Friday, October 17, 2008

An Embarrassment of Sensation

I only have access, at the moment, to the abstract of this article, published in the October 16, 2008 issue of Rheumatology. The reference popped up as the latest item on my MedWorm "CRPS" news feed.

C. S. McCabe, one of the authors, is known to me (giggle) as someone who is at the forefront of investigations into (Step away from this non-scientist's understanding!) how to bridge the gaps between pain sensations, the complex processes of pain perception, and the expressions of pain -- he has written extensively on mirror visual feedback, for example.

Yes, I get the rolly-polly poly-semy of expression.

D. R. Blake is unknown to me, though from looking over his work, as represented in PubMed listings, he seems more oriented toward microbiology and his study of sensory/motor incongruence takes place more often at a cellular level (That was an attempt at clever levity. Quite successful, I'd say.) He also seems to have an intense interest in Chlamydia. (Ar!)

Both hail from the Royal National Hospital for Rheumatic Diseases in conjunction with The School for Health, University of Bath, Bath, UK.

Here is the abstract:

An embarrassment of pain perceptions? Towards an understanding of and explanation for the clinical presentation of CRPS type 1
October 16, 2008 (Rheumatology)


Complex regional pain syndrome (CRPS), a fairly common problem in rheumatological and orthopaedic practice, is an allodynic pain state of uncertain pathology often variably and unpredictably responsive to treatments. Although published diagnostic criteria are available, in the reality of clinical practice these do not appear to encompass the wide variety of symptoms that a patient may present with. This leads to scepticism on the part of the clinician and confusion for the sufferer. This article aims to provide some explanations for an often bewildering clinical picture. We provide a construct for the plethora of symptoms that we have entitled ‘the embarrassment of pain perceptions’. With the aid of a case report we examine recent research that suggests how peripherally based symptoms and signs arise from changes within the central nervous system, with particular attention given to the control function of the motor–proprioceptive integrative system. We speculate how these changes within the central nervous system may provide the patient with CRPS the ability to access complex layers of lower level perceptions that are normally suppressed. We propose that such a system may explain some of the clinical puzzlements seen in this condition and suggest that the complexities of CRPS may provide an insight into brain development through evolution, which is a fruitful area for interdisciplinary clinical and scientific research.


KEY WORDS: Complex regional pain syndrome, Pain, Motor control system

This goes far toward explaining (because in an acceptable format, because provided by acceptable people) the often off-putting richness of pain vocabulary chez someone with CRPS.

Cough. Of course, I am not fooled by the seemingly haphazard use of "interdisciplinary" -- a quaint word in an ugly code.

But then, I haven't read the article yet.

Thursday, October 16, 2008

For Today, At Least: Thank you, Google; Thank you, Milliken

At this moment -- 7:21 pm on Thursday, 16 October -- GOOG sits at 390 in after-hours trading. I am profoundly grateful that my inability to make a decision has not been met, for today, at least, with disaster.

I am also amazed at the antimicrobial silver dressing, specifically SelectSilver by Milliken, which is wicking, at an unbelievable rate, unwanted swampy microbes from a bad foot ulcer. It remains to be seen if it will bring healing or not but it is, without doubt, another very nifty gift to medicine from industry.

And so it is that I pray Google will hold its value, and maybe even hit the yearly target of my dreams, thereby paying for all the antimicrobial silver dressings by Milliken that I will have to use in the coming weeks and months.

Of these small, odd things I sing.

Tuesday, October 14, 2008

Married to the Sea: "The Champagne of Comics"

Married To The Sea
marriedtothesea.com


Maybe it is because I just won the Nobel Prize, I dunno. Whatever. But when I stumbled upon the cartoon siteMarried to the Sea: "The Champagne of Comics," I found it tickled my now elite funny bone.

Before winning the Nobel Prize, I might not have "gotten" this sort of highbrow humor.

That's not to say that winning the Nobel Prize has changed me in any meaningful way. No, I am still the same simple girl that I have always been.

It's just that now I have a Nobel Prize.

Anyway, here's the gist on this funny endeavor:

Married To The Sea is a comic created by Drew and Natalie Dee. Drew's other comic, which also updates daily at midnight, is Toothpaste For Dinner. Natalie's other comic is Natalie Dee. No historical accuracy is implied or intended in Married To The Sea comics.You may put one or more images from this site on your own website / livejournal page / myspace page / blog, as long as you also provide a link to this site, next to the comics. You may not use the images in advertisement(s) or content for your own projects.

Now, *that* is generous, no?

Not to be outdone, I have seen fit to use my influence -- as a Nobel Prize winner -- to encourage the various committees in Oslo to contract with MTTS in the creation of mugs, Tees, and refrigerator magnets bearing my funnified commemorative image.

All the hard work pays off

Hey! Guess what! I won the Nobel Prize!

I gotta give the guys in Stockholm a call back, though, because we were disconnected before I could hear the field for which they had chosen to honor me. I mean, take your pick.

Among the diverse areas acknowledged last year?

