Standing in the Gap: Activated Glia and Neuropathic Pain

graphic from Principles & Practice of Palliative Care
 & Supportive Oncology, 3rd Edition

Difficult Pain Syndromes: Bone Pain, Visceral Pain, Neuropathic Pain

The good folks at the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) recently hosted a discussion about research on the role of activated glia in the context of neuropathic pain. Experts in neuroimmunology, neuropharmacology, neuroimaging, neurophysiology, and pain medicine gathered in early October 2010 for an international workshop.  Thanks, as always, to Jim Broatch for keeping everyone apprised of the goings-on...

Activated Glia: Targets for the Treatment of Neuropathic Pain

Summary of the Workshop Proceedings

The role of activated glia in the neuronal mechanisms of chronic pain was the focus of the workshop, Activated Glia: Targets for the Treatment of Neuropathic Pain, held October 8-9, 2010 and sponsored by the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA). Goals for this workshop included approaching neuropathic pain disorders, complex regional pain syndrome (CRPS), and other chronic pain conditions from a new perspective; bringing together experts in glial cell biology and function, imaging, patient advocacy organizations, clinicians, and industry representatives to challenge current concepts of chronic pain; and, ultimately, developing a knowledge consortium to further the work of this workshop.


Presentations focused on the biology of glia, imaging of activated glia, new ways to attenuate the deleterious actions of glia. Donald Manning, MD, PhD, set the stage with an overview of glial activation and its implications in neuropathic pain disorders. Glia, which until recently were thought to be passive support cells for the neurons, now are considered an important link between the immune and nervous systems in inflammation and trauma. Therapies directed at activated glia hold promise for a new approach to intractable pain. To expedite the goal of developing new diagnostic tools and new therapies for intractable pain, it is important to allow the cross-fertilization of ideas to occur between preclinical and clinical researchers in venues such as this workshop. Dr. Manning cautioned, however, that any new developments in the treatment of chronic pain must also begin and end with the patient. If animal models do not hold up to patients’ experiences, their value in furthering clinical development is questionable.


Joyce DeLeo, PhD, described the evolving model of the synapse, the junction across which a nerve impulse, such as a pain signal, travels from one nerve cell to another nerve cell, muscle, or gland. Glial cells, including microglia, astrocytes, and oligodendrocytes, constitute more than 70% of the total cell population in the brain and spinal cord. Microglia are the macrophages of the brain and are the first responders to central nervous system (CNS) injury, but exactly which signal triggers microglial reactivity is not fully understood. The activating signals may include changes in neuronal transmission, or the appearance of nitric oxide or proinflammatory cytokines.


Glial Activation and Modulation
In neuropathic pain, damage to the peripheral nerves shifts the glia to an activated state within the spinal cord. This occurs as a consequence of signals released by stressed and damaged neurons, including factors that activate the “endogenous danger signal” receptor, toll-like receptor 4 (TLR4). Once activated, the microglia release proinflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF); later, anti-inflammatory cytokines are generated to help dampen the injury response.


Several pharmacologic targets have been proposed that modulate specific glial function and the immune response, including inhibition of glial proliferation and migration, modulation of astrocyte components, and interference with proinflammatory interactions between glial cells and immune cells. Moreover, glial cells block the analgesia induced by morphine, as opioids induce glia to increase the release of IL-1. If we can block the action of glia, we can increase the efficacy of opioids.


Opioids and Chronic Pain
The use of opioids in chronic pain is often limited by hyperalgesia and tolerance. Glia play a key role in the formation and maintenance of morphine tolerance, as chronic morphine treatment has been shown to increase microglial reactivity. Studies by Dr. DeLeo and others in animal models have shown that minocycline, an antibiotic in the tetracycline class, and propentofylline, a glial modulator that decreases mechanical allodynia (an enhanced pain response to touch), can inhibit spinal microglial reactivity and attenuate the development of morphine tolerance. In vitro studies have confirmed that these agents can attenuate microglial migration. Dr. DeLeo and her group hypothesize that morphine enhances microglial reactivity by inducing the release of proinflammatory cytokines and chemokines, as well as through direct signaling between microglia and nociceptive neurons.


Potential Therapies Under Development
Several therapeutic approaches to target the negative consequences of glial activation are currently under investigation. Kirk Johnson, PhD, Chief Scientific Officer at MediciNova, described research on ibudilast, a nonselective phosphodiesterase (PDE) inhibitor that also suppresses glial-cell activation. Ibudilast, also known as MN-166 and AV411, has been available in Japan for 20 years for the treatment of bronchial asthma and poststroke dizziness, and shows promise for its antineuroinflammatory and neuroprotective action, attenuation of activated glia, and inhibition of the molecular targets macrophage migratory inhibitory factor (MIF) and PDE.


Efficacy in animal models as well as positive pharmacologic characteristics has moved ibudilast into human studies. Preclinical studies have shown several actions that can be attributed to attenuation of microglial activation, including attenuation of proinflammatory processes, inhibition of TLR4 signaling, and stimulation of neurotrophic and anti-inflammatory factors. A phase 1b/2a trial in diabetic peripheral neuropathy patients showed efficacy in pain reduction and a reduction in opioid use in those taking ibudilast. In a study of progressive multiple sclerosis (MS), ibudilast showed significant reduction in brain atrophy and reduction in persistent black holes seen in MRI studies.


Dr. Johnson cautioned that the concept of glial modulation, though appealing, has not yet been clinically validated and there are some concerns about the long-term effects of chronic suppression of glial reactivity/activation. However, ibudilast may have the ability to impact several aspects of chronic neuropathic pain or MS, including pain, depression, cognition, and neurodegeneration.


In contrast to the broad-strokes approach to controlling neuroinflammation with ibudilast, Linda Watkins, PhD, posited that by targeting specific receptors, it is possible to provide polypharmacy in a single molecule. According to Dr. Watkins, research in the last 18 years has shown that glia are activated in every clinically relevant model of enhanced pain. Suppressing glial activity and its proinflammatory products suppresses the pain and returns the patient to normal. This concept extends beyond pain—the same uprise of proinflammatory cytokines that begets pain may also be a risk factor for abuse of opioids and other pharmacologic agents.


Strategies for controlling glial proinflammatory responses include targeting specific receptors that are already very well understood: adenosine 2A, interleukin-10 (IL-10), and TLR-4. ATL313 (Adenosine Therapeutics/PGxHealth) is an adenosine 2A agonist (A2A) that suppresses proinflammatory cytokines while enhancing the anti-inflammatory cytokine IL-10. A single injection given intrathecally has been shown to reverse neuropathic pain for 4 to 6 weeks in animal models of chronic constriction nerve injury, peripheral neuropathy, spinal cord injury, and central neuropathic pain.


XT101 (Xalud Therapeutics) is an IL-10 nonviral gene therapy tested in models of peripheral and chemotherapy-induced pain as well as central damage similar to that seen in MS. Following injection, this treatment is microparticle-delivered and slowly degrades into natural products of metabolism, releasing gene therapy for IL-10. A single intrathecal injection of XT101 inhibits the proinflammatory cytokines that are causing pain and paralysis, in turn reversing this pain and paralysis.


