by Jacqueline L. Jones

The Chronic Illness Care Division of the Unmasked Communications™ Store has moved. The new shop features resources on the treatment and prevention of a variety of autoimmune diseases, alzheimer's disease, other disorders, and several other topics. Visit the shop today to start your journey toward improved health.

Last night was terrible.  I had a panic attack while I was in bed, trying to get to sleep.  It's been awhile since I've had panic attack.

My anxiety is so high over my life situation and it doesn't take much to push me over the edge.  That's what happened.

My Mom is coming to visit and I'm trying to get things set for her.  She can't stay here because of the 'trap' that lives here.  So, in order for her to have a nice time I am putting her in a hotel.

While I was trying to get things fixed up I get my face chewed off and told that I am just not accepting that I have a chronic pain issue and I should just sit down and not do anything.  It's more complicated than that but that's it in a nutshell. 

A huge argument ensued and I was, again, lied to about things that were said and promised.  I was accused of "you name it."  But, I have to hang in here and just get through the next 2 years.  After that, I don't even care what I sell this house for, as long as I break even I don't care.  A profit would be nice but I'm not going to stop a quick sale because of that. 

I have to see the Ophthalmologist today and my eyes will be dilated and new glasses ordered.  After a panic attack this is going to be tough.  But, I have to get through it.

Mom will be here Friday and I'm so happy she'll be coming.  I know my anxiety will be very high and I have to swallow it so no one knows.  That's the hard part.  Keeping this to myself because no one will really help nor understand.

Pretty soon I'll have to do something because I'll implode. I'm going to try and talk to my primary Doc when I see him next week for my physical.  It depends because if he puts me off in any kind of way I react by shutting down and removing the question and discussion.

That's where I'm at.  Not where I wanted to be and I intended to post differently but I can't right now.  I'm still shaky after last night and it's not going to take much to push me over the edge again.

I am scared, but hope tomorrow will be better.

Man is the only animal that laughs and weeps, for he is the only animal
that is struck with the difference between what things are and what
they ought to be.

-- William Hazlitt

Gosh, it was a beautiful day today. Bright blue October skies and crisp fall air the way only Wisconsin can make a blue sky in September and October. As I walked Igor down to the dog park late this afternoon, shuffling through the leaves that had been falling all day, I was transported back in time to another day with another dog.

The only thing that was missing was the smell of leaves burning. Well, that and Gram's apple butter simmering on the back burner, turning into a tasty sludge that I would happily slather onto her home made bread in the winter.

My friend Kathleen and I walked Igor up to the Capitol Square tonight for the last potty run of the evening and enjoyed the relatively warm temperatures and the waning Hunter's moon over the shoulder of Lady Forward. You could definitely see the face of the "Old Man In the Moon" tonight.

I did four loads of laundry so I definitely got my exercise in for the day. I stopped in at the chiropractor,Aaron Abplanalp,who has set up in the Metro politan Place retail space as Life City and asked if he accepted medicare and medical assistance. He does so I made an appointment. He's awfully young but then anyone my son's age and younger seems awfully young and my son is almost 37.

I feel a bit guilty about taking business away from the chiropractor I have been going to but this guy is just around the corner and it would be so easy to pop in to see him. So if he's any good, I'm going to switch because I know I would get to him more regularly.

Patches is still residing on the dresser but she is getting braver about the dog. Boy if she had claws, he's have a very sore snout! She has walloped him hard enough to hurt a couple of times so he backs off when she gets that dainty little paw into position. I wish she'd come back to bed with me. I miss the nightly interaction we had with her massage and the purring.

B

Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.

Study indicates role of inflammatory mechanism distinct from joint cartilage

The most common degenerative joint disease, osteoarthritis (OA) is marked by the breakdown of articular cartilage, which is the type of cartilage that lines the ends of most limb bones. It can afflict any joint—fingers, toes, wrists, ankles, elbows, shoulders, and the spine, as well as the weight-bearing knees and hips. As OA progresses, sufferers often experience inflammation around the affected joint. This inflammation has been attributed to bits of cartilage breaking off and aggravating the synovium, the thin, smooth membrane lining a joint. Yet, MRI detection of prominent synovitis in early OA—when joint cartilage appears normal—suggests that other joint structures may be involved in triggering this inflammation. Recent studies of inflammation in spinal arthritis implicate the enthesis, which is the attachment site of ligament or tendon to bone as being a potential driving factor in joint inflammation.

Intrigued by the potential role of tendon or ligament attachment sites in synovitis, Professors Michael Benjamin of Cardiff University and Dennis McGonagle of the University of Leeds decided to investigate the extent to which different entheses could contribute to inflammation by forming a functional unit and destructive partnership with adjacent synovium. Featured in the November 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), their findings shed light on a potential novel mechanism for synovial inflammation in degenerative arthritis. This is based on a structure that the authors have called the “synovial-entheseal complex” (SEC). Basically insertions have a different type of cartilage called fibrocartilage near the bone. Although this is different from articular cartilage that lines the ends of bones, the authors speculated that this type of cartilage could also derive nourishment from synovium. However, this close integration although desirable in health could have unfortunate consequences if the enthesis was damaged.