2007



Aviation: Patricia V. Agostino, Santiago A. Plano and Diego A. Golombek, for discovering that hamsters recover from jetlag more quickly when given Viagra.




Biology: Johanna E.M.H. van Bronswijk, for taking a census of all the mites and other life forms that live in people's beds.


Chemistry: Mayu Yamamoto for extracting vanilla flavour from cow dung.



Economics: Kuo Cheng Hsieh, for patenting a device to catch bank robbers by ensnaring them in a net.



Linguistics: Juan Manuel Toro, Josep B. Trobalon and Nuria Sebastian-Galles, for determining that rats sometimes can't distinguish between recordings of Japanese and Dutch played backward.



Literature: Glenda Browne, for her study into indexing words that start with the word "the".



Medicine: Dan Meyer and Brian Witcombe, for investigating the side-effects of swallowing swords.



Nutrition:
Brian Wansink, for investigating people's appetite for mindless eating by secretly feeding them a self-refilling bowl of soup.



Peace: The Air Force Wright Laboratory in Dayton, Ohio, for suggesting the research and development of a "gay bomb," which would cause enemy troops to become sexually attracted to each other.



Physics: L. Mahadevan and Enrique Cerda Villablanca for their theoretical study of how sheets become wrinkled.

Saturday, October 11, 2008

More Rotten Pot -- That's "Pot Pourri" to You!


    Hmmm. I began this hodge-podge of an entry on October 3, and promptly forgot about it. In fact, when I stumbled upon the list of my dozen or so drafts, it was quite enlightening. As in: Oh, so that's where I left that thought.


      Today is October 11, 2008, and I am different than I was on October 3. Primarily, I am much, much poorer, having lost beaucoup d'argent in the market. My health care costs (insurance premiums, co-pays, out-of-pocket, and care not covered) use over 85% of my private disability income. I am responsible for keeping the household afloat, so supplementary monies from my investments are the only help I have. Rather: HAD. I pay all utilities (except water), groceries, and half the mortgage -- plus, I cover the inevitable unscheduled expenses that occur in the maintenance of your average centuries-old European manor located in the Tête de Hergé. Stuff like the costs of reparation of smoky Rembrandts when Marmy decides to do a little vertical marking. Like weaving a textile patch to match the one-of-a-kind medieval tapestries that depict the warring and artistic history of the Castafiore family. Yes, and the more mundane stuff -- a better grade of lawn mower, hedge clippers, HVAC repair, and the odd new roof. So, as my investment account was decimated, my panic grew in countertime, in immensity. I cannot show fear to the Fredster, to the Felines -- not even to La Belle Biance Castafiore. "Don't worry!" I practically crow. And my-oh-my, the afflictions that go with living with CRPS / RSD? The exacerbations due to emotional stress? I've got 'em! For once, I will spare you the laundry list. (There is one thing, though, that has me confounded -- a blistery rash that feels and looks like a bad burn. Not knowing what to do, I slathered on some betamethasone dipropionate cream. When in doubt, find the closest steroidal concoction!)



          After deleting all the now irrelevant detritus from the draft, and after adding all the flaming issues of the day, this is the sad bit that remains:



        • I have fallen in love with Jon & Kate plus 8 -- I sometimes watch marathon sessions of the television show and am simply in awe... Laughter comes easily: yesterday, one of the sextuplet boys ran to Daddy, full of eureka and aha, to whisper "I am your son!"; Kate keeps her toenails painted because another one of the boys has a toe fetish; The twin girls shop for each other's Christmas gifts but insist, as well, that they each *receive* the same item that is being gifted... Still, I wish Kate would ease up -- verbally -- on Jon, although I get that she is maxed out in every imaginable way. He's amazing, she is awesome -- I am slack-jawed, and those children are blessed.

        • Austrian National-Socialist Joerg Haider is dead. Saves me some trouble. Why is Mugabe still alive?

        • I killed Pinochet. Yes. Yes, I did. Shush! I did, too! Much in the same way that I kept the paper cutout of the life-sized head of Jesse Helms impaled on my cork bulletin board with a 5.5-inch Henckels boning knife.

        • What makes hydrogen peroxide fizz?

        • The mail just came -- and despite my instructions that no bills find their way to me this morning, Fred somehow allowed Plumtree Orthopaedic Dudes' bill into the pile of junk mail (a Vera Bradley catalog, a Fidelity mailer on "retirement planning," and my yearly "invoice" for our CCF-sponsored Ethiopian child). How is it that my insurance refuses to pay for the services of the PA who apparently assisted my orthopedic surgeon in my recent surgeries? Even more wondrous... how is it that said PA *dares* to charge me $7,427.12 for his services when he is as much a surgeon as I am? And... jagged deep breath... what the hell is this additional $17, 125 listed as a balance? Plumtree Orthopaedic Dudes have always engaged in crooked billing, in my experience, but after two go-rounds, years back, I gave up trying to fight it. So how screwed am I? If you have followed my saga, you know that my real and actual (i.e., not the PA) orthopod is yammering the pros and cons of gifting me with a new right shoulder prosthesis, once he is convinced the infection that decimated the success of the old one is definitively gone. Will he proceed if these charges are still in dispute? Because in dispute they are. The hospital bill was over $100,000 and was paid in full by insurance... what is the problem with resolving the surgeon's fees? Could it be that they have finally caught on to the fraudulent billing (primarily double-dipping, duplicate charges in masquerade)? I have excellent coverage and am darned lucky to have it -- but I pay over $17,000 a year for the privilege (privilege?). Where did I stash those spare millions?

