Monthly Archives: January 2014

Kung Hei Fat Choy!

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Welcome Year of the Horse!

As I write, it is New Year’s Eve here in China, and what a massive national celebration it is.

The Lunar New Year, sometimes referred to as Spring Festival, is sort of like the Western world’s New Year + Christmas + Easter all rolled into one.

Mostly like Easter, I think, as this is a holiday of renewal + fresh starts for many.  Indeed, I’m really hoping the Lithium therapy brings me a fresh start this year without incessant pain.

In the largest annual human migration on earth, literally hundreds of millions of Chinese are all traveling at once today to visit family and friends.

So here in Kunming this afternoon we had a little celebration of our own at Tongren Hospital.

The weather is just beautiful right now … lovely spring days all this week, and even the trees here get dressed up for China’s Spring Festival!

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Trees Dress Up in Our Neighborhood

Our hospital celebration featured a homemade dumpling competition organised by Dr. Zhu and her staff.   Only in China!

Hey!  You think a quad cannot roll dumplings?  Feast at least your eyes on these puppies … I made 24 altogether!

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My Dumpling Production Line

Dr. Zhu was in great form today, even bringing along an entire case of excellent French wine for everyone to enjoy.

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Dumplings à la Française

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Mom Working Alongside Dr. Zhu

All the spinal cord patients + hospital nursing staff + senior rehab team members attended and pitched right in, rolling dumplings, cooking sweet sticky rice … and eating and eating … truly China’s favorite national pastime!

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Cooking in the SCI Rehab Center

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Yummy … Traditional Duck! (although I am a vegetarian)

Everyone had a really good time, and on my way out I was loaded down by Dr. Zhu with a weekend’s supply of extra dumplings … a lapful, actually!

And then I was back out into the sunshine with booming fireworks even so early in the day, with individual citizens setting miniature bonfires on public sidewalks, burning documents from the old year to usher in good fortune for the New Year.

So I wish my readers one and all great good health and prosperity in the Year of the Horse … Kung Hei Fat Choy!

Lithium – Round 2!

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This past weekend the effects of Lithium Toxicity seemed to be virtually gone, and Friday’s serum Lithium test results came back at 0.2 nmol/L.  That is apparently a sort of baseline for 95% of the population, because there is some Lithium in the food we eat and the water we drink.

Unfortunately, once the Lithium had cleared for me, my neuropathic pain flared with a vengeance, and I was frustrated that we hadn’t yet been able to give the China SCI Lithium protocol a fair try.

So on Sunday I decided to have another go!

This time, however, I followed my friend Dr. Susan Solman’s advice and started up with much smaller dosing.

Not that Susan has a view one way or the other on this protocol … but, if one is going to take Lithium Carbonate for whatever reason, she advocates serious caution and starting out with small doses until the balance between blood serum level vs. how you feel can be evaluated.

Indeed, Dr Zhu Hui has herself been intrigued by what happened to me and therefore investigated further within China.  Interestingly, Dr. Zhu found a study from Qiqihar Medical University that offers the same advice as did Susan Solman a couple weeks back.

Qiqihar Medical University

The actual China SCI Network protocol calls for starting off at 250mg three times daily, which obviously proved a disaster for me.  So on Sunday I started again with just 150mg three times daily.

And guess what?

Today, 72 hours later, my lab results came back at 0.7 nmol/L … nicely inside the bottom end of the therapeutic range of 0.6 – 1.2 nmol/L.

🙂

I am experiencing mild but tolerable nausea + occasional dizziness … but nothing I couldn’t handle for the 6 weeks of the protocol.

So we’ll see how this works out …

Meanwhile, on account of Lunar New Year holiday here in China that begins on January 31st this year, the Kunming Medical School lab will be closed until next week, but I’ll get another test just as soon as possible, perhaps as soon as next Monday.

