quiri quiri quiri

La gallina

La gallina con el cara cara cara cara cara

Los polluelos

Los polluelos con el pio pio pio pio pi

Y por eso los grandes amores

De muchos colores me gustan a mi

Y por eso los grandes amores

De muchos colores me gustan a mi

CRPS Pain Studies For Brainiacs

Photo courtesy of FreeFoto.com

Greetings, Dear Reader.

Two noteworthy articles about CRPS were recently published in Pain: Journal of the International Association for the Study of Pain.

NMDA-receptor antagonist and morphine decrease CRPS-pain and cerebral pain representation
Volume 151, Issue 1, Pages 69-76 (October 2010)
S.M. Gustina, A. Schwarza, N. Birbaumer, N. Sines, A.C. Schmidt, R. Veit, W. Larbig, H. Flor, M. Lotze  [Corresponding author. Address: Functional Imaging Group, Center for Diagnostic Radiology and Neuroradiology, University of Greifswald, Friedrich-Löffler-Straße 23a, D-17487 Greifswald, Germany. Tel.: +49 3834 866899; fax: +49 3834 866898.]

Abstract
A combination therapy of morphine with an NMDA-receptor antagonist might be more effective than morphine without a NMDA-receptor antagonist for the relief of neuropathic pain in patients with complex regional pain syndrome (CRPS). In order to test the efficacy of this combination therapy we performed a double-blind randomized placebo-controlled study on patients suffering from CRPS of the upper extremity. We used functional magnetic resonance imaging during movement of the affected and unaffected upper hand before and after a treatment regimen of 49days that contrasted morphine and an NMDA-receptor antagonist with morphine and placebo. We postulated superior pain relief for the combination therapy and concomitant changes in brain areas associated with nociceptive processing. Only the combination therapy reduced pain at rest and during movement, and disability. After treatment, activation in the contralateral primary somatosensory (cS1) and anterior cingulate cortex was significantly reduced when the affected hand was moved. Pain relief during therapy was related to decreased activation in cS1 and secondary somatosensory cortex (S2). Our data suggest that the combination of morphine with an NMDA-receptor antagonist significantly affects the cerebral processing of nociceptive information in CRPS. The correlation of pain relief and decrease in cortical activity in cS1 and S2 is in accordance with the expected impact of the NMDA-receptor antagonist on cerebral pain processing with emphasis on sensory-discriminative aspects of pain.

The second article is highly specialized and I cannot begin to unpack it.  The abstract is reproduced here for Serious Brainiacs.

Role of peripheral endothelin receptors in an animal model of complex regional pain syndrome type 1 (CRPS-I)
Volume 151, Issue 1, Pages 174-183 (October 2010)
Magali Millecamps, Andre Laferrière, J. Vaigunda Ragavendran, Laura S. Stone, Terence J. Coderre [Corresponding author. Address: Anesthesia Research Unit, McGill University, Room 1203, McIntyre Medical Bldg., 3655 Drummond St., Montreal, Quebec, Canada H3G 1Y6. Tel.: +1 514 398 5773; fax: +1 514 398 8241.]

Abstract
Chronic post-ischemic pain (CPIP) is an animal model of CRPS-I developed using a 3-h ischemia–reperfusion injury of the rodent hind paw. The contribution of local endothelin to nociception has been evaluated in CPIP mice by measuring sustained nociceptive behaviors (SNBs) following intraplantar injection of endothelin-1 or -2 (ET-1, ET-2). The effects of local BQ-123 (ETA-R antagonist), BQ-788 (ETB-R antagonist), IRL-1620 (ETB-R agonist) and naloxone (opioid antagonist) were assessed on ET-induced SNBs and/or mechanical and cold allodynia in CPIP mice. ETA-R and ETB-R expression was assessed using immunohistochemistry and Western blot analysis. Compared to shams, CPIP mice exhibited hypersensitivity to local ET-1 and ET-2. BQ-123 reduced ET-1- and ET-2-induced SNBs in both sham and CPIP animals, but not mechanical or cold allodynia. BQ-788 enhanced ET-1- and ET-2-induced SNBs in both sham and CPIP mice, and cold allodynia in CPIP mice. IRL-1620 displayed a non-opioid anti-nociceptive effect on ET-1- and ET-2-induced SNBs and mechanical allodynia in CPIP mice. The distribution of ETA-R and ETB-R was similar in plantar skin of sham and CPIP mice, but both receptors were over-expressed in plantar muscles of CPIP mice. This study shows that ETA-R and ETB-R have differing roles in nociception for sham and CPIP mice. CPIP mice exhibit more local endothelin-induced SNBs, develop a novel local ETB-R agonist-induced (non-opioid) analgesia, and exhibit over-expression of both receptors in plantar muscles, but not skin. The effectiveness of local ETB-R agonists as anti-allodynic treatments in CPIP mice holds promise for novel therapies in CRPS-I patients.

