Friday, November 7, 2008

Myopathy in CRPS-I: Disuse or neurogenic?

When I wrote the entry entitled Outsourcing a while back, I never thought that I would again be referencing another study based on amputated limbs so... soon.

Since writing Outsourcing, I have developed an ulcer on the top of my right foot, and visit a Wound Care Center every Wednesday, just for fun. The topic -- the thought -- the spectre -- of amputation, it disturbs me. I am, in fact, having nightmares.

That said, there is this to report: Myopathy in a certain cohort of fourteen CRPS Type 1 patients --whose affected limbs were amputated -- turned out not to be related to disuse.

I am not sure what exactly this conclusion elucidates... maybe it elucidates nothing and is just another piece of a puzzle that may or may not one day be assembled in an order that approximates meaning.

Myopathy in CRPS-I: Disuse or neurogenic?
European Journal of Pain
30 October 2008

Natalie M. Hulsman (a) Jan H.B. Geertzena (b) Pieter U. Dijkstraa (b, c) Jan J.A.M. van den Dungen (d) and Wilfred F.A. den Dunnen (e)


a--Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
b--Graduate School for Health Research, University Medical Centre Groningen, University of Groningen, The Netherlands
c--Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
d--Department of Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
e--Department of Pathology and Medical Biology, University Medical Centre Groningen, University of Groningen, The Netherlands

Received 28 January 2008; revised 16 July 2008; accepted 4 September 2008. Available online 31 October 2008.


Abstract

The diagnosis Complex Regional Pain Syndrome type I (CRPS-I) is based on clinical symptoms, including motor symptoms. Histological changes in muscle tissue may be present in the chronic phase of CRPS-I. Aim of this study was to analyze skeletal muscle tissue from amputated limbs of patients with CRPS-I, in order to gain more insight in factors that may play a role in changes in muscles in CRPS-I. These changes may be helpful in clarifying the pathophysiology of CRPS-I. Fourteen patients with therapy resistant and longstanding CRPS-I, underwent an amputation of the affected limb. In all patients histological analysis showed extensive changes in muscle tissue, such as fatty degeneration, fibre atrophy and nuclear clumping, which was not related to duration of CRPS-I prior to amputation. In all muscles affected, both type 1 and type 2 fibre atrophy was found, without selective type 2 fibre atrophy. In four patients, type grouping was observed, indicating a sequence of denervation and reinnervation of muscle tissue. In two patients even large group atrophy was present, suggesting new denervation after reinnervation. Comparison between subgroups in arms and legs showed no difference in the number of changes in muscle tissue. Intrinsic and extrinsic muscles were affected equally. Our findings show that in the chronic phase of CRPS-I extensive changes can be seen in muscle tissue, not related to duration of CRPS-I symptoms. Signs of neurogenic myopathy were present in five patients.



Tuesday, November 4, 2008

Palm Beach County Strikes Again


Apparently, the correct way to cast this ballot was to fill in the missing space in the arrow to the right of the candidate. Too bad that was not clear to the voters -- who, at this point, must be nostalgic for the hanging chad.

Tin Soldiers

News from the indentured servant Brother-Unit down Florida way. He's stuck grading papers tonight, poor boob.

His university freshmen composition class was given a wide array of "protest songs" to analyze -- an assignment that he hoped would stoke the fires of creative lucidity. Instead:

I'm grading some papers dealing with the protest songs, and I figured we could both use some levity on this election day.

Apparently, a student writing about "Ohio" noted that she didn't think that those students, and students in general, should have been/should be shot. Bravo! I'm all for that, even though Florida law now allows me to carry a gun in the trunk of my car! So now I guess I should buy a gun and don some National Guard paraphernalia. And then I can keep both in the trunk of my aging Echo!



Just a few weeks back, he waxed nostalgic about his own writing prowess as a Freshman math major:

[The article you forwarded] reminds me of a line I wrote in my first year of college, and which I use as a warning to those hooked on the dictionary and the thesaurus:


The canine traversed the thoroughfare.

The professor circled the line and added the following:
Who talks like that?

Who indeed?

With love,
Grader Boob



I loves my brothers, I does.



Tim


I really miss Tim Russert tonight.

I always enjoyed and benefitted from his living civic lessons -- as scribbled on those famous white boards.