Meanwhile, for readers who are not familiar with Chinese New Year, here’s a link to some information about this amazing holiday … which is a MUCH bigger deal than is New Year in Western countries.

 http://www.chinatravel.com/focus/chinese-new-year/traditional-customs.htm

Yesterday we had a surprise visit at our apartment, where Dr. Zhu arrived mid-afternoon with a five-strong delegation from the hospital to decorate both outdoors as well as inside!

Dr Who

Dr. Who?  Must be Dr. Zhu!

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Chief Neurosurgeon Dr. Liu

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How about this?  You like it?

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Mom pitched right in …

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Tongren Hospital Decorating Team

Sure can’t top Chinese hospitality!

🙂 🙂 🙂

 

Murphy Strikes Again!

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All About Murphy’s Law:   http://www.murphys-laws.com/

It’s Wednesday afternoon in China, and the latest blood serum Lithium lab test came back a few hours ago from our friends at the Kunming Medical School.

Monday’s level of 0.95 nmol/L has fallen to 0.26 today.

So toxic levels of Lithium in my blood have fallen quickly since I stopped taking Lithium Carbonate about 48 hours ago.

But the 24-hour nausea continues, to which today have been added severe abdominal pain and resultant Dysreflexia that has driven my neuropathic pain to Level 10!

😦

What’s this all about?

“Murphy”

More general blood tests from the Tongren Hospital today reveal a very high white cell count.  It seems I’ve contracted a severe UTI.  Online literature about Lithium therapy reveals a surprising finding that a fair number of patients contract UTIs after taking Lithium … for reasons unknown.

So I’ve been forced to my last resort against bad UTIs = Ciprofloxacin … a strong antibiotic that you don’t want to make a habit if using too often.  But this should kill off the UTI in just a few days.

From here forward, my strategy is to sit tight until the UTI clears along with the round-the-clock nausea that came on a few days after starting the Lithium protocol.

Once I feel much better, I’m thinking about giving Lithium another go, but this time starting off with 450 mg daily vs. the 750 mg with which I started a couple weeks ago.  Then I’ll see how I feel and what the lab numbers look like and proceed from there.

I wish I had better news to share today.

The main takeaway for other SCI survivors with serious neuropathic pain seems to be this:

If you would like to try the China SCI Lithium protocol to reduce or even eliminate neuropathic pain, then you may wish to consider starting off slowly and building serum Lithium levels into the bottom end of the recommended range of 0.6 – 1.2 nmol/L.  And remember, too:  clinical observations (about how you feel) trump lab tests.

Further, there are available online more than 100 years of medical accounts of the clinical use of Lithium, and it’s plain that sensitivity ranges considerably from patient to patient.

It’s also worth keeping in mind that the potential dangers are such that for a couple of decades the medicinal use of Lithium was banned by the FDA in the United States, being legalised again in 1970.

Caveat emptor!

I’ve Poisoned Myself !!!

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I’m still in tough shape today and having to dictate this post to Dad, as I can no longer function well enough to use my computer.

Nonetheless, since yesterday I think we’ve pretty well figured out what has gone wrong + perhaps also what to do about it.

Before I go any further, both my Dad and I would like to acknowledge the invaluable advice we’ve received from Dr. Susan Solman in Miami.  Susan is a treasured family friend and also an experienced PhD pharmacologist who follows my blog + who wrote last night to highlight a number of issues we hadn’t fully considered.

We are indebted to Susan for her professional counsel + even more appreciative of her caring enough to contact us urgently.

Susan’s most important two points are:

Firstly, clinical observation always trumps lab results.  Or, as she put it …

“Practitioner will always treat the patient, not the lab data!”

From a detailed report on all of my symptoms, it is plain to Susan (as well as from the clinical literature) that I am suffering from what is known as Lithium Toxicity, which has potentially fatal consequences. Here’s a link if you’re interested in more details.

http://emedicine.medscape.com/article/815523-overview

In other words, I’ve poisoned myself.

😦

Secondly, Susan advises that our strategy (explained in yesterday’s blog) of reducing my intake of Lithium Carbonate until my lab data fall to the low end of the recommended dosing range is both flawed + seriously dangerous.

