i was, in short, diminished

This was written... lemme see... wow: 2 January 2010.  If you're a new Beloved Intrepid Reader, I am, as I was on 2 January 2010, stricken with the Dread Viral Crud, cannot sleep, and therefore feel compelled to raise whatever Dead Drafts that are not full of maggots or have worms playing pinochle on their unfinished snouts -- compelled, I say, to raise them from their Drafty Files into the light of day, or the lamplight of night, and where, O where, is the NyQuil?

There's some funny stuff hiding out in the draft pile.  What's not so funny is how things don't seem to change much around The Manor.  Remember, though:  You're never in a rut so long as you have a moat!  [C'mon, Intrepid Reader Darlings, 'Sing along!']

okie-dokie, so we are sick as dogs... although, where the meaning of that comes from, i dunno. dogs are not, by nature, "sick."

right?

in fact, i love dogs.  i am not, by nature, a cat person, no that lifestyle was foisted upon me.  (i just read that sentence out loud, and damned if i did not sound like w. c. fields. go ahead, try it, no one's listening.  especially that end part... "foisted uponnnnnnn meeeeee."

i love dogs so much i once left fred for three days on behalf of my mostly lab girl puppy, name of emma.  he was mean to her, and i had told him that were he mean to her ever again, i was leaving him.  so there we were, after midnight, me (using a walker), emma, an overfull suitcase, and a big plastic bag full of baby girl dog paraphernalia... and one pissed off taxi driver.

a friend who was in barcelona had offered me the use of his apartment.
on the fourth floor of a building with no elevators.
just me and my outraged sense of justice for my baby girl dog who was highstrung, needed lots of exercise, and had a bladder that a pea might envy.

you know how this story goes.  i managed three days, read all my friend's journals, all the secrets everyone had known for years, hurt myself in a dozen new and ingenious ways, but, by god, walked that dog five times a day, even took her to play in the park, but even emma was looking at me like, "why are we at alex's place?  why can't we go home?  don't worry about me, i can take on fred!"

we went home, but rather than force my baby girl dog to have to worry or fear anyone, i returned her to the animal shelter, and i pray every day that they did not take the light out of her eyes.  the days when fred can't figure out why the hell i am such a bitch?  those are my emma days.  god bless that pup. her brain could not seem to process any incoming data as being code for less than brightly dancing bubbles and slobber love.

this virus is cruel. it's a grown-up's virus.

i woke feeling pretty doggone (who let the dogs out?) good. no coughing. temp 98.4 (no shit! i almost called an ambulance... "make haste, there's something horribly amiss!").  just an aching head, with pesky swollen glands. for me? a big nada. no problem. gonna coast through the day, get some work done, mebbe write a little, do my wii, a french clay facial and if there is time left in the day, clean the bathroom. (we're having procastination issues).

i was looking forward to showing off for fred.  let him marvel at what recovery looks like, let him renew his faith, for it *is* possible to speak without a wheeze!  "how do you feeeeeellll, ffffred, dahlink?"

"moi? moi? i feel fuh-fuh-fine, ffffred!"

while waiting for fred to wake up, i did morning chores,
and began to lag.

yes, the energy did flag, and i, i began to fade.

i was, in short, diminished.

sorry. i was briefly channeling t. s. eliot.

or yeats.

it's so hard to tell, anymore. i grow old.

eating the peach is not gonna be my issue. no, i think that monster slinking toward jerusalem is gonna get moi.

hey, i bought a new toothbrush the other day! wait, i didn't tell you i went out, did i? well, i did. grocery shopping:

and i had an emotional meltdown right in the middle of the damned store. see... i hadn't left the house in 29 days. that's right. TWENTY-NINE FREAKING DAYS. that's how high my pain level has been, how miserable my legs, these hands, how very, very bad it has been. oh, poor me, yeah, yeah, and... SCENE!

anyway, i had been begging to go to the store for days, but fred didn't connect my eagerness with the notion of going-to-the-store with my pure excitement at what looked to me as a FUN activity. so when we entered said establishment and he announced, "let's split up, we'll get done faster"?
i started to boohoo. can you believe it? how retarded am i, and increasingly so, with increasing frequency? it was pure lucy mcgillicuddy ricardo, without the charm or talent.

poor man. in fred's mind, i go out whenever he does (pretty much daily, and at least twice a week for social engagements. he had not counted the passing of TWENTY-NINE FREAKING DAYS, nor did he really register the number of DIY amputations of my legs that i had undergone in fits of desperation at the increasingly increasing pain. he *cannot*, of course, and i don't want him to follow the bouncing ball of my suffering, anyway, poor soul. i've ruined his life enough, don't you think?  just trust me... he's told me so, twice in one week, once. with. a. period. between. each. word: and. when. are. you. going. to. die. anyway.

hard to transcribe.

oh, hell, where was i? did i tell you i am spiking a way high, a mile high fever?

the toothbrush. oh, yeah. so we were in the market, en train de faire le marché, when i remembered i needed a new one. i pop a few wheelies and race down the toothpaste, toothbrush, shampoo, deodorant, and sundries aisle. fred is tearing after me, the shopping cart careening this way and that... he sees me stop in front of the pitiable selection of plaque-scrapers, and calls out: "wait! we have a supply of new toothbrushes at home!"

now... i don't know exactly why that sent me over the edge (again) -- but it did. i had not been out of the house for... well, you know. do you get how hard it is to run a household by sending a guy with adhd to do the necessary errands? have you tried making a detailed grocery list when you are only able to go to the store yourself but a couple o'times a year? i am a very visual person. back in the day (i.e., before osteomyelitis, crps, before lupus and avn, before ai, and so on), i just took a mental stroll down the aisles, pictured what was there, made my lists in almost perfect synchronicity with the actual order of the products. i made a killer list, detailed but simple, a list on which even the most shopping-challenged could rely.

no more. oh no. now i am liable to hand my sweet abstracted man something in a breezy handwriting along the order of:

apples, if they are under $1.39 a pound. and fresh. also, please don't buy them if the skin is even slightly loosened from the inner fruit. you know what i mean. like they'd been stored in a cold bin for too long. we're looking for très fresh.  don't buy one without a stem, don't buy them if they're dimpled.  smell them, for god's sake.  didn't i see perfectly deep crimson delicious reds for $1.19?' 

keep an eye out for endive. gots to have my endive.  and one day, god willing, i will. 

toilet paper.  i don't remember this week's criteria. 

pasta, wanna try some whole-wheat penne? 

lowfat plain yogurt (7) as in SEVEN 16 ounce containers.  please do not confuse the flower on the carton of the nonfat yogurt with the vanilla flower the idjits place on the lowfat.  someone should write a letter, and yes, there oughta be a law. 

stool softener (i'm sorry) -- docusate sodium, the largest bottle they have, should be a 400-count for about 18 blessed buckaroos. 

drain cleaner

get yourself something for snacking

bananas, pears 

muesli 

12-oz cans of diced tomatoes, no salt, no sugar, nothing added 

kibble  

         basmati, whole brown, jasmine rices

that everyday spray cleaner with vinegar as its only active ingredient.  i like it. do you like it? 

oils, of all kind. we are almost out of everything from sesame to peanut to olive. did you think that last bottle of olive oil was funny colored, very bland -- old -- tasting? 

diet ginger ale 

your purple sodas 

my bread; your breads. 

i love you for doing this, i so wish i could do it for you...                                                                                   

CRPS: Spatial Perception (Where are my hand?)