Orally deliverable TLR4 antagonists, such as naloxone, also offer a targeted approach to treating neuropathic pain and increasing the efficacy of opiates, such as morphine. Studies have shown that morphine and (+)naloxone administered together produce an increase in analgesia, and repeated dosing prevents the dependence and withdrawal effects that commonly occur with morphine. These effects also extend to the side effect of morphine; studies have shown that the TLR4 antagonist action of (+)naloxone blocks the dose-limiting effects of constipation and respiratory depression...

The entire proceeds of the workshop are summarized HERE.

A few reading recommendations if, like me, you're not quite up to speed on glial research and its potential applications to neuropathic pain syndromes like CRPS:

Nature Reviews Drug Discovery 2, 973-985 (December 2003)
GLIA: A novel drug discovery target for clinical pain
Linda R. Watkins & Steven F. Maier
available as pdf file from Univ. of Colorado
 
The Journal of Pharmacology and Experimental Therapeutics, vol. 297 no. 3 1210-1217 (June 1, 2001) 

Propentofylline, a Glial Modulating Agent, Exhibits Antiallodynic Properties in a Rat Model of Neuropathic Pain

S. M. Sweitzer, P. Schubert and J. A. DeLeo


Neuroimmunologic approaches to the understanding and potential treatment of CRPS
Donald C. Manning, MD, PhD
RSDSA Education Section  [2005?]

Guilt's Stain

Mark Madoff was remembered fondly by former classmates Monday...


Doreen Hebron said Madoff was 'very popular,' dressed well and had a good attitude.

Bernard Madoff's sons, according to their family's legal representatives, were whistleblowers and not co-conspirators in the Ponzi scheme that defrauded investors of 65 billion dollars, and for which, in large part, their father is serving a hefty prison sentence of 150 years.

The story goes that immediately upon being informed by dear old Dad that he had lost the life savings of thousands of investors, Mark and Andrew Madoff contacted the FBI, and Bernard Madoff was arrested the next day, December 11, 2008, on a single count of securities fraud.

That was an amazingly swift reaction.

(I'm just sayin'.)

As the 2-year anniversary approached, there were apparently a good many legal issues that needed attention -- most having to do with the filing deadline for lawsuits seeking recovery of lost assets -- and the attention of the press and general public was again at a peak.

Mark Madoff hung himself this past Saturday, December 11, using a dog leash. He was married and had four children. His father's lawyer states that Bernard Madoff won't seek to attend the funeral out of "consideration" for his son's immediate family.

Despite the fact that investigators still cannot fathom how Madoff pulled off his securities fraud or how he laundered such large amounts of money for so long without the assistance of others, particularly of his brother or sons, all of whom worked at Madoff Investment Securities, authorities now deny that any new criminal charges were imminent.

In his article about the suicide, AP journalist Larry Neumeister interviewed another of Mark Madoff's childhood friends, Lev Seltzer:

[R]eached by telephone in Israel, where he now lives, [Seltzer] recalled working with Madoff on a sixth-grade assignment at a Long Island school to create a fake television commercial. He said the ad mocked a long-running Life cereal commercial that featured a boy named Mikey who hated everything else but liked the cereal.


"Instead of Mikey, we had Marky," Seltzer said.

meh

see more Lolcats and funny pictures

"ai concurz." *




*I completely forgot, in the previous post, to extol the virtues of LOLcats and Funny Pictures when fending off The Crud.

So:

Extol!
Extol!

Pharmacies, Penguins, and Richard Russo (to the tune of "plop, plop, fizz, fizz...")

O, to be a screaming ninny, O!  a screaming ninny, O, to be!

This is what I have been reduced to, after spending the day in such worthwhile endeavors as establishing The Manor as a No Call Zone for the American Heart Association.  You'd think that those ne'er-do-wells would not waste time by canvassing Tête de Hergé (très décédé, d'ailleurs) territory, as there is no heart disease here.

Let's see, what other important tasks has this hypoxic and huffing hunk o'humanity been up to?  Mostly trying to have all my medications that are currently being mangled by local retail pharmacies transferred to Medco's mail service, where they can mangle them, in turn, but for an extended, 3-month period.  It seemed an easy enough thing to do when I thought of it -- and I thought of it precisely when Fred announced his intention to murder a local retail pharmacy employee.  We have been playing "who called whom?" and "who has the prescription but not the medication?" since December 8.  This morning, we switched to a new game called "who has the prescription filled... CORRECTLY?" 

What Fred wants to know from his growing list of Pharmacy Friends, it seems, is:  Why the hell do I have to be present in person for you to confess your pharmaceutical failures and inadequacies?  Isn't that exactly why you have our phone number and email addresses?  Hmmm?  And then, as I said, he dreams of the quick garrote.  O, that boy and his piano wire!

When he finally appeared with my drug in hand, five days after it was prescribed and probably ten days since it was first needed, Fred was triumphant.  But since he, like I, still struggles to breathe after being ill with The Crud, his victory was celebrated by a weak, trembling fist in the air, followed by total collapse.

Would you believe... they gave me extra pills?!  It's a trap, I know it must be a trap.  They are waiting by the phone, ready to impugn my honesty as I have repeatedly impugned theirs (before understanding that it was competency in question, not character...).

I pity my Go-To DoctorGuy.  He is part of the inimitable MDVIP organization, a medical delivery system designed to privilege prevention of illness and maintenance of health.  How he ended up with me as a client is something he must ponder at least several times a week.

 HackHackHack:::*ack*-*ack*-*ack*

We email regularly.  I actually saw him for a fairly extensive visit last Monday.  Two days later, of course, I was deathly ill.  That's the rhythm of our relationship:  I see him; He tries to kill me, I survive but launch a defensive email campaign.

HackHackHack:::*ack*-*ack*-*ack*

Somewhere in there, I started amusing myself with animal videos on YouTube.  God bless YouTube.  Really, I mean it. 

Well, God bless Richard Russo, also.
Specifically, God bless his novel Straight Man.

If you are, or if you know, a frustrated academic, Straight Man will bring you as close to hilarity as anything can at this point in the university calendar.  By page 19, I had logged two episodes of uncontrollable mirth, bed-shaking mirth.  Indeed, pant-wetting mirth, were I the type, which I'm not.

I'm NOT, I said.

I did, however, end up with the entire domestic staff, Fred, The Castafiore (distressingly déshabillée), and all three extant Manor Felines trying to squeeze through our bedroom door like an implausible number of overfed circus employees leaving an imploded clown car.  I sounded, according to them, as if I were in distress.  With the advent of bronchial pneumonia, my harsh laughter apparently approximated the bark of a California sea lion. 

I hate those moments.  You so want to have the people (and felines) peering at you on your side, you know?  They look so distraught, you think.  If only they, too, could experience the joy of this rambunctious prose!  That's when you hatch the worst idea conceivable:  I will read them a passage!  Then we will all be {giggle::giggle} on the same page!

I chose to share the bit about William Henry Devereaux Jr's dog and his propensity for head-butting people in the groin as an expression of pure joy.  It was what was on the page.  I thought it could stand the exposure. 