Ces petits riens::L'alcool

a little bit o'slick stacey kent for a friday breeze. lyrics, of course, by serge gainsbourg

Mieux vaut n'penser à rien

Que n'pas penser du tout

Rien c'est déjà

Rien c'est déjà beaucoup

On se souvient de rien

Et puisqu'on oublie tout

Rien c'est bien mieux

Rien c'est bien mieux que tout

Mieux vaut n'penser à rien

Que de penser à vous

Ça ne me vaut rien

Ça ne me vaut rien du tout

Comme si de rien

N'était je pense à tous

Ces petits riens

Qui me venaient de vous

Si c'était trois fois rien

Trois fois rien entre nous

Evidemment

Cà ne fait pas beaucoup

Ce sont ces petits riens

Que j'ai mis bout à bout

Ces petits riens

Qui me venaient de vous

Mieux vaut pleurer de rien

Que de rire de tout

Pleurer pour un rien

C'est déjà beaucoup

Mais vous vous n'avez rien

Dans le cœur et j'avoue

Je vous envie

Je vous en veux beaucoup

Ce sont ces petits riens

Qui me venaient de vous

Les voulez-vous ?

Tenez ! Que voulez-vous ?

Moi je ne veux pour rien

Au monde plus rien de vous

Pour être à vous

Faut être à moitié fou.

and why not some serge gainsbourg while i pause at this café, under this lacy blue sky, and drink to you?

Mes illusions donnent sur la cour

Des horizons j’en ai pas lourd

Quand j’ai bossé toute la journée

Il me reste plus pour rêver

Qu’ les fleurs horribles de ma chambre

Mes illusions donnent sur la cour

J’ai mis une croix sur mes amours

Les p’tites pépées pour les toucher

Faut d’abord les allonger

Sinon c’est froid comme en décembre

Quand le soir venu j’ m’en reviens du chantier

Après mille peines et le corps harassé

J’ai le regard morne et les mains dégueulasses

De quoi inciter les belles à faire la grimace

Bien sûr y’ a des filles de joie sur le retour

Celles qui mâchent le chewing-gum pendant l’amour

Mais que trouverais-je dans leur corps meurtri

Sinon qu’indifférence et mélancolie

Dans mes frusques couleurs de muraille

Je joue les épouvantails

Mais nom de Dieu dans mon âme

Brûlait pourtant cette flamme

Où s’éclairaient mes amours

Et mes brèves fiançailles

Où s’ consumaient mes amours

Comme autant de feux de paille

Aujourd’hui je fais mon chemin solitaire

Toutes mes ambitions se sont fait la paire

J’ me suis laissé envahir par les orties

Par les ronces de cette chienne de vie

Mes illusions donnent sur la cour

Mais dans les troquets du faubourg

J’ai des ardoises de rêveries

Et le sens de l’ironie

J’ me laisse aller à la tendresse

J’oublie ma chambre au fond d’ la cour

Le train de banlieue au petit jour

Et dans les vapeurs de l’alcool

J’ vois mes châteaux espagnols

Mes haras et toutes mes duchesses

À moi les p’tites pépées les poupées jolies

Laissez venir à moi les petites souris

Je claque tout ce que je veux au baccara

Je tape sur le ventre des maharajas

À moi les boîtes de nuit sud-américaines

Où l’on danse la tête vide et les mains pleines

À moi ces mignonnes au regard qui chavire

Qu’il faut agiter avant de s’en servir

Dans mes pieds-de-poule mes prince-de-galles

En douceur je m’ rince la dalle

Et nom de Dieu dans mon âme

V’là qu’ j’ ressens cette flamme

Où s’éclairaient mes amours

Et mes brèves fiançailles

Où se consumaient mes amours

Comme autant de feux de paille

Et quand les troquets ont éteint leurs néons

Qu’il n’ reste plus un abreuvoir à l’horizon

Ainsi j’ me laisse bercer par le calva

Et l’ dieu des ivrognes guide mes pas

The One Where I Hum "Qué Será, Será" Like Doris Day On Ketamine

Hullo, all. It's been a busy week; I'm exhausted. So straight to the most recent CRPS MedWorm offering. It's a case study, is all, but a good reminder that sometimes the "cause" of CRPS can be a seemingly insignificant event:

