Going up, again.

Repost from 7/22/2010 as recent events have resurrected The Elevator Dream. Not the act of dreaming, of course, because that would imply sleep. No, what has brought the demons back, today, is my need of money. How crass, you may be thinking. No luck with that Gratitude Journal, huh? There's nothing crass about needing money and being too ill to work, too disabled to labor, too unreliable to front a classroom. I know the party line. I know I am blessed to have private long term disability insurance. In the world of blessings and gratitude, hell, I am touched by grace just to be alive. Yet there are days, even whole years, where my inability to effect financial change drags down my health, my soul, my family's health, my family's soul. Somewhere along the line, I bought into the crap that disabled sick people are throw-aways, that I am a throw-away. I may live, but I may NOT live well.  I may live, but to others' standards.  People are deciding my relative worth every day, in ways I am only now beginning to understand.

Left to certain political audiences, I don't merit life, even.


And as I am less and less inclined to worship at the correctness altar -- even with all its delectable old men's wrinkled butt lined up at a kissable level, at the worship ready -- my "options" will soon be limited to a point that will, definitively, take my breath away.

Grader Boob was informed today that he'll be unemployed next semester; 
Fred needs cash to tend to very important Fred-things; 
 Bianca needs a new pair of shoes; Miss Marmy Fluffy Butt prefers the more expensive litter; 
and Buddy the Kitten has decided to be a Maine Coon and will not stop growing for at least three years. 
These are people [well, mostly people] to whom I want to turn
 in my *fullness*, not this perpetual emptiness of almost-can.  


As I sought to relax, it was, unfortunately, the screeching Dr. Sween who provided the audio portion of
 my mental exercise, and I found myself wanting to screech back.  
If putting up another repost keeps me from breaking into full-screech mode tonight?  Small price to pay to get to tomorrow, sane.
 I've got to get out of this damned elevator. 
  

Chuckle.

Remember my recent post on the IASP and the movement toward an improved instrument of diagnostic criteria for CRPS? No?  Well, you can read it here.

These optimistic good folk are at it again, as they now take on "wait times." May their optimism collide with reality in a non-distant future!  Blessed are these forces, tasked with improving our lot!

Give their latest a quick read: The International Association for the Study of Pain Task Force on Wait-Times.

Weary giggle.

Weary sniff.

Yes, as usual, I confront the helping hands of scientific task forces and medical recommendation-makers with my own effed-up brand of real and actual appreciation, spiced with frustration and a dash of jealous resentment.

I appreciate and do my best to broadcast all progress, doing due diligence, working to stay openminded when the work challenges my beliefs, trying to stay humble and happy when the researchers and medicos arrive painstakingly at what seems so very obvious.

In my world, the obvious does not have to undergo the rigors of proof.

I cannot deny the surge of anger I feel, knowing how the system that now teeters and totters its way toward progress, totally let me down back when I needed clear diagnostic criteria and some guideline hammering home the need for quick diagnosis and faster treatment. At least these bitter moments are fewer now, more quickly suppressed, and almost completely consigned to my sleeping hours.

So...you want to know the recommendation from the IASP regarding level of alarm and desirous wait time in new CRPS cases?

Are you sure?

They classify a new case of CRPS as "Most Urgent."
They recommend a wait time of no longer than "one week."

Mwa ha ha!

Having had a "classic presentation," which politely presented itself in a hospital setting, even, you'd think I would have had a great shot at early, correct diagnosis, or, at least, a correct early referral to an appropriate specialty -- neurology or pain management.

Well, of course, I did.  And I did not, as well.

Unfortunately, the hospital (with its specificity of place, persons, and situations) was the direct cause of my CRPS, and so: Lo! Hark! Why am I still surprised to realize that "it" consciously, and with premeditation, condemned me to a life of pain and disability?  So what if they successfully deferred my diagnosis for over 19 months?

I managed to put the details of my CRPS story in a blog post recently.  It may or may not clarify things were you to read that first!

I still dream dreams of being in the elevator of one of the Doctors' Buildings attached to the hospital, on my way to... I don't know where. I am studying the buttons, trying to remember what floor I want. Slowly, I become aware of someone else in the elevator, someone whose white coat is visible out of the corner of my eye.

It is, most often, Dr. Sween. That's kind of not fair, as all he did was obstruct my treatment and -- aside from that little bit of malpractice -- abuse me, emotionally. He told me his tale of woe -- how his department had to suffer the indignity of a state-level investigation because I had the unmitigated gall to report a Sentinel Event that went unreported by a half-dozen doctors, dozens of nurses, and the entire SJHA hospital administration. He scoffed at me when I began to cry over the fear I had of the future -- no possibility of ever teaching again, ever earning my way, supporting my family. It had not dawned on me, then, that I would suffer physically forever and anon. It had not dawned on me precisely because my experience precluded the possibility for that much pain to endure. Who'd a thunk it, outside of a medical professional or two?

Courtesy of The Joint Commission:

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function.  The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.  Such events are called "sentinel" because they signal the need for immediate investigation and response.

Sween yelled that there was no way I had suffered an adrenal crisis due to a failure to premedicate (also intra- and post- medicate, but I don't want to seem picky).  It just wasn't possible and anyone who thought so did not know what they were talking about.  And, certainly, the person ill-mannered enough to actually go into complete adrenal failure was a person to be dismissed and ignored.  As soon as the nitwit navigates his way out of cardiac and kidney failure, squeezes by the dangers of that hospital-acquired infection, 'n his heart rate sees the underside of 160, that is...

Of course, my mind wandered to my endocrinologist, but I am sure that's not whom he meant!  Not the doctor who came in one night -- a few weeks after the initial failure to medicate -- and found me "altered" enough, and complaining of those vague, ridiculous symptoms (weakness, diarrhea, lower back pain, craving salt) to warrant ordering an immediate cortisol level... and found a level of .05 mcg/dL. That's POINT ZERO FIVE.  That's right, he documented another failure to medicate -- the one that you swear has no discernible impact on adrenal function -- and then he documented the result.  We keep that lab result in archival preservative materials, and the Cistercians-Next-Door are guarding it with the same dedication they bring to the protection of Jesus' Foreskin, their greatest relic.