Yeah, so that was about the time when animal videos from YouTube gained preeminence over any type of reading... at the suggestion, precisely, of the domestic staff, Fred, The Castafiore, and all three extant Manor Felines.  Fred allows me a half hour of Richard Russo at bedtime, on condition that I not wake the Cistercians down the road with my verbal shenanigans.  It's a glorious 30 minutes.

There is something reassuring about what we, as a species, tend to find funny.  Particularly (and precisely), I am reassured by what we find hilarious in the exploits of the animals with whom we share the planet. 

One of Fred's Militant Existential Feminist Lesbians condescended that these poor animals were exploited by our raging egocentrism as humans.  "Nuh-uh," I countered.  "It only makes sense that we interpret the actions of another species through the actions of our own, because, heck, we really are the center, object, and norm of all experience!  C'mon cutie, give us a smile!"

HackHackHack:::*ack*-*ack*-*ack*

Take penguins, for instance.  (Any reader out there who periodically shouts "Or she!" gets brownie points)
I resemble these birds and the many human feelings they evoke.

All statements and claims of humor and/or interspecies resemblance will be subject to reevaluation upon our return to baseline ill health.

Oh, that bothersome bot!

graphic by creativeNERDS

Good evening, Friends of The Manor, Minions of Marlinspike!  

I am doing my darnedest to breathe. Fred has passed along his illness, and as is my wont, I am taking it to new heights. As in flirting with, if not in the actual throes of, pneumonia.

Lacking that, I have at least achieved a striking bronchitis.  Marmy Fluffy Butt and I have been performing *ack*-*ack* duets, our pink noses in air.
This self-limiting respiratory virus will serve as my latest excuse, the raison du jour for my absence from the virtual realm.

In such a condition, with its predictable accompanying mood, I decided to check email before gathering with Fred and The Castafiore to sing, all in a jumble, our nightly rendition (in the round) of "plop, plop, fizz, fizz... oh, what a relief it is..."  Marmy scats her *acks* as a sort of background vocal.

Unfortunately, I got pissed off by the very first piece of electronic mail. It was my MedWorm feed report for the term CRPS -- all the news on that funkylpated addlemucked crap of a disease that is fit to spread around like fresh, pungent manure.

The vast majority of the time, the Medworm CRPS feed turns up research just published within the confines of academia. It is remarkable when what pops up derives more from the personal, as in a blog.

And it is regrettable when the singularly personal blog merits reportage for an offhanded and uninformed remark. That's when you remember that it is not so much intelligence that is at work as it is the intestinal contents of a bot.  *

Anyway, you know me (and, again, I'm sorry about that!), I have to read it all. So I dutifully click on the link provided, tap my heels and toes together like a spastic Nazi, and arrive at:
(B)e(LO)n(G), OT -- the blog that the bot bit.

Under the title, blogger Karen appends this description:

I recently made the transition from occupational therapy student to occupational therapy PRACTITIONER. That's right, I am an occupational therapist now, dum dum dum. This blog is having a hard time following me in the transition so bear with me!

Reading this, I am already thinking that turning the computer on at all was a mistake.  My phlegm confirms it, but I figure I'm halfway home, maybe this neophyte has an insight that'll take me to school...

I read on -- it doesn't take long -- and discover that the following passage is what has so commended this woman's blog to the CRPS Medworm bot:

We had a lady come in today, 3 months post carpal tunnel surgery, who is still having a LOT of pain in her L hand and is babying it (her non-dominant hand). She doesn't move it much because it hurts. Her scar is healing well although hypersensitive, and her hand isn't swollen or red, so it doesn't seem like its CRPS/RSD, but something along those lines. To me CRPS/RSD seems like it is directly correlated to the level of depression/anxiety a person has. The more depression/anxiety a person has, the more likely they end up with CRPS [my anecdotal experience]. I was trying to think of ways to handle her pain and I wish I had more of my OT resources here. Oh well.

The unknown but now fully vested OT Julie has managed to offend me which is, of course, ridiculous, as her blog is just another blog, ho hum.  But this blog met the bot and therefore pretends (in the French sense of prétendre, and no, I am not being snobbish, I really cannot find the equal phrase in English), therefore lays claim to a sort of research nobility which its actual bastardized nature cannot support.

Do I need to chase down and reiterate... Do I need to be the counterweight, countering voice?  Do I have to care?

You ought to be able to deduce the answer from the fact that I am writing this while wheezing and bulbous-nosed, head aching and face raw.  Yes, damn it, I have to care.  I did a little reading of Karen's blog and she's definitely talented, definitely dedicated... but she blew it with this broadened (haphazard and unsought) publication.  Because for her every mention of prostheses, I've got mine (both the mentions and the prostheses themselves, eh wot?!) and for her doomed reference to anecdotal experience... well, en garde, chica, en garde! 

No, in all seriousness, it sound like Karen is dedicated and immersed in helping people obtain and acclimate to prosthetic limbs and the various sundries that go with disability.  And yes, I am sure that is an understatement of all that must be involved.

As long as the truth is going to be contained in winked-out citations of [not-much] experience, people with diseases like CRPS will remain disadvantaged by health care professionals who prefer their truths watered down.  It doesn't matter what you know, wink::wink, it only matters what you KNOW, if you get my heavy handed drift...

In sum, as I need to go evacuate my lungs, please, young professional, newly minted OT, bone up a bit, do some reading -- but just know that how you choose to deal with the psychosocial factors associated with any disease process... well, it shows, and not just in your blogging, and it can serve as a sort of casual litmus test for your patients.

It's funny, Karen, but as I reach the end of this ridiculous post, this rant, I find I kind of like you.  I took some time out to deal with the gastrointestinal sequelae of antibiotic therapy (yes, folks, I am now on the SECOND course of abx, the osteomyelitis experiment continues midst a budding pneumonia!) and to reflect on my personal dealings with occupational therapists, my own anecdotal evidence, of sorts.
 
It is not for nothing that part of the introductory packet of information sent out by Reflex Sympathetic Dystrophy Syndrome Association (RSDSA.org) is a a fairly dense article written in 2003 by E. Daniela Hord, MD and Anne Louise Oaklander, MD, PhD -- Complex Regional Pain Syndrome:  A Review of Evidence-supported Treatment Options.

 

Because of the discrepancy between the subjective complaints
of pain of patients with CRPS and the limited
objective evidence of underlying pathology, some authors
in the past have suggested that psychiatric factors are a
major cause of CRPS. Although many patients with longterm
CRPS battle depression and anxiety, these conditions
usually are a consequence, rather than a cause, of their pain
[18]. It is clear that experiencing significant ongoing pain is
a major adverse life event that will challenge the coping
skills of even the most well-adjusted patient. Clinicians
should be aware of the high rate of secondary psychiatric
problems in CRPS and refer patients for counseling and
medical treatment as needed.

Bottom line!  (And good luck in what I know will be an awesome career helping people, OT Karen!)

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

*  What is a bot?  Well, first of all, it is not a botfly, fascinating as those creatures can be.  If you are into botflies, you might enjoy this "compilation," much treasured over at Pop That Zit.

Sometimes a bot (or zombie) refers to a type of malware.

