On This Day

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On This Day

Dedicated To The Marriage Of Don Marino And Melody Anne
April 18th 1998
Mr. and Mrs. Don Tresca

TODAY, YOU HAVE TAKEN HER,

TO BE YOUR LIFETIME WEDDED WIFE-

TO LOVE, HONOR AND CHERISH HER,

EVEN AFTER SOMEDAY TAKES HER LIFE.

TODAY, YOU HAVE PROMISED TO LOVE HIM,

UNTIL DEATH DO YOU PART-

AND TO LOVE HIM MORE TOMORROW,

AS THIS DAY- WITH ALL OF YOUR HEART.

TODAY- YOU HAVE JOINED TOGETHER,

FOR INFINITY MIGHT BE RIGHT NOW-

TODAY, TOMORROW AND FOREVER,

YOU HAVE TAKEN GOD’S SACRED VOW.

A NEW BEGINNING HAS STARTED TODAY,

BY MARRIAGE YOU ARE ONE-

MAY YOUR LOVE BE UNCONDITIONAL,

AND NEVER COME UNDONE.

©1998-2015 Twinkle Wood-VanFleet/Golden Rainbow Poetry/All rights reserved.
For viewing purposes only. May not be copied, reproduced or altered in any way.

Copyright Laws and Regulations of the United States http://www.copyright.gov/title17/

HappyAnniversary

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Prescribing Task Force Meeting | April 13, 2015

mb

Prescribing Task Force
The Medical Board of California
April 13, 2015

I’ve been apart of this Prescribing Task Force since it began. These are the highlights of the meeting as it pertains to current affairs.

Refer to UStream MBC 4-13-2015 (98:02) Monday at 9:52 a.m
http://www.ustream.tv/recorded/61075030

Jason Smith- Generation Lost
Jason’s story begins at 13:00 of MBC 4-13-2015 (98:02) Monday at 9:52 a.m.

Mr. Smith begins his story by showing us photos of what a drug addict doesn’t look like, he immediately tells us that he abused the system 10 years ago. He say’s we have a preconceived notion of what a junkie looks like as he flips through slides of street bums and obvious users in dirty clothing in underground structures. He tells us that when he was 17 years old he became hooked after a car accident. He shares how he was put on Fentanyl, Norco and Soma. He believes his addiction started from Fentanyl. He said prior to the accident he was never interested in a drug “but when this hit my system, don’t get me wrong, I loved it”.

He was never honest with his doctor because he was worried his doctor would cut him off. He does say now, he has to take personal responsibility. He says his doctor didn’t know any better that he was just trying to keep him out of pain.

Additional Commentary-

I appreciate Mr. Smith’s truthfulness to come forward and tell his story. It would be honest if more patients did the same. We know they are out there. I am glad he is alive to tell his story and help the drug abuse problem. However, I can’t hold back. It is because of patients like this who make patients like me look bad. It is doctors like his that were duped that will second guess me now. I say me because I represent many pain patients who are falsely accused and judged for someone else’s deceit.

Jason appears friendly, handsome, not what society perceives an abuser to be. He’s right about the photo’s he’s shared.

Abusers are every day people, in any community, wealthy, poor, religious, strong, weak, and of any race. It is said that certain populations are at higher risk than others. We hear that over and over again. Don’t be fooled! They are in every class of people. Most dress quite well, are physically beautiful and are not just the poor folk, they are corporate managers, they are of the populations we don’t care to consider. If you think their aches and pains are more relevent then some one elses who might be on medi-cal you are misguided by your own misconceptions.

There has to be patient provider communication. There needs to be patient assessment, risk stratification, and screenings for abuse. Labeling a pain patient a potential abuser without merit because of other people who have used and abused our doctors and themselves is unjust.

Overdose means a person didn’t take a medication as prescribed, mixed it with alcohol, or another substance. Generally addiction and abuse occurs when mis using, again not taking as prescribed. Where is the personal responsibility in all of this? It is because of patients who do these things that contribute to the negative stigma and impede in the access to care and analgesic management to responsible chronic intractable pain patients. Much more work needs to be done not just in curbing abuse, but by making sure access to proper pain care on a case by case basis in ensured.

I admire Jason for sharing his story. His honesty actually brings truth and enlightenment to what many of us have been saying all along. You’re looking in the wrong place.

Dr. Rupali Das, Executive Medical Director of the Division of Workers Compensation spoke on Workers Compensation Guidelines, prescription drug misuse and overuse, and the multidisciplinary approach that the guidelines recommend. Treating providers are required to use the Evidence Based Treatment Schedule (MTUS). Opioid Treatment Guidelines- Refer to 57:00 of MBC 4-13-2015 (98:02) Monday at 9:52 a.m. http://www.ustream.tv/recorded/61075030

Dr. Das’ intentions are decent, yet early treatments such as acupuncture, physical and occupational therapy, yoga and other interventional treatments are more often than not, denied. This leads to the progression of disability and in some cases, irreversible disease. There is no wean down program when determining a modification of medication in many situations. Injured worker’s are abruptly halted leaving them in withdrawal. Even if a patient isn’t taking an opioid medication, withdrawal is dangerous. Injured worker’s continue to deal with denials and delays.

Agenda

1. Call to Order
2. The Lost Generation – Jason Smith
3. Update from the Prescription Opioid Misuse and Overdose Prevention Workgroup –
Julie Nagasako, California Department of Public Health
4. Update from Division of Workers Compensation – Rupali Das, M.D. Depart of Industrial Relations
5. Update on Controlled Substance Utilization Review and Evaluation System (CURES) –
Kimberly Kirchmeyer
6. Discussion on Statewide Best Practices
—–
Twinkle VanFleet
Executive Board Member/Advocacy Director
Power of Pain Foundation http://powerofpain.org

In attendence with
State Pain Policy Advocacy Network (SPPAN) Fellow Leader’s
Scott Clark of the California Medical Association (CMA) http://www.cmanet.org/
Maggie Buckley of the Pain Community http://paincommunity.org/

Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome

April 2015

Highlights

  • Significant cortical thinning in the prefrontal cortex was observed in CRPS patients.
  • Patients with CRPS made significantly more perseverative errors on the WCST.
  • Patients with CRPS showed significantly longer stop-signal response time.
  • The alterations may explain executive dysfunction and disinhibited pain perception.

Abstract

Few studies have examined the involvement of specific sub-regions of the prefrontal cortex in complex regional pain syndrome (CRPS). We analyzed cortical thickness to identify morphological differences in local brain structures between patients with CRPS and healthy control subjects (HCs). Furthermore, we evaluated the correlation between cortical thickness and neurocognitive function. Cortical thickness was measured in 25 patients with CRPS and 25 HCs using the FreeSurfer method. Pain severity and psychiatric symptoms were assessed using the Short Form McGill Pain Questionnaire and the Beck Depression and Anxiety Inventories (BDI and BAI), respectively. Neurocognitive function was assessed via the Wisconsin Card Sorting Test (WCST) and the stop-signal task (SST). The right dorsolateral prefrontal cortex (DLPFC) and left ventromedial prefrontal cortex (VMPFC) were significantly thinner in CRPS patients than in HCs. CRPS patients made more perseveration errors on the WCST and had longer SST reaction times compared with HCs. Although BDI and BAI differ significantly between the groups, they were not correlated with cortical thickness. Our study suggests that the pathophysiology of CRPS may be related to reduced cortical thickness in the DLPFC and VMPFC. The structural alterations in DLPFC may explain executive dysfunction and disinhibited pain perception in CRPS.

Read more-

via Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome.

Article in Press (see also)

Brain alterations and neurocognitive dysfunction in patients with complex regional pain syndrome

http://www.jpain.org/article/S1526-5900(15)00599-4/abstract

 

Odessa Virginia

wwgrctwvf_rsdadvisory

ODESSA VIRGINIA
by Twinkle VanFleet

 

I NEVER CALLED HER MISSES- I NEVER CALLED HER MOM-

BUT A MOTHER SHE WAS- BORN ODESSA VIRGINIA RAAEN.

DURING WORLD WAR TWO- SHE BUILT B TWENTY NINES,

HELPING US WIN THE FIGHT-

A GRAY LADY SHE WAS, FOR HER GENERATIONS PLIGHT.

SHE FELL IN LOVE AND MARRIED A MILITARY MAN

TOGETHER THEY HAD 4 CHILDREN- AFTER THEY FIRST BEGAN.

JAMES, CRYSTAL, TANYA AND ERIK-

AFTER 32 YEARS IT WAS OVER,

SOME SAY SHE JUST COULDN”T BARE IT

.

SHE NEVER RE-MARRIED, SHE TOOK GOOD CARE OF HERSELF-

DEPENDENT ON NO ONE, SHE KEPT TO GOOD HEALTH.

SHE HAD A POWER OF KNOWLEDGE, A SECRET TO MOST-

AND A WISH TO LEAVE THE CITY- HER DREAM WAS THE COAST.

LEAVING BEHIND THE PAST- AND THE FUTURE SHE KNEW-

TO BE FREE OF THE PAIN, SHE COULDNT UN-DO.

I’LL NEVER LOVE ANOTHER QUITE LIKE SHE-

HER INSIGHT GAVE ME THE WISDOM-

FOR WHAT TODAY, TOMORROW AND FOREVER MIGHT BE.

DESTINY WAS TO KNOW HER- GOD GAVE ME TO HER YOUNGEST SON-

THE LAST ONE TO SEE HER- HER DYING WAS YET TO COME.

ALONE SHE CLIMBED THE STAIRWAY TO HEAVEN-

FOR THE COAST AWAITED IN HER SLEEP,

BLESSED IS THE WOMAN SHE WAS- ODESSA VIRGINIA VANFLEET.

 

©1993-2015 Twinkle Wood-VanFleet/Golden Rainbow Poetry/All rights reserved.
Copyright Laws and Regulations of the United States http://www.copyright.gov/title17/

Complex Regional Pain Syndrome | Diagnosis using the Budapest Criteria – Specialist Pain Physio Clinics

The Budapest Criteria should now be used to diagnose Complex Regional Pain Syndrome (CRPS):

A: The patient has continuing pain which is disproportionate to the inciting event

B: The patient has at least one sign in two or more of the categories

C: The patient reports at least one symptom in three or more of the categories

D: No other diagnosis can better explain the signs and symptoms

Sensory: Allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or hyperalgesia (to pinprick)

Vasomotor: Temperature asymmetry (more than 1 deg.) and/or skin colour changes and/or skin colour asymmetry

Sudomotor/oedema: Oedema and/or sweating changes and/or sweating asymmetry

Motor/trophic: Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin)

Signs – see or feel a problem

Symptoms – patient reports a problem

via Complex Regional Pain Syndrome | Diagnosis using the Budapest Criteria – Specialist Pain Physio Clinics.

 

Additionally –

Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome.

Shared previously

Ask the Expert: Complex Regional Pain Syndrome (CRPS)

Online Health Chat with Michael Stanton-Hicks, MD

April 30, 2014

 

Understanding Diverticulosis

ColonwithDiverticulosisdoc163913On April 1st I had another procedure to assist in finding out why the symptoms in my belly have worsened over the last year. It wasn’t a routine procedure. Prior to 2013, I was having upper stomach pain that came and went. Held at a 3/4 on average and would rise to a painful 8/9 until I ended up in the Emergency Department at a hard 10 and was admitted for emergency surgery to remove my grossly diseased Gall Bladder. So that I don’t go back into all that, those posts can be found here and ending here for the most part. My stomach never did get better. I was diagnosed with Gastritis during the ERCP in 2013 after my first Gall Bladder surgery, so I knew I had the issue of inflammation around the stomach lining. Reducing fat intake didn’t seem to make a difference, but I’ve kept to low to no fat on a regular basis. My kidney’s are no longer in the greatest shape, but they are functioning. The issues that took me back to the same Gastroenterologist was bleeding, pain, and months of diarrhea, after years of constipation. My tailbone has been clicking in and out-of-place for over a year more and more frequently. Worse when getting up from a sitting position or when on the toilet. I thought it might be due to the Osteoarthritis of the Lumbar Spine diagnosis I’ve had.

I knew I could also feel something inside me when going to the bathroom. As it turns out there was and it was removed during the Colonoscopy. I was diagnosed with Diverticulosis in the recto-sigmoid colon and in the sigmoid colon with colonic spasm. The 3 mm polyp in the sigmoid colon was resected and retrieved.  Internal hemorrhoids were found as well, I think many of us have those, either internal or external. Either from constipation, strain or from having babies.  I haven’t received the biopsy results yet. I am not worried about that, I’m just glad to have the annoyance out of me. Severe diarrhea has complicated things to the point my legs have a hard time carrying me to the bathroom several times a day and during the night. It’s unfortunate that sometimes there hasn’t been time to get there and I’m closest to the bathroom I can be. That symptom still nags me. I’ve been relying on my Spinal Cord Stimulator even more using it to mask the discomfort around my mid section as well as my legs. Newer reports suggest fiber isn’t as beneficial as previously thought but that mesalamine might be. This September 2014 Mesalamine for Recurrent Diverticulitis Prevention: Results from Phase 3 Controlled Trials report doesn’t seem promising. Everything else is invasive at the critical point. I gained a horrible amount of weight the last 2 years with little to no change in activity or eating habits. Swelling in my face is often, gray color to my facial appearance, a look of black eyes. My stomach extends to the point of looking like there’s a hill-top on one side or so swollen I’m harvesting a human in there. It makes sense now why the area where my Gall Bladder use to be has never stopped hurting. I’ve learned to deal with it and gastritis, the only time it knocks me down some is during a flare up. What I couldn’t fully grasp was all the extra that sprung up along with it.

Sigmoid Diverticulitis- A Systematic Review

Diverticular Disease of the Colon

The Colon

AnatomyColon

Over 14 years of CRPS type 2 from a mid-metatarsal separation. I’ve had several lesions removed from my liver, my kidney’s have declined, my uterus lining is inflamed, diagnosed by ultrasound and surgery, with a suggestion to have a hysterectomy. Stomach lining inflammation, and now colon inflammation confirmed. I’ve had an infection for over 2 years. My white blood cell count has been elevated above normal range. I’ve been treated for high blood pressure for a few years now with Lisinopril and recently put on Hydralazine for when it gets above 180/. Maybe a course of antibiotics will help my belly. I still have to followup. I was given 12 photos of my insides after procedure.  I’ve been extremely Vitamin D deficient for years now with only 1 testing where I made it into the normal range. My blood is monitored every 4 months.

I have another report that will be ready on the 15th of the month. This one may have CRPS documented as part of the cause.  It was at the feedback session. I underwent those tests awhile ago. Still have a few things to work on in regards to the sleep disorders, narcolepsy, brain, brain stem and other issues, but things are moving a long. I’ve been using an Auto Servo Ventilator for about 3 years for OSA, CSA with Cheyne Stokes. It hasn’t helped with the EDS, it has helped with breathing. It’s ability to record every breath I take, don’t take, deep breaths, short breaths and so much more is amazing.

I don’t contribute everything to CRPS, I know that it is part of what’s going on. If doctors aren’t going to consider them related and document it then how can I? I could never go to a new physician and say my insides are coming apart do to CRPS and them ask “who told you that?” and me say “I did”. I’d get laughed right out of the office or not taken seriously about what really might be true and most likely is. That’s why continued awareness, research, documentation, diagnosis’ and timelines are so important. There are many other’s who have developed similar health issues. If we help educate then eventually documentation will take place. We know there is literature to support internal organs being affected, but hardly any providers recognize it.

SigmoidDiverticulosisI’m not sure yet what the plan will be. I should know more this upcoming week. I need to verify too. My procedure photos I came home with are copies. In the copies it shows areas of white outs, white space and white dots, so on film that would look different. I need clarification.  I just keep bleeding. JP drain in 2013 for internal bleeding, a hemorrhage during wait period for second surgery months later and during the surgery and again more bleeding.  Hurt, hurt and hurt.

But what do we do..

.. We go on.