So *bleep* you, and your department, Dr. Sween!  Your discomfort at being investigated came and went;  Your means of livelihood are intact;  Nothing too bad happened to you. You are the SJHA Poster Boy!

*Bleep* you.  And *bleep* your Mama, too.  How you loved to tell me how you loved teachers.  "I come from a family of teachers.  I know how hard you work!"  No problem loading me up on ungodly amounts of Oxycontin -- but see that I was diagnosed and treated in a timely fashion for a severe and disabling neurological disorder?  Hell, no!

Next, I catch a glimpse of a white coat so starched that it looks to be of marble, a coat more brilliantly white than... well, white. It always turns out to be Dr. Kelman, the doctor most likely to form opinions according to the direction of the prevailing breeze upon his spittle-drenched index finger. Truly a bad doctor. I really mean that. Dr. Sween? He is capable of being a superb doctor. It's basically his choice. Dr. Kelman? Poor thing, he can't help himself.  Plus, I believe he may be a sociopath. I'm not entirely sure about that yet.

Almost, but not quite.

As the neurologist, it should have been evident what he was dealing with -- an emergent case of CRPS. ("Classic." "Textbook." That is how the neurologist who did make the diagnosis described my case, 19 months later. There was nothing difficult or bizarre in my presentation.)  Doctor Kelman, though, is not in tune, not up with, such medical niceties... but man-o-man, is he ever atune to the niceties of MedMal law and knows to whom he owes allegiance. In case you are wondering -- he was the mouthpiece for the hospital. The sequalae I suffered after a totally preventable Addisonian crisis and a fall in ICU that fractured several bones, concussed my one head, and introduced weeks of internal g.i. bleeding, etc.? They were laughable (I think that because he laughed...) and due to "emotion." My left hand was in the shape of a claw, spasming, too painful to touch... My right leg was in deplorable condition, rotating outward, hugely swollen, reacting to the movement of air with ugly recrimination -- forget how it felt when actually poked or gripped for pulses...

He did not even speak *to* me. Dr. Kelman stood at the foot of my bed -- indeed, he once bumped the bottom of my right foot and laughed at my reaction (in addition to being emergent CRPS, the ankle was fractured) -- he stood at the foot of my bed and loudly proclaimed to the orthopedic surgeon covering for my own wayward specialist, that my problems were emotional and that clearly I had had too much pain medication.

I cannot even work up a respectable "mwa... haaaaaaaaaaa... haaaaaaaaaaaaaa - ah - ah" at the memory of Dr. Kelman.

When it became clear to him that I was not an idiot (which took more time than I like to admit), he tried a new claim. Actually, I guess he never did stop thinking that I was an idiot because his claim was this: "What NEW case of CRPS? Why, you've always had CRPS. I should know, I diagnosed it years ago!"

No, sorry, despite years of reflection, review of records, inquiries made and answered --  I cannot explain what he was hoping to accomplish with that announcement!  Many a brow has furrowed in its wake.  I do, however, have a letter saved -- that I do not remember writing, but which I do like, and like very much. In it, I defend the honor of the Physical Therapist doing home visits with me, a talented young woman who hit upon CRPS almost immediately. When I shared her diagnosis with Dr. Kelman, he started yipping at me like an overexcited little lap dog, saying, among other things: "How dare you question my diagnosis, especially because of some stupid PT who doesn't know anything about anything..." That was my last visit to dear, dear Dr. Kelman. He never took me up on my offer to put his claims of "preexisting CRPS" in writing.  It would have been quite the accomplishment to have diagnosed me with CRPS/RSD years before the onset of any symptoms -- a real diagnostic tour de force.

Oddly enough, the person least often in the elevator of my dreams is Dr. Carson, the orthopod who really should be first in line for any oneiric revenge fantasies. The thought of him still terrifies me enough that I cannot even let the elevator doors close before I panic.  Sometimes my wheelchair is caught in the opening-closing-opening-closing doors, and I am trapped.

I was still in the ICU the day he stood by my bed and told me: "I do not have to fix your leg... really it is an elective surgery, you know, I don't have to do a thing about it." {Large, ingratiating, insouciant smile}

I asked him what would happen to my broken, oddly-angled foot and ankle without surgery;  He laughed. He said, "It would stay like it is now, a perfectly acceptable outcome." {Large, ingratiating, insouciant smile}  That would mean hanging weirdly on the end of my swollen, red leg, unusable?

At the evident horror on my face, and in sagacious fear of a taperecorder: "I will fix it, but I want you to know I don't have to..." More laughter.

Shiver. More shivers.

Oh, I bet you want to know what goes on in my elevator! Well, each man says something like, "Ahem. Hello, Ms. Retired Educator. How have you been doing?" Their voices are not normal. They are castrati: mezzo-soprano, contralto. Kelman, as much a true soprano as Michael Maniaci.

I cannot answer their polite queries, of course.

I have no voice.

The doors close, we go up precisely two floors, and the doors open. I rush my wheelchair through the opening, zig-zagging in my nervousness. This is not my floor but I have to get out of there...

Yes, well.

Not even my dreams are subtle.

As I said, the news in the world of pain management today comes in the form of these recommendations about "wait time" from the IASP:

•Most urgent (1 week): acute painful severe condition with risk of deterioration or chronicity (new CRPS) or pain related to cancer or terminal or end stage illness (acute herpes zoster also requires urgent treatment but ideally should be treated at the primary care level rather than requiring a pain specialist service).