But what I am referencing are --

Internet bots, also known as web robots, WWW robots or simply bots... software applications that run automated tasks over the Internet. Typically, bots perform tasks that are both simple and structurally repetitive, at a much higher rate than would be possible for a human alone. The largest use of bots is in web spidering, in which an automated script fetches, analyzes and files information from web servers at many times the speed of a human.

Specifically, I'm on about RSS Bots -- "a web-crawling robot [that] collects RSS, RDF, and ATOM feeds from the internet to build a searchable index..."

Tim Minchin: White Wine in the Sun

White Wine In The Sun

I'm looking forward to Christmas
It's sentimental, I know, but I just really like it
I am hardly religious
I'd rather break bread with Dawkins than Desmond Tutu, to be honest

And yes, I have all of the usual objections to consumerism
The commercialisation of an ancient religion
And the westernisation of a dead Palestinian
Press-ganged into selling Playstations and beer
But I still really like it

I, I really like Christmas
Though I'm not expecting a visit from Jesus

I'll be seeing my dad
My brother and sisters, my gran and my mum
They'll be drinking white wine in the sun
I'll be seeing my dad
My sisters and brother, my gran and my mum
They'll be drinking white wine in the sun

I don't go for ancient wisdom
I don't believe just 'cos ideas are tenacious it means they are worthy
I get freaked out by churches
Some of the hymns that they sing have nice chords but the lyrics are dodgy

And yes I have all of the usual objections to the miseducation
Of children forced into a cult institution and taught to externalise blame
And to feel ashamed and to judge things as plain right and wrong
But I quite like the songs

I'm not expecting great presents
The old combination of socks, jocks and chocolate is just fine by me

Cos I'll be seeing my dad
My brother and sisters, my gran and my mum
They'll be drinking white wine in the sun
I'll be seeing my dad
My sisters and brother, my gran and my mum
They'll be drinking white wine in the sun

And you, my baby girl
My jetlagged infant daughter
You'll be handed round the room
Like a puppy at a primary school
And you're too young to know
But you will learn yourself one day
That wherever you are and whatever you face
These are the people who'll make you feel safe in this world
My sweet blue-eyed girl

And if, my baby girl
When you're twenty-one or thirty-one
And Christmas comes around
And you find yourself nine thousand miles from home
You'll know what ever comes
Your brother and sister and me and your
Will be waiting for you in the sun
Girl, when Christmas comes
Your brothers and sisters, your aunts and your uncles
Your grandparents, cousins and me and your mum
Will be drinking white wine in the sun
We'll be waiting for you in the sun
Baby whenever you come
We'll be waiting for you in the sun
Waiting...

I, I really like Christmas
It's sentimental, I know

-- Tim Minchin

Allwine Resigns

My first post about Rebecca Allwine appeared on November 3, and was titled What are they thinking?

Between then and now, I've given this a lot of thought:  I might be a curmudgeon were a curmudgeon young, lithe, lighthearted and not pegged "a crusty irascible cantankerous old person full of stubborn ideas."


I'd also like a little latitude to play with alternate spellings.  I'm thinking something along the lines of "kermudjin."   
 
Curmudgeon that I am not, then, I still doubt that Rebecca Allwine has made what amounts to the right decision by virtue of... well, by virtue of her own virtue.
 
What? 
Speak plainly?
Now, there's a notion.

[One of my Brother-Units is a patient educator of 18-22+ year olds at a state university, and as such, has had occasion to offer a good many composition tips over the years.  He has, he says, "seen it all." Although he marvels at my writing, he offers me the same boring critique, year in, year out:  Too many words.] 
 
When elementary school teacher Rebecca Allwine graced these hallowed manor halls a few weeks back,  she had been arrested for attempting to kill her husband by poisoning his drink with a lethal dose of Ambien.  As the newspaper put it, succinct to a fault, "he survived."
 
[With my luck, on one of my more suicidal nights, the only thing that would likely happen after such a dosing?  A little zombie refrigerator raiding, unrecalled the next morning, as I puzzle my way through a farewell note smeared with chocolate sauce.] 
 
What she did is what ought to have been remarkable enough as news fodder, but you know, and I know, that it was not.  So she poisoned her husband: Well,  meh.

What moved me to mention the endearing educator in this blog was the fact that she was allowed to continue teaching there, in Coweta County, Georgia,.  Why?  Because, we are told, she had always been "a good teacher." 
 
Oops.  Sorry.  That's a ridiculously erroneous quote.
 
She was "a very good teacher."
 
Back in November, I did verbal gymnastics over the word turpid, as found in turpitude -- the moral sort of which the governing standards commission for teachers in Georgia determined her to be free of.  Or, at least, unconvicted.  Of. 
 
My grammar is dangling all over the place tonight!
 
Okay, so there is breaking news in Coweta County. 

Rebecca Allwine voluntarily resigned.  I think any reasoning reasonable adult would recognize that as the proper course -- that a teacher charged with such a crime not remain in the classroom (until the facts of the case are elucidated), that a teacher determined to have committed such acts never again grace the classroom.

Unfortunately, what remains a puzzlement to this kermudjin is the insistance of her school colleagues on the excellence of her character and job performance.  I suppose there is a throw-away phrase or two to which newspaper readers are not exposed -- something like "given that it was a crime of passion" or "she just must not have been in her right mind, momentarily..." There are probably even a few versions of "he had it coming..."

Well, Dear Apologists -- you are just wrong and, in your wrongness, manage to beg so many disturbing questions that we have issued writs and warnings throughout the realm of Tête de Hergé (très décédé, d'ailleurs) about the dangers of sending one's children to a school in Coweta County, Georgia. 

The fear, though, is far less about the moral fiber of Rebecca Allwine than it is about the lack of common sense of school and state education officials in that otherwise fine region.

Teacher in domestic dispute resigns
By Jeff Bishop


The Times-Herald


Facing continued questions from concerned parents and even national publicity, teacher Rebecca Allwine has resigned from her position at Willis Road Elementary School.


"We have accepted her resignation, and it was a voluntary resignation," said Coweta County School System spokesman Dean Jackson. He said he could not comment further because the matter is a personnel issue.


Allwine's last day of employment was last Friday.


The second grade Coweta County teacher allegedly attempted to poison her husband last winter. But she kept teaching at Willis Road Elementary School, even after she was arrested for the crime and later indicted by a Coweta County grand jury.


The controversial move to support Allwine made national news, with popular Headline News Channel host Nancy Grace expressing outrage and asking her viewers, "How can she not be a threat?"


"A second grade school teacher has been discovered poisoning her husband -- she's not in jail. In fact, she's back in the classroom?" said Grace on her nationally-televised cable show.


"Someone explain. She's back in the classroom with second graders. How could she not be a threat?"


As late as two weeks ago, Coweta school officials said the school system had not changed its position of support for the teacher. But parents in the meantime continued to meet with Superintendent Blake Bass and others, expressing their concern.


Newly-elected Coweta Board of Education member Amy Dees said she had problems with the school system's decision.