Spatially defined modulation of skin temperature and hand ownership of both hands in patients with unilateral complex regional pain syndrome

1. G. Lorimer Moseley¹,², 
2. Alberto Gallace³ and 
3. Gian Domenico Iannetti⁴

+Author Affiliations

1. 1 The Sansom Institute for Health Research, University of South Australia, Adelaide 5000, Australia
2. 2 Neuroscience Research Australia, Sydney, Australia
3. 3 Faculty of Psychology, University of Milano-Bicocca, Milan 20126, Italy
4. 4 Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1E 6BT, UK

1. Correspondence to: Lorimer Moseley, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide 5001, Australia E-mail: lorimer.moseley@gmail.com

Received March 21, 2012.
Revision received August 16, 2012.
Accepted September 19, 2012.

Summary

Numerous clinical conditions, including complex regional pain syndrome, are characterized by autonomic dysfunctions (e.g. altered thermoregulation, sometimes confined to a single limb), and disrupted cortical representation of the body and the surrounding space. The presence, in patients with complex regional pain syndrome, of a disruption in spatial perception, bodily ownership and thermoregulation led us to hypothesize that impaired spatial perception might result in a spatial-dependent modulation of thermoregulation and bodily ownership over the affected limb. In five experiments involving a total of 23 patients with complex regional pain syndrome of one arm and 10 healthy control subjects, we measured skin temperature of the hand with infrared thermal imaging, before and after experimental periods of either 9 or 10 min each, during which the hand was held on one or the other side of the body midline. Tactile processing was assessed by temporal order judgements of pairs of vibrotactile stimuli, delivered one to each hand. Pain and sense of ownership over the hand were assessed by self-report scales. Across experiments, when kept on its usual side of the body midline, the affected hand was 0.5 ± 0.3°C cooler than the healthy hand (P < 0.02 for all, a common finding in cold-type complex regional pain syndrome), and tactile stimuli delivered to the healthy hand were prioritized over those delivered to the affected hand. Simply crossing both hands over the midline resulted in (i) warming of the affected hand (the affected hand became 0.4 ± 0.3°C warmer than when it was in the uncrossed position; P = 0.01); (ii) cooling of the healthy hand (by 0.3 ± 0.3°C; P = 0.02); and (iii) reversal of the prioritization of tactile processing. When only the affected hand was crossed over the midline, it became warmer (by 0.5 ± 0.3°C; P = 0.01). When only the healthy hand was crossed over the midline, it became cooler (by 0.3 ± 0.3°C; P = 0.01). The temperature change of either hand was positively related to its distance from the body midline (pooled data: r = 0.76, P < 0.001). Crossing the affected hand over the body midline had small but significant effects on both spontaneous pain (which was reduced) and the sense of ownership over the hand (which was increased) (P < 0.04 for both). We conclude that impaired spatial perception modulated temperature of the limbs, tactile processing, spontaneous pain and the sense of ownership over the hands. These results show that complex regional pain syndrome involves more complex neurological dysfunction than has previously been considered.*


*over-used punchline!

Graphic from CRPS UK

       

Useful adjunct article published in same journal, September 14, 2009, available in entirety (pdf)

Space-based, but not arm-based, shift in tactile
processing in complex regional pain syndrome
and its relationship to cooling of the affected limb


G. Lorimer Moseley [1]

Alberto Gallace [2,3]

and Charles Spence [3]

1 PaiN Group & Department of Physiology, Anatomy & Genetics, University of Oxford, UK and Prince of Wales Medical Research Institute &
School of Medical Sciences, University of New South Wales, Sydney, Australia
2 Department of Psychology, University of Milano-Bicocca, P.zza dell’Ateneo Nuovo 1, 20126 Milano, Italy
3 Department of Experimental Psychology, Oxford University, South Parks Road, Oxford OX1 3UD, UK

Correspondence to: G. Lorimer Moseley,
Prince of Wales Medical Research Institute,
Cnr Easy & Barker Streets,
Randwick, 2031,
Australia
E-mail: lorimer.moseley@gmail.com


Complex regional pain syndrome (CRPS) occurs after stroke, but most cases develop after peripheral trauma and without evidence of brain trauma. However, CRPS is associated with symptoms that appear similar to those observed in patients suffering from hemispatial neglect. Ten participants (four males) with CRPS of one arm performed temporal order judgements
of pairs of vibrotactile stimuli, one delivered to each hand, at one of 10 possible stimulus onset asynchronies, under two conditions: arms held each side of the midline and arms crossed over the midline. Participants released a foot switch to indicate which hand had been stimulated first. The order of conditions was randomized and the foot under which the switch was
positioned was counterbalanced. There were two blocks of 150 trials in each condition. The stimulus onset asynchronicity at which the participants were equally likely to select either hand, the point of subjective simultaneity (PSS), was compared between conditions and between those with left or right-sided symptoms. When arms were not crossed, the participants prioritized stimuli from the unaffected limb over those from the affected limb (mean SD PSS = 25 7.5 ms) and the magnitude of the PSS strongly related to the degree to which the affected hand was cooler than the unaffected hand (r = 0.942, P50.001). When the arms were crossed, the effect was reversed: the participants prioritized stimuli from the affected limb over those from the unaffected limb [PSS = –18 13 ms; main effect of condition F (1, 9) = 98.6, P50.001]. There was no effect of the side of
symptoms. These results show that CRPS is associated with a deficit in tactile processing that is defined by the space in which the affected limb normally resides, not by the affected limb itself, and which relates to the relative cooling of the affected limb. This pattern is consistent with data from those with hemispatial neglect after stroke and raises the possibility that chronic CRPS
involves a type of spatial neglect.

Abbreviations: CRPS = complex regional pain syndrome; JND = just noticeable difference; PSS = point of subjective simultan



References  (I post these whenever possible as they are invaluable guideposts for my own, much more laborious efforts to understand scientific texts,)

Acerra NE, Moseley GL. Dysynchiria: watching the mirror image of the
unaffected limb elicits pain on the affected side. Neurology 2005; 65:
751–3.

Acerra NE, Souvlis T, Moseley GL. Stroke, complex regional pain
syndrome and phantom limb pain: can commonalities direct future
management? Journal of Rehabilitation Medicine 2007; 39: 109–14.

Andersen RA, Snyder LH, Bradley DC, Xing J. Multimodal representation
of space in the posterior parietal cortex and its use in planning movements. 
Annual Review of Neuroscience 1997; 20: 303–30.

Andre JM, Martinet N, Paysant J, Beis JM, Le Chapelain L. Temporary
phantom limbs evoked by vestibular caloric stimulation in amputees.
Neuropsychiatry Neuropsychology and Behavioral Neurology 2001;
14: 190–6.

Baylis G, Simon SL, Baylis LL, Rorden C. Visual extinction with double
simultaneous stimulation: what is simultaneous? Neuropsychologia
2002; 40: 1027–34.