Following the returns just isn't the same without his boyish, unrestrained enthusiasm for the process.


Couture v. Lesnar

La Belle Bianca Castafiore? Elle adore Randy Couture. Et elle a bien peur de le voir complètement d.é.t.r.u.i.t. quand il va contre cet homme incroyablement énorme et fort, Brock Lesnar, pendant UFC 91.


Truly, it has been awhile since I have activated the MMA Prayer Tree, but this may just be the occasion for it. As much as Couture is clearly the superior fighter, how can he offset Lesnar's size, weight, and excellent speed.

When Lesnar fought Frank Mir, how long do you think Mir could have held out, if he had not managed that incredible kneebar at 1:30 in the first round?

Hmmm. But that's the thing, right? He *did* manage to submit him -- and what a thing of beauty that was! He was secure and calm enough in his jui-jitsu and MMA won out over WrestleMania Hype.

Since then, though, I think Lesnar has reconsidered things and has trained very seriously, not wanting to be seen as playing at these disciplines. When he beat Heath Herring in UFC 87, it was evident that he was putting his new skills on display. One had the sense that he could have ended it rather easily at any point but that he wanted the three-rounds as a showcase opportunity, and he wanted it to go to a decision.


Randy Couture is surely among the finest to ever fight, and being in an unenviable physical matchup is nothing new for him (think Tim Silvia). We'll be rooting for him here at Marlinspike Hall, in the Tête de Hergé. He will be bringing his experience and talent to the mix. I hope that will be enough. La Belle Bianca Castafiore goes about muttering to herself; I don't think she can take much more in the way of stress.
go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama! go obama!

Chris Leben

Shoot. I had hoped that Leben finally had his act together. Now I understand how he managed to look so chiseled in his fight against Bisping.

He's been suspended for nine months after testing positive for the steroid Stanozolol.

Monday, November 3, 2008

Ain't No Line Too Damn Long: VOTE

Slideshare

Are you familiar with Slideshare? It's worth checking out, and registration is free and easy. The powerpoint presentation below addresses some of the basics of assessing for CRPS Types 1 and 2.

Purple Peace

The whole gang piled into Ruby the Honda CR-V last Thursday to go vote. You probably thought that folks from Marlinspike Hall -- way down Tête de Hergé way -- wouldn't even bother! Well, on behalf of La Belle Bianca Castafiore, diva extraordinaire, my darling Fred, the most adorable chauffeur and studmuffin du monde, and Les Trois Chats: HARRUMPH!

It is surely one of the greatest feelings in the world to participate in a truly democratic election, to cast a ballot, to choose, to count.

We hope that you will go make your mark tomorrow, if you have not availed yourself of the early voting opportunities already. It's a rare and wonderful thing!

Sunday, November 2, 2008

Too and Also

Well, shut my mouth.

Out toodling around... Fred dropped me off at the Disabled Person's Unloading Dock in front of Home Depot. Waiting for him to park, I pulled out my Palm to continue my obsession with Crazy Daisy.

A smartly styled, poofy-haired Elderly Southern Lady stood next to me, uncomfortably shifting from foot-to-foot, waiting, I suppose, for her Southern Gentleman to bring the mid-sized Plymouth Breeze around.

She determinedly hoisted the bag-that-matched-her-shoes higher up on her arm, stood, if possible, even *more* ramrod straight, and said to me -- because polite conversation was necessary:

"Do you know Julie Barnesforth, dear?"

"No, I don't. Sorry. Why do you ask?" I say, in my best smiley-voice.

"Well, Julie is in a wheelchair, too..."

Friday, October 31, 2008

Your Unwanted Vehicle Can Help RSDSA


That Jim Broatch is at it again! Remember him? He's one of the good guys! Executive Director of RSDSA -- Reflex Sympathetic Dystrophy Syndrome Association, "Raising Awareness of Complex Regional Pain Syndrome since 1984." I have not been as dedicated as I intended in forwarding to you his various e-alerts to benefit RSDSA members and interested others. This one seems timely, though, as we head into the end of the year and begin thinking about income tax deductions for 2008. It is a win-win situation, and those are increasingly rare these days.