• Urgent or semi-urgent (1 month): severe undiagnosed or progressive pain and risk of increasing functional impairment generally 6 months duration or less (back pain not resolving, neuropathic pain, post surgical or post traumatic pain)


•Routine or regular (4 months): persistent long-term pain without significant progression

My Three in the Morning

Individual Spanish Tortillas for Fred and the Militant Existential Lesbian Feminists
(with whom he dines each Wednesday evening). Total Count? Twenty-five.
This week's culinary offering from the Doyenne of the Manor features collard greens,
mushrooms, red peppers, celery, and eggplant in a standard spicy potato and onion Tortilla Base, with
Notes of Basil, White Pepper, and Oregano as the Uppity-Sounding Flavor Profile.


So what were *YOU* doing in the wee hours, hmmm?

In the Spanish Omelet afterglow, I allowed myself the pleasure of several chapters from The Jean-Paul Sartre Cookbook*:

October 3  Spoke with Camus today about my cookbook. Though he has never actually eaten, he gave me much encouragement. I rushed home immediately to begin work. How excited I am! I have begun my formula for a Denver omelet.

October 4  Still working on the omelet. There have been stumbling blocks. I keep creating omelets one after another, like soldiers marching into the sea, but each one seems empty, hollow, like stone. I want to create an omelet that expresses the meaninglessness of existence, and instead they taste like cheese. I look at them on the plate, but they do not look back. Tried eating them with the lights off. It did not help. Malraux suggested paprika.

October 6  I have realized that the traditional omelet form (eggs and cheese) is bourgeois. Today I tried making one out of a cigarette, some coffee, and four tiny stones. I fed it to Malraux, who puked. I am encouraged, but my journey is still long.

October 7  Today I agian modified my omelet recipe. While my previous attempts had expressed my own bitterness, they communicated only illness to the eater. In an attempt to reach the bourgeoisie, I taped two fried eggs over my eyes and walked the streets of Paris for an hour. I ran into Camus at the Select. He called me a "pathetic dork" and told me to "go home and wash my face." Angered, I poured a bowl of bouillabaisse into his lap. He became enraged, and, seizing a straw wrapped in paper, tore off one end of the wrapper and blew through the straw. propelleing the wrapper into my eye. "Ow! You dick!" I cried. I leaped up, cursing and holding my eye, and fled.

*Sartre's Cookbook Courtesy of the fertile mind of Paul Vincent Spade, Professor of Philosophy (Emeritus) at Indiana University, Bloomington (spade@indiana.edu)




Previous meditations on the Militant Existential Lesbian Feminist Wednesday Night Feasting Phenomenon:
Wednesday Night Suppers;
Writer's Block and Its Detritus
Coconut Milk Confessions
and the incomparable Vent: Saving the Day.

belle::position::amour -- the third incarnation

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At our Family Meeting last evening, held in the Haddock Clan's rendition of the Knoppenburg Manor* Stables, we voted to repost belle::position::amour for a third year, despite a barrage of online petitions from Change.org calling for its removal.

Although we've signed a fair number of Change.org petitions, usually with their authors breathing down our collective back, a quick Family Canvas showed that, au fond, we do not believe that "empower[ing] anyone, anywhere to start and win campaigns for social change" is altogether desirable.   Oh, put your tongue back in your mouth.

Mostly, though, the Family reasoned that keeping belle::position::amour might be the only way to remain statistically relevant in the blogosphere, since we continue to receive a good number of daily visits from searchers in politically and socially repressive countries, searching for the best ways to get it on.

Call it part of our Liberal Bias, call it What You Will, belle::position::amour is the star
 of our Outreach Program for Excellence.  Well, okay, it is second only to XXX Porn -- about which, surprisingly, we've received nary a petition.

* Knoppenburg Manor is, in fact, for sale. Sad that one of its key selling points is that this area of Belgium has "remained free
 from the threat of terrorist attacks." Our stable replica -- or "agricultural outbuilding" -- is a lovely place in which to relax, chat, contemplate -- at least on warm days. Built some time in the 16th century, the Manor Knoppenburg's charm is in its 
simplicity and enduring functionality. Make a bid!

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At 3:41 pm this afternoon, a visitor from Qatar dropped by. From far away Doha, Ad Dawhah, this person was steered here by their search engine: google.com.qa.

Like so many who have come before, tongues hanging out, my qatari friend was looking for "belle position amour."

We here at elle est belle la seine la seine elle est belle cannot let such a quizzical, and perhaps painful, cry pass unanswered.

Our first thought was the usual one -- throw the Kama Sutra at it. But really, if someone has resorted to googling sexual positions that are "belles" -- something more immediately accessible might be à propos.



And so the final consensus was to recommend the following:

Sex Deck: Playful Positions to Spice Up Your Love Life

by Dr. Dawn Harper

(Cards)
Buy new: $14.95
SALE @ Amazon: $10.17, Eligible for FREE Super Saver Shipping on orders over $25;
You Save: $4.78 (32%)

[We heartily recommend investing in the NEW, for reasons of basic hygiene.]

Want it delivered Tuesday, October 11? Order it in the next 10 hours and 4 minutes, and choose One-Day Shipping at checkout!

To be honest, we are not familiar with Dr. Harper's book but love the idea of sex positions being put on cards -- very handy. Once you get to Amazon.com to check it out, there will be other books of the same ilk advertised on the page. Our feelings won't be in the least hurt should you choose another guidebook.

However, in the interest of quality control, it would be helpful to this website's management
if you would return to the comment section for this blog post to share
what position did, indeed, turn out to be very, very belle.


[cue music... dim lights...]




Sincerely,

La Bonne et Belle Bianca Castafiore

The Retired Educator

Fred

Sam-I-Am

Marmy

The Dobster

Uncle Kitty Big Balls

(the original signatories)




photo credit 1 -- that's **spooning**, people, **spooning**!
photo credit 2

A Few of My Favorite Things

Nothing happening between these ears, so I set myself the task of wandering our private quarters this morning and snapping a record of "favorite things."