Summary
Complex regional pain syndrome (CRPS) is a chronic progressive disease characterised by severe pain, swelling and changes in the skin. Precipitating factors include injury and surgery, and a variety of causes have been described. We present the case of a 68-year-old lady who presented with features indicative of a CRPS following steroid injection for a ‘trigger’ thumb.
--Published in the October 2010 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, Volume 63, Issue 10

Something equally innocuous can cause "spread" of CRPS, as well, which is why someone with the disease can be particularly anxious about injections, blood draws -- and, needless to say, things like surgeries.

I have wanted to politely bop a few nurses and lab techs on their pointy little heads for rolling their eyes at my concerns about being stuck in a CRPS-afflicted limb. Even my top-notch, worldclass, wunnerful::wunnerful surgeon doesn't follow all the established precautions for preventing spread... I have shared with him the protocols I find, which include early admission for i.v. infusions and pain meds (yes, ketamine is involved!) and similar infusions afterward -- something that purportedly stops spread and prevents "flare." [These are the recommendations at the Hospital for Special Surgery, an orthopedic Mecca.]

If anyone doubts how far reaching the Dr. Scott Reuben scandal is? One of the often recommended articles on prevention of CRPS spread during/after a surgical procedure is called, nattily enough: Preventing the Development of Complex Regional Pain Syndrome after Surgery
and yes, the author is "Reuben, SS."

He pops up again with Perioperative Pregabalin Reduces Neuropathic Pain at 3 Months after Total Knee Arthroplasty (TKA) and if you are certain that he is not simply a mercenary in his promotion of Pregabalin, then you are a trusting, simple, stupid soul.

On the other hand, the level of my distrust might be excessive.

[It could happen.]

The ideas posited in Surgery on the Affected Upper Extremity of Patients with a History of Complex Regional Pain Syndrome: The Use of Intravenous Regional Anesthesia with Clonidine are considered indisputable, or were, given Reuben's ghoulish signature on the work.

I look forward to the day when baby and bathwater can be carefully and correctly identified, separated -- and the cold, scummy liquid discarded.

In the meantime, take all the precautions that you can when someone approaches your CRPS-afflicted regions. At the very least, say "Stop! Don't touch..." and then take a moment to talk things out with the person in front of you, readying to wield some invasive tool -- because as much as I have maligned nurses and phlebotomists, I have encountered some who were very well informed and who promptly took preventive measures (using the smallest of butterflies, avoiding nerve-rich areas, etc.).

What is immeasurably valuable is the relief that comes from dealing with a health care professional who is familiar with this bug-a-boo syndrome.

The very best advice about surgery in people with CRPS? Avoid it.

Don't get me wrong... You *can* rely on certain truths in this world, in this life.

Scott Reuben is still a dirtbag, and Jose Ochoa remains a big, fat turd.

"If it quacks like a Duck and sets a Quran on fire then it must be a Republican"

God Loves A Good Book Burning
by: Helen Philpot | September 9, 2010

Margaret, did we really expect anything less? Religious intolerance has defined the Republican Party for almost 30 years now. A culture of life. Family values. America’s Christian Heritage. The sanctity of marriage. Gays in the military. Prayer in school. A mosque in Manhattan. For goodness sakes, the current leaders of the Republican Party (Palin, Limbaugh, and Beck) have been screaming about a Muslim family in the White House for months now. It was only a matter of time before someone called for a good ‘ole fashion book burning. Does it really matter if that book is the Quran instead of The Catcher in the Rye?