*** ** ***

Your Unwanted Vehicle Can Help RSDSA

Have a great car, boat or RV you can't sell because of a mechanical problem? Don't trade it in for next to nothing, donate it to RSDSA. The Vehicle Donation Program through V-DAC will auction it and send the net proceeds to RSDSA. You receive a tax deduction, and RSDSA receives funding that supports public and professional awareness, education, and research initiatives for CRPS.

RSDSA Vehicle Donation Homepage

You are eligible for an itemized tax deduction of your vehicle's Retail Fair Market Value. Find out more.

This service is totally free and includes convenient pick-up of your car, truck, or RV anywhere in the US. Find out how.

Donate a Vehicle When...

Your vehicle needs repairs that cost more than the vehicle is worth.
A 5 to 12 year old vehicle that has a good body but needs mechanical repairs can be a valuable donation. An individual might not be able to sell a vehicle with mechanical problems but these vehicles sell well at wholesale auctions.
It is easier to donate rather than sell it yourself.
Is your vehicle sellable in the shape it's in? Newer vehicles that have mechanical problems, particularly if not running, may sell for more at wholesale auction than a donor could get selling it himself. The mechanics that buy these vehicles can repair them much cheaper than the average donor.
The dealer gives a low trade-in offer.

Some dealers offer next to nothing for vehicles that have major mechanical problems. If less than 10 years old with good bodies these vehicles may still yield excellent results at wholesale auction, resulting in an above average donation yield.

Donate by December 31 if you would like the deduction for this tax year.

Find out more about the Vehicle Donation Program for RSDSA here.


This E-alert was made possible by the contribution of the members of the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA). To learn more about becoming a member of RSDSA, please click here.

The Communion of Saints


Like most adults, I love Halloween; I love it for the excuse it gives for silliness -- and neighborliness, too. This may be the only time all year that I even see some of our neighbors -- the grown-up ones, I mean, those over 5 feet.


We've been gnoshing on the Trick-or-Treat candy, Fred and I. You know, on the sly. Unbeknownst. In secret. Surrepticiously. But then, you realize, as you take the last Reese's Peanut Butter Cup, that you are leaving a gaping hole in the bowl of sweets, that everyone is aware of your stealth, and that you are not stealthy at all. La Belle Bianca Castafiore giggles at it all, pokes fun. The nerve of her. (She only eats the finest of chocolates and turns up her considerable nose at our commercial sweets. Her dresser at the Opéra, especially, admires --and appreciates -- her resolve.)


I miss partying, though I hate to admit it. The very best parties in my memory are associated with the Día de los Muertos. Those Latin American Studies folk knew how to celebrate the perquisite saints and the souls, which dances to dance in the hilly backyard, hands held in a laughing circle, me done up as a pregnant nun -- whirling, whirling!

It comes down to community -- Halloween, el Día de los Muertos, and the upcoming All Saints' and All Souls days. We remember, not as individuals, but as something... larger.
(As I wipe the tear from my eye... I see Bianca slinking near the goody bowl... She reaches, she grabs, she looks furtively around. Aha! Gotcha, you freakish diva! Gotcha!)

Be safe out there tonight!

Wednesday, October 29, 2008

Palin pales



Q: Is an abortion clinic bomber a terrorist, under this definition, governor?

PALIN: (Sigh). There’s no question that Bill Ayers via his own admittance was one who sought to destroy our U.S. Capitol and our Pentagon. That is a domestic terrorist. There’s no question there. Now, others who would want to engage in harming innocent Americans or facilities that uh, it would be unacceptable. I don’t know if you’re going to use the word terrorist there.


I apologize for being about a week behind, apparently, on Palin-News-That-Startles-and-Shocks.

Let's see... can she claim, in this instance, to be taken out of context? No.

How about decrying the inherent meanness of the liberal media that whosits represents. Brian Williams. No. It's not that difficult a question, really, nor is its [correct] answer particularly dependent on an ideology. In fact, doesn't it seem a poorly positioned lob, its arc just begging for an overhead putaway? Isn't it a gimme? An easy test of her steely steadiness in the equal application of her Ethic?

{yes, i said "correct"!}

Wow. I begin to regret my Stupid People post -- because I am definitely dumbfounded and stupefied, because with such figureheads, stupid needs constant redefinition, and to thus dedicate my efforts would mean surefired brain death.

How scary is it that she appeals to lots of people?