        • Sarah Palin, reverse-nepotism in action!

        • Does crystal meth give women a high, whiny voice? Or do women with high, whiny voices have an unusual affinity for the drug?

        • And, as always, I wonder, along with Bill Cosby: Why is there air?



        Thursday, October 9, 2008

        Low Dose Ketamine and Memantine for Neuropathic Pain

        I recognize and respect the frustration that doctors and nurses must experience when patients delve into the internet to obtain medical information, and then bring that "research" in to appointments in full "eureka!" mode.

        That said (ar! ar! ar!), one of my MedWorm news feeds, on ketamine, turned this up:
        ultra-low dose ketamine and memantine treatment for chronic pain -- specifically, neuropathic pain. As usual, the non-malignant neuropathic pain is represented by diabetic peripheral neuropathy. This use of memantine is off-label (of course) -- the drug is usually used in moderate to severe Alzheimer's disease (Namenda).

        In the October 2008 issue of Anesthesia and Analgesia, doctors from the Anesthesia Department of the University of Washington published "Ultra-low dose ketamine and memantine treatment for pain in an opioid-tolerant oncology patient."

        This is the abstract of the article that the authors submitted to PubMed:

        Patients taking high-dose opioids chronically for tumor-related or neuropathic pain may develop pain that is refractory to opioids. One option for control of such pain is the use of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine. We describe a case of opioid-refractory pain that responded to a low-dose IV infusion of ketamine in the inpatient setting. The patient was then successfully transitioned to oral memantine for long-term outpatient management, in a novel use of this oral NMDA receptor antagonist. We present recent findings from basic research on pain mechanisms to explain why opioid tolerance, as in this patient, may contribute to the analgesic benefit of NMDA receptor antagonists.


        "Memantine Significantly Reduces Peripheral Neuropathy Pain in Diabetics" was the next thing I turned up -- yes! I released the hounds! I let the dogs out! And I dare to call it research... But will I dare to stalk my internist, neurologist, and pain management doctor-dude with the information that I have culled, and will continue to cull?

        Yes, I think so. It has been several years, actually, since I have dragged in any articles. Mostly, I read and then present anything interesting in a very brief oral report that inevitably results in the same reaction of "uh-huh." That is not to say there is no interest -- no, the problem lies elsewhere. The problem is that "no one knows" how CRPS / RSD really comes about, sticks around, or is best treated. I feel myself on almost equal footing with some of the more speculative researchers out there, with the difference that I cannot afford -- neither by bank account nor by insurance coverage -- the treatments that are in the pipeline.


        Bitter? Moi? Of course not.


        Shoot, we just added Forteo as an off-label use -- why not give this ketamine-transition-to-memantine idea a go? I think sometimes that they give me way too much credit. There is this tacit assumption that Retired Educator, succored by Fred, the felines, and La Belle Bianca Castafiore, and living the luxe in Marlinspike Hall, Tête de Hergé, can handle any amount of pain.


        Not so. More and more "not so" with each passing day.


        (Oh -- for those who don't know, MedWorm is a "medical RSS filter engine" and proves *occasionally* helpful in turning up germane articles -- but only if you feed the worm with very specific and well-thought out search guidelines. You must then bring the full power of your intellect to bear upon the results and vett the weird and unfounded, the scientistic and the industry-driven.)


        Wednesday, October 8, 2008

        "i carry your heart with me"

        Encore un cadeau de la part de TW -- quelle image calme et sauvage en même temps. Il faut dire que j'aie mélangé la photo d'un jour avec la citation attachée à un autre -- une liberté que j'espère ne sera pas trop -- trop. Libertine? Violente? En tout cas, si cela semble ne pas marcher, ne pas aller ensemble, c'est de ma faute à moi -- ça n'a rien à voir avec TW!






        nearing Seventyfive Mile Canyon on the Escalante Route



        here is the
        deepest secret
        nobody knows
        (here is the
        root of the root
        and the bud
        of the bud
        and the sky
        of the sky
        of a tree
        called life
        which grows
        higher than
        the soul
        can hope
        or mind
        can hide)
        and this is
        the wonder
        that's keeping
        the stars apart

        i carry your heart
        (i carry it in my heart)

        --e.e. cummings (from "i carry your heart with me")

        Merci encore une fois, mon frère.

        Tuesday, October 7, 2008

        Critical Mass or Freshman Comp

        A close relative of mine is an English professor at a university that I've never been able to locate on a map. This semester he has been stuck with some Freshman Comp courses, designed to instill good writing and research skills, as well as a measure of critical thinking.