The reason for this warning is rooted in pharmacokinetics, a field in which Susan has many years of working experience.

http://en.wikipedia.org/wiki/Pharmacokinetics

The bottom line turns out to be counterintuitive — that is, I could reduce my intake of Lithium Carbonate right away, but my blood serum Lithium levels could continue to rise for some time.

So … since I’m already deep into toxic territory, this would be needlessly tempting fate.  In other words … playing with fire … not clever!

Consequently, we decided to eliminate Lithium completely as of today and wait until I no longer manifest symptoms of toxicity before considering whether to get back on track with the protocol.

Since Lithium has a half life of about 24 hours, I probably won’t see improvement in symptoms until tomorrow at the earliest.

Meanwhile, we’ll continue to get frequent lab reports from the supportive Kunming Medical School team.

Today’s (Monday) lab results came in at 0.95 mEq/L … so almost identical to last Thursday’s 0.97 result.  And Wednesday is my next scheduled blood test.

Perhaps the ideal outcome would be that I end up symptom-free at a serum Lithium level of about 0.6 mEq/L that is the bottom end of the range thought to be therapeutically effective to alleviate SCI-associated neuropathic pain … which is why I’m going to all this trouble in the first place!

Anyway, we’ll see … much still to play for.

Lithium Week One – Not So Good

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Off to a rocky start, suffering round-the-clock nausea, vomiting, severe intestinal pain, diminished mental acuity + low energy.

😦
 

At the end of Week One of the China SCI Network Lithium protocol, my blood serum Lithium level tested at 0.97 mEq/L. This is toward the upper end of the recommended therapeutic dosage range of 0.6 to 1.2 mEq/L.

On the other hand, we have independently uncovered evidence that “patients abnormally sensitive to lithium may exhibit toxic signs at serum levels of 1.0 – 1.5 mEq L.”  So maybe I’m just in that “abnormally sensitive” subset of the population.

Anyway, presently I’m taking the initial recommended 750 mg daily dosage of Lithium Carbonate tablets in three doses of 300mg-150mg-300mg, respectively.

Problem is, logically we do not have any proof yet that my serum Lithium level was actually stable at 0.97 when the test was completed on Thursday.  This is because in the first week the serum Lithium level accelerated from baseline test @ 0.1 up to 0.97.

That is, the serum Lithium level may have reached 0.97 on, say, Day 4 and then stabilised … or the level might have been still accelerating through 0.97 on Day 7 when my blood was drawn + tested.

So tomorrow (Monday) morning we’re going to test again + I’ll post the results in a short blog update.

Meanwhile, test levels aside, the clinical picture is not good. I’m seriously ill and getting worse by the day. I can’t make it six weeks like this.

After we have the Monday test results, I’ll see if it helps to reduce dosage to get back into the lower end of the recommended therapeutic range.

And until we get this under control, I’m going to have my serum Lithium level tested every 72 hours.

New Year’s Resolutions and Pain Management Update

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I’ve spent the past few months reflecting on how to operate in the New Year such than in 12 months I could look back on a successful 2014.  This has meant thinking more critically than ever — and editing my own ideas to focus on those with highest possible payback.

Since I broke my neck 3 1/2 years ago, day-to-day life has gotten pretty complicated, dishing up more surprising twists and turns than a riding a roller coaster blindfolded.

One might think, or least I did, that when you break your neck it’s pretty much the worst thing that can happen and that life can only go up from there, right? 

Well,  right now I’m actually sitting here chuckling to myself about the astonishing cascade of secondary complications I have had over the last several years.  This is something I’m sure many, if not most, spinal cord injury patients are familiar with.

This time last year, for example, I was thinking “Great, I’m going to China, where I’m going to regain some motor function, going have surgery to fix my cyst and everything will be smooth sailing from there.” 

However, as regular readers know, I’ve hit roadblock after roadblock … broken leg, new scar tissue impinging on cervical nerves, increased neuropathic pain, etc.  In all the circumstances, I suppose I should be happy simply to have survived 2013!