I need to check myself -- I have an enduring high opinion of "people," making her fame that much more frightening.

Yes, this definitely renders my Stupid People post insipid -- because Palin is far from stupid, because she is crazy like a fox, because John McCain thinks her a worthy president.

Vote early, and vote often.

Tuesday, October 28, 2008

Bull Crap Bull Skeet of Tête-de-Hergé


Retired Educator here.


A week or so ago, I received my usual hefty packet of health insurance Explanation of Benefits forms from Bull Crap Bull Skeet of Tête-de-Hergé. The trouble was that only one of the enclosed EOBs related to me. The other five reflected insurance use by four different individuals whom I'd never had the pleasure of meeting. Now, however, I knew their full names (and for two, their spouse's moniker), Social Security Numbers, employers, employee ID numbers, doctors' names, and what medical facilities they use. Just by the type of coverage they opted for, and their met or unmet deductibles, co-insurances, out-of-pocket, in-network and out-of-network payments -- it's easy to form a financial picture of my four new buddies. A couple of them are strapped for cash.


Somehow, knowing exactly where they were, what they were doing, and what was being done to them, on a certain day -- well, I think an e-vil person could parlay that into Deceitful Gain. (The term came to me in a dreamscape wherein I walked unseen around the current President of the United States as he stood at a podium, in the proverbial jeans with rolled cuffs, blue shirt with rolled cuffs, cowboy boots, and herniated stance. He was speaking a fiction, talking about "bad guys," those reprobate E-vil Doers, when -- unbidden -- he found himself salivating over the notion of the E-vil Doers reaping Deceitful Gain. He tossed it out to the press like a verbal hand grenade.)


Choo? Choo? Train of thought? Ah, yes. Knowing such specificity, anyone could return to the scene of the ersatz "benefit," posing as:


Celeste S. T. or as her husband Dale A. T. -- I do hope Celeste is recovering from her surgery in early July. Maybe I should contact Dr. Stuff's office to get the date of her next appointment. Without breaking a sweat, I know that Dr. Stuff is an OB/GYN and even that his PA's name is Courtney. I checked him out at the Composite State Board of Medical Examiners, and wow, is he an impressive doctor, currently Department Chair at one of the local medical schools! Oh, a bit of trivia for you -- Dale, it turns out, is a graduate of G. J.'s Comedy Workshops, so he is bound to take all of this confusion with good humor.


or


Doretha A. D. or as her husband Clark O. D. -- he works for PoDunk Seal & Stamp, "a bonafide mover-and-shaker in the world of embossed aluminum products." Now, I don't know if we're talking about the same Clark O. D., although most of the personal information does line up for this, but it looks like this guy was one of the original Gospel Intrepids: "God blessed the group to record their first album "I Want To Be Adored" which became a hit and carried the group around the country with some of the great gospel artists of our time. The group was then signed to a recording contract with Spotless Sounds Records. They recorded six (6) albums during the seven (7) years they were with Spotless Sounds Records." But back to Doretha -- wow, would you look at this! Thank goodness case law is public domain, eh? It turns out that sometime back in the 80s (those were the days...) Doretha and Clark appealed to a Court of Appeals about a Big Bad Creditor's e-vil lien, and they were successful in having the lower court's opinion reversed! Yay, Doretha! Yay, Clark! Hmm, so now I know a great deal more about them, including the fact that their lawyer back in June of 1984 has since become an inveterate ambulance chaser and horrific TV commercial maker! And lessee, what else? Ah, just by doing a little lazy genealogy work, I have found Clark and Doretha's son, L. Heathcliff.


The Fredster just stuck his head down to see what had me tsk-tsking so much, and went pale. Seriously, he turned white as a sheet. Well, white as a *white* sheet. (I have an Analogy Disability.) "You can't do that," he said. "You had better not mess with Bull Crap Bull Skeet of Tete-de-Hergé, Retired Educator, I mean it! And you cannot publish other people's private information, either. You have crossed the line this time." Then he fairly ran away, knowing by my big smile that I am going to proceed anyway -- he didn't even get to hear my assurance that I have made as many changes to my "case presentation" as the sainted nurses and doctors do in their HIPAA-fied blogs. Shoot, probably *more*.