Baylis GC, Simon-Dack SL, Greene K, Jelsone L, Rorden C. The effect of
ipsilesional cues on line-bisection errors: the importance of predictive
value. Neuropsychologia 2004; 42: 175–82.

Berberovic N, Pisella L, Morris AP, Mattingley JB. Prismatic adaptation
reduces biased temporal order judgements in spatial neglect.
Neuroreport 2004; 15: 1199–204.

Bisiach E, Bulgarelli C, Sterzi R, Vallar G. Line bisection and cognitive
plasticity of unilateral neglect of space. Brain Cogn 1983; 2: 32–8.

Bisiach E, Luzzatti C, Perani D. Unilateral Neglect, Representational
Schema and Consciousness. Brain 1979; 102: 609–18.

Bisiach E, Ricci R, Lai E, De Tanti A, Inzaghi MG. Unilateral neglect and
disambiguation of the Necker cube. Brain 1999; 122: 131–40.


Bisiach E, Vallar G. Unilateral neglect in humans. In: Boller F, Grafman J,
Rizzolatti G, editors. Handbook of neuropsychology. Amsterdam:
Elsevier Science; 2000. p. 459–502.

Bottini G, Bisiach E, Sterzi R, Vallar G. Feeling touches in someone else’s
hand. Neuroreport 2002; 13: 249–52.

Braus DF, Krauss JK, Strobel J. The shoulder-hand syndrome after
stroke—a prospective clinical-trial. Ann Neurol 1994; 36: 728–33.

Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et al.
External validation of IASP diagnostic criteria for Complex Regional
Pain Syndrome and proposed research diagnostic criteria.
International Association for the Study of Pain. Pain 1999; 81: 147–54.

Cate A, Behrmann M. Spatial and temporal influences on extinction.
Neuropsychologia 2002; 40: 2206–25.

Cohen HE, McCabe C, Hall J, Harris N, Blake D. Labile vasomotor
autonomic responses to ambiguous visual stimulation in patients with
complex regional pain syndrome (CRPS) Type 1. Rheumatology 2008;
47: ii8.

Coslett HB. Evidence for a disturbance of the body schema in neglect.
Brain Cogn 1998; 37: 527–44.

Davis SW, Petrillo CR, Eichberg RD, Chu DS. Shoulder-hand syndrome in
a hemiplegic population – 5-year retrospective study. Arch Phys Med
Rehab 1977; 58: 353–6.

Drummond PD, Finch PM. Sensory changes in the forehead of patients
with complex regional pain syndrome. Pain 2006; 123: 83–9.

Eccleston C, Crombez G. Attention and pain: merging behavioural and
neuroscience investigations. Pain 2005; 113: 7–8.

Frassinetti F, Angeli V, Meneghello F, Avanzi S, Ladavas E. Long-lasting
amelioration of visuospatial neglect by prism adaptation. Brain 2002;
125: 608–23.

Frettloh J, Huppe M, Maier C. Severity and specificity of neglect-like
symptoms in patients with complex regional pain syndrome (CRPS)
compared to chronic limb pain of other origins. Pain 2006; 124:
184–9.

Galer BS, Jensen M. Neglect-like symptoms in complex regional pain
syndrome: results of a self-administered survey. J Pain Symptom
Manage 1999; 18: 213–17.

Gallace A, Soto-Faraco S, Dalton P, Kreukniet B, Spence C. Response
requirements modulate tactile spatial congruencyeffects. Exp Brain Res
2008; 191: 171–186.

Gallace A, Spence C. The cognitive and neural correlates of ‘‘tactile
consciousness’’: a multisensory perspective. Conscious Cogn 2008;
17: 370–407.

Girardi M, McIntosh RD, Michel C, Vallar G, Rossetti Y. Sensorimotor
effects on central space representation: prism adaptation influences
haptic and visual representations in normal subjects.
Neuropsychologia 2004; 42: 1477–87.

Grande LA, Loeser JD, Ozuna J, Ashleigh A, Samii A. Complex regional
pain syndrome as a stress response. Pain 2004; 110: 495–8.

Grefkes C, Fink GR. The functional organization of the intraparietal
sulcus in humans and monkeys. J Anatomy 2005; 207: 3–17.

Guerrini C, Berlucchi G, Bricolo E, Aglioti SM. Temporal modulation of
spatial tactile extinction in right-brain-damaged patients. J Cogn
Neurosci 2003; 15: 523–36.

Haggard P, Wolpert DM. Disorders of body scheme. In: Freund HJ,
Jeannerod M, Hallett M, Leiguarda I, editors. Higher-order motor
disorders. Oxford: Oxford University Press; 2005. p. 261–71.

Halligan PW, Hunt M, Marshall JC, Wade DT. When seeing is
feeling: acquired synaesthesia or phantom touch? Neurocase 1996;
2: 21–9.

Halligan PW, Marshall JC, Wade DT. Left on the right – allochiria in a
case of left visuospatial neglect. J Neurol Neurosurg Psych 1992; 55:
717–19.

Hirsh IJ, Sherrick CE Jr. Perceived order in different sense modalities. J
Exp Psychol 1961; 62: 423–32.

Hudson ML, McCormick K, Zalucki N, Moseley GL. Expectation of pain
replicates the effect of pain in a hand laterality recognition task: bias in
information processing toward the painful side? Eur J Pain 2006; 10:
219–24


Iadarola MJ, Max MB, Berman KF, Byas-Smith MG, Coghill RC,
Gracely RH, et al. Unilateral decrease in thalamic activity observed
with positron emission tomography in patients with chronic neuropathic pain. Pain 1995; 63: 55–64.

Iwamura Y. Hierarchical somatosensory processing. Curr Opin Neurobiol
1998; 8: 522–8.

Iwamura Y, Iriki A, Tanaka M. Bilateral hand representation in the postcentral somatosensory cortex. Nature 1994; 369: 554–6.

Janig W, Baron R. Complex regional pain syndrome is a disease of the
central nervous system. Clin Auton Res 2002; 12: 150–64.

Karnath HO, Christ K, Hartje W. Decrease of contralateral neglect
by neck muscle vibration and spatial orientation of trunk midline.
Brain 1993; 116: 383–96.

Karnath HO, Zimmer U, Lewald J. Impaired perception of temporal order
in auditory extinction. Neuropsychologia 2002; 40: 1977–82.

Kitazawa S. Where conscious sensation takes place. Conscious Cogn
2002; 11: 475–7.

Lewis JS, Kersten P, McCabe CS, McPherson KM, Blake DR. Body
perception disturbance: a contribution to pain in complex regional
pain syndrome (CRPS). Pain 2007; 133: 111–19.

Loetscher T, Regard M, Brugger P. Misoplegia: a review of the literature
and a case without hemiplegia. J Neurol Neurosurg Psych 2006; 77:
1099–100.

Maihofner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al.
The motor system shows adaptive changes in complex regional pain
syndrome. Brain 2007; 130: 2671–87.

Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Patterns of
cortical reorganization in complex regional pain syndrome. Neurology
2003; 61: 1707–15.

Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Cortical reorganization during recovery from complex regional pain syndrome.
Neurology 2004; 63: 693–701.

Marshall JC, Halligan PW. Line bisection in a case of visual neglect –
psychophysical studies with implications for theory. Cogn
Neuropsychol 1990; 7: 107–30.

McCormick K, Zalucki N, Hudson ML, Moseley GL. Faulty proprioceptive
information disrupts motor imagery: an experimental study. Aus J
Physiotherapy 2007; 53: 41–5.

Moseley GL. Why do people with CRPS1 take longer to recognise their
affected hand? Neurology 2004; 62: 2182–6.

Moseley GL, Olthof N, Venema A, Don S, Wijers M, Gallace A, et al.
Psychologically induced cooling of a specific body part caused by the
illusory ownership of an artificial counterpart. Proc Natl Acad Sci USA
2008a; 105: 13169–73.

Moseley GL, Parsons TJ, Spence C. Visual distortion of a limb modulates
the pain and swelling evoked by movement. Curr Biol 2008b; 18:
R1047–8.

Moseley GL, Sim DF, Henry ML, Souvlis T. Experimental hand pain
delays recognition of the contralateral hand – evidence that acute
and chronic pain have opposite effects on information processing?
Cogn Brain Res 2005; 25: 188–94.

Moseley GL, Wiech K. The effect of tactile discrimination training is
enhanced when patients watch the reflected image of their unaffected
limb during training. Pain 2009; 144: 314–9.

Moseley GL, Zalucki NM, Wiech K. Tactile discrimination, but not
tactile stimulation alone, reduces chronic limb pain. Pain 2008c; 137:
600–8.

Muggleton NG, Postma P, Moutsopoulou K, Nimmo-Smith I, Marcel A,
Walsh V. TMS over right posterior parietal cortex induces neglect in a
scene-based frame of reference. Neuropsychologia 2006; 44: 1222–9.

Necker L. Observationson some remarkable phenomena seen in
Switzerland; and on an optical phenomenon which occurs on viewing
a figure of a crystal or geometrical solid. Philos Mag Third Ser 1832; 1:
329–37.

Nico D. Effectiveness of sensory stimulation on tactile extinction. Exp
Brain Res 1999; 127: 75–82.

Parsons LM. Integrating cognitive psychology, neurology and neuroimaging. Acta Psychol 2001; 107: 155–81.


Petchkrua W, Weiss DJ, Patel RR. Reassessment of the incidence
of complex regional pain syndrome type 1 following stroke.
Neurorehab Neural Repair 2000; 14: 59–63.

Pleger B, Ragert P, Schwenkreis P, Forster AF, Wilimzig C, Dinse H, et al.
Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome.
Neuroimage 2006; 32: 503–10.

Rommel O, Gehling M, Dertwinkel R, Witscher K, Zenz M, Malin JP,
et al. Hemisensory impairment in patients with complex regional pain
syndrome. Pain 1999; 80: 95–101.

Rorden C, Mattingley JB, Karnath HO, Driver J. Visual extinction and
prior entry: impaired perception of temporal order with intact motion
perception after unilateral parietal damage. Neuropsychologia 1997;
35: 421–33.

Rossetti Y, Rode G, Pisella L, Farne A, Li L, Boisson D, et al. Prism
adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature 1998; 395: 166–9.

Rubens AB. Caloric stimulation and unilateral visual neglect. Neurology
1985; 35: 1019–24.

Schwoebel J, Coslett HB, Bradt J, Friedman R, Dileo C. Pain and the body
schema: effects of pain severity on mental representations of movement. Neurology 2002; 59: 775–7.

Schwoebel J, Friedman R, Duda N, Coslett HB. Pain and the body
schema: evidence for peripheral effects on mental representations of
movement. Brain 2001; 124: 2098–104.

Shore DI, Spry E, Spence C. Confusing the mind by crossing the hands.
Cogn Brain Res 2002; 14: 153–63.

Sinnett S, Juncadella M, Rafal R, Azanon E, Soto-Faraco S. A
dissociation between visual and auditory hemi-inattention: evidence
from temporal order judgements. Neuropsychologia 2007; 45:
552–60.

Spence C. Prior entry: Attention and temporal perception. In: Nobre A,
Coull J, editors. Attention and time. Oxford: Oxford University Press;
2009.

Spence C, Shore DI, Klein RM. Multisensory prior entry. J Exp Psychol
Gen 2001; 130: 799–832.

Sumitani M, Rossetti Y, Shibata M, Matsuda Y, Sakaue G, Inoue T, et al.
Prism adaptation to optical deviation alleviates pathologic pain.
Neurology 2007a; 68: 128–33.

Sumitani M, Shibata M, Iwakura T, Matsuda Y, Sakaue G, Inoue T, et al.
Pathologic pain distorts visuospatial perception. Neurology 2007b; 68:
152–4.

Vallar G. Extrapersonal visual unilateral spatial neglect and its neuroanatomy. Neuroimage 2001; 14: S52–8.

Vallar G, Antonucci G, Guariglia C, Pizzamiglio L. Deficits of position
sense, unilateral neglect and optokinetic stimulation.
Neuropsychologia 1993; 31: 1191–200.

Vallar G, Ronchi R. Somatoparaphrenia: A body delusion. A review of
the neuropyshological literature. Exp Brain Res; 192: 533–51.

Vallar G, Rusconi ML, Barozzi S, Bernardini B, Ovadia D, Papagno C,
et al. Improvement of left visuospatial hemineglect by left-sided
transcutaneous electrical-stimulation. Neuropsychologia 1995; 33:
73–82.

Vallar G, Sandroni P, Rusconi ML, Barbieri S. Hemianopia, hemianesthesia, and spatial neglect: a study with evoked potentials. Neurology
1991; 41: 1918–22.

Van Damme S, Gallace A, Spence C, Crombez G, Moseley GL. Does the
sight of physical threat induce a tactile processing bias? Modalityspecific attentional facilitation induced by viewing threatening pictures.
Brain Res 2009; 1253: 100–6.

Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a
motivational account of attention to pain. Neurosci Biobehav Rev;
in press.

Vibell J, Klinge C, Zampini M, Spence C, Nobre AC. Temporal order is
coded temporally in the brain: Early event-related
potential latency shifts underlying prior entry in a cross-modal temporal order judgment task. Journal of Cognitive Neuroscience 2007;
19: 109–20.


Vongiesen HJ, Schlaug G, Steinmetz H, Benecke R, Freund HJ, Seitz RJ.
Cerebral network underlying unilateral motor neglect – evidence from
positron emission tomography. J Neurol Sci 1994; 125: 29–38.

Walker R, Findlay JM, Young AW, Welch J. Disentangling neglect and
hemianopia. Neuropsychologia 1991; 29: 1019–27.


Yamamoto S, Kitazawa S. Reversal of subjective temporal order due to
arm crossing. Nat Neurosci 2001; 4: 759–65.

Zampini M, Bird KS, Bentley DE, Watson A, Barrett G, Jones AK, et al.
Prior entry’ for pain: attention speeds the perceptual processing of
painful stimuli. Neurosci Lett 2007; 414: 75–9

Next to a decadent chocolate, this note

On my pillow, next to a decadent chocolate, this note:

Dear Retired Educator, You Prof-de-Rien, Vous!


Tonight, when you get depressed and down on yourself as barely qualifying as a waste of space, remember that you did the following things today:


You took care of the animals, meaning the indoor cattery.  Please leave the Petting Zoo Miniatures to the Miniature Experts. [If you are ever sorely tempted to meddle in that domain again, pause and think of Tiny Todd, who might have lived had you not mixed microscopic Egyptian adders with Barely There Anguis fragilis, the amoebic slowworms gifted to The Captain by County Clare for safekeeping. The same admonition, but larger, goes for the Gigantesque Bovines!  They are best herded and milked by classically trained teams of tireless Cistercian Brothers;  Good thing the Haddock ancestral manor has a monastery for its closest neighbor.]  


Anyway, you successfully fed Marmy Fluffy Butt, Buddy the Freakishly Large Kitten, and Dobby the Runt big bowls of basic kibble, as well as providing nutritious treats.  In fact, you catered to their every whim, giving Marmy milk-flavored crunchy nuggets, giving Buddy handfuls of restaurant grade tuna flakes, and teasing Dobby with "liver and cheese" morsels.  You watered them, twice -- a necessity because Dobby polluted the water by giving several spinach tortellini, some stolen eye drops, two yarn balls, and a paper towel a good dunk.  


You brushed all three of them, too, no mean feat.  All praise to the veterinary techs who tag-teamed Buddy last week, successfully lopping off an inch of claw, at least, per bear paw!  Otherwise, your dream of flailed flesh might have come true.  Dobby rolled from side to side from pure joy upon the presentation of a new comb, just for him, and the persistent dandruff at the base of his tail. You tended Marmy and Dobby's runny eyes, a genetic trait, apparently, identical in this mother and offspring.  Marmy hissed at you;  Dobby blew kisses. You put some serious loving on Buddy, who is distressed by his recent virgin hairball experiences.  It turns out that he is afraid of them -- of the actual hairball, itself.  He produced one, looked at it, and ran, screaming as only a Maine Coon can.


He is in a Glom Phase and is never far away -- sniffing at my peeling feet, demonstrating proper tether ball technique, exuding please-don't-abandon-me-to-the-hairballs desperation.  Such a gentle giant.


So you did well, Retired Educator, with these creatures.  Good job!  Do your remember entertaining Dobby with one of your 37 grabbers?  [Insert gratuitous cat video here]

There is more, Madame! You did two (and a half) loads of laundry.  So what if you picked up where you left off on Monday, at week's dawn?  So what if the wet clothes had been sitting all that time in the washer?  You ended up with clean clothes, clean comfy throws, and plenty of fresh and thirsty kitchen towels to throw on the floor the next time you spill water from the cat bowls.


You cleaned the microwave.  Granted, you cursed a bit too much.  There was an incident report to Haddock Family Values, Inc. but the corporate office seems enamored of results over style, so just be more careful in the future.  You may want to review some of The Captain's favorite oaths, all considered socially acceptable, such as "Parasites! Patagonians! Pestilential Pachyderm! Phylloxera! Pickled herrings! Pirates! Pithecanthropic montebanks!"


You did the dishes, three times (and another sink full awaits your attention).  This is one of the harder tasks in your repertoire of daily activities now, and you managed it without too much complaint, and, shockingly, without obscenities. Per your one plaintive request to management, we are sending, under separate cover, the explanation you requested as to "why men think they've 'done the dishes' when they wash, precisely, only those dishes that they were responsible for dirtying?"


You cleaned the stove top.  You did a lousy job.  Do it again tomorrow, and this time, use the correctly purposed grabber to reach all the oily crevasses and boiled potato smears.  


[I mean crevices. No I mean crevasses!] 


Nowhere near exhausted, you mopped the kitchen floor.  However, you then proceeded to vacuum it.  *After* mopping it, not before.  Remember the long ago afternoon in that mountain hideout of a laundromat, with your good friend Jean, the poet, who accused you of putting your dirty clothes directly into the dryer?  You folded them all nicely, piled them in your gold plastic laundry basket, and then into the hatchback before being enlightened by God's Gift to Occasional Verse.  Her poetry was derivative, and anyone who would marry their psychiatrist is clearly troubled.  Remember, too, that she threw a heavy ceramic ashtray in the general direction of your head.  {Green Glass Wings!}


You partially cleaned a bathroom.  Oh okay, you emptied the trashcan, straightened the towels, and retrieved three volumes of Will Shortz' Crossword Puzzle Toilet Omnibus from under a 20-pound ValuPak of three-quarter ply tissue. Then, of course, you vacuumed.  Apparently, when you can no longer bend like a lithesome wood nymph done up in toothsome diaphanous greens -- because, oh, I dunno, you fractured a rib, your glenoid cavity is awash in pus, and you have no knees -- the extension provided by the vacuum is more valuable than a hairless cat.  I mean, gold.  More valuable than gold.


Because we never tire of cleaning cat hair, here in Marlinspike Hall, deep, deep in Tête de Hergé, do we?
[Editorial inquiry:  When was the last time you took your temperature?]


At this point, you were observed by Regional Emergency Gossip Coordinator Tante Louise as you took a short break, slaking your thirst with a generic lemon-lime diet soda.  There were several descriptions submitted to Twitter about your hair, deemed at that juncture to border on inappropriate, and judged by Tante Louise to constitute a fire hazard. 


The Crackhead Lady From Across The Way -- our local claim to fame, being a very well-known, juste comme il faut organic pig farmer -- and the inimitable Bianca Castafiore were seen a-traipsin' across the lowered drawbridge during this interlude, but have not been seen since.  Please contact REGC T. Louise with any sightings.


You went on to vacuum the rest of the Northeast Wing Manor Living Quarters.  We noted your  concentrated efforts at cleaning the new boudoir carpets ordered during the Recent Deliriums, supposed to be a rich, woven black offset with a crisp, beige diamond design.  Kudos, by the way, for your efforts to echo, par terre, the rectangular accents of color, emotion, and primordial memory hung on the walls in the form of black-framed Rothkos. 


The rug design had quickly become covered in weird speckles, however, which turned out to be a collection of massive slough-off from your Little-Old-Lady skin. After dedicating whole days to the mystery of the omnipresent white flakes, doubling and tripling the effort to keep Dobby's dandruff under control, only to learn that the stuff was falling from these hideous peeling CRPS-afflicted legs.  More incentive to clean. [Another reason to hide?]


Time enough tomorrow to ask if peeling, flaking feet are to be expected or whether some odd treatment -- a  grape jelly and duck fat marinade, perhaps -- is called for.  In the interim, flakes, flakes, flakes are everywhere.


You kept going, Dear Prof, you did not cave in to momentary defeat.  


You baked 12 muffins and three individual cakes.  Wonderful result - moist, delicious, healthy.  Bananas, apples, and raisins in a cardamom and cinnamon rich batter. A cup and a half of oats and a generous handful of oat bran.  For some reason, two eggs instead of one.  Radical time management.  Twenty minutes at 400 did not do it.  Twenty-three was perfection.


You tackled some of the mounting issues in Your Office, where it seems everything from stray straw hats to scary rocking chairs are being stored.  You finally contacted the right agency and donated the old power chair and the walker to someone who desperately needs them.  You alphabetized a few sections of books, you cleared a path through the piles of bills, at least sorting it all out into different pile categories -- now one is dedicated solely to Explanation of Benefits and another to Most Creative Collection Agencies, all superceded by the overarching category:  Dear President Obama... [This imaginary epistle might continue with references to how PCIP was supposed to insure that I'd not lose all my possessions in my fight to become and stay healthy... and might end with the reality of my checking account.]

As you put head to pillow tonight, be kind to yourself, for a change.  


Today, you broke free from inertia and the paralyzing effect of outside opinion, at least for a while. You made an appointment for outpatient surgery to have your port removed:  April 20, 9 am.  


You threw away keepsakes that had followed you several times around the world, but that you did not love and did not want.  Dusty postcards, snippets of textile, photographs.


You sometimes cried as you vacuumed, you miss some people like you might miss a left arm.  But you kept moving, now into a laugh, now into new friendship, now into being okay with things as they are.


You did good, girl.  


Tomorrow?  Washing trash cans, repairing blinds, one-pot wonders, more bills, and heightened efforts to recover Fred's sweet smile.


Grosses bises,
The elle est belle la seine la seine elle est belle Editorial Board

A Letter to My Doctor

Names have been changed, not to protect the innocent or to shield the guilty, but to hide the identity and location of some of the most talented medical professionals to grace the planet. I don't want to lose access to them due to a sudden spike in earthly demand.

I just emailed my MDVIP Go-To-Guy. This was the subject line: "I made a decision..."

What an ominous subject line!


In the last few weeks, despite a STELLAR lab report [!], it's become clear that whatever infectious/inflammatory process is going on in my left shoulder/arm has not been stopped even with the very best efforts of a lot of good people, not to mention considerable pain, suffering, and pity parties here at home. Looking back at all the surgeries involved, it's equally clear that I've begun pushing my luck, since the post-op periods have become harder and harder; It also seems that CRPS has decided to take a dim view of these efforts as well, as it has spread up this left arm like wildfire in the past 8 weeks.


So when I saw Dr. ShoulderMan yesterday, I beat him to the punch and told him that the best option looks to be a flail arm. He tried to hide it, but he looked so relieved. As he said, "There are worse things."


I don't know where you stand on all this, but I hope you can follow my reasoning, such as it is. I don't think the odds of this problem killing me change one bit whether we proceed with another prosthesis (and then, in all likelihood, resume the chase for wily pathogens) or remove all hardware (and still, perhaps, cannot stop those wily pathogens). All things being equal, I'd rather not die in Lone Alp Hospital, with good-intentioned people poking my legs and telling me my whole problem is undiagnosed cellulitis.


So... I am not thrilled at the idea of a useless left arm and have many fears for the well-being of the right one. Fred is upset with me, but will get over it, I hope. Dr. ShoulderMan says that after about 3 months, the scar tissue that forms helps to provide some stability, and may enable more movement.


In other news -- I'm plagued, again, with spasms, almost always for an hour or two in the late afternoon, then beginning again between 8 and 10 pm. I DO NOT KNOW WHAT TO DO. This one thing, more than any other, I cannot deal with...


Fever -- usual pattern, and staying mostly in the 100s -- for the last 8 days. Increasing pain in the shoulder, and returning pain in other bones as well, all of which is typical when fevers hit. And though it never seems to mean anything specific, I am exhausted! I am going to try and push myself some this weekend, as I need to get some stuff done around here. [ManorFest will not plan itself, y'know!]

That's about it. I think it's high time I stopped wasting medical resources -- looking over the bills from January and February, I am mostly shocked at the expense. There are more precious resources -- time, patience, and good will come to mind -- that have been wasted, too.


I am likely to get depressed thinking about the flail arm thing... My inspiration to counter that is going to be a young lady I've met online, named Hannah. Without complaint, she underwent a rotationplasty about two weeks ago. If she can do that and keep on trucking, I can do this little thing!


Take care -- and, as always, any ideas to defeat spasms are most welcome!


Retired Educator,
Prof-de-Rien

Cat Videos and Pity Parties

The plan, which I never hide from my Dear Readers, is to salvage this post with a few lame videos of the cats of Marlinspike Hall.  I've been trying to put together some footage of Dobby the Runt and his affinity for all things "butt," however, the little guy has an uncanny awareness of the camera and refuses to be cute or even very butt oriented in its presence.

He senses that I'm drifting into Trouble Territory, however, and may just think that wasting my troubled time recording his predilection for tail pulls and rear whacks is a little too ridiculous, even for me.  Dobby has never before been a lap cat but now gently climbs all over me -- still causing a few episodes of spontaneous screaming when he missteps -- and stares.  I've noted before that he never got the "staring is aggression" memo.  

Dobby will stare at you, pupils huge, all placid-faced and irresistibly pink-nosed -- absolutely luminous -- for as long as 15 or 20 minutes.  He doesn't mind in the least should you stare back, though he does pick up on *your* aggression, should you harbor any.  Should you be thinking, for example, "Why the hell is this cat staring at me?  What, do I have mustard greens stuck to my teeth?  Does he know about that vet appointment?"

The iconic photograph of Dobby, iconic for those of us who know his unique character and weirdnesses, is called "Dobbox."  The love of boxes is not unique, of course, but he seemed to consider this small one a sort of home base, from whence he could survey the world, and particularly, Fred, with immunity from accusations  of Stare Aggression.  He'd trot over to it, hop  in, do the "perfect cat" pose, and immerse himself in the pleasure of staring at Fred, who kept the box next to his office chair.

We used to enjoy yelling out "olly olly oxen free," and then watching Dobby careen around the corner, head high, ears flattened, tail whipping in his own wake, flying to his box.

One night, Fred was working (assiduously, always assiduously -- there's no time wasting going on, no, not ever) and felt The Runt's eyes boring through the back of his lovely curly head.  Dobby sat in his box, adoring Fred, with hardly a blink of a break, for over 20 minutes.  At the 20 minute mark, in fact, Fred snapped this picture.  You know, the iconic one.

Dobbox

I created one of those "Magic Movies"  that Flip video offers for videographers afflicted with shaking hands and not much imagination, using what little The Dobster allowed to be recorded -- a couple of lame butt whacks, tail pulls, and the obligatory scene with a brush.  Excuse me, *The* Brush.  We've purchased five different brushes in an attempt to get him to give up chirping and grabbing for the worn out one seen here, to no avail.  He sniffs them, then bats them on the floor, and begins the most god-awful wailing you've ever heard.

It's lame but hey, it's a cat video, and that buys me a few paragraphs for a Pity Party and enough space for a CRPS / RSD update of my feet and hands -- the going rate for the blogger who navel-gazes.

I see the orthopedic surgeon, Dr. ShoulderMan, this afternoon, for the second post-op visit.  It's not going to be pleasant, I fear.  Although the decision about whether my immune system can support another prosthesis has already been made, by my body, I still don't look forward to hearing it from him.  

The fistula has reappeared right next to the newly closed wound from the February 13 surgery, which is just below the healed incision from the January 23 operation.  It ain't pretty.  I've been febrile for the last 8 days, with sweats and increased pain, and an almost constant headache.  The Infectious Disease folks didn't bat a proverbial eye before changing the antibiotic, accepting without question my suggestion that the bleeping infection is back, or more likely, has never left, lurking as it does behind the teflon shield of its biofilm.

I have completely dropped the ball regarding the port that is implanted in my chest.  I called the cancer clinic that usually takes care of flushing it every 6 weeks, to keep it patent, and they required a new physician order.  Well, I made that call, but haven't followed up with the appointment, because in the course of conversing with MDVIP Go-To-Guy, he got a little too animated at the idea that the biofilm infectious phenomena might well be happening to/on that port.  My mind shut down.  According to legend, the first culpable biofilm identified came from someone's pacemaker:

[Two years after Costerton coined the word/concept biofilm] Tom Marrie, a young doctor working in Halifax, Nova Scotia, examined a feverish homeless man who had wandered off the street and into his emergency room. The man had a raging staph infection and, on his chest, a lump the size and shape of a cigarette pack. It was an infected pacemaker, Marrie reasoned. For three weeks the man was given huge doses of antibiotics but did not get better, so Marrie and his team decided to operate. They invited Costerton to sit in. “If there were ever going to be a biofilm infection in a human being, it was going to be on the end of that pacemaker,” Costerton says. “We took out the pacemaker and there was our first medical biofilm. It was a great big thick layer of bacteria and slime, just caked on.”


Biofilms on implants are now recognized as a serious and growing health problem. Bacterial infections hit 2 percent to 4 percent of all implants. Of the 2 million hip and knee replacements performed worldwide each year, 40,000 become infected. More than a third of these infections lead to amputation, and not with very successful results: Most of those people die. “Implant operations have a 98 percent success rate, so people don’t want to talk about the infections,” Costerton says. “They’re a bit of a disgrace, really.”


Biofilm infections are not limited to implants. They can be found in the bodies of the young and the healthy. Many children suffer from undiagnosed biofilm infections in their ears, which require months of oral antibiotic therapy while the underlying infection smolders untouched. Millions of others live with chronic biofilms: urinary tract infections in women that last for years; prostatitis that no antibiotics permanently cure; bone infections (osteomyelitis) that cripple and immobilize people for the rest of their lives. Each year roughly 500,000 people in the United States die of biofilm-associated infections, nearly as many as those who die of cancer.


As Marrie’s experience shows, biofilms repel antibiotics, although scientists do not fully understand how. Some drugs cannot fully penetrate the biofilm’s protective matrix. In other cases, even though most of the germs die, enough remain alive to regroup and develop another biofilm. The matrix also keeps its resident germs under cover, hiding the chemical receptors on the bacteria so that drugs cannot latch onto them and kill the germs.


The study of this newly discovered behavior is rooted in the basic and ancient biology of bacteria. Geneticist Bonnie Bassler of Princeton University thinks group-living bacteria may give us a window onto the origins of multicellular life. “Bacteria grow best when each one does its own thing…together,” she says. “Bacteriologists had it wrong for the past 300 years—bacteria don’t live alone.”

Today, then, I must do two things, beyond hearing that my best bet is to be left shoulderless, with a flail arm -- I must arrange for this thing to be flushed, if, indeed, it still can be, and I must call the surgeon who put it in, and arrange for it to be removed.  I got it at the insistance of the doctor who oversaw my subanesthetic ketamine infusions, my last ditch effort to quell the advances of CRPS.  Every doctor and nurse that I have asked, except for MDVIP Go-To-Guy, has insisted that I should keep it -- saying vague things like "you never know,"  voices trailing off with much drama.  Do they USE it?  No!  "It's too close to the infection site, to the incision site..."  "I am not trained to use it..."  "We could use it, but we'd have to get the IV Team..."

Go-To-Guy, I trust him.  He thinks things through, has no interests in play other than my welfare and avoiding as many bumps in the road of this journey as possible.

I was hoping to have the blood work results from Monday before visiting ShoulderMan, as they might give a hint of a clue as to what is going on, but the results aren't in.  Of particular interest, beyond white counts, are the C-Reactive Protein and the sedimentation rate.  Both are indicators of inflammation/infection, but one is elevated in a more acute situation and the other indicates a more chronic course.  Historically, when I've been under the gun from these bacterial miscreants, BOTH tests have been greatly elevated.

I know you are tired of hearing about it.  Well, I am tired of living it.  How I wish that this osteomyelitis and this insane CRPS were deadly instead of causing unlimited pain and disability!

I did a video update of what my feet and hands look like, since the last one was from May 2011, if you don't count the ones I did in January 2012 -- and I don't, because the circumstances then were... what?  Extraordinary?!

My right foot/leg looks about the same, to me.  The left foot is awful, is worse, though it doesn't seem to show the change, visually, not the way I feel it.  Both legs are peeling and have larger areas of "ash."  This despite being cleaned daily, and -- for the past three nights, at least -- coated in lotion.  The skin seems to no longer absorb lotion or oils.

The left leg and foot are the banes of my existence, right now.  Spasming, severely spasming, burning, aching.

My hands are much worse in terms of pain but -- apart from both sets of middle finger and thumb nails (ah, the perverse symmetry of this disorder!) -- look about the same.  Both hands were peeling, much like my feet, so I suppose I have the benefit of "new" skin!  I have significant tremor now, and not the greatest grip in the world, on either side.  It used to be that the pain sort of followed the areas of discoloration, but now the burning and aching extend beyond those former borders.  In the left arm -- all the way to the shoulder.  I very much hope that is going to change.

Dobby is now asleep.  I think I will sit here and stare at him for a while, and try to see the way that he sees.

Or I could get on the phone and start the process of getting this port flushed and yanked.  Wish us luck chez ShoulderMan -- and wish him patience, and insight, as he must surely be as sick of all this as I am.

A Calm Acceptance Is Within My Grasp

we did okay yesterday.  at the end of the day, there we were:  accounted for, joking around, a little breathless.

the end of the day jars my memory -- i've never read kazuo ishiguro's the remains of the day. i enjoyed the film adaptation, despite not having much fondness for anthony hopkins. i chuckled nervously just now upon learning that there was a well-received musical version... surely someone is punking moi?

let's steal it as a theme, what do you think? the decline of aristocracy. i see it all about me, i see it in marlinspike hall, in spite of (or because of?) a strict tradition of genetically indentured servitude within the domestic staff's nucleic code.  i see it in the algae colorfully clinging to the edges of the moat, sliming the captain's miniature pink submarine.  all of tête de hergé (très décédé, d'ailleurs) is witness to the fading luster, what with budget cuts to roadside bonsai forests, as well as the recent spate of re-appropriations of museum donations -- primarily of period clothing -- by some of the oldest, most respected, and storied families of the realm.