There is just one thing I haven’t been able to figure out yet. How many more groups of people does the Republican Party have to hate before its members finally call for a new platform? Those signs they carry at their rallies are getting pretty full. The print will have to be pretty small at the next Beck rally to fit God Hates Gays, Jews, Blacks, Muslims, Clinton (him and her), the Liberal Media, Obama, Pelosi, French Fries, Activists Judges, Environmentalists, Feminists, Mexicans, and small puppies. Maybe they can just print up a sign that simply says God Hates Everyone Who Isn’t Like Me.


And trust me Margaret. The minute Matthew puts this on that web page blog of ours, a bunch of jack-asses are going to tell us that God hates us too and we shouldn’t generalize all Republicans like that. Well all I have to say is if it quacks like a Duck and sets a Quran on fire then it must be a Republican.


If you vote Republican today, what exactly are you voting for? It’s certainly not smaller government. If you vote Republican today you are telling “Pastor” Terry Jones that fifty religious fanatics are more important than any chance for world peace. You are telling Sarah Palin that when it comes to the presidency - pretty is more important than smart. You are telling Glenn Beck that honesty isn’t really necessary if you have your own cable news show on Fox. You are telling Michele Bachmann that hearing voices in your head isn’t cause for alarm. Hell, if you vote Republican today you might as well just shove a few more dollars in Rush Limbaugh’s pockets and a few more pills in his mouth. It’s all very entertaining, I’ll give you that. But considering what they did when we gave them the keys to the car the last time, are you really ready to put them behind the wheel again so soon? I’m just not sure there are that many more countries we can bomb, world religions we can vilify and oil wells we can drill before the rest of the world calls us on our bullshit.


Here’s a thought. If Pastor Jones is so dead set on burning a book he should just wait until The George Bush Memoirs come out. After all, everyone knows the only thing God loves more than a good book burning is a burning Bush.


If the Democrats can’t muster enough votes to beat this bunch of yahoos then we deserve what we get on November 3rd. Besides, Harold said we could move to Canada and you know how much I love Anne Murray.


Vote Republican and burn a Quran. Same difference. I mean it.  Really.

The blog Margaret and Helen, comprised mostly of Helen Philpot's right-as-rain commentary to her friend Margaret Schmechtman, is my absolute favorite bit of wit on the web.  From About Margaret and Helen:

My name is Helen Philpot. I am 82 years old. My grandson taught me how to do this so that I could “blog” with my best friend Margaret Schmechtman who I met in college almost 60 years ago. I have three children with my husband Harold. Margaret has three dogs with her husband Howard. I live in Texas and Margaret lives in Maine.

If you haven't checked them out, you are missing a lot of truth and laughter. Don't worry about possibly being offended or nonplussed or whatever, because these ladies are as easygoing and nonsectarian as it is possible to be.

I mean it.

Really.

Combining Ketamine With Astrocytic Inhibitor

Astrocytes

Well, I know how hard it is for me to go without news about ketamine.  It's been a few days since I last spoke of this panacea, this club drug gone antidepressant, this animal tranquilizer deemed curative for CRPS/RSD.

It's going to take a lot of research, duplicated, peer-reviewed, and sanctified, thrice, by a Comprehensive and Integral Ad Hoc Committee Assembled by the Creator of the Universe, for me to get on the Ketamine Bandwagon. 

It could happen.

Today's offering comes from a group of scientists from the K. K. Leung Brain Research Centre of the Fourth Military Medical University in Xi’an, China, and is published in Molecular Pain.  The authors come from the Departments of Anesthesiology and Anatomy. 

The folks hailing from Anesthesiology are further specialized as "stomatologists." "Ewww!" was my first thought, closely followed by curiosity about CRPS of one's stoma... but it turns out that stomatology is the study of the mouth and its diseases:  dentistry, in other words!  I guess an anesthesiologist/stomatologist represents -- in Western formulations -- someone with a DDS who has done post-graduate work in anesthesiology.  What it means in the Chinese context, I dunno.  Perhaps it includes acupuncture.

That there is a décalage between Western Dentistry and Chinese Stomatology is clear:  For instance, like the American Dental Association, the Chinese Stomalogical Association declared that fluoride toothpaste helps prevent tooth decay... but C.S.A. did it in 2007.  I guess the actual availability of fluoridation plays a big part in that evolution, and further realize that the issue of fluoridation is not as clear cut to some as it is to me.  If you believe that fluoride causes cancer, then the topic of fluoride in your communal water supply is not a lighthearted topic.  [Okay, moving right along... don't wanna get lost... too late?  Is it too late?]