"I absolutely feel that she should not have been placed back in the classroom," said Dees soon after her election. "She was obviously having some emotional issues and our children were exposed to that. Whatever rules protected her need to be changed." Times-Herald reader comments also tended to be critical of the decision. One Sound Off contributor asked, "Would you let your child be in a classroom with this woman?" Another stated, "I have children at Willis Road Elementary. While I'm sorry for Allwine's personal problems, I resent the school board's attitude on this matter. She's demonstrated that she's unstable. She should not be teaching small children. She will never teach mine."


"I have a student at Willis Road Elementary School in first grade," said Sharpsburg resident Brad Gaines in a Letter to the Editor of The Times-Herald. "I am appalled the teacher accused of such a serious crime is allowed to continue to teach our kids.


"Call it what you want, but she was originally charged with attempting to murder her husband by putting something in his drink.


"I believe as parents in our community we should not just stand by quietly and allow the school board to make such a stupid decision. She has obviously proven by her actions that she is an unstable person."


Allwine so far has not responded to requests for comment.


Allwine pleaded guilty earlier this fall to disorderly conduct. A Coweta County grand jury meeting for Coweta Superior Court indicted Allwine in September for aggravated assault and battery, alleging that Allwine had attempted to poison her husband, Joshua Allwine, with Ambien and melatonin pills, court records show.


The charges arose from an incident that occurred on Jan. 31, 2010, at 2:01 a.m., following a domestic dispute, according to testimony given by Coweta County Sheriff's Office officer Trent Hastings, who arrested Allwine, according to court records.


Hastings said Mrs. Allwine did "intentionally cause physical harm to her husband" when she "struck him with her hands numerous times" in the head, "resulting in multiple lacerations," according to court records.


Allwine also "intentionally put approximately 18 melatonin and 10 Ambien in the victim's drink that he prepared for himself, and that she knew he would be consuming," said the officer. "The victim did consume the drink, resulting in a likely chance for bodily harm or death."


"The school system does not feel that she is a danger in any way, not in the least," said Jackson, speaking on behalf of the school board, after the incident became public. "If we did, we would have taken action from the beginning.


"We were made aware of the details of this incident from the start, and the school, the school system and the Professional Standards Commission were all involved. If at any time the school system has a question about whether or not a teacher should be in the classroom, that teacher is not going to be there, but there were no such concerns in this case."


The school system took the position that this was a private, domestic dispute. Mrs. Allwine filed for divorce and a temporary protective order shortly after the altercation.


The Professional Standards Commission stated that because the assault charge did not result in a conviction of a felony involving moral turpitude, Allwine's employment status was left up to the school district.


"We were continuously informed of the legal proceedings, and the issue was reviewed by the Professional Standards Commission," said Jackson. "The charges were resolved.... She has continued teaching throughout, and is a good teacher and employee."

meh:


Indifference; to be used when one simply does not care.

A: What do you want for dinner?
B: Meh.

Used in the greatest tv show of all time, The Simpsons. In the episode Hungry, Hungry Homer, Bart and Lisa respond to a Homer inquiry with "meh."

Homer: Kids, how would you like to go... to Blockoland!
Bart & Lisa: Meh.
Homer: But the TV. gave the impression that--
Bart: We said "meh".
Lisa: M-E-H. Meh.

-- The Urban Dictionary

all we have to do is keep on walking

Again, I have that feeling of being the Last Known Blogger in the Universe to have seen this YouTube video gone viral.  That incomparable Brother-Unit, Tumbleweed, posted it on another of his blogs -- one that I'll not advertise -- but I like to think I'd have stumbled on it eventually by my own initiative.

He managed, however, to tag the thing with a perfectly apt quotation:

If we are facing in the right direction,

all we have to do is keep on walking.

--Buddhist proverb

Posted on YouTube by derbydanx, with "[t]hanks to Matthew Stevens at Woodbine Racecourse" on November 7, 2010.

on a day we meet to walk the line

Howdy high there, buckaroos!  It's been a hoot of a day.

Without disclosing what exactly made me think of it, I spent a good quarter of an hour this afternoon extolling the merits of Frost's poem Mending Wall.  We were on the way home from my two medical appointments, and stuck in nasty traffic behind tentative drivers, all of whom, according to Fred, represented the fruits of the bastardization of our species.  Or something like that.

I had a captive audience, is what I'm saying.

In a vain effort to keep me from endless nattering, he switched on NPR.  At some point after the story on Clinton's meeting with our "chief Asian allies," shortly after the report on the televised arguments before California Supreme Court on Prop 8, but before the bit on the Random Hacks of Kindness Hackathon, I managed to reproduce the poem in its entirety.  You might call it A Blurt.

Mending Wall

SOMETHING there is that doesn't love a wall,
That sends the frozen-ground-swell under it,
And spills the upper boulders in the sun;
And makes gaps even two can pass abreast.
The work of hunters is another thing: 
I have come after them and made repair
Where they have left not one stone on stone,
But they would have the rabbit out of hiding,
To please the yelping dogs. The gaps I mean,
No one has seen them made or heard them made, 
But at spring mending-time we find them there.
I let my neighbor know beyond the hill;
And on a day we meet to walk the line
And set the wall between us once again.
We keep the wall between us as we go. 
To each the boulders that have fallen to each.
And some are loaves and some so nearly balls
We have to use a spell to make them balance:
"Stay where you are until our backs are turned!"
We wear our fingers rough with handling them. 
Oh, just another kind of outdoor game,
One on a side. It comes to little more:
He is all pine and I am apple-orchard.
My apple trees will never get across
And eat the cones under his pines, I tell him. 
He only says, "Good fences make good neighbors."
Spring is the mischief in me, and I wonder
If I could put a notion in his head:
"Why do they make good neighbors? Isn't it
Where there are cows? But here there are no cows. 
Before I built a wall I'd ask to know
What I was walling in or walling out,
And to whom I was like to give offence.
Something there is that doesn't love a wall,
That wants it down!" I could say "Elves" to him, 
But it's not elves exactly, and I'd rather
He said it for himself. I see him there,
Bringing a stone grasped firmly by the top
In each hand, like an old-stone savage armed.
He moves in darkness as it seems to me,
Not of woods only and the shade of trees.
He will not go behind his father's saying,
And he likes having thought of it so well
He says again, "Good fences make good neighbors."

Personally, I found my outburst not just appealingly literary but also perspicaciously germane. 

Okay, so I didn't reproduce the poem perfectly, all of a piece.  Maybe I paraphrased a little and transformed larger passages into morcels of personal opinion -- but largely?  Largely, it was there.

It was enormously beneficial that Fred was very familiar with Mending Wall, and, of course, fairly familiar with my belief that poetry is as important as politics, and often times is as much -- or more -- of an event.

Did I align myself as pro-community, against isolationism?  Did I declare my make-up to be all pine in a world of hardwood fruit trees?  Do I hate walls but believe in the neighborly act of gathering to repair the divider?  

Maybe the wall has value only as a point of broken-down and crumbling old references, as what is familiar, and therefore dear, no matter whether proven true, disproved, or established as patently irrelevant. 

It's where we gather;  It's where we start.