Meanwhile, in recent months I’ve been laying a mental foundation for the New Year that is now upon us — although here in China maybe I get a month’s bonus because the Lunar New Year will not be celebrated until the end of January!

Either way, this year I am determined to achieve more positive results!  And I feel I’m  just that little bit wiser that I can make that happen here in Kunming.

 🙂

In recent months I have posted blog entries explaining various pain management strategies, and I am presently in the process of implementing no less than three of these.  They include:

1.     Electro Acupuncture and Massage

a.      I have been working with my Japanese electro-acupuncturist, Ericko, for about two months.  Ericko has mostly focused on the new scar tissue that formed in my neck after triple laminectomy last May and that is now pressing against a cervical nerve.

While the main purpose of the surgery (removing the arachnoid cyst + related scar tissue) was a success, the neck pain remains very intense. This pain radiates down the right side of my neck, shoulder and arm pretty much around the clock and especially when I am sitting in my manual wheelchair. 

Ericko has been trying to soften the scar tissue around the cervical area while working on massaging my muscles, which have been seizing in serious knots that arise from always tensing my upper body to release some of the pain I feel in my neck.

2.     Lithium Protocol

a.      In one of my previous blogs …

https://chinaquaddiaries.org/2013/09/07/pain-management-take-1-lithium-carbonate-protocol/ I outlined the details of  Dr. Wise Young’s Lithium Protocol for neuropathic pain.  The so-called Lithium protocol is based on a published trial.  Here is a paper on that trial:

China2011_Lithium_Trial

The observation that high dose Lithium carbonate for 6 weeks can significantly reduce SCI-related neuropathic pain on a long term basis was incidental to the original purpose of the trial, which had to do with evaluation of whether Lithium could promote motor function recovery.  (No joy there.)

b.     Lithium appears to change the behavior of pain-related neurons, whether in the spinal cord or brain.  In other words, Lithium seems to erase the earlier pain memory imprint and changes neuronal circuitry in the brain in such a way as to perhaps permanently reduce neuropathic pain.  The most interesting (pain-related) thing about the China trial was that neuropathic pain relief continued for many months after the Lithium has been discontinued, so the Lithium was evidently not acting as a pain killer in the ordinary sense of the expression.

c.      In order to execute the Lithium protocol by myself, my blood serum levels need to be accurately tested for Lithium every single week, because if excessive Lithium builds up in your system it can cause very serious complications, including the stroke.  So, my Dad and I spent months working with the Kunming Medical School to obtain the special reagents needed to test the blood serum lithium levels. 

d.     I am happy to say the re-agents finally arrived last Wednesday, and so I started taking Lithium carbonate (750mg daily … 300-150-300) this past Friday and will continue to do so for six weeks, adjusting dosing according to how the blood tests turn out.  Once the Lithium builds up in my system, say in about three weeks, I’m thinking I might begin to notice  whether there is any relief from my currently high levels of neuropathic pain.

e.     I am presently on Day # 3 and will update you on a weekly basis as to my Lithium progress.  Blood test results come every Thursday. 

3.     Open-Focus

a.      This pain management approach involves practicing audio- guided visualizations every single day for about an hour in order to re-program the way my pain interprets pain signals.

b.     Neuroscience research has repeatedly demonstrated that pain is “simply” a set of electrical signals created by our brain … sometimes referred to as a pain map. Therefore, the idea here is that, with practice and hard work, virtually everyone is capable of training their brain to ignore the pain signals, just as athletes do when they train around the clock to become Olympians. 

c.      I have now been practicing Dr. Les Fehmi’s Open-Focus technique for about a month and a half. I have to say this is the hardest thing I’ve ever done in my entire life.

     Have you ever tried to sit still for 30 minutes-to-an-hour, fully conscious, and just not think about anything at all?  This must be harder than trying to climb Mount Everest! 

Obviously I am still a beginner, but when I am sitting there trying to meditate and listen to these guided visualizations, a million thoughts pop in and out of my mind at a dizzying pace. When I do manage to stop thinking, I wake up 15 minutes later only to realize that I’d fallen asleep!  