        Last week he assigned a critical and rhetorical analysis of some famous protest songs and first drafts are beginning to trickle in. He began the initial evaluation of these gestational pieces today.

        It is a bad sign that I should receive an email about their content so soon.

        My dear brother writes:

        I'm spending the morning looking at first drafts of the song project; things aren't looking too good. I give them minimal guidance for the first drafts, hoping to see just how they've interpreted the assignment. Apparently, the idea of a thesis merging literary and rhetorical analysis escapes most of my writers. (Although I must admit, it is an odd notion indeed, smacking of a grad school assignment adapted for freshmen.)

        So they tell me in very broad terms about the singer ("Marley was a Jamican who sometimes visited the island of Hadee"--No, I'm not kidding) or about the hippies roaming free during the 60s or about how Donovan wouldn't dare sing "Universal Soldier" to an audience of American patriots because as "[t]he movie 'The Punisher' said it best: 'if you want peace, prepare for war.'"

        War indeed. Where do I begin?

        Monday, October 6, 2008

        Creepy

        What is worse? That I post pictures of my limbs afflicted with CRPS / RSD or that people download those pictures?

        Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.


        I am sorely disappointed.

        Sigh.

        The appropriate -- but discouraging in its very appropriateness -- response?

        Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.

        The significant difference? McCain, at the time a United States Senator, was determined by the Ethics Committee of exercising "poor judgment" -- poor judgment that contributed to the Savings and Loan debacle of the late 1980s and early 1990s. Barack Obama points out that Bill Ayers is “somebody who engaged in detestable acts 40 years ago, when I was 8.”

        Is it noteworthy to point out that McCain's indiscretion occured when he was at the comparative ripe old age of 51 (depending on what date one chooses: I chose 1987 because it marks McCain's maverick-y response to being called a "wimp" -- that is, it marks his participation in the infamous April 1987 meetings with FHLBB members.)

        Oh, did I forget to point out that once McCain discovered Keating was under criminal investigation, he ended his involvement? Selon Wikipedia:

        On April 2, 1987, a meeting with chairman Gray of the FHLBB was held in DeConcini's Capitol office, with Senators Cranston, Glenn, and McCain also in attendance.[8] The senators requested that no staff be present.[13] DeConcini started the meeting with a mention of "our friend at Lincoln."[8] Gray told the assembled senators that he did not know the particular details of the status of Lincoln Savings and Loan, and that the senators would have to go to the bank regulators in San Francisco that had oversight jurisdiction for the bank. Gray did offer to set up a meeting between those regulators and the senators.[8]

        On April 9, 1987, a two-hour meeting[5] with three members of the FHLBB San Francisco branch was held, again in DeConcini's office, to discuss the government's investigation of Lincoln.[12][8] Present were Cranston, DeConcini, Glenn, McCain, and additionally Riegle.[8] The regulators felt that the meeting was very unusual and that they were being pressured by a united front, as the senators presented their reasons for having the meeting.[8] DeConcini began the meeting by saying, "We wanted to meet with you because we have determined that potential actions of yours could injure a constituent."[14] McCain said, "One of our jobs as elected officials is to help constituents in a proper fashion. ACC [American Continental Corporation] is a big employer and important to the local economy. I wouldn't want any special favors for them.... I don't want any part of our conversation to be improper." Glenn said, "To be blunt, you should charge them or get off their backs," while DeConcini said, "What's wrong with this if they're willing to clean up their act? ... It's very unusual for us to have a company that could be put out of business by its regulators."[8] The regulators then revealed that Lincoln was under criminal investigation on a variety of serious charges, at which point McCain severed all relations with Keating.[8]

        I am very attracted to people, politicians, especially, who are able to adjust their attitudes and actions when new information comes to light. Nothing proved more disheartening to me than W's constant noise about not changing horses in midstream, not abandoning a stance, even a clearly inappropriate and losing stance.

        More than just a sign of intransigeance, his rigidity heralded his cruel stupidity.

        Mais je divague... So I admire, to an extent, McCain's retrieval of his good sense from the edge of criminal intent and activity -- back then. What an honest guy. What a maverick. WhooHoo.

        Likewise, I am very put off by people, politicians, especially, who figure, and appeal to, some sort of lowest common denominator.

        In June, the Washington Wire blog at WSJ.com published this interesting take on current applications of Swift Boat style political attacks:

        June 30, 2008, 6:55 pm
        McCain Supporter Defends Swift Boat Attacks
        Laura Meckler reports on the presidential race from Harrisburg, Pa.

        A group of John McCain’s supporters came together today to defend McCain against charges that he was overstating the importance of his military service. Many remember how Democrat John Kerry was wounded by attacks in 2004 on his military record, and the McCain campaign does not want to let any charge go unanswered. More important, the spat gives the McCain campaign a reason to talk about his military service, a topic that serves him well.

        The conference call with reporters took an odd turn when the supporters were asked if the anti-McCain comments, including one issued Sunday by retired Gen. Wesley Clark, were analogous to charges issued by Swift Boat Veterans for Truth, the group that attacked Kerry in 2004. The group was condemned in many quarters, and today its very name — swift boat — is used as a synonym for a slimy political attack. Even McCain condemned the Swift Boat group in 2004.