Why not end with a story, a true one, both germane and tangential?  When I was browsing, reading about walls [[[I am weird that way... a poem about mending walls requires at least some time thinking about actual walls {always remember:  "imaginary gardens with real toads..."}]]] -- Anyway, I came across this at a site called Texas Escapes which sometimes features columns by Mike Cox, and in this instance, one called Rock Fences. He particularlizes one of the German immigrants who authored the many rock fences of Texas Hill Country, the "backyard of Austin and San Antonio," and one is reminded, even more, what a rich expressive vehicle a wall can be:

Louis Grosz, born in Hueffenhardt, Germany in 1853, came to Texas when he was 18. His uncle, Phillipp Eckert of Mason County, had written and told him what tools he needed to bring to make a living in America. Grosz weighed his two trunks down with iron, including a broad axe needed to build a log cabin.


As Estella Hartmann Orrison related in a family history she self-published in 1957, “Eckert Record,” when Grosz finally reached the Hill Country he had to go to work to repay the $50 his uncle had advanced him for his passage to Texas. His first income came from laying rock fences at 50 cents a day in an era when no one had yet considered working only eight hours out of 24.

Likely toiling from “can see to can’t,” Grosz’ rate of compensation amounted to only pennies on the hour. And the work must have been brutally hard. Roy Bedichek, in his 1947 book “Adventures with a Texas Naturalist,” estimated the stone fences on his place in Hays County weighed “not less than a ton per linear yard.” The rule of thumb passed down to the present is that it took one man one day to build three feet of fence three feet high.


That three-feet-a-day pace involved not only the relatively mindless toil of finding, digging up, lifting and hauling suitable rocks but the more cerebral activity of sorting and stacking them just so. Gravity held these fences together, not mortar. The rocks had to fit snugly and be balanced.


Picture working a gigantic puzzle with very heavy pieces in a climate where most of the time it’s too hot and sometimes too wet or cold or both. Throw in a sore back and the occasional displaced scorpion or rattlesnake and you have a pretty tough way to make four bits a day. Oh, and hostile Indians still posed a danger in Mason County when Grosz had to earn money as a rock fence builder.


While rock fences also are known as “German fences,” research by University of Texas graduate Laura Knott, a landscape architect specializing in historic preservation revealed that dry-laid fences did not originate in Germany. Rather, the style used in Texas and elsewhere in the South seems to have been modeled after rock fences common to Great Britain.


Knott theorized that German Texans learned of the style and imitated it. On the other hand, it doesn’t take a rock-it scientist to figure that a potential farm field strewn with plow-breaking stones could be both fenced and cleared by stacking those very stones.

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

THE BIT I WROTE AFTER REACHING THE POINT WHERE ONE IS SUPPOSED TO STOP WRITING AND WHICH MOST PEOPLE MANAGE TO EDIT AWAY also known as my usual after-post detritis:

Of course, the truly infuriating thing is that no matter how outnumbered are the Forces That Would Have A Wall, the mere existence of a single wall proponent is enough to necessitate a building project worthy of the Army Corps of Engineers.  In much the same way that one must opt for the plural masculine form of the third person personal pronouns if a single masculine element is present in the subject pool, one wall-lover casts a broad shadow.

After all these years it still pisses me off -- that when 999 women openly gather, you just have to discover one guy in the coat closet to ruin The Sisterhood.  You must represent the group as masculine plural; You must choose ils as subject pronoun.


And unless you can withstand the onslaught of Shrugs-for-Answers, you don't ask "Why?"


Laws of race, laws of gender, politics of sexual orientation, tax breaks for millionaires, warning shots across the bow, ideas of intellectual ownership, and walls.  Walls.  Yeah, my ride home was deep today!

Jonathan Brookins, TUF

Congratulations to Jonathan Brookins who just took two of three rounds to become this season's TUF winner over Michael Johnson.  Johnson had a great first round and had he been able to connect, could have taken Brookins out at any time.  Jonathan seemed to get the point and was fairly adamant about keeping it on the ground for the last ten minutes!

He's refreshing, is Brookins, and so I make the usual wish that he may stay that way...

Stephan Bonnar won his match, handily (29-26, unanimous) but I still was able to complete a crossword, groom two cats, fetch dessert, and fold laundry during the fight -- all without that gnawing sense of deprivation.

No, he did well against Igor Pokrajac -- and the Words of the Day seemed to be momentum and reliability, and the struggle to establish them both.  Bonnar was fit and fairly twinkling on his toes, and when on the ground showed steady aggression.

Pokrajac lost a point for kneeing Bonnar in the head, and Bonnar lost one for blows to the back of the head.  Mazzagatti might even have been about to stop the fight, seconds left in the third, when he censured Bonnar for the illegal blows.  Fortunately, the bell sounded and Mazzagatti wasn't able to act on those fascist urges, born, no doubt, from the silly brown Hitler Youth uniforms that some refs now sport.   Joe Rogan had a few things to say about both point charges and the rules that prompted them.

RetroShivers

Just the thing on a cold winter's day -- Bob Woodward's trilogy.  From the third book in the series, State of Denial, this eerie quote from Daddy Bush, as he maneuvered behind the scenes on behalf of his boys:

On February 28, 1999, the former president was the honored guest at a gathering of some 200 Gulf War veterans at the Fort Myer Army base, just across the Potomac River from Washington.


...It burned him up when people said they hadn't finished the job, he said. "Had we gone into Baghdad -- We could have done it. You guys could have done it. You could have been there in 48 hours. And then what? Which sergeant, which private, whose life would be at stake in perhaps a fruitless hunt in an urban guerrilla war to find the most-secure dictator in the world? Whose life would be on my hands as the commander-in-chief because I, unilaterally, went beyond the international law, went beyond the stated mission, and said we're going to show our macho? We're going into Baghdad. We're going to be an occupying power--America in an Arab land--with no allies at our side. It would have been disastrous."  [p. 11]

Prescient is not my usual adjectival pick for George H. W. Bush...

LINDSEY BAUM: december update

There is no hard news to report on missing child Lindsey Baum, who disappeared June 26, 2009, from her small hometown of McCleary, Washington. She is now twelve years old. 

Local law enforcement, volunteers, the FBI, and Interpol -- all continue to publicize her case, and to search.  There is a $30,000 award being offered to information leading to her recovery.

Shonya Kay (username shonyakay at YouTube) is doing a marvelous job turning out well made videos that both move and keep the various stories alive, without sacrificing the factual evidence that will be what ultimately solves these cases. Drop by her YouTube channel and see the magnificent work she has done.

You can read everything that has appeared on this blog about Lindsey J. Baum, by clicking HERE.

My thoughts and prayers go out to Lindsey's Mom, Dad, and brother -- as well as to all who are searching and working for her return home. 

If you have any information regarding Lindsey Baum, please call the Grays Harbor County Sheriff's Office at 866-915-8299 [Tip Hotline].

NATIONAL CENTER FOR MISSING & EXPLOITED CHILDREN

1-800-843-5678 (1-800-THE-LOST)

McCleary Police Department (Washington) 1-360-533-8765

Family Website: Lindsey Baum

a confusion of appendages

I am having some new difficulties and apologize to my scant readership for not posting much, either in quantity or of quality.

Mostly, these problems are neurological. I find the brain and its doings fascinating, usually, but not so terribly much when the brain in question is stashed in my own skull.

