Sunday, January 28, 2018

gunshot victim tells....

andrew cuomo to read the eork of dr eugene j rstner eg the lancet p106 jan 14, 1978 who did treat the cause of causalgia in. ny


silas weir argues for a more direct approach, firearms for all to stimulate interest the work of dr eugene j ratner



Cuomo invokes Lincoln law to challenge tax reform


Gov. Andrew Cuomo on Friday claimed Abe Lincoln as an ally in his fight against the new federal tax code.
In a conference call, Cuomo joined the governors of New Jersey and Connecticut to announce a multi-state coalition to challenge the legality of the new federal law that limits deductions for state and local taxes.
Cuomo invoked a law signed in 1862 by Lincoln — who approved the first national income tax — that he said demonstrates that state and local deductions of taxes are protected by “state’s rights” and to avoid “double taxation.”
“This violates both principles clearly,” said Cuomo, speaking alongside Connecticut Gov. Dannel Malloy and new New Jersey Gov. Phil Murphy — all Democrats.
“This clearly discriminates against our states, our economies. It is fundamentally unfair and illegal,” agreed Malloy.
The new federal tax law slashes the corporate tax and income taxes for many Americans.
But it also imposes a $10,000 cap on how much taxpayers can deduct for state and local taxes.
The three governors noted that the 12 states most severely impacted by the new tax laws are blue or


Democratic-leaning states.
“It’s punishment of blue states,” said Murphy.
The governors said other states — including California — are expected to join the coalition. The lawsuit is expected to be filed in federal court in coming weeks.
All three governors also said they’re looking at other ways to offset the blow from the loss of SALT to their residents and their own state budgets — including shifting collection of revenues from the income tax to the payroll tax, which is still deductible. They’re also looking at allowing taxpayers to voluntarily donate money for government services, which could be written off as a charitable deduction.
Cuomo acknowledged that the ballot box may be the best way to undo the new tax code.
Asked if he will even try to knock off the five New York congressional Republicans who voted against limiting the deductions, Cuomo answered, “Yeah.”




HISTORY of RSD/CRPS

"Perhaps few persons who are not physicians can realize the influence of which 
long-continued and unendurable pain pain can have upon both body and mind".
Silas Weir Mitchell "Nerve Injuries" 1864.

The first descriptions of CRPS were documented during the America Civil War (1861-65) by Silas Weir Mitchell MD, a young US Army contract physician, who treated soldiers with gunshot wounds. In his book "Gunshots Wounds and Other Injuries", he described pain which persisted long after the bullets were removed from the bodies of soldiers. He noted that the pain was characteristically of a burning nature, and named it "causalgia"(Greek for burning pain)which he attributed to the consequences of nerve injury. He observes:
"...a painful swelling of the joints....may attack any or all articulations of a member. It is distinct from the early swelling due to the inflammation about the wound itself, although it may be masked by it for a time:nor is it merely a part of the general edema....Once fully established, it keeps the joint stiff and sore for weeks or months. When the acute stage has departed, the tissues become hard and partial anklyosis results."
Mitchell et al 1864
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The following is excerpted from a story which appeared in the Johns Hopkins Medical Institutions' publication, Brainwaves, and was written by Janet Worthington. It's an account of causalgia, a type of neuropathic pain, as described by Dr Mitchell:
"Under such torments, the temper changes, the most amiable grow irritable, 
the soldier becomes a coward, and the strongest man is scarcely less nervous than the most hysterical girl."

Silas Weir Mitchell, M.D., a 19th century neurologist, was as perplexed by the phenomenon of sympathetically maintained pain (he called it causalgia), as his modern counterparts. In his 1872 book, "Injuries of Nerves and Their Consequences," he carefully documented case after case in which injuries resulted in:
"the most terrible of all the tortures which a nerve wound may inflict."

Most of his patients were Civil War veterans, otherwise healthy men whose lives had been forever changed by this peculiar, burning pain, described by one as a 
"red-hot file rasping the skin." 
In many, pain was associated with a mysterious glossiness in the skin. 
"The burning comes first, the visible skin-change afterwards," 
Mitchell reported. 
"Of the special cause which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about." 
The pain's location varied from patient to patient, but:
"its favorite site is the foot or hand...the palm of the hand or palmar face of the fingers, and on the dorsum of the foot; scarcely ever on the sole of the foot or the back of the hand. When it first existed in the whole foot or hand, it always remained last in the parts referred to...if it lasted long it was finally referred to the skin alone. The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperaesthetic, so that a touch or a tap of the finger increases the pain." 
Patients took obsessive lengths to avoid exposing the area to the air, Mitchell wrote.
"Most of the bad cases keep the hand constantly wet, finding relief in the moisture rather than in the coolness of the application." 
The pain took its toll.
"As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperaesthetic state, so that the rattling of a newspaper, a breath of air...the vibrations caused by a military band, or the shock of the feet in walking, gives rise to increase of pain. At last...the patient walks carefully, carries the limb with the sound hand, is tremulous, nervous, and has all kinds of expedients for lessening his pain." 
_____________________________________________________


Another military surgeon, Rene Leriche MD, (1879-1955), treated many WW1 soldiers who also had nerve damage. He documented the classic signs of CRPS and tried to alleviate the pain with a sympathectomy:
"A few months previously I had unexpectedly encountered one of these cases. I was struck by the resemblance which the condition had to that of a sympathetic disorder; the cyanosis, the sweating, the paroxysmal nature of the pains, the effect on the general mental state, the reference of painful phenomena to a distance---all pointed in that direction. And, remembering that the sympathetic, in its distribution to the limbs, follows the course of the arteries, I asked myself whether, in those cases of nerve injury complicated by arterial wounds, it was not the injury to the sheath of the vessel that determined their painful and trophic features---the wound of the sympathetic---... Starting from this point, I asked myself whether, by acting upon the perivascular sympathetic, I might be able to succeed in modifying the causalgia."
He goes on to discuss a case study:
"I saw the patient on the 20th June; the upper limb was completely paralyzed---arm, forearm, hand and fingers....dominating everything, was an intense burning pain, concentrated particularly in the palm of the hand and on the pulp of the fingertips....On the 27th August, I exposed the brachial artery, which I found small and contracted. I removed its adventitia for a distance of 12 cm....By the next day it was obvious that the patient had less pain."
In conclusion, he thought that "novicain infiltrations of the paravertebral sympathetic chain" was an effective treatment for causalgia. He was tormented by the pain suffered by the brave soldiers and in 1937 he wrote "La Chirurgie de la Douleur" (Surgery of Pain) documenting his experiences.
During WWII, William K. Livingston MD, (1892-1966), a military doctor, was working at Oakland Naval Hospital where he treated peripheral nerve injures of soldiers who had chronic pain. He wrote about the "vicious circle of pain as similar with vasoconstriction and atrophy". He compared this pain to "circus movements in the heart muscle." He also talked about "mirror images" of pain or sympathetic pain in which the limb contra lateral to the injury becomes sympathetic. Modern research has found interneuron connections that not only ascend and descend the pain pathways but result in abnormal neurotransmission also to the contralateral side.

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