I forgot to turn on the camera half the time, something in the order of "Ooh, shiny!" -- mouth agape.  And so you missed my collection of stones and crystals stored in my grandmother's cut glass bowl.

My earrings from Tehran.  They're red, gold, and beautiful.

The world's most incredible twig basket ($1.05 at the Thrift Store).

The soup tureen (with mismatched lid) I inherited from my (multi-millionaire) aunt.

One of Fred's guitars, in the process of being lovingly refinished.

The double chocolate prune cake I whipped up at 4 AM.  Don't let the "prune" fool you, it ain't in no way health food.

My closet full of slings, casts, braces, walkers, spare wheelchair parts, and -- inexplicably -- seventeen empty coffee cans.

Ah, but I did manage to get pictures of some things quite dear to the old coeur!


One to Count Cadence by James Crumley.  It's been a long, slow read about a part of the world and a time that was all too quick, all too real, and much too... moist.  (That's for those of you who have passed a monsoon season in the P.I.)  It's pretty rare for this Sister-Unit to wonder whether the Brother-Units have read something.  Anyway, it's the first favorite thing by virtue of being the first "currently in favor" thing captured with the video camera ON.  Oh, and that long metal thingy is -- verily! -- a most appreciated item: one of my five reacher-grabber thingies.  Gimp gold!

Yeah, then there's Buddy the Kitten, some guy whose sweet goodness outshines the sun [It's Fred!], and my humongous bottle of bear repellent.  Special dispensation from Captain Haddock and Tante Louise permits me to attach the UDAP Bear 911 canister to my wheelchair so that I may render impotent any intruder into the peace of Marlinspike Hall.  In reality, of course, I keep it in a cluttered carry-all stashed under my jewelry tree.

Shoot.  The jewelry tree!  That *is* one of my favorite things.  Drat. Oh, well, next go round.  I wonder how many times Scorsese has felt the sting of remorse over a lost shot?

My Pléiades cigar box!  You can pick one up at eBay for under ten bucks, but the love of the thing here depicted comes from the guy who gave it -- one of the world's most invested poseurs -- for whom I was a mannerism he briefly affected.  He thought I'd like it, and I did.  {shiver :: ick :: ewww}

Beyond that, the water-stained warped box is cherished as an adequate container for the things contained -- a tough category that includes granules of fine (Parisian) pastels in its corners, and, in its most recently incarnated use, an absorbent receptacle for the blood stains from glucose testing.

Unintended, but correct, is the inclusion of my flowery cane.  It's a great way for people who are uncomfortable around disability to disassociate.  With that cane as a prop, such folk can exclaim, "If you have to have a cane, why not get a pretty one, right?"  If things are particularly squirrel-y, this $12 cane can sustain a monologue until the ambulance arrives.


My Tracy Porter tea cup and saucer.  It's not a favorite thing... It's more a sometimes perfect note, when perfect means facile.  I was aiming at the stuff in it!  Fred went through a Winnie the Pooh figurine stage a decade or so back, and would bring home gift ensembles featuring the bear or maybe -- my favorite -- Eeyore.  It was reminiscent of Barbie stylings, somehow -- Teacher Barbie or Barbie Collector Twilight Saga Bella Doll.


[We used to enjoy making Alternative Crèches, and Winnie the Pooh + Friends were terrific in the Underwater Nativity before we moved our considerable talents on to Stonehenge Parodies [shout out to @HengeClub ].


Nestled under the cup is an Iranian prayer rosary, or tasbih, given to me by a woman who uses them as worry beads.  I use them as bracelets.  I hope she's grown less worried with age;  I might profit from her serenity with more wrist adornments.  


Then there's a brief interlude with My Boys:  Grandfather, TW and his charming grin, Adrean, Grader Boob as a Young Man, Some Dood with a Goo-Goo Eyed Woman Draped on his Shoulder, and then a seamless and meaningful segue into a shot of My Favorite Hair Bands.


Wow, I should be issuing a blanket apology.  Whatever.  I like textiles!


Mon bel oranger by José Mauro de Vasconcelos only made the director's cut because I ran across it by accident a few days back.  The felines dislodged it from a bookcase and my hand crossed it like a live wire while restoring order.  I decided to read it aloud and have been enjoying that.  Very much, in fact.


Disturbing trend:  the Iranian Worry-Bead Woman?  She also introduced me to Mon bel oranger.  A few years later, I had a wonderfully blue neon light constructed to form Zézé, the personnage principal that she somehow brings to mind.


So it's My Sweet Orange Tree in English... but very few USAmericans know of it.  Have you read it?  It's a children's classic that adults have come to mostly via translation.  Of course, according to Amazon, you need to shell out $250 for an English copy, which might explain a few things.  It needs to be back in print!  It's one of those books to cherish, to force into a loved one's hands.  Good going, felines.  I wonder what they've in store for me next.  Probably Tolkien.


Clearly losing my hold on reality, this videographer next centers her food processor in the frame, delightfully accented by some juicy red bells, followed by a candid shot of favorite flavors:  ginger, cayenne, rosemary, cumin, balsamic vinegar.  Wasabi?  What the heck is wasabi doing in this shot?  Am I queen of sushi?  No, I am not.  In sauces, dressings, toppings, fine -- but do I gravitate to wasabi, first off, first thing, as first choice in a flavor profile?  No, I do not.  Harrumph. 


Knives.  Okay, so we have a few knives.  I confess that the paring knife collection is over the top, and I cannot see why we have more than two boning knives, but heck, we just do.  


Should you ever hear that I've met my demise in some sort of violent domestic conflict?  Check the kitchen, count the knives.  Look between my shoulder blades.  Is that a Chinese cleaver parting my tresses?  [Psst!  I would check into Sven Feingold's whereabouts and his alibi.  I hate to insinuate, but if La Bonne et Belle Bianca Castafiore serves as his witness, or even Cabana Boy (recently found to be Sven's biological son)?  Someone may well be getting away with murder...]