To validate the widespread formation and to explore further, the possible inflammatory function of SECs, researchers collected ligament and tendon attachment samples from 60 cadavers, 35 male and 25 female, with a mean age of 84 years at death. 49 different entheses—19 from the arms, 26 from the legs, and 4 from the spinal column—were preserved for examination. To exclude cartilage degeneration as a trigger for synovial inflammation, 17 of the selected entheses were not immediately adjacent to joint cartilage. Each sample was studied for evidence of inflammatory cells and soft tissue microdamage, as well as for the composition of SECs.

At 82 percent of the entheses, the formation of a SEC was found. As expected, this occurred in entheses very close to joint cartilage, where the synovium was often part of the joint itself. However, a SEC was also detected in 47 percent of the sites separated from joint cartilage. For example, the SEC found at the Achilles tendon was formed with synovium that protruded from a cavity called a “bursa”, located a considerable distance from the ankle joint.

Joint insertions are sites of high mechanical stressing and the authors speculated that this could lead to damage within them, including their fibrocartilage This is exactly what the authors found. Degenerative changes—at least one and sometimes several—were detected on the soft tissue side of attachment sites. Most notably, cell clustering and/or fissuring was found in 76 percent of entheses. In 85 percent of SECs, the synovial component also showed evidence of mild inflammatory change. Finally, in 73 percent of the attachments, small numbers of inflammatory cells were present in the enthesis itself. Therefore the authors suggest that joint degeneration of fibrocartilage at insertions could trigger inflammation within SECs.

As Professors Benjamin and McGonagle note, one their most striking findings was the large number of attachment sites with evidence of changes in the entheses mirroring those typically seen in joint cartilage in OA—fibrocartilage cell clusters, cell hypertrophy, and fissuring among them. “Such changes at certain entheses could be directly relevant to older subjects with joint symptoms due to degenerative disease,” Professor McGonagle observes, “and some of the symptoms could be emanating from the SEC.”

Affirming the concept of a “synovio-etheseal complex” as widely applicable at many sites in the body, both right next to and removed from joint cartilage, this study also supports the idea that biomechanical factors related to the enthesis could play an important role in synovial inflammation in both degenerative and inflammatory arthritis.

###

Article: “Histopathologic Changes at ‘Synovio-Entheseal Complexes’ Suggesting a Novel Mechanism for Synovitis in Osteoarthritis and Spondylarthritis,” Michael Benjamin and Dennis McGonagle, Arthritis & Rheumatism, November 2007; (DOI: 10.1002/art.23078).

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Source

Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. via CiteULike

King Arthur Don’t Give Up

Ye learned Knights lay your sorrow aside as the wordes of an angell speaketh to you.     Now the day is doen and the night is come , I bid you to listen to thy minstrel Josh Groban, who hath a voice of sweet nectar.    Like a ship that comes upon a rocke with horrible dismay and shatters in thousand peeces rives, hope may lie with timbered bones.

Please,  Don’t Give Up.

When thou dost fall in the field of battle, and looketh down in great despair, feel the touch of a noble herte by your side.  Behold your King Arthur, doth carry a daggere and will thrust forth this daggere for thee. 

Please,  Don’t Give Up.

When life doth seem unkind, remember love doth keep residence in thy heart.  Like a Silver Swan, unlock the song within you that is unsung.  Fortune hath found a Camelot for thee.   Your heart shall to you answer.

Please, Don’t Give Up.

Let the golden beame of this song, cast aside the feare, and hearken to the truth that resides in the song.     In these fayre hours you are not alone.     Thou art a Knight of the Pain Table with honour by each side.     Thou art Loved and not Forsaken.

With Loyalty and Love,
Your King Arthur,
Knights of the Pain Table of Camelot

Note:  Josh Groban has just released his Christmas Album which is gently beautiful.  We loveth this Minstrel.  To visit Josh’s Website go  to www.joshgroban.com.  To hear some of his Christmas songs visit http://myspace.com/joshgroban 

Lady Sharon

Lyrics

Don't give up

It's just the weight of the world
When your heart's heavy
I, I will lift it for you
Don't give up
Because you want to be heard
If silence keeps you
I, I will break it for you
Everybody wants to be understood
Well I can hear you
Everybody wants to be loved
Don't give up
Because you are loved
Don't give up
It's just the hurt that you hide
When you're lost inside
I, I'll be there to find you
Don't give up
Because you want to burn bright
If darkness blinds you
I, I will shine to guide you
Everybody wants to be understood
Well I can hear you
Everybody wants to be loved
Don't give up
Because you are loved
You are loved
Aaaah
Don't give up
Its just the weight of the world (You are loved)
Dont give up
Everyone needs to be heard (Dont give up)
You are loved (You are loved - Dont give up)

A study,  expected to be published in the Dec. 1 issue of Cancer, found that neither positive or negative emotional states predict how long a person with cancer will survive.    The University of Pennsylvania researchers found by the end of the five-year study that among head and neck cancer patients, their emotional status had no effect on the course of the cancer or the patient’s survival.    All of the 1,100 patients in the study were in a clinical trial for new head and neck cancer treatments.