        But one McCain supporter, retired Col. Bud Day, who was held prisoner with McCain in Vietnam, said the attacks on McCain were nothing like the swift boat attacks. He helped produce those attacks against Kerry, which were true, he said. The attacks against McCain are not, he added.


        Put all of this in the context of Sarah Palin's most recent idiocy -- and we are back to old-school backroom nonsense, made almost intolerable by this bright and shiny, now inane, now astute, new mouthpiece. She is paving the way for another detour from today's problems in order to reintroduce Jeremiah Wright, and -- undoubtedly -- Tony Rezko. God forbid she should address the economy in lieu of "associations" that have been explained and vetted ad nauseum.

        Douglass K. Daniel goes beyond pointing out the blatant dishonesty of Palin's lowest-common-denominator approach and notes a frightening racial "subtext" in her golly-gosh-gee remarks:

        Palin's words avoid repulsing voters with overt racism. But is there another subtext for creating the false image of a black presidential nominee "palling around" with terrorists while assuring a predominantly white audience that he doesn't see their America?

        In a post-Sept. 11 America, terrorists are envisioned as dark-skinned radical Muslims, not the homegrown anarchists of Ayers' day 40 years ago. With Obama a relative unknown when he began his campaign, the Internet hummed with false e-mails about ties to radical Islam of a foreign-born candidate.

        Whether intended or not by the McCain campaign, portraying Obama as "not like us" is another potential appeal to racism. It suggests that the Hawaiian-born Christian is, at heart, un-American.

        The fact is that when racism creeps into the discussion, it serves a purpose for McCain. As the fallout from Wright's sermons showed earlier this year, forcing Obama to abandon issues to talk about race leads to unresolved arguments about America's promise to treat all people equally.

        John McCain occasionally says he looks back on decisions with regret. He has apologized for opposing a holiday to honor Martin Luther King Jr. He has apologized for refusing to call for the removal of a Confederate flag from South Carolina's Capitol.

        When the 2008 campaign is over will McCain say he regrets appeals such as Palin's?


        I am sorely, sorely disappointed. This was supposed to be the election of all elections, wherein dialogue was to be on point, on policy, and all about respecting the intelligence of the American electorate. Instead we are left with inflammatory analogies that kill the intellectual rigor most had been hungrily anticipating for the presidential elections of 2008.

        Barack Obama and William Ayers = John McCain and Charles H. Keating, Jr.

        Wednesday, October 1, 2008

        Keep the Faith



        Every time I encounter a good blog entry about CRPS/RSD, I try to link to it -- and offer a huge "thank you" to the author, because such things are few and far between. This morning, my Medworm subscription hit upon the following:







        over at Suture for a Living. The intro to this blog sketches the broad lines of this blogger's interests:




        I am a plastic surgeon in Little Rock, AR. I may "suture for a living", but I "live to sew". When I can, I sew. These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.




        Such a desire, such an approach, is appealing to me, especially, as most of my professional "specialty" deals/dealt with the interplay between the plastic and the written arts, and my interest peaks whenever I encounter a unifying vision of plural modes of representation.




        Lord, how easy it is to lapse into Ivory Tower Speak (yet another of my foreign languages).




        So, this morning I am grateful to the incredible technology that scans the world of electronic communications for things that are of interest to me, and possibly to me, alone. I am grateful for the chance to connect, however artificially, with someone of a completely different ilk who nonetheless has transected the thread of my thoughts... I don't get excited anymore about the likelihood of effecting any real progress in the diagnosis and treatment of CRPS/RSD through internet "publicity" -- I am too jaded, too much in pain, too depressed, too disabled.




        I hate that word -- disabled.




        Yesterday, after coming home from the weekly Infectious Disease appointment (the PICC line comes out next week! Hooray!), I was in bad shape. Riding in the car is difficult, and my pain level was hovering around 8 (grrrr -- what a useless thing, the pain scale). However, I had made noises the evening before about my firm conviction to clean the house a bit, and so, after finishing the first two infusions of the day, I gathered my weapons of war and began vacuuming.




        Okay... I am used to Wheelchair Vacuuming, an Olympic endeavor, an Olympic sport. But now it is complicated by a useless right arm and a *&^%#@ hurting left shoulder. The nurse in the ID office had set off a flare of pain in my left hand because she had been unable to get any blood through the PICC line and had been forced to stick me several times in that hand. Not her fault, just an unfortunate thing when there are needle sticks in an area already involved with CRPS.




        Given the circumstances, I chose to use the Power Chair Push-me-Pull-you technique -- basically accomplishing the task by combining the thrusts of the vacuum with the thrusts of my ruby-red chariot.




        And somewhere between sucking up the huge pile of carpet cleaner that I had placed over Sammy's last deposit (please see: Potpourri -- Olla Podrida) and the gymnastics of getting into the nooks and crannies of the dining room, I went mental.




        Poor Fred. When I go mental, I strive to share the warm and fuzzy experience with my beloved. Poor Fred.