Finally... my favorite triptych, our Laughing Buddha, plus a beloved detail of that old cliched Klimt and his golden kisses.  The cat condo keeps getting shoved in front of it, and so it's fitting that Buddy the Kitten should languidly drape himself into the last shot.


Pray for sleep, because in the queue of things-that-might-pass-as-interesting should my brain not rest a bit are such pressing topics as:  


The Linen Closets:  A Retrospective; 
Fred's Flashlights; and...
Dobby's Secret Stash of Tiny Top Hats.

Happy Birthday, Grader Boob!

J'ai passé une nuit blanche.  No surprise there.  The good news is that I completed all the forms necessary for my continued receipt of the big monies.  No, that stretched and screaming envelope has NOT been mailed or otherwise transferred from my sticky fingers to my insurer's cold claw.  I plan to weasel my way into Fred's Good Graces so that it gets dropped into the appropriate mail box -- as soon as The Fredster wakes up.


[He did NOT pass a white night, sleepless.  He did, however, only wish me a good evening at 4 am, before stumbling in the direction of the closest uninhabited Guest Wing.  Sometimes we sleep where the Manor tells us to -- She murmurs "Gargoyle Alley," and off we go -- She suggests the Paisley Pavilion, and you grab your favorite pillow, because those suites were meant more for play than rest, and the Brother Monks like to make semi-permanent forts out of bolsters and piled mattresses (with Abbot Truffatore carefully packed in their centers).]


Despite lacking the clarity that comes from sleeping, I was pretty darned focused. I think I ate every 10-15 minutes, following a free-wheeling menu ranging from scorched Kettle Korn, apples, a peach, yogurt, and cauliflower to rye toast.


I had a fit of laughter when I spotted a carefully dated frozen washcloth that I'd folded inside a plastic bag to serve as a cold compress for my future aching head.  Fred had placed it on a plate inside the fridge -- to defrost, I guess -- and had affixed this query:  What *is* this?  Clearly, he thought something fuzzy, green, and out-of-date had no place inside his freezer.


Anyway, due to a resultant blood sugar in the one bazillion range, my vision is a mess.  That'll clear up once I take my 9 million units of insulin.


The way the story goes, I don't "really" have diabetes.  Oh, no.  That would be too simple.  I have "steroid-induced hyperglycemia," or, as the nurses in the hospital deigned to call it:  Diabetes.  The "steroid" part is only important when NOT being formulaic about insulin -- for example, on a day where my steroid consumption will be decreased.  In that case, it's important that I not be loaded up with the usual dose of long-acting insulin, since my blood sugars will be lower in the absence of prednisone or hydrocortisone, or whatever.  Given that infection also causes blood sugars to rise, no one is convinced that I have the dread diabetes, but I still end up testing 3-4 times a day and injecting insulin or scarfing down glucose, depending on the results.  It's crazy.  MDVIP Go-To-Guy is more fearful of me dying via hypoglycemia than he is concerned about the myriad symptoms caused by high blood sugars... try explaining that to a classically trained nurse-type person.


I have a point, and that point is that I started jonesing for cake, sometime after the yogurt and before the peach.


Cake made me think of birthdays, and that reminded me that today belongs to Grader Boob:  Happy Birthday, Grader Boob!


When last we heard from our intrepid Educating Hero, a mere two days ago, he was whining:

Have 84 papers -- Rogerian arguments all -- to grade in preparation for conferences next week. Papers and conferences -- I truly am in Hell! They get a week off from class and have to see me for a 10-minute period, while I get to say the same thing 84 times.But that's why we earn the big bucks.

I hope his students know about the "no contact" rule on birthdays.

check out more designs by carolina chic!

Never, Disambiguated

I am cutting it close!

If ever you've wondered how Fred and I are able to afford such a luxurious lifestyle, here's our secret:  We live on 60% of my salary (frozen at its lofty 2001 level with nary an adjustment for pesky details like "costs of living in A Manor") and have expenses that exceed that amount by 127% (excluding some medical debt that would be economically lethal to consider as actual money owed).

We've saved beaucoup bucks thanks to our dedicated squatting here at Marlinspike Hall, an endeavor that was envisioned as a convenient feet-propped-on-a-plush-leather-ottoman kind of thing but that turned out, as my dedicated readership knows, to be more of a trompe l'oeil affair, in which lazy leisure is the trick.

To push the edge of the tattered brown envelope, our anxious virtuosity is less Magritte's crisp "lucid dreaming," being infinitely more in keeping with his "alleged" forgeries.

I don't mean the kind of cleverness involved in faking one's own work ("to raise cash"), the assumptive motivation behind the existence of two Flavour of Tears:

Courtesy of Online Tate

No, I am referring to the outright, intentional theft of someone else's work, be the thievery clever or not.  Specifically, I cite Marcel Mariën's claims to have sold numerous forged Picasso, Klee, Leger, De Chirico, and Renoir on Magritte's behalf in the 1940s -- none of which were "pipes," none of which were parody or illustrations of subversion.

Yeah.  Well.  My blurry vision informs me that Mariën’s pretension was culled from "La Reproduction Interdite: René Magritte and Forgery" by Patricia Allmer, a piece published in Papers of Surrealism, Issue 5 Spring 2007.  She is referencing, of course, Marcel Mariën’s autobiography, Le Radeau de la mémoire.


But we're not worms in the apple, Fred nor I, nor our entourage of Tintinistes, felines, and local-yokels:
We live in, and among, the Haddock family's ancestral home and holdings in Tête de Hergé (très décédé, d'ailleurs) but it is definitely luxury beyond what we cannot afford, so we tend and maintain it, following The Captain's orders and philosophies.


La Bonne et Belle Bianca Castafiore stays here under the same sort of understanding, though her opera career cuts back on the amount of damage she can inflict on Manor property.  She's proving, however, to be a reckoning force in the development of the Haddock's Detox and Rehab facilities, as well as their Best and Most Frequent Flyer.