Rather quickly, I am wondering about the quality of translation in this work.  The current PDF version at Molecular Pain is provisional, with a promise of a fully formatted/full text version to be available soon.  I hope that can include scrutiny of translation from Chinese to English.  For instance, I am sure this sentence can be improved upon:

However, the present clinical therapeutics is still just concerning about neuronal participation.

And just because, I would like one of the authors to expound upon this:

Combined administration obviously relieved mechanical allodynia in a quick and stable manner.  [How?!  How did they know?!  I mean, my assumption is that we're talking lab rats here...  Was it that deep sigh of relief?  The fading furrows on the brow?  That certain sassy swish to the tail?]


Hmmm?  The claim?  The object of the study?  Jeez, but You Readers are demanding.  Is that a Burgeoning Sense of Entitlement rearing its ugly little head? 

Combining ketamine with astrocytic inhibitor as a potential analgesic strategy for neuropathic pain

Molecular Pain 2010, 6:50   doi:10.1186/1744-8069-6-50

Published: 6 September 2010



ABSTRACT
Background: Neuropathic pain is an intractable clinical problem. Intrathecal ketamine, a
noncompetitive N-methyl-D-aspartate receptor (NMDAR) antagonist, is reported to be useful for
treating neuropathic pain in clinic by inhibiting the activity of spinal neurons. Nevertheless,
emerging studies have disclosed that spinal astrocytes played a critical role in the initiation and
maintenance of neuropathic pain. However, the present clinical therapeutics is still just concerning
about neuronal participation. Therefore, the present study is to validate the coadministration
effects of a neuronal noncompetitive N-methyl-D-aspartate receptor (NMDAR) antagonist
ketamine and astrocytic cytotoxin L-α-aminoadipate (LAA) on spinal nerve ligation
(SNL)-induced neuropathic pain.

Results: Intrathecal ketamine (10, 100, 1000 μg/kg) or LAA (10, 50, 100 nmol) alleviated
SNL-induced mechanical allodynia in a dose-dependent manner respectively. Phosphorylated NR1
(pNR1) or glial fibrillary acidic protein (GFAP) expression was down-regulated by intrathecal
ketamine (100, 1000 μg/kg) or LAA (50, 100 nmol) respectively. The combination of ketamine
(100 μg/kg) with LAA (50 nmol) showed superadditive effects on neuropathic pain compared with
that of intrathecal administration of either ketamine or LAA alone. Combined administration
obviously relieved mechanical allodynia in a quick and stable manner. Moreover, down-regulation
of pNR1 and GFAP expression were also enhanced by drugs coadministration.

Conclusions: These results suggest that combining NMDAR antagonist ketamine with an
astrocytic inhibitor or cytotoxin, which is suitable for clinical use once synthesized, might be a
potential strategy for clinical management of neuropathic pain.

Direct Correspondance to:

Dr. Li-Xian Xu at
Department of Anesthesiology, School of Stomatology
Fourth Military Medical University, Xi’an, 710032, China
Tel: 86-29-84776115 Fax: 86-29-84776115 E-mail: kqmzk@126.com

Dr. Sheng-Xi Wu at
Department of Anatomy, Histology and embryology; K.K. Leung Brain Research Centre, Fourth
Military Medical University, Xi’an 710032, China
Tel: 86-29-84773074 E-mail: shengxi@fmmu.edu.cn

Dr. Yun-Qing Li at
Department of Anatomy, histology and embryology, K. K. Leung Brain Research Centre, Fourth
Military Medical University, Xi’an, 710032, China
Tel: 86-29-84774501 E-mail: deptanat@fmmu.edu.cn

ABOUT MOLECULAR PAIN:

Molecular Pain is an open access, peer-reviewed, online journal that encompasses pain research at the cellular, subcellular and molecularlevels.

Molecular pain is a growing research field that represents an advanced step from conventional pain research, addressing physiological and pathological pain at the cellular, subcellular and molecular levels.

Molecular pain research integrates pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has great promise for the identification of highly specific and effective targets for the treatment of intractable pain.