An Australian study released in the February issue of Cancer showed similar results for lung cancer patients. Patients in that study also completed questionnaires about their outlook before treatment and after treatment.

Michael Fisch, is an associate professor of gastrointestinal medical oncology at the University of Texas M.D. Anderson Cancer Center, who treats head and neck cancer patients in Houston.     According to Fisch, survival also has more to do with access to health care and the biology of the cancer in question than attitude.

To read more details about the study visit Medline Plus.

Personal Note from Lady Sharon:  

 Each person is unique and there are many factors contributing to ill health and what causes different diseases.   I do believe that it is important to take responsibility for one’s health.    However, I do not believe that having a great attitude will always cure an illness.  If you have ever visited a children’s hospital, you will see many very ill children.   But you will also see tremendous joy and a great attitude in these little Warriors.    If attitude were the only factor on curing illnesses then children should not be dying.     Anyone who has been close to their pet will also know that if attitude cured illnesses exclusively, then their friends would never leave them. 

Different personalities deal with illness differently and it is hard to know what the patient is going through if you have not walked in their shoes.    This study may help those patients who feel guilty for being ill.   There are cases where patients seemed to be cured by their positive attitude.    But this may not work for everyone, and when it does not work, it can be very discouraging for the patient. 

It is very difficult to be positive when your world is falling down around you.    I salute all those Warriors of chronic pain and Warriors of chronic illness for just surviving the ordeal.   I understand the kind of courage that it takes to just make it through another day.    Perhaps a positive attitude will not cure all illnesses, but I do think keeping joy in your heart keeps something alive in you.

Lady Sharon

Scribe of Knights of the Pain Table

Functional Anatomy

The anatomy of the nociceptive system can be grossly divided into the peripheral and central nervous system. The peripheral nervous system consists of small myelinated and unmyelinated nerve fibers. These nerve fibers converge into a region of the spinal cord referred to as the dorsal horn. The dorsal horn is the first relay station in pain signal transmission. The next element of pain transmission includes nerve fibers that then travel to the thalamus. From the thalamus the next order of neurons ascend to the limbic system and sensory cortex. This accounts for the affective elements and discriminative of pain respectively.

Nociception

The experience of pain biologically is referred to as nociception. Nociception occurs in any tissue or organ in which pain signals arise secondary to a disease process or trauma. The nociception can also occur if there is dysfunction or damage to nerves themselves.

The Pathophysiology of Chronic Pain

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition, it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established^.

Classification

Nociception (pain) may arise from injury or disease to visceral, somatic and neural structures in the body. More broadly pain is described as malignant or non-malignant in origin.

Diagnoses

Pain may be a response to injury or any number of disease states that provoke nociception. Advances in imaging studies and electrophysiological studies allow us to gain a deeper insight into the characteristics and properties associated with the phenomenon of chronic pain.

Chronic Pain Syndrome

Chronic pain may generate other adversities including affective symptoms of depression and anxiety. It may also contribute to decreased physical activity given the apprehension of exacerbating pain. Conversely it may itself have psychosomatic or psychogenic component to its cause.

Management

It is rare to completely achieve absolute and sustained relief of pain. Thus, the clinical goal is pain management. Pain management is often multidisciplinary in nature. A recent journal article by Gatchell and Okifuji recognizes the importance of comprehensive pain programs(CPPs) in the management of chronic pain. They summarize their findings as follows: "CPPs offer the most efficacious and cost-effective treatment for persons with chronic pain, relative to a host of widely used conventional medical treatment."

Ahhhhh....Saturday morning. The day we get to loll in bed, snuggling and drinking coffee and catching each other up on the week's news. We jabber endlessly about everything under the sun, make plans for the future, and map out the weekend. My favorite day.

During the week, Tom wakes up and gets us coffee. He brings a carafe of it up to me in bed before he gets ready for work. This morning, I woke up first. My plan was to sneak downstairs, brush my teeth, get the carafe and bring it upstairs to my sleeping sweetie, who I'd awaken with a kiss.

It didn't exactly go according to plan. With a the finesse of a delicate ballerina, I started at the top step, and WHAM! My feet went out from under me like they were covered in banana peels. In fast-motion, I slid down six or seven steps, making a nice loud BOOM, BOOM, BOOM sound as my head hit each one. Nice. Smooth. Tom leapt out of bed and ran down to help me. All I could think about was that I hadn't brushed my teeth yet, so I wouldn't talk to him to tell him that I was okay. Besides, I'm still not sure if I am okay.

Even the tiniest misstep can have devastating effects on me. Last week, I misjudged the height of the step on my mother's back porch and sort of jarred my body. It made me cry, because I knew that a little mistake like that could cost me for a long time, because of the Fibromyalgia. And it did. Of course, I then I get into the whole cycle of trying not to see it that way, trying to change my thinking so as not to make what I'm anticipating (from past history) come to pass. But it always does. And it's happening again today, in spades.

I have to go lie back down now.

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