It would be nice if we could get Bianca to understand the concept of "paying it forward," but we may forever be working on that slippery notion of "paying it back."  In the Fullness of That Which is The Castafiore, she has mal-adapted a behavior that covers both of these ideas, a cheerful, warbled version borrowed from Chapter Two of The Adventures of Tom Sawyer:

"Hi- yi ! You're up a stump, ain't you!"


No answer. Tom surveyed his last touch with the eye of an artist, then he gave his brush another gentle sweep and surveyed the result, as before. Ben ranged up alongside of him. Tom's mouth watered for the apple, but he stuck to his work. Ben said:


"Hello, old chap, you got to work, hey?"


Tom wheeled suddenly and said:


"Why, it's you, Ben! I warn't noticing."


"Say -- I'm going in a-swimming, I am. Don't you wish you could? But of course you'd druther work -- wouldn't you? Course you would!"


Tom contemplated the boy a bit, and said:


"What do you call work?"


"Why, ain't that work?"


Tom resumed his whitewashing, and answered carelessly:


"Well, maybe it is, and maybe it ain't. All I know, is, it suits Tom Sawyer."


"Oh come, now, you don't mean to let on that you like it?"


The brush continued to move.


"Like it? Well, I don't see why I oughtn't to like it. Does a boy get a chance to whitewash a fence every day?"


That put the thing in a new light. Ben stopped nibbling his apple. Tom swept his brush daintily back and forth -- stepped back to note the effect -- added a touch here and there -- criticised the effect again -- Ben watching every move and getting more and more interested, more and more absorbed. Presently he said:


"Say, Tom, let me whitewash a little."


Tom considered, was about to consent; but he altered his mind:


"No -- no -- I reckon it wouldn't hardly do, Ben. You see, Aunt Polly's awful particular about this fence -- right here on the street, you know -- but if it was the back fence I wouldn't mind and she wouldn't. Yes, she's awful particular about this fence; it's got to be done very careful; I reckon there ain't one boy in a thousand, maybe two thousand, that can do it the way it's got to be done."


"No -- is that so? Oh come, now -- lemme just try. Only just a little -- I'd let you , if you was me, Tom."

"Ben, I'd like to, honest injun; but Aunt Polly -- well, Jim wanted to do it, but she wouldn't let him; Sid wanted to do it, and she wouldn't let Sid. Now don't you see how I'm fixed? If you was to tackle this fence and anything was to happen to it -- "


"Oh, shucks, I'll be just as careful. Now lemme try. Say -- I'll give you the core of my apple."


"Well, here -- No, Ben, now don't. I'm afeard -- "


"I'll give you all of it!"


Tom gave up the brush with reluctance in his face, but alacrity in his heart. And while the late steamer Big Missouri worked and sweated in the sun, the retired artist sat on a barrel in the shade close by, dangled his legs, munched his apple, and planned the slaughter of more innocents. There was no lack of material; boys happened along every little while; they came to jeer, but remained to whitewash. By the time Ben was fagged out, Tom had traded the next chance to Billy Fisher for a kite, in good repair; and when he played out, Johnny Miller bought in for a dead rat and a string to swing it with -- and so on, and so on, hour after hour. And when the middle of the afternoon came, from being a poor poverty-stricken boy in the morning, Tom was literally rolling in wealth. He had besides the things before mentioned, twelve marbles, part of a jews-harp, a piece of blue bottle-glass to look through, a spool cannon, a key that wouldn't unlock anything, a fragment of chalk, a glass stopper of a decanter, a tin soldier, a couple of tadpoles, six fire-crackers, a kitten with only one eye, a brass door-knob, a dog-collar -- but no dog -- the handle of a knife, four pieces of orange-peel, and a dilapidated old window sash.


He had had a nice, good, idle time all the while -- plenty of company -- and the fence had three coats of whitewash on it! If he hadn't run out of whitewash he would have bankrupted every boy in the village.

Yes, so some days Fred and I marvel along with a snickering Domestic Manor Staff as various visiting Baritones and Tenors, interspersed with the odd Contraltos, have taken up feather dusters or been seen hauling firewood or mucking out horse stalls -- each and every one with such an air of satisfaction that we've ceased to query The Castafiore on her methods.

Anyway, as I said at the outset, I am cutting it close.

The various formulas and barters that complicate life as a Working Squatter sometimes feel like more of a cognitive confusion than a rich system of interconnectivity.  I get turned around, disoriented.  And scared.  I mean, there's a good number of good people who depend on me and my attempts to preserve and extend the aforementioned 60% of a frozen salary.

Even though Captain Haddock has provided netting in the event of my total fiscal collapse, we have needs that escape the understanding of Tintinistes -- like insurance coverage, for instance.

I will explain -- AGAIN -- how it is that Fred and I are not immune to disease like the vast majority of Tête-de-Hergéens.  Simply put, because we entered the country in an unusual way -- via The Captain's miniature submarine, The Schvitz, with its patented Corkscrew Technology -- we were not subjected to the curative BioHasard Filter normally employed on immigrants.  Hence, we've needed to maintain our health insurance, even when doing so ate up 97+% of that famous aforementioned 60% of a frozen 2001 salary!

Since 2001, this private disability insurance has kept us afloat, although the occasional wave of tepid moat water does wash up my quivering nose.  And, with this private disability insurance, I purchase private health insurance, as I, the Resident Socialist, am not eligible for state-sponsored disability coverage.  That's right... I am totally and permanently disabled, but because the majority of my working life was spent in universities, few of which pay into the Social Security systems, I lack sufficient "work credits" to receive anything resembling state-administered disability income.

I know what you are thinking, Friend.  Something like:  "Well, then, they had to have paied into a pension plan on your behalf, so stop whining, Profderien!  Stop this mad shell game, Retired Educator!  'Fess up and show us the money!  I mean, didn't I read that she drives a 2008 Honda CR-V?  Equipped with a motorized wheelchair lift, too!"