        Suddenly I was rolling myself in circles around the living room, sounding off about the state of the puked-upon carpet, about the total invasion of the cat creatures. (Of course, this problem only exists in one tiny part of Marlinspike Hall in the Tête de Hergé -- the rest of this opulent manor is spotless and petless, crucial since we house several museum quality painting and sculpture exhibits, as well as an extensive decorative art collection of baroque furniture -- mostly cabinets, commodes, and French stools.) Fred stretched out on the nearest chaise longue, steeling himself against volley upon volley of invective.




        Let's just say this: Promises were made; Christmas gifts were agreed upon. And yes, the removal of carpet and the refinishing of the medieval stone and early 20th century wood floors were part of the negotiations. So it goes when I get mental.




        I worked on for several hours, and ended up needing help getting into bed -- always a depressing thing, not to be able to do even that. Plus, I left some of the cleaning undone.


        Anyway, my hope was that a bit of rest would conquer the pain and difficulty moving, so that I could redeem myself by being a fun partner for the remainder of the day. Instead, Fred ended up having to nuke a frozen dinner for me (losing points), cut up the pale but purportedly "blackened" slab of purported chicken (winning back what he had lost), and take on the feline's evening meal, as well. Poor Fred. Yes, it is a refrain, and one you may as well learn.




        When my acronyms are under control -- from the SLE to the AVN, passing by the AI, and back to the CRPS/RSD -- I defy the meaning and intent of the label disabled. Doing anything without assistance and in my own time is wondrous. That life has been unavailable to me since late last year. Everytime I try to pretend this is not so? I pay, and everyone who loves me pays.




        So sometimes the best I can do is celebrate the stray blog that -- in the best of all possible worlds -- might make a difference. Thank goodness for this quilting, sewing, needle-wielding plastic surgeon who decided to disseminate some information about one of the more obscure neurological disorders in existence! Somewhere there is a woman who will be able to joyously and painlessly vacuum her living room, who will pirouette as she cleans the toilet, who will dash from one satisfying professional experience to another, from one colloquium in the Rainbow-Ribboned Multicultural Center to the next in Stuffy Whosits Library.




        I just gotta keep the faith.




        Ar!

        Monday, September 29, 2008

        Potpourri -- Olla Podrida


        Pot pourri (rotten pot). Fitting that the name for a beautifully arranged bowl yielding questionable scents derives from the Spanish designation for olla podrida -- pork&beans. True, the Spanish being Spanish, said pork&beans stew is subject to the rarefying whims of the creative cook, a clay pot, and a long cooking time, and becomes a satisfying culinary hodgepodge.

        I learned from reading the entry for potpourri in Wikipedia that, "(w)hen mixed, you need to enclose the mixture in a bottle or jar, and let it sit for a few weeks. Towards the middle of the weeks, the soon to be potpourri may smell rotten. If you wait a little while longer, it will start to smell better, so don't get discouraged or disappointed." (I particularly relish, and appreciate, the encouragement to fend off the ravages of clinical depression.)

        And so it goes that necrotic pots and gentrified stinkiness head up this blog entry -- the result of my search for an excuse that might unify my disjointed thoughts.

        There is this notion in linguistics and lit crit -- about the process of voiding words, terms, implications, insinuations. It is recuperative, the voiding of terms, the emptying of cloying traditional meanings. (This is how, according to the insightful inhabitants of the Ivory Tower, the signifier nigger is being... reclaimed and rehabilitated. Isn't all this pseudo-intellectual crap grand?)


        I am going to take a break -- now that I have obliterated the notion of tastefully deployed, pretty and soothing potpourri, this message square becomes clean space for the odds-and-ends of my poor brain and its pitiful, pitiable expressions (of life).


        Ar! Harrumph!


        If you knew me? You'd be laughing, too. As it is, you probably have shivers and goosebumps. Anyway... I am going to wash up, change my antibiotic i.v. bottle, and maybe try to sleep some. After, I will be potpourri-ing all over the damned place.



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

        I'm b-a-a-a-c-k. In the interim quarter of an inch, the HVAC repairman has come and gone, as has, amazingly, most of the crankiness in the house. Three days of unconditioned air almost robbed us of civility. La Belle Bianca Castafiore took off, in fact, after the first stuffy night, checking into the Hilton nearest Marlinspike Hall in the Tête de Hergé.



        If I had to put a dollar value on the time between then, and now... I might say $637.



        About a week ago, I dropped my laptop on my decrepit right foot. It was already reddish blue and tremendously swollen due to CRPS. There was so much bleeding under the skin that the foot fairly throbbed due to the pressure. Finally, last night, it... well. It burst. Now sealed off again by its own internal pressures, the pain is hard to take. Initially, the schtuff was clear but quickly became yellow with spots of blood. Simply Sera? Sounds like the flavor-of-the-day for some knock-off lipstick. I've cleaned it several times but, beyond that, am clueless as to what to do. I see the ID Physician's Assistant tomorrow and maybe she'll entertain a few questions about this wounded hoof.