The Taiji Slaughter Set to Begin, Again

The photo above has NOT been ‘Photoshopped’ – that is the actual color of the water due to the annual slaughter of tens of thousands of dolphins in a secluded cove in TAIJI, Japan. You can see several of the killed dolphins in the boat. That’s all blood – a sea of blood.


The coastal village of Taiji, Japan, is home to the worst dolphin massacres in the world, motivated entirely by greed and fueled by the ignorance of the local people and the Japanese government. The bloody red waters of Taiji, Japan are only the beginning of this story...

From blog Taiji, Japan

If you've not seen the documentary The Cove, you should. 

La Bonne et Belle Bianca rented it, by mistake, one hot summer night last year.  It was Movie Night at The Manor, just a little something we do on behalf of Management and Domestic Staff Relations -- to bring everyone a little closer, build a little camaraderie.

It was the last hot day of ManorFest 2009. We were inundated with Monks taking advantage of Last Day Specials -- especially the discount to Walk the Labyrinth.  The sun was setting and there were still some 55 Cistercians wandering around the Marlinspike Manor Maze, which they consider a spiritual exercise.  The Brothers who had already found their way out lined the rear arc of the amphitheater, killing time with a movie while their colleagues quietly cursed the falling darkness inside the serpentine boxwood.

(Our Rescue Teams would lead them out during Intermission.)

The Castafiore thought she had snagged a film of The Kooks in concert and -- given the amazing way in which sound carries in our open-air stadium -- disrupted the first ten minutes of The Cove with Fierce Mutterings:  Oh! Dieu, que de bijoux-oux-oux!  Ah... ah... ah... je ris de me voir-r-r si belle en ce miroir-r-r!

Kind of hard to ignore, I admit, but we've had years of practice.

Eventually, even Bianca was drawn into the strange world of Taiji, Japan, and its accusatory eyes and barely concealed evil.  The Monks would have heaved Big Sighs, if that were allowed.  Those moments when Prayerful Intercession runs smak dab into Active Need are hard to reconcile.

That's not to say that this movie's Call to Action fell on completely deaf (or tonsured) ears.  A good many emails went out, righteously indignant.  None were answered, and there were no second volleys of indignation on our part.

It's easier just to forget.

But we've ordered time so that it cycles for many reasons, one of which is annual remembrance, recurrence.  Yesterday, I read:

These are dark days in Taiji, Japan, as far as conservationists are concerned, because this week marks the beginning of the annual dolphin hunt in the remote village made famous last year by the Academy Award-winning documentary, "The Cove."

The hunt began Wednesday despite widespread international opposition and protests in Tokyo.

Ric O'Barry, who trained dolphins for the 1960s show "Flipper" and helped produce "The Cove," traveled to Tokyo and delivered a petition of opposition, signed by 1.7 million people from 155 countries, to the U.S. Embassy. The activist, who also has produced an Animal Planet miniseries called "Blood Dolphins," was forced to cancel a trip to Taiji amid alleged threats from an ultra-nationalist group.

"I wish all these people could be in Taiji," O'Barry told The Associated Press. "It was too dangerous. The big losers are the people of Taiji."

Most of the dolphins corralled into the cove during the hunts are killed and processed for meat, but some specimens are sold live to aquariums. Japan allows the killing of about 20,000 dolphins a year and claims the hunts are an important part of the nation's culture and tradition.

Taiji, a community of about 3,500 and the birthplace of Japanese whaling, accounts for about 1,500 dolphin deaths annually. Its "oikomi hunting" practice of banging on metal poles to create a wall of sound to herd dolphins into the cove in preparation for slaughter is what drew worldwide criticism after "The Cove" was released.

"We will pass down the history of our ancestors to the next generation, preserve it. We have a strong sense of pride about this," town Mayor Kazutaka Sangen told the AP. "So we are not going to change our plans for the town based on the criticism of foreigners."

The first victims, about 20 bottlenose dolphins, were herded into the infamous cove on Thursday. The cove, with the help of netting, will serve as a holding pen. The actual killing of dolphins won't begin for about two weeks...
-- Despite swelling opposition, dolphin hunt begins in Taiji, Japan
By Pete Thomas, GrindTV.com
Friday, September 3, 2010 9:33am PDT

This video about the dolphin killing in Taiji was made by BlueVoice.org in late 2006: