Shhhh! [Part 2]

Okay, so the doctor with whom I had an appointment on the 23rd turns out to be a quack.  I cannot tell you how badly I took that news.  There were numerous red flags, and to mix some good metaphors, the icing on the cake was being told that there was a good possibility that I could come home with the infusion pump and do the subanesthetic ketamine treatments by myself.

Ummm, okay-y-y.

I kept turning up other things and can only say that I spent a lot of time bursting into tears as I watched my chance at getting some real relief slip away.

Enter Jim Broatch, Executive Director over at RSDSA.  I sent out a Hail Mary email to the organization, and he wrote back with the name of another doctor I might try. 

I have to say... this new doctor does not check out as... what?  Pristine, I guess. He has had action taken against him in the past for lying on an application.  But he is actually a rocket scientist, so he is at least interesting.  Really!  He was an aerospace engineer originally...  Moreover, my friends, he has hospital privileges and is on the staff of a famous rehab hospital.  He's board certified and is included on my insurance's provider list. 

The first dood wasn't on that list and had no privileges anywhere.  His former partner left a patient brain dead a few years ago when he interpreted an O2 sat monitor alarm as being the alarm's problem... He just replaced the monitor without checking the patient.  [Reportedly, the nursing staff was having a collective cow at that point.]  Even after replacing the monitor, then finally realizing the patient was, indeed, coding, he failed to get him to the hospital in "a timely manner."  Worst of all, though?  He claimed people were out to get him because he (the doctor) was recovering from cancer.  Uh-huh.  Right.  That would explain the other 5+ malpractice insurance settlements as well.  I tell you, if a physician is impaired because of serious illness, I kind of expect him or her to recuse themselves from active patient care.  But that's just me...

Anyway, the first dood won't admit that this friend of his, who lost his license, is on staff at his facility -- but I managed to somehow talk to the guy on the phone there.  Same guy outlined the "take-the-ketamine-home-with-ya" bizarro program.

No, thanks. 

Fred was fairly smirking, which hurt my feelings. 

And when I told him I had a new, more better lead?  He looked crestfallen.

I don't feel much support for this.  It feels very lonely, scary.  I know I am being silly, but crapola!  There is NO other treatment available to me beyond polypharmacy, and besides not working very well, that just sucks. 

So... I am waiting for a call from the Hail Mary doctor that Jim told me about.  As a result of an immensely stressful couple of weeks and abuse of the old body, I am in a high pain period. 

I saw the ophthalmologist yesterday.  I dreaded it.  He wanted to see me, on average, every three months, as I have glaucoma.  So I waited two-and-a-half years.  What?  I was busy having surgery after surgery, infection after infection, fever upon fever, and so on.  You know the drill.  Also, my vision was getting bad despite treatment and I just didn't want to face it.

My grandfather was blind, and I watched his sight decline throughout my childhood, until he was living in the dark.

I cannot imagine not being able to read.
Not being able to see Fred's face.

Back in 2002, when Dr. DooDooHead was fervently trying to kill me and left me on a respirator with failing systems due to a completely avoidable adrenal crisis, the only bright moment I had to hang onto was the vision of Fred's face as he bent down to me when I finally opened my eyes in ICU.  He had a smile like I have never seen since, a smile that absolutely blessed me and made me want to fight, and live, because I wanted to be with that man, forever.

I have cataracts in both eyes, my eye guy said yesterday, and my pressures were both over 30 -- historically, they hung out in the low 20s.

The redeeming feature of my life right now is that worry will accomplish nothing.  It won't cure my infected bones, the massive inflammation throughout my body, the pain, the fractures, lupus' nefarious effect on kidneys and heart muscle.  It won't make my legs work, or my hands.  Worry won't make ketamine heal me, and worry won't allow me to pick a doctor with the right bright ideas. 

It will only make the pain seem worse, and the troubles, insurmountable.

Much better to remember that beaming face, enjoying his company while I knock out those ADLs that make life so incredibly meaningful.

Look, Ma!  I dressed myself today...

Sorry. Don't fret -- this pity party will be over before I bring out the first tray of hors d'oeuvres.

Hydrocodone with Acetaminophen and Phenobarbital Voluntary Recall by Qualitest Pharmaceuticals

Most of the time, I confess that the various medication recalls don't seem all that alarming. Not this one! Hopefully, anyone with the involved drugs will recognize that the pills do not seem right and will doublecheck the names and dosages...   

The American Pain Foundation has joined in spreading the word by eAlert:

Qualitest Pharmaceuticals Announces a Voluntary Recall of Hydrocodone with Acetaminophen and Phenobarbital

Safety Alert: Voluntary Recall
February 8, 2011

Qualitest, a generic drug manufacturer recently acquired by Endo Pharmaceuticals, Inc., issued a voluntary recall of three lots (11,000 bottles) of its hydrocodone with acetaminophen product on February 5, 2011. One bottle was found to be mislabeled, causing the medication to be identified as phenobarbital. According to the manufacturer, the error was discovered as a printing error and immediately corrected. About 5,000 bottles were found in the warehouse prior to pharmacy shipment which leaves 6,000 bottles out in the marketplace. Qualitest and Endo Pharmaceuticals, Inc., notified the Food and Drug Administration (FDA) and wholesale and retail pharmacies.

If you are taking generic hydrocodone or phenobarbital, please check your lot numbers immediately. These lots were distributed between September 21, and December 29, 2010, to wholesale and retail pharmacies nationwide (including Puerto Rico). Affected lots are:

• hydrocodone bitartrate and acetaminophen tablets (10mg / 500mg): Lot numbers T150G10B, T120J10E and T023M10A
• phenobarbital tablets (32.4 mg): Lot numbers T150G10B, T120J10E and T023M10A

Lot numbers can be found on the side of the bottle. Hydrocodone bitartrate and acetaminophen tablets are large (approximately 16.5 mm in length), pink capsule-shaped tablets with 3600 imprinted on one side, and V on the other. Phenobarbital tablets are small (approximately 6.4 mm in diameter), white, round, scored tablets with 5012 and V on one side and plain on the reverse side.

As a result of this mix-up, individuals may unintentionally take hydrocodone and acetaminophen tablets, instead of the intended dose of phenobarbital. Unintentional administration of hydrocodone can lead to serious adverse events including respiratory depression, central nervous system (CNS) depression, coma and death, especially in individuals who do not take opioid analgesics on regular bases or when it is combined with other CNS depressants. Unintentional administration of acetaminophen in excess of the maximum daily dose (3-4 g/day) may result in liver toxicity in individuals who take other medications containing acetaminophen, individuals with liver dysfunction or people who consume more than three alcoholic beverages a day. Additionally, missing doses of phenobarbital could result in loss of seizure control for those with seizure disorders.

Individuals who have these lots in their possession should:

• Stop using the product and contact Qualitest at (800) 444-4011 for disposal and reimbursement information. The lot number can be found on the side of the bottle.
• Contact the FDA and report if you have had any adverse reactions like loss of seizure control, excessive sleepiness, difficulty breathing, nausea, vomiting or itching. Adverse reactions or quality problems experienced with the use of this product should be reported to the FDA's MedWatch Adverse Event Reporting program online at www.fda.gov/medwatch/report.htm; by regular mail to 5600 Fishers Lane, Rockville, MD 20852-9787; or by fax to (800) FDA-0178.
• Notify the pharmacy where this medication was filled and report that you are in possession of an affected lot.
• Notify the health care provider who writes your pain medicine prescriptions and ask for guidance.
• Notify your insurance provider should a new prescription need to be written, so that it will be covered.
• Consumers with questions may contact Qualitest at (800) 444-4011 for more information.

To find out more about the American Pain Foundation and its efforts:

Contribute your voice to the 10,000 Voices campaign.
Please check out our newly launched PainSAFE™ (Pain Safety & Access For Everyone) website.
Support our efforts by donating to the cause. Donate Now.
Keep up with us on Facebook
Follow APF on Twitter at for the latest pain news and information and at www.twitter.com/painadvocacy for information on advocacy, policy and public awareness activities.
Get involved by using our online Advocacy Toolkit
Visit the APF Action Network site to learn what advocates are doing to build the movement for better pain management and get involved!
Visit the Exit Wounds site to learn more about our Military and Veterans living with pain.
Join PainAid, our online support community.

Sarah Palin Battle Hymn

Uh, I found this lying all innocent-like in the middle of a blog post over at Shadowfax's place, Movin' Meat. 

This is the warning he gave and which I echo and only slightly modify:

Use caution before deciding to watch it. Remember, what is once seen (or heard) can never be unseen (or unheard).

Written-Tom Dempsey
Vocal- Gary Mcvay

I dunno who the chick is...

Pray and Fast for Kate on Monday, February 7

Kate Mcrae's PET scan is scheduled for Tuesday, February 8.  This brave seven-year-old has a rare and aggressive form of brain cancer that has returned despite surgery, chemotherapy, and radiation.

In her journal on CaringBridge, Kate's mom Holly has shared how hard this time is, how many decisions need to be made, and how they continue to pray for a miracle.

We have been contacting various healthcare specialists around the country researching potential options, as Kate's healthcare team does the same. If things would proceed in an undesirable direction, we will need to be making rather informed, but quick decisions. We continue to cry out for healing for our baby. It would be nothing short of miraculous for the PET scan to come back not indicating cancer. We are boldly praying for that.

Kate's father Aaron has asked for those who are willing and able to join them tomorrow in a day of prayer and fasting.  As always, this faithful couple has imbued their prayer with specifics, something that has always delighted me and been a real help when storming heaven on behalf of Kate.  I'm pretty sure God finds my efforts much improved when the Mcrae's needs keep them focussed and appropriate.  Aaron writes --

Here are a few requests for those who will partner with us:


For Healing… for Kate’s complete healing from top of her head to her toes
Psalm 107: 19 Then they cried to the LORD in their trouble, and he saved them from their distress. 20 He sent forth his word and healed them; he rescued them from the grave.


For Wisdom… for Holly and I, for the doctors, and people we consult with
Colossians 1:9 For this reason, since the day we heard about you, we have not stopped praying for you and asking God to fill you with the knowledge of his will through all spiritual wisdom and understanding.


For Jesus to be Glorified… for Christ to be seen as POWERFUL & to be praised
John 11:4 Jesus said, ‘This sickness will not end in death. No, it is for God’s glory, so that, God’s Son may be glorified through it.’

Again, I want to thank the countless people who have prayed and encouraged us for some time. We would be honored if some of you could join us in this day of seeking God in prayer and fasting. Please pass this along and ask others. If you need some guidance in fasting, I have found this site to be helpful:  Awake21 particularly the ‘Prayer, Fasting, and Personal Devotion Guide.’

I really appreciate Aaron and Holly continuing to minister in the middle of their pain and hurry -- I appreciate them telling us exactly what we can do, providing resources, providing scriptural references. I am not exactly fertile ground for much of this, but I always hope for a time when sarcasm and an ironic world view will ease. Until then, I'll just do the best I can. If you, too, are uncomfortable and inexperienced with prayer and fasting born from beliefs so fierce and necessarily literal, join me tomorrow and let's try to shed our smart-assed ways.

Being dumb before God can't be anything too new.

All we gotta do is remember Holly and Aaron, and their children Olivia, Will, and most especially, Kate.

Will, Aaron, Holly, Kate, Olivia

From The TomKat Studio

E-Alerts from RSDSA

Some interesting things forwarded by Jim Broatch over at RSDSA:

Kentucky Bill Would Require Nurses to Complete 2 Hours of CRPS Education


On Tuesday, February 1, 2011, HB 234 was introduced in Kentucky. The bill would require all nurses in the state to take a one time 2 hour course in CRPS/RSD. It will go before Health and Welfare Committee Chairperson Rep. Tom Burch.


We are asking all Kentuckians to contact Tom Burch at Tom.Burch@lrc.ky.gov or 1-800-372-7181 and request him to choose this bill to go before it goes before the committee.


For more information, please contact Carolyn Clemons
South Central KY RSD Support Group, 270.879.4023

Transportation Security Agency Issues new Medical Notification Cards

The Transportation Security Administration (TSA) has issued a new medical notification card that travellers can present to airport screeners. The card will not exempt passengers from screening, but it will alert the TSA employee that a health condition exists. Click here for the link to the card.


We also suggest that before you fly, ask your physician for a recently dated letter addressed to TSA Employees/Security Checkpoint Supervisor stating that you have been diagnosed with Complex Regional Pain Syndrome (CRPS), a neurological syndrome characterized by intense chronic burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch. Your physician can recommend that you be scanned by an electronic scanning device rather than being physically searched, which will cause intense pain and prevent your traveling.


CRPS Diagnostic Codes


CRPS has been assigned the code number 337.2. It has been classified into four categories:
(1) 337.20 - unspecified site
(2) 337.29 - other specified site
(3) 337.21 - upper extremity
(4) 337.22 - lower extremity

In 2006, RSDSA put out this article about working with the TSA:

RSDSA has been asked by a person with CRPS how she can avoid a symptom flare-up, resulting from being patted down by security personnel at airport security checkpoints.

We suggest that prior to flying, you obtain a recently dated letter from your physician addressed to TSA Employees/Security Checkpoint Supervisor stating that you have been diagnosed with CRPS, a neurological syndrome characterized by intense chronic burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch and he/she recommends that you be scanned by an electronic scanning device rather than being physically searched which will cause intense pain and prevent your traveling.

Other ways to avoid a pat-down is wear clothes that are designed for
traveling such as:

Shoes with no metal shanks or eyes for laces
Skirts, pants, shirts, etc. with no metal zippers or buttons (plastic only)
No belt buckles or metal fasteners or if the passenger is wearing a
belt with a metal buckle, all they have to do is to open up the
buckle and allow the TSA agent to "feel it"
Sports bra with no metal hooks/eyes or strap adjustment.
No jewelry.
Keep all keys, cosmetics, money and change in a belt pouch or purse that will be placed in a tray for x-ray clearance with a minimum of
fumbling.
Nothing metal goes in pockets--have everything that would be in your pockets, put into a clear plastic ZIPLOC bag. A few of the airports now have such bags available for this use and 9 times out of 10, you can keep the bag

The TSA agent may ask you to go over to seat down area and remove your shoes. THE TSA AGENT IS REQUIRED TO GENTLY REMOVE YOUR SHOES AND PUT YOUR SHOES BACK ON WITHOUT CAUSING YOU ANY PAIN. Just chat with the TSA agent about your shoe removal and replacement needs. Most are very helpful...except at San Francisco Airport where they are getting the most complaints of any TSA-maintained airport in the states.

Metal-detector "safe" clothing for travelers is available and advertised as such on the following two websites:

Travel Smith
Magellan's
As a general rule, most of the TSA people are good at understanding the needs of travelers with disabilities.

RSDSA board members Dr. Peter Moskovitz and Wilson Hulley contributed to this announcement.

the view from the big round bed

Scoop, by Saba Italia

I love men. 

Big, burly men.  Decisive, friendly, efficient men.  Cheerful, joshing, smiling men.

So... even with our living quarters a complete, disassembled mess, this lovely group of tonsured monks -- our flooring installers -- have kindly advised me to plant my booty in the middle of our half-mile wide round bed and just relax.  It's the polite way of telling me to get out of the way. 

They are working around  me, literally.

Our menagerie is less than thrilled.  I don't think Dobby has blinked in several hours.  I actually had to poke him with my GimpGrabber to make sure he was alive.  Even then, he didn't blink -- he allowed one ear a quick twitch, that was it.  I offered him his most coveted treat -- a salmon Pill Pocket, of all things -- and it is still sitting there by his front paws. 

But we are not bereft of the "awwww" factor, because Marmy Fluffy Butt and her brother, Uncle Kitty Big Balls, who usually are not the friendliest of siblings, are so intertwined that it is hard to tell where one ends and the other begins. Still, Marmy's huge fluffy butt provides a big hint to the edges of their ontological division.  Uncle Kitty Big Balls' tail is more like a stiff bottle brush and though it is a perfectly fine tail, it doesn't hold a candle to her monumentally large and wispy rear end.

What do I think of the flooring?  Have you ever spent so much time choosing and pricing some home improvement material that by the time your project is finished you just don't care anymore?

Well, have you?

I like it.  I don't love it... yet.  It's very different from the plush, toe-grabbing carpet we're used to -- although  we never quite felt comfortable dropping crumbs on the museum-quality medieval silk tapestries that the Haddocks use as area rugs and bath mats.

Fred is saying all the right things:  "It makes our rooms look bigger!" being his favorite.  His next favorite thing to say is "Now we're gonna hafta paint!"   [When pigs fly will Fred willingly take up a brush... No, he is thinking in terms of gesso and murals.]

I didn't sleep much due to... oh, what was it?  Oh, I remember!  This soul-sucking pain!  So I caught up on world news, then read until my eyes failed to focus.

Events in the middle east are breathtaking.  As I watched USAmerican news coverage of the revolution in Egypt, what also proved interesting were the attitudes toward this nascent democratic struggle.  It makes people nervous.  Raucous applause for the Egyptians peaceably protesting in the streets and squares against the decades of repression under Hosni Mubarak alternate with worried whispers about the "direction" and "allegiances" the new Egyptian leadership may assume.

Then there is the "thug" factor.  Middle eastern "thuggery" shares many characteristics with the mysterious "outside agitators" so common to western protests.  Mubarak's paid plants add another element of confusion to the mix of the police and the military, the secular and the religious...

Anti-government protesters are heroic in the face of violence -- police vans plowing through crowds, snipers shooting from bridges, human rights activists detained, journalists harassed and arrested. STRATFOR reports, via Egyptian newspaper Al-Mesryoon, that 

Leaders from Egypt’s ruling party, members of the People’s Assembly and security commanders attended a secret meeting in Alexandria on Feb. 2 and made plans to mobilize hundreds of 'thugs' to attack demonstrators and disperse them by force... According to sources that attended the meeting, a number of People’s Assembly members offered 250,000 Egyptian pounds ($42,700) to finance the attack, while security officials offered hundreds of clubs and explosive devices for use against the demonstrators.

It will be interesting to watch the wrangling for position in the political vacuum left by Mubarak, particularly the role of the changing Muslim Brotherhood, a popular and populist group about which, I think, western attitudes will evolve -- in spite of the not-terribly-insightful journalism of CNN's Eliot Spitzer (certainly my choice for moral and political guidance) and Piers Morgan, Insta-Pundit.  I am not suggesting any pardon of violent acts such as Sadat's assassination -- just a willingness to assess them according to their present context. They are, for instance, supportive of Mohamed ElBaradei.  Unfortunately, the group's growing temperance and history of good works in the social arena can be obscured by a single mention of Al Qaeda and the Brotherhood in the same journalistic breath.

Last night, Spitzer elicited a pledge against violence from MB representative Mohamed Morsy, and even acknowledgement of Israel's right to exist.  Morsy said:

We are not against people. We are not against mankind. We are not against the Jews. We are against Zionism. We are against torturing the Palestinians.

Immediately, CNN posted the subscript "Muslim Brotherhood against Zionism"!

Ah... the smoke alarms are going off.  That can't be good.  It looks like I must budge from this comfy bed and go see what progress has been made and whether there actually is threat of a fire (no, there is no fire, only some smokin' saws!).

The Monks are about half done and are calling it a day.  We have only another 24 hours or so of disorganisation and chaos. 

Peace out.  Later, if I've the energy, I'd like to share my enjoyment of my current read, The Liar's Club: A Memoir.  Talk about revolutionizing the genre!

What a mess...

It's a crazy time.  Given the extent of the wackiness around here, and the opportunity for more, I'll not be blogging for a few days.

Today I see the orthopedic surgeon, my old friend.  (I slept last night with my mp3 player set to repeat and repeat a Michelle Shocked album... "my old friend" is running around my brain to the tune of Anchorage... anchored down in Anchorage....

I took the time to write to my old friend

I walked across the burning bridge

I mailed my letter off to Dallas, but

Her reply came from Anchorage, Alaska

She said Hey girl it's about time you wrote

It's been over two years now my old friend

Take me back to the days of the foreign telegrams

And the all night rock 'n rollin' hey Chel

We was wild then

Yeah, well. So I'll be humming and buzzing along with the x-rays today.

Then we are rushing about Tête de Hergé like freaking maniacs, getting groceries (I am on a goodly dose of antibiotic and we are out of plain, lowfat yogurt.  Also vanilla extract, bread, and milk.  Not to mention caffeine-laced diet colas...) and a few other items of a more esoteric nature.

Then we are flying home to finish disassembling our wing of The Manor, Marlinspike Hall.

Why?  Are we being thrown out onto the streets?  If so, wouldn't The Brotherhood down the road take us in?  Yeah, couldn't we just crash at The Monastery?

No, we're not imminently homeless, we are just having some 16th century reclaimed beams and timbers -- heart of pine planks, specifically -- put in as "new" flooring here in our tiny section of the world. 

And don't knock The Cistercians, even in jest, because they're doing the installation...

What I really wanna know is:  Who bought all these damn books?

I have so much to do and such little space and time to do it in.  Also, I tend to injure myself.  Immediately.  Within five minutes of packing and piling and sorting and moving...  Yesterday, I spent the afternoon with tears rolling down my red, red face,  while putting my arcane collection of Objectivist Poetry into flimsy bags and boxes. 

When I was done, I heard this from My Darling Cohort:  Sweetie Pie?  Are you okay?  Do you need any help?

Wrong!  Well, only partially wrong.  Wrong in the sense that I implied that My Darling Cohort was not assisting.  Because he did.  A lot.  As in, a whole lot. 

Okay, I lied.  His offer to help preceded my headstrong and tearful attempts at packing up my tiny office. 

He's a good boy, is Fred!

The Felines are freaked and part of today's plan entails finding three carriers that we can safely stash them in, as the monks, who love them to pieces, tend to try and sneak them over the orchard wall, tucked in their voluminous robes.  When we retrieve them they reek of incense and garlic.

I have beaucoup medical stuff on tap for Monday and Wednesday of next week, too.  ["Too"?]  The thoughts and worries about the subanesthetic ketamine treatment never really leave my mind.  I am pinning a shitload of hope on this procedure.

So. Be good out there.  Stay warm, stay well, be happy.

The next time I talk at you, I will be able to zip around the place without the wheelchair meeting so much impedence in the form of medieval tapestries and persian rugs.  I'm gonna redefine the speed of light.

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

Okay, so... here I am blogging again, less than a day after swearing off the activity.  I've said it before, and look!  I am saying it again -- I need one of those pensieve thingies, like Albus Dumbledore had stashed in his office.  The basin with swirling, shimmering vapors.  Thoughts as strings to be pulled out of the head, twirled on the end of one's wand.  Though I suppose a chopstick will do, in a pinch.

The Pensieve has multiple functions.


At times, when one's head is so full of thoughts that one cannot hear oneself think, it is useful to be able to take some of those thoughts and literally set them aside. The practiced Wizard can extract a thought from his head and store it in a phial or in the Pensieve for another time. If it is in the Pensieve, it is possible to stir the thoughts stored there together and look for patterns. It appears that the wizard has the choice of extracting an entire memory, leaving no trace of it in his head, as Professor Snape does in Harry Potter and the Order of the Phoenix, or extracting a copy of a memory, retaining the original, as Professor Slughorn does in Harry Potter and the Half-Blood Prince. It is also apparently possible to edit these extracted memories, though it is a difficult task and one which is often not done well.


If one places one's head within the Pensieve, one becomes immersed in a memory that is stored in the Pensieve, and is able to relive it as if one was living that time over again. Harry experienced Professor Dumbledore's memories of the Wizengamot trials of several Death Eaters this way in Harry Potter and the Goblet of Fire, and Professor Snape's memories of Harry's father in Harry Potter and the Order of the Phoenix.


A thought or memory stored in the Pensieve can, with proper stimulus, appear to nearby viewers as if standing on the surface of the basin. Professor Dumbledore used this technique to show Harry the prophecy that had been made about him, in Harry Potter and the Order of the Phoenix, and it is used in Harry Potter and the Half-Blood Prince when full immersion in memory was not needed.


It is also possible to take another person's memories, place them in the Pensieve, and then enter them to relive them as if one were the person whose memories you have just added to the Pensieve. Harry and Professor Dumbledore do this a number of times in Harry Potter and the Half-Blood Prince in order to determine the salient points of the early history of Tom Riddle, or as he later styled himself, Lord Voldemort.

This blog is my pensieve.

So... although we spoke of it briefly the last time I saw him, it sort of blew my mind -- and all its twirling little vapors -- when the surgeon offered up an inverted total shoulder arthroplasty as my sole option for my left shoulder.  He is fabulously talented, so to hear him call something "difficult" was scary.  It looks like this... and this looks WEIRD!

I guess I sorta didn't believe him in October when he first pitched this.  Or I developed amnesia.  The Good Doc says I've not much left to work with -- remember (someone has to), I have rampant avascular necrosis going on as well as osteomyelitis.  Oh, and I am now missing one rotator cuff.

No problem!

He's been such a savior to me, this guy, that I simply don't believe there is a technique or an obstacle that he cannot conquer or overcome.  I mean, he's done... let's see... 8 of my 9 shoulder surgeries. 

We were doing a pre-exam chat -- I was bemoaning the mess at the manor, the monks and the flooring... then the ketamine infusion therapy popped in my head, and consequently, out of my mouth.  But instead of giving him some background, or even notifying him that we were leaving the discursive region of home improvement and religious adherents for the vague regions of dissociative drug therapy, I just blurted:

"Guess what!  I'm gonna do ketamine!"

And his eyes bugged out.
And he opened, then closed his mouth.  Several times.
I could see the confusion and what may have been a burgeoning certainty of my extreme moral turpitude spread across his usually composed visage...

So I explained.

Which made it worse.

He thinks I am nuts for doing this.  Well, ptooey on you, Fabulous Orthopedic Surgeon!  Ptooey, I say, on you!  Then he went on and on about this upside-down, spikey prosthesis -- only an option, of course, if the joint space and long bones are free of infection.

Why am I always so confused?  (No, I am serious.  Why?)  Is there a cumulative but late arriving deficit that hits a person after so many surgeries, after so many foreign bodies are implanted, after nine years of insufficient sleep?  After all the pain, fevers, sweats?  How is it that I can block out such important information?  Denial?  I don't think I am in denial about anything, but then who does?  Do you know that last week, I managed to forget entirely that I have an "aortic root dilation" of growing dimensions -- now sitting right at 5 cm..  I got there because of a run of something or other, that ended in about an hour of trigeminy, and this thought:  "It would be so nice to have a heart rate under 112..." We are so wrapped up in stopping this infection that we haven't even scheduled an echo.  The last one was in ICU back in... July 2009.  Whoa.

Just what I need to indulge in:  more catastrophic thinking!  (Thar she blows!)

See?  I DO need a pensieve -- just to get rid of boring, scary, fruitless thoughts about stuff I cannot do crap about. 

Okay... I feel better.  The reverse shoulder option will only come to be when/if we rid my body of sneaky pathogens and the pain reaches the I-CAN'T-STAND-IT-ANYMORE stage.  With careful coaxing, I can stand a whole hell of a lot!

The title of this post stands unchallenged:  What a mess...

dear, darling kate

when news was not joyously swift in coming after kate mcrae's mri today, i think everyone in her extended network knew that the news was not good.

from her caringbridge update:

Never have words been more difficult to pen. Never have our hearts felt the angst of pain quite like today. I hoped to never write these words. I prayed that our hearts would never feel this torment. However, today, we received devastating news. There are new spots on the MRI, at least one on the other side of our daughter's brain.


The all too familiar feeling of nausea followed by haziness settled over our bodies. We vasalated between bouts of sobbing and looks of disbelief. We felt trapped in a horrific nightmare until the sound of small sobs shook us loose. Our sweet Kate was huddled up on the table sobbing into her arm. Her little body shook for about half an hour. Tears of pain, and fear letting loose. She was scared. Our baby was scared and all we could do was hold her.


Through the tears Kate slowly got out the words, "why". "Why daddy, why? Why hasn't Jesus healed me?" The sound of heartbroken sobs all that could escape from her daddy's lips. Crys of pain.


I have rarely felt angry this past year and a half. About every other emotion under the sun, but not very often anger. Today I was angry. I had promised Kate we would swim with dolphins together. We had dreamed of Hawaii together. We have so many plans. And yet now this. Words could never detail the hurt.


So tonight we sit in disbelief, or horror may be more accurate. We had gone into the MRI very hopeful. She was making gains on all ends. She had no obvious symptoms. We had one of our favorite anesthesiologists for the scan. She held Kate in her arms and sang to her as she held the mask over her face and put her to sleep. I was so grateful she cared for my baby. After the MRI we saw her again. I struggle not to try and interpret everyones body language after a scan. However, her eyes were watering. She said it must be allergies. My heart suddenly felt the icy grip of fear, what if something was seen. I tried to dissuade the feeling, the panic, for the next few hours.


Our meeting with the neurosurgeon relayed the devastating news. We cried until the meeting with Kate's oncologist.


Tomorrow the tumor board will discuss her scan and the best way to determine wether or not it is definitely cancer. Most likely Kate will be undergoing a PET scan as soon as possible. They will also be discussing the best possible route for us to take if it is tumor. They will be contacting institutions around the country for open studies, and anything that could possibly hold some hope for treating a recurrance.


We are crushed. Kate is heartbroken. And we need God's miraculous intervention. Please pray. Please ask others to pray for our sweet baby. I know she is one child among many battling. But she is our daughter, and she is a sister, and a niece, and a granddaugther. Please pray that God would spare her from this disease. Please.


Please pray that after further investigation they would determine it not to be tumor. We understand the likelyhood of that is slim. But please pray. Please intercede on our behalf.


Things will be moving quite quickly, we hope, as if this would be tumor, time is not in our favor.

as i have mentioned before, caringbridge is such a great "place" for sharing. why don't you go and share your strength with the mcraes, as they have been so generous in sharing theirs?

shhhh!

i have an appointment to be evaluated for subanesthetic ketamine treatments on february 23.

please, please, please... let it work!

Premonition of Civil War

Salvador Dali, Soft Construction with Boiled Beans (Premonition of Civil War)

Okay.  This is where things stand:  After considerable confusion about names, addresses, phone numbers, and staffing... I was able to call the interventional pain center that is reportedly doing low dose ketamine infusions for CRPS/RSD.  That was about 3 on Friday afternoon.  The office was open until 4:30 pm but my call went to voice mail and I left a message. 

Then, of course, I started cooking something fantastically difficult.  I was also in serious pain, thanks to being over-emotional and moving around more than normal.  I don't know if I have mentioned that my right hip replacement, soon to have its 10-year anniversary, is, well, messed up and very painful -- the belief is that there's a post-replacement BooBoo.  Very painful.  Making sitting a nightmare.  It's called a periprosthetic femoral fracture.  (Turns out I did mention it.  What are the odds?)

The point being that I have to limit my time in the wheelchair and maximize my time with legs [carefully] elevated. 

So going full-speed ahead for four hours in the kitchen is kind of contraindicated.  If you've ever wondered why I cook so many things in stages, that's why!  I can rest while a dough rises.  I can rest while a protein marinates.  While something bakes, I'm in bed.

Not this past Friday.  In lieu of doing what I should have, I made ridiculous side dishes, each preceded by an intricate mise en place.  I made a sauce for everything on my menu, damn the calories, damn the weirdness.  I washed, dried, and put away every dish.  I washed things that weren't dirty. 

I even started a "kitchen" load of laundry, because God loves a clean oven mitt.

The phone rang twice.  Neither call was from the interventional pain center, confirming that they do subanesthetic ketamine treatments, that these treatments were custom-made for me, that we could start first thing Saturday morning, and that I'd be walking, dancing, twirling by Sunday evening.  Instead, I spoke with a flooring company and we agreed to a Monday morning delivery of 60 boxes of flooring, with installation scheduled for this upcoming Friday.  I told Fred that next Friday was *perfect* for me, as I would be cured of CRPS by then.  Unfortunately, I added, the installation schedule was going to interfere with my plan to win the Australian Open.  I was going to have to let Na Li take my place in challenging Kim Clijsters and allow the tournament to finish up a week early.

Luckily, changing my plans for swimming the English Channel (scheduled for the 7 - 8:30 Saturday morning activity block) didn't inconvenience anyone beyond the captains and stewards of Captain Haddock's private jet.  Clearly, I need to schedule more individual sporting championships -- out of simple courtesy to family, friends, fans, and support personnel.

So they didn't call.  So I served a many-coursed, complicated dinner that no one really wanted.  So I became terminally crabby, as well as, it sometimes seems, eternally depressed.  So Fred seemed not to be able to reference ketamine without also saying "horse tranquillizer." The first time he neighs, his ass is grass...

My go-to guy of MDVIP fame finally answered my middle-of-the-night email from Thursday.  Do you wonder why I trust this man as much as I do (never mind that he has saved my life a couple o'times)?

No worries. I agree with you about making the consultation visit and really seeing for yourself what it is all about. You are well read and educated on much of this stuff and you are very astute and I believe you will get a feeling one way ot the other whether this is right for you or not. I do know that group and I do have a few patients that I've shared with them and I personally have never had an issue. Give it a try...

That went a long way toward helping me to calm down.

I'm a stute!

In addition to being freaked out over the prospect of entering ketamine treatment, I failed to anticipate one of the more interesting things that happen when I am on the antibiotic regimen... my blood sugars, high from the impact of infection, DROP dramatically.  That's one of the reasons we're doing it, in fact.

An intelligent person, someone who was really A Stute, would have refrained from injecting herself with her usual 70/30 insulin.

It's just that the first two times on the antibiotic, the change in blood sugars happened on the second or third day. My numbers, this time, did not plummet so soon... it took a week. Still, I should have switched over to regular insulin only, and stayed away from the long acting stuff. Live and learn. And learn again. Then, in my case, relearn.

I have spent many hours reading... reading about the original protocols from Dr. Harbut, reading Dr. Schwartzman's studies, reading patient stories. Every so often, I make myself read something from the anti-ketamine crowd, a crowd that is not unsubstantial.

I can't ignore those who think it is too dangerous, too untested, too much of a question mark... because, though he doesn't press the point right now, that's Fred's opinion. {whinny::whinny::neigh::neigh}  Also, it turns out, the opinion of my half-sister, though she knows little about the technical, medical side of things. She said she did not want to have to come here to hurt someone. I'm still not sure whether she was referencing moi, The Stute, or the ketamine-wielding doctor in question.

I cannot seem to rein in [sorry] my wild hopes, though. What if my new insurance coverage won't recognize it as a valid treatment? What if my mind goes on a hike during the infusion, and doesn't come back? What if I am one of those who does not respond? What if I respond, but the pain comes back within a few days?

There is one poor man who worked hard to raise the $30,000+ for a trip to Germany and the ketamine coma treatment.  It was difficult and he had a slow recovery, but he was pain free for the first time in a decade.  He and his family travelled a bit around Europe afterward, and life was suddenly, amazingly, full of promise.  They boarded a plane a few weeks post-treatment and flew into JFK in New York.  He collected his luggage, a simple thing that he couldn't have done before ketamine, and headed out to find a van for the trip home.

He stubbed his toe.

Within minutes, his CRPS/RSD was active again, his foot and leg already changing color, becoming cold, the burning, burning, burning was back.  The stabs, the shooting pain.

True story.  A story I am trying to sit with for a few minutes each day.  Something has to keep me grounded.

American RSDHope, a website/organization that I have never much liked, has an entire section online dedicated to Patient Stories about ketamine treatment -- both the coma therapy and the subanesthetic version.  I think that I may have mellowed since the last time I visited American RSDHope, or they have become more responsibly cautious.  Whatever -- if you are looking for experiential reports, go there.

Below is a list of what I have read so far, the content of which is often redundant -- a redundancy that is both reassuring and frustrating.  Virtually all of it is available over at RSDSA, the site that remains, in my opinion, the most trustworthy of CRPS organizations. Excuse me for not giving the full citations.

Overview of Ketamine Infusion Therapy

Multiday Low Dose Ketamine Infusion for Treatment of CRPS

Use of  oral ketamine in chronic pain management

Ketamine in Chronic Pain Management:  An Evidence Based Review

The neurocognitive effects of 5 day anesthetic ketamine for treatment of refractory CRPS

Safety and Efficacy of Prolonged Outpatient Ketamine Infusions for Neuropathic Pain

Two Approaches to Ketamine Move Forward for Complex Regional Pain

Ketamine Treatment for Intractable Pain in a Patient with Severe Refractory Complex Regional Pain Syndrome:  A Case Report

Ketamine Provides Effective and Long Term Pain Relief in Patients with CRPS Type I

Efficacy of Ketamine in Anesthetic Dosage for the Treatment of Refractory CRPS: An Open Label Phase II Study

Ketamine:  Does Life Begin at 40?

Gambling on experimental treatment for pain

Glutamate and the Neural Basis of the Subjective Effects of Ketamine

Intravenous Ketamine for CRPS: Making Too Much of Too Little?

Outpatient Intravenous Ketamine for the Treatment of CRPS: A Double Blind Placebo Controlled Study

Effect of low dose intranasal (s)-ketamine in patients with neuropathic pain

Trapped in a Medical Nightmare: NJ woman travels to Germany for banned medical treatment, ends up fighting for her life

Update on CRPS (Johns Hopkins 2004 Annual Pain Meeting)

Update on low dose ketamine infusions
 
CASE REPORT:  Complete Recovery From Intractable CRPS Type I Following Anesthetic Ketamine and Midazolam
 
Relief for Worst RSD May Lie With Ketamine Coma


What if I get the call tomorrow, and what if they say they aren't doing ketamine infusions?  What if I get turned away because of co-morbidities?  What if it is inaccessible due to cost?
 
I can't allow myself to entertain this not happening.  I deserve a shot, a chance.  Oh, please, please, please... let this happen, let me try, let me at least try.
 
In the meantime, The Manor needs cleaning and straightening.  Fred is defrosting a couple of Wild Beast Loins.  It is a beautiful sunny day, and if the yeast will proof, I see deliciously fragrant homemade bread in our near future. 

The Poor Ye Have Always With Thee [Or At Least The Irish]

I just got home from a whirlwind tour of some of my favorite blogs.  Perhaps because I am in the middle of making some very serious medical decisions, I chose to visit the best of the medical blogosphere. 

I have no idea what is fuelling my sudden urge to revisit one of the best and bravest attacks on entrenched hypocrisy and state-supported systemic squalor, Swift's civic-minded Proposal.   Praise the Maker, though, that we are safely at great historical remove from such circumstances, making his temperate suggestions that much more tolerable when applied to our present day trifles. 

In no way did the irresistible desire to reprint this centuries-old tract reflect on anything [ever] written over at Crass-Pollination: An ER Blog.  I do honestly admire Nurse K, although it is difficult to articulate that sometimes, as her satirical powers can approach swiftian dimensions.  She can also, however, be so rude -- a comportmental flaw that would never be ascribed to Jonathan Swift.  No sir!

Too bad we don't have the Irish to kick around any more.

Illustrated by Jeremy McHugh

A Modest Proposal






For Preventing The Children of Poor People in Ireland
From Being Aburden to Their Parents or Country, and
For Making Them Beneficial to The Public




By Jonathan Swift (1729)





It is a melancholy object to those who walk through this great town or travel in the country, when they see the streets, the roads, and cabin doors, crowded with beggars of the female sex, followed by three, four, or six children, all in rags and importuning every passenger for an alms. These mothers, instead of being able to work for their honest livelihood, are forced to employ all their time in strolling to beg sustenance for their helpless infants: who as they grow up either turn thieves for want of work, or leave their dear native country to fight for the Pretender in Spain, or sell themselves to the Barbadoes.

I think it is agreed by all parties that this prodigious number of children in the arms, or on the backs, or at the heels of their mothers, and frequently of their fathers, is in the present deplorable state of the kingdom a very great additional grievance; and, therefore, whoever could find out a fair, cheap, and easy method of making these children sound, useful members of the commonwealth, would deserve so well of the public as to have his statue set up for a preserver of the nation.

But my intention is very far from being confined to provide only for the children of professed beggars; it is of a much greater extent, and shall take in the whole number of infants at a certain age who are born of parents in effect as little able to support them as those who demand our charity in the streets.






”I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled ...”






As to my own part, having turned my thoughts for many years upon this important subject, and maturely weighed the several schemes of other projectors, I have always found them grossly mistaken in the computation. It is true, a child just dropped from its dam may be supported by her milk for a solar year, with little other nourishment; at most not above the value of 2s., which the mother may certainly get, or the value in scraps, by her lawful occupation of begging; and it is exactly at one year old that I propose to provide for them in such a manner as instead of being a charge upon their parents or the parish, or wanting food and raiment for the rest of their lives, they shall on the contrary contribute to the feeding, and partly to the clothing, of many thousands.


There is likewise another great advantage in my scheme, that it will prevent those voluntary abortions, and that horrid practice of women murdering their bastard children, alas! too frequent among us! sacrificing the poor innocent babes I doubt more to avoid the expense than the shame, which would move tears and pity in the most savage and inhuman breast.


The number of souls in this kingdom being usually reckoned one million and a half, of these I calculate there may be about two hundred thousand couple whose wives are breeders; from which number I subtract thirty thousand couples who are able to maintain their own children, although I apprehend there cannot be so many, under the present distresses of the kingdom; but this being granted, there will remain an hundred and seventy thousand breeders. I again subtract fifty thousand for those women who miscarry, or whose children die by accident or disease within the year. There only remains one hundred and twenty thousand children of poor parents annually born. The question therefore is, how this number shall be reared and provided for, which, as I have already said, under the present situation of affairs, is utterly impossible by all the methods hitherto proposed. For we can neither employ them in handicraft or agriculture; we neither build houses (I mean in the country) nor cultivate land: they can very seldom pick up a livelihood by stealing, till they arrive at six years old, except where they are of towardly parts, although I confess they learn the rudiments much earlier, during which time, they can however be properly looked upon only as probationers, as I have been informed by a principal gentleman in the county of Cavan, who protested to me that he never knew above one or two instances under the age of six, even in a part of the kingdom so renowned for the quickest proficiency in that art.


I am assured by our merchants, that a boy or a girl before twelve years old is no salable commodity; and even when they come to this age they will not yield above three pounds, or three pounds and half-a-crown at most on the exchange; which cannot turn to account either to the parents or kingdom, the charge of nutriment and rags having been at least four times that value.


I shall now therefore humbly propose my own thoughts, which I hope will not be liable to the least objection.


I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee or a ragout.


I do therefore humbly offer it to public consideration that of the hundred and twenty thousand children already computed, twenty thousand may be reserved for breed, whereof only one-fourth part to be males; which is more than we allow to sheep, black cattle or swine; and my reason is, that these children are seldom the fruits of marriage, a circumstance not much regarded by our savages, therefore one male will be sufficient to serve four females. That the remaining hundred thousand may, at a year old, be offered in the sale to the persons of quality and fortune through the kingdom; always advising the mother to let them suck plentifully in the last month, so as to render them plump and fat for a good table. A child will make two dishes at an entertainment for friends; and when the family dines alone, the fore or hind quarter will make a reasonable dish, and seasoned with a little pepper or salt will be very good boiled on the fourth day, especially in winter.


I have reckoned upon a medium that a child just born will weigh 12 pounds, and in a solar year, if tolerably nursed, increaseth to 28 pounds.


I grant this food will be somewhat dear, and therefore very proper for landlords, who, as they have already devoured most of the parents, seem to have the best title to the children.


Infant's flesh will be in season throughout the year, but more plentiful in March, and a little before and after; for we are told by a grave author, an eminent French physician, that fish being a prolific diet, there are more children born in Roman Catholic countries about nine months after Lent than at any other season; therefore, reckoning a year after Lent, the markets will be more glutted than usual, because the number of popish infants is at least three to one in this kingdom: and therefore it will have one other collateral advantage, by lessening the number of papists among us.


I have already computed the charge of nursing a beggar's child (in which list I reckon all cottagers, laborers, and four-fifths of the farmers) to be about two shillings per annum, rags included; and I believe no gentleman would repine to give ten shillings for the carcass of a good fat child, which, as I have said, will make four dishes of excellent nutritive meat, when he hath only some particular friend or his own family to dine with him. Thus the squire will learn to be a good landlord, and grow popular among his tenants; the mother will have eight shillings net profit, and be fit for work till she produces another child.


Those who are more thrifty (as I must confess the times require) may flay the carcass; the skin of which artificially dressed will make admirable gloves for ladies, and summer boots for fine gentlemen.


As to our city of Dublin, shambles may be appointed for this purpose in the most convenient parts of it, and butchers we may be assured will not be wanting; although I rather recommend buying the children alive, and dressing them hot from the knife, as we do roasting pigs.


A very worthy person, a true lover of his country, and whose virtues I highly esteem, was lately pleased in discoursing on this matter to offer a refinement upon my scheme. He said that many gentlemen of this kingdom, having of late destroyed their deer, he conceived that the want of venison might be well supplied by the bodies of young lads and maidens, not exceeding fourteen years of age nor under twelve; so great a number of both sexes in every country being now ready to starve for want of work and service; and these to be disposed of by their parents, if alive, or otherwise by their nearest relations. But with due deference to so excellent a friend and so deserving a patriot, I cannot be altogether in his sentiments; for as to the males, my American acquaintance assured me, from frequent experience, that their flesh was generally tough and lean, like that of our schoolboys by continual exercise, and their taste disagreeable; and to fatten them would not answer the charge. Then as to the females, it would, I think, with humble submission be a loss to the public, because they soon would become breeders themselves; and besides, it is not improbable that some scrupulous people might be apt to censure such a practice (although indeed very unjustly), as a little bordering upon cruelty; which, I confess, hath always been with me the strongest objection against any project, however so well intended.


But in order to justify my friend, he confessed that this expedient was put into his head by the famous Psalmanazar, a native of the island Formosa, who came from thence to London above twenty years ago, and in conversation told my friend, that in his country when any young person happened to be put to death, the executioner sold the carcass to persons of quality as a prime dainty; and that in his time the body of a plump girl of fifteen, who was crucified for an attempt to poison the emperor, was sold to his imperial majesty's prime minister of state, and other great mandarins of the court, in joints from the gibbet, at four hundred crowns. Neither indeed can I deny, that if the same use were made of several plump young girls in this town, who without one single groat to their fortunes cannot stir abroad without a chair, and appear at playhouse and assemblies in foreign fineries which they never will pay for, the kingdom would not be the worse.


Some persons of a desponding spirit are in great concern about that vast number of poor people, who are aged, diseased, or maimed, and I have been desired to employ my thoughts what course may be taken to ease the nation of so grievous an encumbrance. But I am not in the least pain upon that matter, because it is very well known that they are every day dying and rotting by cold and famine, and filth and vermin, as fast as can be reasonably expected. And as to the young laborers, they are now in as hopeful a condition; they cannot get work, and consequently pine away for want of nourishment, to a degree that if at any time they are accidentally hired to common labor, they have not strength to perform it; and thus the country and themselves are happily delivered from the evils to come.


I have too long digressed, and therefore shall return to my subject. I think the advantages by the proposal which I have made are obvious and many, as well as of the highest importance.


For first, as I have already observed, it would greatly lessen the number of papists, with whom we are yearly overrun, being the principal breeders of the nation as well as our most dangerous enemies; and who stay at home on purpose with a design to deliver the kingdom to the Pretender, hoping to take their advantage by the absence of so many good protestants, who have chosen rather to leave their country than stay at home and pay tithes against their conscience to an episcopal curate.


Secondly, The poorer tenants will have something valuable of their own, which by law may be made liable to distress and help to pay their landlord's rent, their corn and cattle being already seized, and money a thing unknown.


Thirdly, Whereas the maintenance of an hundred thousand children, from two years old and upward, cannot be computed at less than ten shillings a-piece per annum, the nation's stock will be thereby increased fifty thousand pounds per annum, beside the profit of a new dish introduced to the tables of all gentlemen of fortune in the kingdom who have any refinement in taste. And the money will circulate among ourselves, the goods being entirely of our own growth and manufacture.


Fourthly, The constant breeders, beside the gain of eight shillings sterling per annum by the sale of their children, will be rid of the charge of maintaining them after the first year.


Fifthly, This food would likewise bring great custom to taverns; where the vintners will certainly be so prudent as to procure the best receipts for dressing it to perfection, and consequently have their houses frequented by all the fine gentlemen, who justly value themselves upon their knowledge in good eating: and a skilful cook, who understands how to oblige his guests, will contrive to make it as expensive as they please.


Sixthly, This would be a great inducement to marriage, which all wise nations have either encouraged by rewards or enforced by laws and penalties. It would increase the care and tenderness of mothers toward their children, when they were sure of a settlement for life to the poor babes, provided in some sort by the public, to their annual profit instead of expense. We should see an honest emulation among the married women, which of them could bring the fattest child to the market. Men would become as fond of their wives during the time of their pregnancy as they are now of their mares in foal, their cows in calf, their sows when they are ready to farrow; nor offer to beat or kick them (as is too frequent a practice) for fear of a miscarriage.


Many other advantages might be enumerated. For instance, the addition of some thousand carcasses in our exportation of barreled beef, the propagation of swine's flesh, and improvement in the art of making good bacon, so much wanted among us by the great destruction of pigs, too frequent at our tables; which are no way comparable in taste or magnificence to a well-grown, fat, yearling child, which roasted whole will make a considerable figure at a lord mayor's feast or any other public entertainment. But this and many others I omit, being studious of brevity.


Supposing that one thousand families in this city, would be constant customers for infants flesh, besides others who might have it at merry meetings, particularly at weddings and christenings, I compute that Dublin would take off annually about twenty thousand carcasses; and the rest of the kingdom (where probably they will be sold somewhat cheaper) the remaining eighty thousand.


I can think of no one objection, that will possibly be raised against this proposal, unless it should be urged, that the number of people will be thereby much lessened in the kingdom. This I freely own, and 'twas indeed one principal design in offering it to the world. I desire the reader will observe, that I calculate my remedy for this one individual Kingdom of Ireland, and for no other that ever was, is, or, I think, ever can be upon Earth. Therefore let no man talk to me of other expedients: Of taxing our absentees at five shillings a pound: Of using neither cloaths, nor houshold furniture, except what is of our own growth and manufacture: Of utterly rejecting the materials and instruments that promote foreign luxury: Of curing the expensiveness of pride, vanity, idleness, and gaming in our women: Of introducing a vein of parsimony, prudence and temperance: Of learning to love our country, wherein we differ even from Laplanders, and the inhabitants of Topinamboo: Of quitting our animosities and factions, nor acting any longer like the Jews, who were murdering one another at the very moment their city was taken: Of being a little cautious not to sell our country and consciences for nothing: Of teaching landlords to have at least one degree of mercy towards their tenants. Lastly, of putting a spirit of honesty, industry, and skill into our shop-keepers, who, if a resolution could now be taken to buy only our native goods, would immediately unite to cheat and exact upon us in the price, the measure, and the goodness, nor could ever yet be brought to make one fair proposal of just dealing, though often and earnestly invited to it.


Therefore I repeat, let no man talk to me of these and the like expedients, 'till he hath at least some glympse of hope, that there will ever be some hearty and sincere attempt to put them into practice.


But, as to my self, having been wearied out for many years with offering vain, idle, visionary thoughts, and at length utterly despairing of success, I fortunately fell upon this proposal, which, as it is wholly new, so it hath something solid and real, of no expence and little trouble, full in our own power, and whereby we can incur no danger in disobliging England. For this kind of commodity will not bear exportation, and flesh being of too tender a consistence, to admit a long continuance in salt, although perhaps I could name a country, which would be glad to eat up our whole nation without it.


After all, I am not so violently bent upon my own opinion as to reject any offer proposed by wise men, which shall be found equally innocent, cheap, easy, and effectual. But before something of that kind shall be advanced in contradiction to my scheme, and offering a better, I desire the author or authors will be pleased maturely to consider two points. First, as things now stand, how they will be able to find food and raiment for an hundred thousand useless mouths and backs. And secondly, there being a round million of creatures in human figure throughout this kingdom, whose whole subsistence put into a common stock would leave them in debt two millions of pounds sterling, adding those who are beggars by profession to the bulk of farmers, cottagers, and laborers, with their wives and children who are beggars in effect: I desire those politicians who dislike my overture, and may perhaps be so bold as to attempt an answer, that they will first ask the parents of these mortals, whether they would not at this day think it a great happiness to have been sold for food, at a year old in the manner I prescribe, and thereby have avoided such a perpetual scene of misfortunes as they have since gone through by the oppression of landlords, the impossibility of paying rent without money or trade, the want of common sustenance, with neither house nor clothes to cover them from the inclemencies of the weather, and the most inevitable prospect of entailing the like or greater miseries upon their breed for ever.


I profess, in the sincerity of my heart, that I have not the least personal interest in endeavoring to promote this necessary work, having no other motive than the public good of my country, by advancing our trade, providing for infants, relieving the poor, and giving some pleasure to the rich. I have no children by which I can propose to get a single penny; the youngest being nine years old, and my wife past child-bearing.


The End

ketamineketamineketamine

i'm too tired to go into it at the moment, but it looks like i may have a chance to get ketamine infusion treatments (the "awake" version) for crps. 

the problem? 

(and you know there has to be a problem.)

the two docs doing it are... less than pristine, far from stellar, not exactly objects of admiration. 

as the referring health practitioner put it, they are "cowboys."

one had his license revoked for a few years and has multiple medmal settlements.

the other is a D.O. not well liked by his patients, and is really into the ka-ching-side of pain management -- procedures, procedures, procedures. costly intervention!

 however, on the plus side?  the referring health practitioner reports that he "used to be cute."
(well, that settles it.)

additional problems?

(and you know there have to be additional problems.)

getting anyone in my life on board to be supportive about ketamine infusions.  i will need support -- logistically, physically, emotionally.  also a problem?  pitching this to my "go-to" group of doctors, all of whom are less than keen about ketamine anything, much less intravenous infusions of it done on purpose, repeatedly!  i expect resistance based on the unresolved osteomyelitis/infected prostheses and a couple of other persnickety comorbidities.

should i start a petition?  a write-in campaign? 

if i want this treatment, if i can get insurance coverage for it (oh, yeah, i forgot to mention that as a potential problem... mwa ha ha), what does it matter what my "team" thinks?  or my life partner? 

or even la bonne et belle bianca castafiore? 

i remember when the prospect of "only" receiving temporary and incomplete pain relief was a prospect not deemed worthy of pursuing.  now that i have a good dozen viable suicide plans, "temporary and incomplete" sounds downright enticing.

fred's only comment thus far relates to the probability of hallucinations during treatment... i keep trying to tell him that i doubt he'll be able to notice much of a change.

i'm grateful to the kind practitioner who told me about this today.  she risks putting herself in the middle of an uncomfortable and unsupported referral.  i am enormously grateful that she took the risk. 

i don't quite understand why the availability of "awake" ketamine infusions for crps/rsd in this region of tête de hergé isn't being shouted from our elevated medieval slate rooftops... but if it works out for me, i'll be yodelling the news throughout hill and dale.

from the Holy Wikipedia entry on CRPS:

Ketamine, a potent anesthetic, is being used as an experimental and controversial treatment for Complex Regional Pain Syndrome. The theory of ketamine use in CRPS/RSD is primarily advanced by neurologist Dr Robert J. Schwartzman of Drexel University College of Medicine in Philadelphia, and researchers at the University of Tübingen in Germany, but was first introduced in the United States by Doctor Ronald Harbut of Little Rock Arkansas. Doctor Harbut and Doctor Graeme Correll (of Queensland, Australia) first began studying the use of ketamine in the treatment of CRPS patients. Dr Harbut's first CRPS patients in the USA were successfully treated in 2002 with the low-dose ketamine infusion; also called the "Awake Technique" and he soon began work with FDA on an approved protocol. In early 2003 Dr Harbut began sharing his treatment methods with the Doctors at Drexel University College of Medicine, including Doctor Schwartzman. The hypothesis is that ketamine manipulates NMDA receptors which might reboot aberrant brain activity.


A 2004 article discussing ketamine infusion therapy states, "Although ketamine may have more than one mechanism of action, the basis for using it to treat CRPS may reside in its strong ability to block NMDA receptors. Experimental evidence suggests that a sufficiently intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nociceptive afferents onto dorsal horn neurons within the spinal cord. The glutamate released, in turn, stimulates NMDA receptors on second-order neurons that produce the phenomena of windup and central sensitization. It is reasonable to consider that, by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization [4–7,15]. Ketamine is the only potent NMDA-blocking drug currently available for clinical use. Our interpretation is that an appropriately prolonged infusion of ketamine appears to maintain a level of ketamine in the central nervous system long enough to reverse the effects of the sensitization process and associated pain."[41]


There are two treatment modalities; the first consist of a low dose subanesethesia Ketamine infusion of between 10–90 mg per hour over several treatment days, this can be delivered in hospital or as an outpatient in some cases. This is called the awake or subanesethesia technique.

Good morning. This is God.

Hopefully, I will play "catch up" today and get some things posted -- some newly published CRPS research comes most to mind.  My hands and feet have been undergoing drastic CRPS-related changes and while I enjoyed a brief respite from spasticity, my jerks and massive spasms are back and... well, getting me deeply down. 

I'm fighting back, though.  It may not be obvious, but I am.  I am grimly cheerful.  I am cooking up a storm, despite many close calls with knives in these clumsy hands, and near catastrophes with rippling oils in very hot pans.  I am reading with wild abandon, hours at a time. Dobby and Uncle Kitty Big Balls have been subjected to training sessions worthy of the smartest border collie, the most ingenious of poodles.  (Sadly, but predictably, Miss Marmy Fluffy Butt proved resistant to training, at least *group* training.  She will show off in private.)  Then, of course, there are all the seasonal tasks inherent to Manor maintenance and the many requirements of keeping a large domestic staff working hard and free of revolutionary sentiment.  An insurrection is all I need right now.

So I celebrated my birthday yesterday!

A good part of it was spent sleeping, as I started the third round of antibiotics on Saturday, and for some reason, the stuff exhausts me.  Last week, my body decided to engage in some irrational weirdness involving the bones and joints of my hands -- trying to match the grim state of my lower extremities.  Though I suppose it's likely coincidence, my hands have steadily improved since I started Round 3, and that has been a huge relief.  Meaning that -- even though I snoozed through some of it -- I had a fine b'day! 

(This go-round of abx will last a month... Why we are doing a month instead of the usual two weeks, I dunno.  I ain't the doctor.  I just take the pills.  Maybe because, beyond a beneficial effect on blood sugars
-- that are elevated by infection -- my blood work reflecting the infection and inflammation from osteomyelitis was unaffected by the first two treatments, even as it was unaffected by seven orthopedic surgeries.  Yeah, duh, that might be why we've doubled the treatment duration, eh?  It shows a little bit that we are winging it based on some vague suggestions from the Infectious Disease consult back in... when?  October?  My go-to-guy MDVIP Dood is so intent on finding me some relief from daily fevers, weakness, bone pain, and sweats that I am almost ready to lie to him.  I know, I know, that is some messed up thinking.  I just tire of... well, you know.  Blah blah blah!  I'm sure you're tired of it, too!)

I wanted to share with you one of Fred's cards * .  Technically not of the birthday card genre and pretty silly, it made me laugh and want to hug and kiss the guy.  Which I promptly did.

* The card was based on a series of magnets by Claire Vohman.  You can see her cards, shirts, painted windows, magnets, and prints at her website, HERE.

From the Buckeye Surgeon: American Exceptionalism Needs a New Heart

Jeffrey Parks MD, also known as blogger Buckeye Surgeon, has posted some wonderfully clear pieces about Dick Cheney. 

I appreciate clarity. 

And I am with him on this sentiment, as well:

 

Former Vice President (and still war criminal) Dick Cheney may soon place himself on the list for a heart transplant, according to this WSJ article. Usually heart transplants are restricted to those patients younger than 70 (Cheney turns 70 next week). I say, let the old bastard get on the list, on the condition that he submits to being waterboarded as a live, pay per view event on HBO. He doesn't have to get the full KSM treatment (i.e. 187 waterboardings). Just once is good enough for me.

KSM = Khalid Sheikh Mohammed

You can enjoy more of the Buckeye Surgeon's analysis of Dick Cheney's general son-of-a-bitchedness by clicking HERE.

For some excellent additional background, read Andy Worthington's December 2008 piece, The Ten Lies of Dick Cheney.