I think I've written before about the "Where is my leg?" phenomenon, wherein locating one's own appendages in space becomes either problematic or hilarious, depending.

My upper body has joined in the fun, my hands being downright wicked.

I caught Fred watching me last night as I was dressing down these things called legs. In transit from the bathroom to the bed, a voyage usually marked by pirouettes and grands jetés, I lost control of my legs -- in the sense that they decided my directions were flawed. All I was asking for was a basic straight line of approximately seven steps, with the assistance of a cane . Ironically, there is one major obstacle in my carefully delineated path, and that is my wheelchair.

It won't fit through the bathroom door, and so is parked alongside the bed, where I try to keep it connected to the charger. You never know when someone's gonna call out, "Road trip!" -- and I wanna be ready.

In addition to the chair itself, then, I have the thick wires of the battery charger that snake across my path.

Lastly, there is one red plastic water bowl, Dobby's Beloved. I keep it neatly tucked in the corner behind the bathroom door. Alas, that is not where Dobby likes to keep it. He nudges and moves it with the encouragement of his nose and a front paw.  (Yes, he still talks to it, even sings in an odd chirpy dirge, followed by head bows and head butts -- and water everywhere, of course!  Silly humans, we love to watch and eavesdrop, and I don't think we would be totally shocked were the bowl to talk back one day.)

He seems to prefer it precisely in the middle of the path between door and wheelchair, approximately one-third of the distance between the bathroom door and the beckoning bed.

There's no need to weave a fun, cute story out of this Journey of Seven Steps.  With my brain set on dementia, apparently, I could not provide my legs with directions that they thought worth following.  

The first thing my right leg decided to do, when realization of its freedom set in, was to kick Dobby's beloved red water bowl -- freshly filled with cold, filtered water, of course.  This is an old picture of my right foot -- from about three years ago.  It's much worse now, after deep ulcers, repeated nail loss, and the general deleterious effects of CRPS. You can see the beginnings, at the top of the foot, below the toes, of typical CRPS lesions. At the moment, the right foot's coloring is a deeper purple, certain areas evocative of, say, *black*, whereas the left is chilling and holding at a kind of grey-blue.





CRPS in right foot, approx 2007.  (I don't recall the reason for the tape)
Since then, the foot has ulcered, fractured, and lost nails.

  
Here is an even earlier photo that shows both feet -- It would be wonderful to return to that state!  It looks so much less painful than what I am now experiencing.  The left leg, at present, rivals the right in terms of pain, but the right will always be worse, I suppose, both in appearance and sensation, as it was the site of the initial "noxious" injury in May 2002.  Somehow, miraculously, the left foot has also escaped most of the little traumas over these past eight years -- no cuts, scrapes, ulcers, bruises. (I did lose the big toenail for some reason)  It is only in the last month that the left leg has joined the right side in the torture of spasms-'n-jerks hi jinks. 





This was very early on, maybe 2003/4.  The level of discoloration extended just above the ankles.  Now it extends above the knee on the right side, and just below the knee on the left.

 




These were my "winter" CRPS feet -- thin, very purple, ice cold, incredibly painful.  In the summer, there was more edema, a redder cast, and they were sometimes radiating heat.   Again, much different, much worse, now.

 
Both feet have been fractured multiple, multiple, MANY times... to the point where we barely react anymore.  We certainly no longer report the fractures as needing immediate care, because the advice is usually inappropriate for the disease.  You do NOT want to immobilize a CRPS limb.  You do NOT want to apply ice to a CRPS limb.  And you really don't need to rush off to get an x-ray after the fifth or sixth break... It's been documented to death. Another confirmation by x-ray and a wasted bone scan just lines someone else's pockets with green.  Generally, I will tell my internist or ortho at a regular appointment, note their sage advice, and then continue doing what I know is best. 

I remember the first bad fractures to the metatarsals of the right foot. It was my introduction to an orthopedic surgeon who specialized in feet.  He seemed to be expecting quite a tale to explain the broken metatarsals, the incredible edema, and the astonishing array of colors.  He was pretty disappointed by my claim that I took a step outside, on concrete, and they just broke.  I had not been diagnosed at that time.  He knew, of course, immediately that this was CRPS, and advanced enough already that I had broken bones by simply stepping onto concrete.  Did he tell me, or even suggest to me that something more ominous than weak bone in a previously badly broken ankle, was going on?  No.  He asked me if I would mind him writing a letter to the orthopedic surgeon who had repaired the ankle (my shoulder doc, the asshole Eric Carson, major player, major cause, of my "sentinel event.")  Anyway, the foot guy knows me well now, and nothing much surprises him anymore. 

We did once furiously clash -- furiously, awfully, saying things that hurt. This time, I had my diagnosis, and I was consumed with anger at every doctor who had contributed either actively, or -- almost worse -- by maintaining a complicit silence, to my loss of quality of life.

It was hellaciously hot, and I was being sent to him on an emergency basis, as my right leg had very suddenly worsened.  It was huge and red and throbbed in cadence with the miles of backed up, churning, honking traffic -- the trip, first to my internist, then across two counties to this OS, was marked by an extremely bad attitude, considerable cursing, and a partner that was ready to kill the next hindrance to appear.

The week prior, I had sent a letter to the billing department of this huge orthopedic practice.  They were blatantly double-billing, determined to get the payment they felt they deserved, no matter the opinion of my insurance company.  Balance billing was the usual method, though sometimes they liked to dick around (à la the Happy Hospitalist!) with coding.  The PA once treated me to a 15-second injection of cortisone that ended up costing my insurance company over $600 -- coded as surgery, etcetera.  They tried several times to charge for splints that I actually had to buy elsewhere (Oh, *that* is quite the racket... they refer you to what amounts to a specialty boutique for splints/braces, saying they will make custom devices and carefully fit them and blah blah blah.  Upon arrival, the fee is immediately addressed, and when paid, you are escorted to a room in the back.  The, uh, specialist comes in, looks at the involved body part, hums a show tune, and grabs a box from the pile of boxes on the shelves.  He handed it to me, said, "This oughta do it..." -- signed the fee sheet -- and advised me that "the girls" would check me out, and to be sure to have a good day.  My insurance paid, without question, $200 for the brace -- almost identical to what you'd find in a drugstore --and over $200 for the "evaluation" and "fitting.").

So I wrote a letter.  I used to do a lot of that.  Now, I don't bother, as it makes no difference.

The congenial billing department wanted the medical crowd to know what an insufferable ingrate I was, especially considering that I had, at that time, great insurance, so they had appended my letter to the front of my chart.

It really was hellaciously hot that day.  I was kind of scared by my internist's reaction to the state of my leg, and I was acutely aware -- newly so, but still acutely -- that no one honestly knew how to deal with CRPS.  It might have been 3 or 4 months since my then new neurologist had made the diagnosis, to the consternation of the hospital and the involved orthopedists.