So I guess I will honor Fred and forego telling you about Willie E. J. -- nice guy, works for the state. The great news for Willie is that he only owes $15 on his X-ray bill at County Hospital...


The day these EOBs arrived, I weathered the idiot telephone computer to reach a Customer Service Representative. (See? I can be nice. I did not even mention the word oxymoron.)


Never have I been treated so well! Warm tones, terms of respect, adequate time to present my issue, immediate recognition of the problem, and an equally swift offer of a solution. Solution? Well, no, what was done was done. The questions I had related more to ascertaining whether my personal information, like those of these lovely people that I now knew intimately, was in the hands of someone who did not work for good, as I do, but for e-vil.

Customer Service Representative Number One told me that he had a real, live specialist lined up for me to talk to, and would I mind very much holding just a few seconds? "Not at all!" I crowed.


Hmmm. Customer Service Representative Number Two? Smarmy, very, very smarmy. We danced around a few issues. Like how Bull Crap Bull Skeet of Tête-de-Hergé knew who had received whose information, like how "they" had plugged all leaks, and -- my favorite -- like how they knew that my information had not been compromised. She issued reassurances that *no one* could fulfill and Retired Educator stopped pulling her punches.


"Retired Educator, we will send you a stamped, addressed envelope in which you can return those EOBs to us at no cost or disruption to you!" (Like I had just won the Lottery.)


"Customer Service Representative Number Two? I have a shredder. It's taken care of. So if you will just note that on your little computer? Actually, come to think of it... Might it not be more righteous, and righteous *is* what we're reaching for here, yes? -- Might it not be more righteous for me to contact these poor folks by phone, and then mail *them* their EOBs? They are the rightful owners, you might say! Whaddaya think? Oh, and about your reassurances that none of my EOBs were sent erroneously to some e-vil Deceitful Gainers -- that's what the gol' darn President of these United States of America calls them, you know? Deceitful Gainers. They're out there, Customer Service Representative Number Two, they are out there. Anyway, I need for you to tell me exactly how you know that my EOBs are not in the Evil-Doers, Deceitful Gainers little hot hands, 'kay? Come on, put my mind at ease, Customer Service Representative Number Two!"


"Retired Educator, can you hold?" she whispered. I was wearing her down.


When she returned, she launched a cock-and-bull story worthy of Bull Crap Bull Skeet, all about how they had crosschecked the triplecrosser doo-hicky with the appropriate top secret incantations and by golly, my name remains unsullied. That envelope that she'd mentioned was on its way, and if I would just return those errant papers...


"Right-O," I told her. "I'll get right on it. The shredder is warming up, as we speak. Oh -- do you mind if I blog about this?"


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

I have indeed shredded the EOBs in question.


Yesterday, I received a notice from BCBS that my personal info had, in fact, been compromised, and so would I please accept a free year's subscription to Equifax Credit Watch (Gold level!).


"Well, that's okay. Yeah. Cool," thought I. I love getting free stuff, even if it is my own financial history. I logged on at Equifax, gave every bit of data requested, then entered my free year's subscription code... and was told that it was an invalid number.


Why am I not surprised?

Stupid People

I have held my tongue. I have quietly rolled my eyes. I have pinched myself to be sure that I was actually sentient -- oh, and awake.

Where do all the stupid idiots spouting off -- invariably in shrill voices, because their voices are not anchored by anything approaching the weight of *content* -- about "sharing/spreading the wealth," "socialism," "communism," and occasionally the backhanded "terrorism" --

Oh, where did my sentence go? Where do all the stupid idiots spouting off... get off? come from? leave their senses of shame?

Given that I am a socialist, I feel fairly comfortable assuring the nitwits that socialism is not in play, but they are pulling their definitions out of the Big Book of Dumbed Down Political Smears. I *wish* we were about to experience a foray into socialism.

Tempered wisdom, often so silly, itself, reminds that these are only "scare tactics."

That almost makes me feel better, except that, as the cacophony swells, one cannot escape the realization that these chronically painful bloggeurs are not tacticians, no -- they truly are just stupid.

Stunted? Incapable of critical thought?

No. Just stupid. Really, really incapable and stupid.

It boggles the mind.



i am not afraid of fire


nor the groundswell that heralds the mob.
[...]


no, i am afraid


of the stupid people.