Oh, chill.  Of course I tried to recoup the millions stashed in various pension plans under my illustrious name, thinking to create a dandy little Health Savings Account ("tax-advantaged"!)  because that would solve everything! 


{attempts::to::chuckle, failed}

Here's the punchline to that joke:  In order to get one's pension money, one must be vested, and usually one must be vested to the tune of five - seven years.

Guess who was enjoying a life of living-here::living-there, studying with this Famous Person on the West Coast, struggling under these Over-Inflated Egos of the Eastern Seaboard?  The idea that I needed to stick with any one university long enough to be able to access my pension just did not register in my conscious mind.  


"Employers use this strategy to promote loyalty.  Employees do not want to leave free money on the table, so they may not want to leave the employer." {guffaw}


So, yes, there are two large, well-known universities that owe a small measure of their financial health to having bilked me of my benefits.

You can see that the aforementioned 60% of a frozen 2001 salary assumes more and more importance in our world.

Cutting it close: I believe I've mentioned that tendency of mine before.  Okay, so perhaps I tend to project the blame for all procrastination onto Sweet Fred, since he suffers from ADHD, and I, well... I do not.

Except when it comes to filling out the paperwork from my private disability insurer in order to update them about my progress as a completely useless, worn-out, debilitated, and totally gimpified person.

They cram this stuff down my throat every THREE years or so!  I mean, Jeez, give a person a chance to breathe, would 'ya?

The paperwork to be completed arrived six weeks ago.  It is due tomorrow.  Technically, I can turn it in whenever, but they did make the terroristic threat that failure to get it in by tomorrow might result in an interruption of my benefits.  Harrumph.

The most important part has been done, and was done within a week of the request:  the Attending Physicians Disability Status Update.  I was thinking that my MDVIP Go-To-Guy Doctor would need time for reflection and careful consultation of his notes, so Fred and I zipped it out to him right away.

He filled it out in front of me.  At one point, he giggled.  As I began to explain where he could fax the completed forms, he handed them back to me, in triplicate, notarized -- all done.

The remaining sections contain such thrilling morsels as medication lists, hospital admission dates, specialists' names and addresses, and my sworn testimony that I am not on anyone's payroll.

I've kept Go-To-Guy's portion carefully tucked away in a crisp, white envelope.  I was hoping to stave off curiosity and just toss it into the final mix when my sections were finished.  I mean, what could he say that would be news to me, anyway, y' know?

So here I am, febrile again, dripping all over the laptop, headache raging, bones screaming, facing a deadline that can no longer be avoided.  And, of course, instead of dedicating myself to the 15 minutes worth of writing required to finish this task, the only thing worth doing, suddenly, is perusing the Physician's Status Update.

The first thing I notice is that he's knocked off a good 20 pounds on my weight.  What a nice man!  The second thing that jumps off the page is that, next to my diagnosis, he has written "Severe," with an exclamation mark.  Underlined.

I figure that his giggling episodes must have been triggered by the Functional Capacity, because this Fool of a Medico went crazy with notations and equivocations.  I have a 1-33% ability to push/pull with my dominant hand but 0% ("Never") in the other, for instance.

I have 0% ("None") ability to CLIMB but a confusing 1-33% ability to TWIST/BEND/STOOP.  Even more disconcerting, though, is that my twisting/bending/stooping is matched by my 1-33% ability to OPERATE HEAVY MACHINERY.  What the heck?

The very next line asks about current restrictions, which he begins to answer by writing: "Do not operate heavy machinery..."!

Okay, so I was finally laughing along.

Then, as I was checking that he spelled his own name correctly, my eyes fell on the last nugget of information they needed.

Q:  "When do you expect improvement in the patient's functional capacity?"
A:  "Never."

Except that it looked more like "Neve." The final R is there, but it looks as if his pen might have fallen out of his hand, or slipped on the page, somehow.

If they cut off my benefits or some other nasty deed, it's gonna be because of his bad penmanship, not because I didn't rush to make sure they knew I was such a diamond in the rough.

Wikipedia has the following disambiguation information for the word neve:

• Neve (band), American pop rock group, 1997-2001
• Neve (titular see), former Roman Catholic diocese in Arabia
• Neve, Hebrew word for oasis, first word in the name of several settlements in Israel
• Névé, young, granular type of snow which has been partially melted, refrozen and compacted

From Case Reports to Disinhibition: CRPS Odds and Ends

It's been a day of music and a kind of leisure.  It seems appropriate to top the hours off with a bit of light housekeeping:  Here are a few of the research article abstracts that are piling up around here. [I would say that the waste of redundant hard copies gather dust in the corners... but I can't fool you.  You know that Computer Turrets don't have corners!]

There is nothing earth-shattering, just the train-train quotidien of progress.  So long as we have that dull, repetitive noise as a lazy day soundtrack, we're okay.

For today's lazy day, that's fine.  Come tomorrow?  Maybe we can step it up a bit, eh, you scientist types?

Tease a little more information from those short fibers (Destined for Ganglia!)!

Add the Ketamine to the Propofol, whaddaya get?  Ketofol!

[Will my insurance cover Deep Brain Stimulation, do you think?  The At Home version?  I've had about enough of this tw-tw-twitching... Shouldn't be that hard to sink a few carelessly modified TENS leads into the old gray matter, then hook those babies to the ramped-up three-phase step-down transformers that Fred mounted between the two utility poles in back of the barn...  Don't worry, we'll carefully document our results and protocols.  The ABSTRACT ought to be ready to go by the weekend, pending publication in the October DIY CRPS Revue.]