        She's extremely nice, knowledgeable, and -- best of all -- approachable. She reviews my labs every week, and keeps me in the loop without alarming me overly much. Right now, we are both anxious about my still elevated white count -- how can that be, given twice daily infusions of vancomycin and cefepine? She said last week that she'd recheck the cultures for TB and fungi. Oh, yeah, low grade fevers are back, too. As for areas of increased pain, this foot is now vying for attention with my left shoulder.

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




        Sam-I-Am would be cruising for a bruising were I the type of pet owner that swats her animals. You know the theory that "children" can best be manipulated into good behavior by the creative use of each child's particular type of currency? For instance, the tween who values the availability of video games can be successfully led to complete his English essay on the symbolism of the whale in Moby Dick by their judicious allowance or disallowance. That's a crappy example, but it's all that comes to mind. Hmmm. Well, using myself as a tweeny example, restricting my access to tennis courts might have been pretty darned influential in molding my behavior...



        Ah, but back to Sammy. HE has ME backed into a corner, à la B. F. Skinner. When he decides that it is time for food to be offered, and when I am in the least resistant to his playful kitty pantomimes, this feline shyster turns to what amounts to nuclear warfare: first, he threatens to pee; second, he pees; third (after I cave in and feed him), he throws up. The first and second instances occur, of course, in an inappropriate spot -- the third, almost invariably on my bedding, or, on a creative night, carefully divided between my favorite quilt and the off-white carpet.



        Tonight? He treated me to the trifecta. He decided he wanted to eat an hour early. I decided to ignore him. I rolled into the living room to talk to Fred about something, Sammy tailing me. While we were talking, I became uncannily aware of the Grey Ghost, perched on the sofa, assuming the well-known Pee Position, and fixing me in a cold, cold glare.



        "No, Sammy! No, Poopy Head!" I yelled. (Poopy Head is a rarely used term of endearment.) Normally, I would swing away, arms flailing -- but lacking one shoulder, and the other being locked in a severe pain mode, all that happened was some ugly upper body jerking. Whatever, it was enough to shock him into momentary anuria. He beat a quick retreat back to the master bedroom, where I was working.



        I explained, in loving but firm terms, that he had an hour to wait. He nodded. I went back to work.



        A few minutes later, something began to nibble at the edge of my consciousness. I slowly kicked my submerged awareness up to the surface... and heard the unmistakable sound of cat claws furiously scratching against plastic. That, in itself, was fine -- even wonderful, for it might mean that Sam-I-Am was relieving himself in his grand (brand new) litter box, and then performing his after-pee syncopated percussion routine. But something about the sound was off.



        So again I zipped off... pressing this power wheelchair to its speedy limits, taking doorways at high velocity, making the tight turns with impressive control of G-forces. Remember, as says Wikipedia, so says this blog, its unofficial mouthpiece. Ergo and forthwith, ipso and facto-dactyl!



        The human body is considerably better at surviving g-forces that are perpendicular to the spine. In general when the acceleration is forwards, so that the g-force pushes the body backwards (colloquially known as "eyeballs in"[3]) a much higher tolerance is shown than when the acceleration is backwards, and the g-force is pushing the body forwards ("eyeballs out") since blood vessels in the retina appear more sensitive in the latter direction.
        Early experiments showed that untrained humans were able to tolerate 17 g eyeballs-in (compared to 12 g eyeballs-out) for several minutes without loss of consciousness or apparent long-term harm.
        [4]



        Got it? I took those turns, eyeballs well in, retina rejoicing, certainly pushing the envelope of that lame 17 g experimental record.



        What? Oh, right. Back to Sammy.



        It turned out that the funkitude of the sound was due to the fact that my cat was *outside* his huge brand new litter box, peeing against it, and scratching the side of it as casually as if this were normal toileting and not guerrilla warfare.



        Okie-dokie, then! 2-0, Sammy. Ah, but has he succeeded? Has he won? The battles, maybe, but not the damn war!



        We cleaned up after him (how sad that I feel it so important to inform the blogosphere that we are hygienic folk) but we did it with quiet, heroic resolve (cue music). I told him, once again, that he had to wait. He nodded. All the principals returned to their original positions.



        But we have three cats here at the Manor, and why should the innocent suffer for the sins of Sammy?



        So -- after waiting what seemed a decent time, much as a widow might take up dating after the proper interval between death and renewed lust, I fed the cats.



        That, in itself, is quite a chore. Dobby and Marmy, son and mother, eat a different diet than the Samster, who has to stay away from all dry food. So we all gather in the kitchen, and they are as sharks swirling around my chair. I serve up the kibble for Dobby and Mom, spritz it with the the eliminate-the-smell-from-the-poo magic spray, and set it down for them to eat.



        This is where the fun begins. Dobby, still officially a kitten, is very smart, and very fast. He is perpetually hungry and -- thanks to having been raised knowing nothing but loving approbation -- does not understand exclusion. So this is our dance with every meal: as soon as the dry food touches the kitchen floor, Dobby moves in for a few mouthfuls, then stands back to allow his mother her share. More importantly, he gears up for the grand rush to The Other End Of The House.