first on the list yesterday morning was the infectious disease doctor and his fancy-schmancy new infusion center.  we left early, we got there late.  lots of tête de hergé traffic (balloons and the usual signage game play), lots of fender-benders -- but tiny fenders, at least, on the mostly clown cars.  red bulbous noses, yarn hair, voluminous striped britches.  it was hard to be upset in the middle of primary colors and popping jewel tones.  ruby, the honda cr-v, waded through the mess like the champion that she is.

the office had relocated since my last visit, and while the staff was perfectly calm, there were glazed eyes, lost supplies, misplaced charts (doctors' notes were being recorded on pink post-it notes) and rooms piled high with the disparate art work of gone-out-of-business motels.  the few finished walls boasted cooler fare, mostly activist expressions about HIV/AIDS, human rights, amnesty international, as well as small touches in each exam room, like autographed pictures of the docs with magic johnson or anthony fauci.

what they are gonna do with the motel art?  well, dear readers, i respectfully introduce the motel art show series, such as "The One Night Stand At The Ole Miss Motel on September 3, 2009":

Under the direction of photographer Erin Austen Abbott... [of Oxford, Mississippi] the show kicked off in 2007, followed by one in Los Angeles the next year. “I was taking pictures at an old Travelodge-style motel, the type that you drive up and park outside your room, set in a u-shape,” says Abbott. “All the doors had these wooden red hearts on them. I had heard rumors that the walls inside the rooms were brown wood paneling, and I suddenly had visions of T. Model Ford sitting on the edge of the bed, playing his hill country blues while fine art leaned against the furniture or replaced the current art hanging in the rooms.”


Abbott immediately went out and found 10 artist friends who were having a hard time showing their work locally. They made up the first show, and, in 2008, she took her motel art show on the road to Los Angeles. Over a thousand people showed up for “The One Night Stand at The Beverly Laurel Motel,” and the show was featured on Yelp and in the Los Angeles Times...


For art lovers who don’t live near Oxford, Abbott has good news. Next year, the show will be presented by The Yoknapatawpha Arts Council (named after Faulkner’s fictional county) and, in addition to being held in Oxford each October, travel to other locations in the spring and fall. For 2012, the Motel Art Show is scheduled to hit Brooklyn, New York, in May and Nashville in September.

so i am thinking, why not a variation on the motel art show model?  why not "decoration's remains," about medical office leftovers?

i'm jittery this morning, can you tell?

anyway... what i most appreciate chez the infectious disease dude's place are the boxes of tissues placed at intervals of every 2-3 feet.  i am always springing a leak of some sort when i visit.

it was determined that yesterday was day 36 of my 42-day intravenous antibiotic sentence, and that i would, all things being equal, have my PICC line pulled next wednesday after the final dosing of antibiotic tuesday evening.  there were arguments made over then beginning an unending course of oral antibiotic.  i didn't listen very closely -- spasms in the left leg and in the left shoulder (that's a distressing place to have muscles seize, smack dab in the middle of an open wound).  i have nothing to contribute to the conversation.  just tell me what to do.

ever since the head infectious disease doctor dude saved me from an ignominious end a few years back, i've trusted him implicitly.  i was an inpatient, crammed into a shoebox of a room ["it's a private room!"].  trapped by thick beige plastic bedrails, i could just make out the outline of my wheelchair, stashed in the corner by the leaking sink and plywood wardrobe.  a familiar urge overpowered my good sense and i crawled between the burglar bars, landing atop, although also landing askew, one of three bedside commodes. shoving aside four types of aluminum walkers [a rollator, a hemi-walker, a platform walker, and the drive knee thingy] before reaching my power chair.  satisfied sighs as she powered up, no worries in that regard, no need to find a charger midst all that junk.

long story short, yes, of course, now i was trapped in my chair instead of in my bed.  i strove to push my way out of the corner, tried equally hard to plot the path of least resistance in the general direction of freedom.

within five minutes, i was red-faced, hair all sweaty tendrils, cursing and sobbing, à la fois.

enter infectious disease dude, the head dood, in fact.  he's a geeky looking fellow, very tall, bent, kind of a craggy face, but kind. a marvelous sense of humor, but you have to be patient with it -- it's shy. better not to laugh too loud or too much.  in fact, better to arch a simple eyebrow and allow just a hint of a smile in the eye.

the doctors of today don't engage. they see a patient trapped as if surrounded by an ice floe in a room that draws junk to itself like a magnet attracts iron filings.  this doctor, however, fairly leapt over the obstacles, deftly (well, not deftly, but with dreams of deft-itude) piling and reworking the layout.

"there!" he crowed.  "you're free!"  i've been downright fond of the man ever since that liberation.  he laughed with me as i confessed that i really had nowhere to go but back to bed...

i saw a new PA there, my doctor and his usual PAs apparently having been lost among the huge boxes and crates.  [wow, a leitmotif!]  having a new PA was distracting, as she was staring at my feet and hands, her own hands suddenly anxious, her fingers picking at her fingers, now and then twirling a thumb ring.  she had some sort of medical blackberry, some sort of know-it-all electronic resource, and was peeking, picking and pecking, making furious inquiries.

CRPS is oddly symmetrical, i've noted that before.  the latest evidence comes in the form of "matching" pus leaks from below the cuticles on my middle fingers and thumbs.  it is bizarre and has held the attention of many hospital types, usually in lieu of dealing with my screamed complaints about the spasms.

so we all oooohed and aaahhhed over the pus on my hands, how weird, hmmm, and huh, wouldya look at that?

fred and i drove across town, got lost, got found, checked in, finally, at one of the satellite offices of dr. shoulderman, my orthopedic surgeon.  we stared at CNN. i zoned out. fred kicked me, and i was called back into the labyrinth of exam rooms and x-ray cloisters.

the x-ray tech looked very familiar and she positively lit up upon seeing me.  she and her pals had been working the last time i had been there, mere hours before ending up in an ambulance, heading for hell in the icu.  "you were so sick," she said.

"you look a thousand times better," she ended, and i decided she was the most talented and deserving of x-ray techs that i'd ever met.  cute, smart, perspicacious, insightful.

the gist of the visit?  pseudomonas in the wound, which had an unattractive green cast to it, and a smell which the surgeon described as "fruity," but which made moi gag.  he was completely calm, and swore that a vinegar solution, in place of the saline soaked wet-to-dry packing, would quickly solve the problem.

we hope so.

i especially hope that it is easy to do, since the first message on the answering machine upon our return home was my MDVIP go-to-guy's nurse saying that insurance was not covering home health visits and that she'd cancelled their plans for this wound.

my reaction to having compiled yet another huge bit of medical debt was to try and sleep a little bit.

thus far this morning?  the home health agency has called three times, and -- convincingly -- told me that my MDVIP go-to-guy's nursenurse is misinformed.

i don't care. someone is right, someone is wrong, but i just don't care.  i can do this dressing change -- piece of cake! fred, bianca and i have the antibiotic infusion under control; and i am getting stronger, day by day, thanks to not being trapped in bed by wires and tubes, and ignorant assumptions.

i'll let you know if there is any attitudinal shifting once i am faced with the green stinky evidence.

psychologically, i am not in a good place, but i am trying.  if the spasm-meanies will give me a bit of peace, i think a calm acceptance is within my grasp.