Efficacy of Outpatient Ketamine Infusions in Refractory Chronic Pain Syndromes: A 5-Year Retrospective Analysis

Patil, S. and Anitescu, M. 
(2011), Pain Medicine. doi: 10.1111/j.1526-4637.2011.01241.x


Objective.  We evaluated whether outpatient intravenous ketamine infusions were satisfactory for pain relief in patients suffering from various chronic intractable pain syndromes.
Design.  Retrospective chart review.
Setting and Patients.  Following Institutional Review Board approval, we retrospectively analyzed our database for all ketamine infusions administered over 5 years from 2004 to 2009.
Outcome Measures.  Data reviewed included doses of intravenous ketamine, infusion duration, pain scores on visual analog scale (VAS) pre- and post-procedure, long-term pain relief, previous interventions, and side effects. All patients were pretreated with midazolam and ondansetron.
Results.  We identified 49 patients undergoing 369 outpatient ketamine infusions through retrospective analysis. We excluded 36 infusions because of missing data. Among our patients, 18 (37%) had a diagnosis of complex regional pain syndrome (CRPS). Of the remaining 31 (63%) patients, eight had refractory headaches and seven had severe back pain. All patients reported significant reduction in VAS score of 5.9 (standard error [SE] 0.35). For patients with CRPS, reduction in VAS score was 7.2 (SE 0.51, P < 0.001); for the others, the reduction was 5.1 (SE 0.40, P < 0.001). The difference of 2.1 between groups was statistically significant (SE 0.64, P = 0.002). In 29 patients, we recorded the duration of pain relief. Using the Bernoulli model, we found (90% confidence interval) that the probability of lasting pain relief in patients with refractory pain states was 59–85% (23–51% relief over 3 weeks).

Conclusions.  We conclude that in patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS scores. In half of our patients, relief lasted for up to 3 weeks with minimal side effects.

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Complex regional pain syndrome with associated chest wall dystonia: a case report

David J Irwin and Robert J Schwartzman

Journal of Brachial Plexus and Peripheral Nerve Injury 2011, 6:6

doi:10.1186/1749-7221-6-6

Published: 26 September 2011

Patients with complex regional pain syndrome (CRPS) often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

Provisional PDF of the complete article is available HERE.

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Complex regional pain syndrome in adults

1. Andreas Goebel

Rheumatology (2011) 50 (10):1739-1750.

doi: 10.1093/rheumatology/ker202

Complex regional pain syndrome (CRPS) is a highly painful, limb-confined condition, which arises usually after trauma. It is associated with a particularly poor quality of life, and large health-care and societal costs. The causes of CRPS remain unknown. The condition's distinct combination of abnormalities includes limb-confined inflammation and tissue hypoxia, sympathetic dysregulation, small fibre damage, serum autoantibodies, central sensitization and cortical reorganization. These features place CRPS at a crossroads of interests of several disciplines including rheumatology, pain medicine and neurology. Significant scientific and clinical advances over the past 10 years hold promise both for an improved understanding of the causes of CRPS, and for more effective treatments. This review summarizes current concepts of our understanding of CRPS in adults. Based on the results from systematic reviews, treatment approaches are discussed within the context of these concepts. The treatment of CRPS is multidisciplinary and aims to educate about the condition, sustain or restore limb function, reduce pain and provide psychological intervention. Results from recent randomized controlled trials suggest that it is possible that some patients whose condition was considered refractory in the past can now be effectively treated, but confirmatory trials are required. The review concludes with a discussion of the need for additional research.

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The 'disinhibited' brain

New findings on CRPS -- a disease characterized by severe pain

The Complex Regional Pain Syndrome (CRPS), also known as Morbus Sudeck, is characterised by "disinhibition" of various sensory and motor areas in the brain. A multidisciplinary Bochum-based research group, led by Prof. Dr. Martin Tegenthoff (Bergmannsheil Neurology Department) and Prof. Dr. Christoph Maier (Bergmannsheil Department of Pain Therapy), has now demonstrated for the first time that with unilateral CRPS excitability increases not only in the brain area processing the sense of touch of the affected hand. In addition, the brain region representing the healthy hand is simultaneously "disinhibited". The group has been performing research on and treatment of CRPS for a number of years. The researchers are reporting the new findings in the renowned journal Neurology. The study was supported by the Research Funds of the Deutsche Gesetzliche Unfallversicherung (DGUV).

Contact: Dr. Martin Tegenthoff
martin.tegenthoff@rub.de
49-234-302-6810
Ruhr-University Bochum 
The rest of this press release can be read HERE.

This is the ABSTRACT for the much-hyped research itself:

Bilateral somatosensory cortex disinhibition in complex regional pain syndrome, type 1 

Neurology September 13, 2011 vol. 77 no. 11 1096-1101

1. M. Lenz, 
2. O. Höffken, MD, 
3. P. Stude, MD, 
4. S. Lissek, PhD, 
5. P. Schwenkreis, MD, 
6. A. Reinersmann, 
7. J. Frettlöh, PhD, 
8. H. Richter, 
9. M. Tegenthoff, MD and 
10. C. Maier, MD

Objective: In a previous study, we found bilateral disinhibition in the motor cortex of patients with complex regional pain syndrome (CRPS). This finding suggests a complex dysfunction of central motor-sensory circuits. The aim of our present study was to assess possible bilateral excitability changes in the somatosensory system of patients with CRPS.

Methods: We measured paired-pulse suppression of somatosensory evoked potentials in 21 patients with unilateral CRPS I involving the hand. Eleven patients with upper limb pain of non-neuropathic origin and 21 healthy subjects served as controls. Innocuous paired-pulse stimulation of the median nerve was either performed at the affected and the unaffected hand, or at the dominant hand of healthy controls, respectively.

Results: We found a significant reduction of paired-pulse suppression in both sides of patients with CRPS, compared with control patients and healthy control subjects.

Conclusion: These findings resemble our findings in the motor system and strongly support the hypothesis of a bilateral complex impairment of central motor-sensory circuits in CRPS I.

Data Supplement: Three tables; Three Microsoft Excel documents