        As fast as I can, I put Sam-I-Am's food in my lap and take off. If I am lucky, and I never am, I might make the door dividing the bedrooms from the rest of the domicile before Super Kitten. (Unfortunately, due to HIPAA -- or HIPPA, if you're WhiteCoat -- I am having to lie about the floor plan of The Manor. I wouldn't want to overwhelm my audience with accurate descriptions of its grandeur. Indeed, if you did not know any better, you might mistake our opulent digs for a normal suburban domicile.) Marmy gets the best of all deals, being left in peace with a supply of food, all the idiots having rushed off en masse.



        I put Sammy's canned food, supplemented with the same magic no-poo-smell spray plus some water, on the floor. Dobby rushes forward, Sammy hangs back, making terrified eyes at me.

        Oh, the drama of feline competition. I gently push Dobby back, and make encouraging noises at the elder, and completely mental, animal. Once Sammy begins eating his own food, in earnest, I show Dobby back to the kitchen by employing basic deceit and an abundance of love. He has learned that if he will follow me, I will give him a taste of the good stuff, a portion that I reserve from Sam's wet food. Every meal it is the same -- because Dobby is really and truly conflicted each time we do this. As soon as his energetic little body clears the area, I whirl around and shut the connecting door.



        Sometimes, after Dobby and Marmy return to their feeding, I insert myself back into the Sammy Zone. It's a good time for us, a chance for him to get the individual attention he craves so much, and for me to benefit from his unwavering love. Usually.



        Tonight, he was hitting on all cylinders.



        Fred insists on buying him cans of tuna flakes mixed with egg. Sam loves it. This evening, after all the drama, he fairly scarfs it down, then jumps up on the bed to settle down on my lap...



        ...where he throws up.



        Olla podrida, indeed. Pot pourri, you bet!



        There is so much on my mind, so many things beyond animal anecdotes and tales of woe. I will have to attempt another Potpourri entry tomorrow. Consider yourself forewarned.



        Excuse me, while I go check on the laundry.

        Sunday, September 28, 2008

        "Despite everything, I believe that people are really good at heart."




        Believe it or not -- and, likely, you do not, given my latest postings -- I don't think that videos and photos are sufficient to a blog.

        Fred sent me a link to this YouTube video last night. Neither one of us can figure why we had never heard of this... event -- before. Late to the party and irrelevant, I nonetheless found myself belatedly typing away as if something might depend on it beyond my own sanity, outrage, and sadness.

        This is a remarkable piece of footage that chills the soul. Knee-jerk leftist-leaning liberal that I am -- because real socialism is not available in a ready mix formula here in the states -- I respect the authority of police and believe, à la Anne Frank, that "(d)espite everything... people are really good at heart."

        Usually, tossing in a laden quote from such a heavy source as Anne Frank translates as nothing short of cheesy -- and mightily lazy.

        But I think I can pull it off here. The "ceremon(ies) of innocence" are so well documented, by the diary, by surveillance film, that assignations of guilt and innocence should be rote and incontestable.

        Thesaurus.com claims these synonyms for incontestable: hard, inarguable, incontrovertible, indisputable, indubitable, irrefutable, positive, sure, unassailable, undeniable, unquestionable.

        And yet, in both cases, all we really know is that the principles are dead -- and only in rereading do I see the double entendre, that ethical rigor is as much absent to these situations as mercy or justice, individuated or girded by systemic approbation.

        Oh, big words, grand thoughts.

        In this video, Michael Pleasance is murdered by police officer Alvin Weems.

        When I read about the ensuing cover up, scary in its extent and practiced nature, I found myself humming Dylan's Lonesome Death of Hattie Carroll. (Really! Not a song I normally reference, it had been recently in mind due to the title of my post about Evan Tanner.) Most of the lyrics, I remembered, but not the all important last strophe wherein William Zantzinger faces the judge and is sentenced to six months for Carroll's murder.

        When so much has gone so wrong, we all would like to be able to isolate the blame and forget that an ultimate necessitates a penultimate. When so much has gone so wrong, we forget that no event is discrete.

        You who philosophize disgrace and criticize all fears,

        Bury the rag deep in your face,

        For now's the time for your tears.


        Saturday, September 27, 2008

        Paul Newman


        “We are such spendthrifts with our lives,” Mr. Newman once told a reporter. “The trick of living is to slip on and off the planet with the least fuss you can muster. I’m not running for sainthood. I just happen to think that in life we need to be a little like the farmer, who puts back into the soil what he takes out.” -- New York Times, September 27, 2008

        Friday, September 26, 2008

        It was a very good year

        This photo -- of the outcroppings, the rocks, at Slate Creek in the Grand Canyon -- comes from one of TW's latest posts. He goes on to seamlessly pair image with verb:
        but now
        the days
        grow short
        i'm in
        the autumn
        of the year
        and i think
        of my life
        as vintage wine
        from fine
        old kegs
        from the brim
        to the dregs
        that poured
        sweet and clear
        it was a
        very good year