He lit into me like nobodies business, this doctor.  Yes, he knew it hurt, and badly.  That was what CRPS was about, didn't I understand that?  Didn't I know yet that that was my life now?  What did I expect him to do?  Loud and jeering, he seemed to yell, but probably did not.  Over and over he spoke of the worst pain there is, and explained, angrily, why -- because it never stops, it never relents, it never gets better.  I, the patient, had to change.  I had to adjust.  I was crying and without the benefit of a tissue or handkerchief, I remember smearing snot all over my face, and then being angry and frustrated about THAT. 

I yelled at the x-ray tech who kept grabbing my leg so as to get the right picture.  I did not yet know the secret:  if you tell a medical professional to NOT touch a body part, the first inclination will be to TOUCH that body part.  Often this comes -- or so one of them decided to tell  me -- from a desire to ease pain -- I suppose with some sort of bleeping Healing Touch ("energy medicine") in mind.  Beware the practitioners of Healing Touch, unless you ascribe to its theories, as it is impossible for them to understand that sometimes even the gentle, lavender-scented, sun drenched waves of air created by their sanctimonious undulating hands can cause severe pain to someone with CRPS.  Plus, they annoy me, and I say this despite the convictions of a dear, dear friend that the love in her hands can cure all...

That day?  There was no love in the air!  When he finally examined me, Foot Guy managed to pose a few questions and fairly leapt at one of my responses.  My answer, he crowed, provided the diagnosis -- I had a blood clot, by golly.  (No, I'll not embarrass him by telling you the question, though I will tease you:  It involved a symptom that occurred when I took a deep breath.)  Why, by George, by Golly, by Gee, it *was* an emergency after all.

He was ecstatic.  We had all enjoyed about 20 minutes of air conditioning and declining levels of anger, resentment, and adrenalin.  Plus, now he could save face by sending me for an emergency doppler/ultrasound at one of the area's many hospitals -- two of which were just blocks away. 

Of course, he thought it best to send me back to the very heart of downtown, to the hospital across the street from his practice's main clinic.  That made sense, especially since one of the nearby hospitals had multiple stored copies of several prior doppler studies.  They might have been able to simplify things by comparing those previous studies with a new one!

Having successfully avoided the best quality of care, Fred and I set off, again, now in rush hour traffic.  The highway was like a parking lot.  Fred gets frustrated in this situation, and tends to stop and start with huge jerks, speeding the distance of a few car lengths, then jamming on the brakes.  So, of course, I jammed my right leg against the floor mat in an imaginary effort to apply also-imagined brakes.  We both heard the crunch that issued from my ankle, and I just cried.  Just sat there and cried.

Anyway... we got the ultrasound: no blood clot.  The only medical response was to suggest admission, though, again, there were no clear ideas about what that would entail.   The sun long set, we went home and tried to decompress.  The day was not a waste, in that I had learned -- been taught yet again -- that seeking help with a CRPS-related problem was most likely to be an exercise in futility and frustration.  The next morning, I woke in heart failure.

Which I successfully treated with loads o'lasix, and hours of slug-like rest.

Foot Guy and I get along now.  Of course, I only go to see him when a foot fracture is not improving.  We are very polite to each other, and have never discussed the heated exchanges of that hot summer day.  I have always wanted to know the content of the letter he wrote to Eric Carson, author of my CRPS.  I mean, really, what did he say?  "Ummm, Eric, old pal, are you aware that this woman has developed a whopping case of RSD?" Who knows? 

Yes, right.  I was telling you about the neurological pitfalls that plagued my journey from the bathroom back to bed last night.  Gosh, I wonder why that didn't keep my prose heightened and dedicated solely to the telling of such a fascinating tale!

I got as far as Dobby's red plastic water bowl.  Then came the wire from the wheelchair battery recharger, and the wheelchair itself.  The short version?  I had no directional control -- not for up, not for down, not for left, not for right.  Every directional thought or command was met with the wrong action by my legs/feet.  I managed to end up sitting in the wheelchair, cords wrapped around my right ankle, yelping from the pain of that contact.

I bent down to pick up the recharger and to free my foot.  I could not get my hands to cooperate.  I couldn't grip the cane handle.

This morning, I littered the kitchen with joyously tossed coffee grounds.  Then I thought it would be fun to strew kibble in seemingly random -- but really quite artful -- arcs and other geometrical designs.  Trying to arrange an appointment before the one scheduled for February, I inadvertently hung up on my neurologist's office when I dropped the phone.

My head is throbbing and my temp is over 101.

I have no idea where my legs are.  Fred is in need of my curative chicken soup (Yes, he is sick again, poor fellow) but do I dare pick up a knife or deal with boiling water? 

Thanks again for letting me vent.  Yes, I know it's my blog.  Still, this gets old and I am aware of that...

* PLEASE DON'T REPRODUCE MY PHOTOS.  UNFORTUNATELY, A PHOTO OF MY HANDS IS BEING CIRCULATED AS AN EXAMPLE OF UPPER BODY CRPS.  THERE ARE PLENTY OF PHOTOS AVAILABLE AND PROPERLY DOCUMENTED ON MEDICAL SITES DEDICATED TO CRPS/RSD.

here's a clue...

here's a clue:  no matter how peeved you become at not being able to vacuum the entire expanse of the very tall cat condo, when you are in a wheelchair because of the basic unreliability of your legs, and you have been instructed to lift nothing above 5 pounds?

do not gently guide the condo onto the floor so as to put its many levels within reach of suction. 

more importantly, when time for the condo to rise back skyward, do not stand up, do not attempt to resurrect the 75+ pound monument to silliness, especially in a posture that approximates a lopsided clean and jerk virgil grissom elementary school weightlifting team tryout. 

okay, "approximates," most precisely, in the highly technical sub-specialty of clean-and-jerk screaming.  you betcha, screaming like a freaking bean-sidhe was de rigueur in the virgil grissom elementary school training camp.  probably still is!

(oh yeah!  be sure not to travel four or five steps away from the waiting chair!  it would be much better, even best, to be able to sit down, however abruptly or involuntarily, and land somewhere appropriate.

you know, as opposed to the floor.)

The 800th Win: Praise the Lord

Fervent wee-hour prayer spotted over at GoDuke.com:

Dear God, Please allow the NBA lock-out to occur this coming year and keep Kyrie Irving at Duke for one more year to play with Austin Rivers, Quinn Cook and Marshall Plumlee. Amen.

Best summation, by Matt Wallace, Compleat Heretic:

LET'S GO DEVILS!!!
There is One Coach and his name is Coach K and the Duke Blue Devils are his instrument. Woe to the unbelievers . . . especially Tar Heel fans...


Total domination on a hostile court against an excellent team!!! This Duke team has the potential both to repeat and to do so undefeated; it's that deep and that talented. Mason Plumlee is looking really good in the hybrid F/C position; I love watching him get called for goaltending! On the downside, Kyrie Irving is so scary good that he's clearly one-and-done regardless, but one can dream of a full collegiate career...


. . . and having watched the last two Carolina games, it appears they're going to have another season of five random guys running up and down the court in Tar Heel uniforms . . . Roy Williams is clearly no Mike Krzyzewski...


Blessèd be the Orange Orb.

Photo courtesy of The Sports Union: Cameron Crazies
("I don’t know that there is a tougher place to play...")

Congratulations to Coach K for
 his *800th* win
at The Gothic Wonderland!