I have been reading that this is pretty normal for beginners, but I keep at it every single day and am determined to be one with my mind. On a related note, being able to sit quietly with my thoughts will, I believe, also help me to find a mental framework in which I am able to better accept the accident that landed me where I am right now. 

So that about covers it for my current pain management initiatives.

My family and I are determined to find a solution to this neuropathic pain problem, because I have come to the point where my desire to walk has greatly decreased, while my desire to have no pain — without resorting to regular drug use — is my highest priority.   No pain means I can “get a life” and I have good ideas about how to make a pain-free life seriously productive!

Winston Churchill once cracked:   “When you are going through hell, keep going!” 

 I am going as fast as I can!

 🙂

Christmas in Kunming

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Happy New Year!

I spent the Christmas holidays and New Year’s Eve with my parents, my sister Tiffany and her boyfriend Matthias at our apartment in Kunming.  We celebrate Christmas on the Christmas Eve, as do many Europeans because my Mom was born in Nuremberg, Germany.

Our family tradition is not to cook a large Christmas Eve meal but, rather, to enjoy a cold cut platter with smoked salmon, cream cheese, pickles, capers, onions, etc.  Sort of fancy finger food!

To our amazement, we were able to find all of our Christmas fixings in several international supermarkets located around Kunming.  The French retailer Carrefour, for example, have no less than four of their “hyperstores” located around Kunming.

As you can see from the photo below, my mother is quite an artist when it comes to making food look beautiful … not to mention delicious.

Christmas Eve Supper

While my mother and sister Tiffany were decorating our Christmas tree, our two local caregivers looked on in amazement and obvious delight, as they had never seen Christmas celebrated before.

Christmas Eve

Our apartment was decorated such that for an entire week no one would ever have known that we are presently living in China.  We even decorated the garden outside and had numerous Chinese neighbors admire our decorations, albeit they did appear slightly puzzled as they walked by.

Gone China We Have

Tiffany and I decked out in Chinese winter attire …. gifts received from our family’s assistant and now good friend, Wenjun Liao (“Jenny”)

We spent Christmas Day at the nearby Wyndham Grand Hotel, which was more elaborately decorated than I have seen most hotels in the United States. While the Chinese do not celebrate Christmas per se, this international holiday does offer them an extra occasion to go shopping!

We had a superb Thai meal in the Wyndham followed by several lattes at an independent local coffee shop.

Christmas Day Outing

About a month ago I mentioned in a blog post that I had been introduced by Dr. Zhu to Kopi Luwak coffee, also referred to as “Cat Poop Coffee.”  Coffee beans are fed to small catlike animals called Civets, which rather resemble small weasels, and they then proceed to “pass” the coffee beans through their system. The undigested coffee beans then go through a some kind of purification process!

This coffee is considered quite a delicacy and fetches an astonishing $3,000 per kilogram … that over $1,300 per U.S pound!   Indeed, this coffee has become so popular that Chinese entrepreneurs have started to open up dedicated coffee lounges that serve this coffee in any form imaginable.

So after our Christmas Day Thai lunch, we ventured over to one of these cafés and were all set to order a cup of the special coffee, but the asking price was a remarkable RMB 268 ($44.67) per cup, so we decided to stick with regular lattes, which I could see really pleased my Dad.

However, Tiffany and I had visited this café the prior week and purchased a box of less expensive pre-packaged coffee for him and my sister’s friend, Matthias, as a whimsical Christmas present.  So, several days later my Dad could find no excuse not to try the coffee!  I have to say he’s willing to try pretty much anything at least once.

Here’s a link to a funny story + video on the subject:

http://www.huffingtonpost.com/2013/07/16/cat-poop-coffee-taste-test-video_n_3605707.html

All in all I’ve passed a very pleasant Christmas with the family, notwithstanding still persistent high pain levels.

In my next post I will update you on my progress with reprogramming my brain and additional pain management strategies we’ll be exploring.

Here’s to wishing everyone a Happy New Year again!