INTRODUCTION: In order to understand and appreciate the quality of my reply to Mike's previous post, it really is necessary to compare the two side-by-side or one above the other.

This is easily done by opening this thread twice, one screen for Mike's post and the other to see my reply. You can use the "restore" option and reshape the windows into two columns or one over the other.

I always try to make point by point replies, so the reader will find them in the same sequence as that in the post to which I'm replying. You won't have to look up and down either post to find the points that correspond to one another.

Hi Mike,

First, when I began working on this reply it was going to be another (typical Vic) 1,000 or so word essay. A recent insight into the serious flaws in my approach to writing about this disease (see 4-1/2 years of being wrong), altered my thinking about the need to overexplain, and I hope this will be much shorter.

I don't think I'm being hasty in my conclusion that Dr S is a fraud; we have discussed him in posts at the other forum and back then I had serious reservations about his views on this disease, but I didn't conclude that he is a fraud (in this case a deceiver who manipulates facts and research to fit into his own agenda; part of which involves garnering excessive profits from a very questionable procedure; ketamine infusions). You are the lawyer, if my analysis of his behavior and apparent motives are correct, would he be a fraud? More on Dr S later.

Yes, I do prefer abstracts over articles for many reasons; not the least of which is money. I could never afford to build up my small library of the literature on RSD, ischemia-reperfusion injury, or even the immune response to trauma if I had to pay for all those individual articles.

In addition, the damn things are nearly impossible for me to read and gain a comprehensive understanding of what is being said, too much statistical information and too many new words in "med-speak" that I would have to look up, only to learn that they are procedure specific rather than helpful in understanding the topic under discussion.

I would never post an article or link to one because I feel my several years of reading research and then learning to translate med-speak into people talk, qualifies me as the closest thing to an expert on RSD in the lay community. If I can't understand everything the article says, I am not going to pass it on to others who are even less able to understand them. If this makes me seem arrogant, so be it.

The RSDSA website does offer a limited number of research articles, but RSDSA is run by people who, the last time I looked, still believed in the SNS model. Dr Kirkpatrick, Medical Chair of RSDSA wrote a relatively recent article expounding on the benefits of the surgical sympathectomy. The man is a disosaur and RSDSA reflects his anachronistic thinking.

While many of the articles offered by RSDSA are reflective of that organization's continuing SNS agenda, doc S is also on the board, and is a powerhouse in the RSD community, so many of the remaining articles reflect his agenda. Both of these views are wrong, so I consider RSDSA a source of inaccurate and often deceptive purported research that obfuscates rather than edifies.

Speaking of inaccurate, and especially deceptive research, the article Subanesthetic Ketamine Infusion Therapy is a perfect seg-way; the first thing I noticed when I went to RSDSA to read the article is that one of the coauthors, Maleki, is a doc S co-conspirator; he authored another article that included doc S as a coauthor. That put my b**l-s**t detector into maximun overdrive. I do believe in guilt by association. If you lay down with dogs, you rise up with fleas.

The figures you cite from this study are impressive; at least until you look at them more carefully:

16 of the 33 subjects had a history of RSD of less than one year. We all know that earlier interventions offer more optimal outcomes. When half of the subjects come from this group, one can only conclude that subjects were screened to select patients with the best chance of a good outcome (no matter what procedure is being studied).

There is enough information in the literature to conclude that many patients in the acute stage of this disease spontaneously recover. The body is designed to fix itself and it sometimes does this even with RSD,

Only two of the subjects who reported having RSD longer than 24 months were followed up for more than 24 months. This represents another deceptive practice; screening subjects out from follow-up protocols. The thinking behind this is that if we don't ask them we won't have to report what we believe will be a greater number of unsuccessful outcomes.

Finally (about this article), “…every suggestion of a mechanism of action is tied to ketamine’s role as [an] NMDA receptor antagonist...” is not mere overstatement, it too is outright deceptive.

The arguments against this conclusion are too complex and involve too much med-speak to try to discuss here, but the bottom line is that the benefits from an NMDA receptor antagonist do not and cannot solve the problem of RSD, Yes they are useful; so are GABAergic agonists (stimulants) like gabapentin and gabatril (and others in this category), but the need to supplement one or inhibit the other are part of treating the symptoms of RSD, not of addressing its cause or of the process that leads to a use for these medications.

RSD begins with a physical trauma to an extremity and its signs and symptoms progress (actually retrogress) from that. Suppressing excitatory neurotransmitters or activating inhibiting ones can provide symptom relief, but they act on specific synapses in the spinal cord; they do nothing that can cure the actual disease.

Also, our neurological systems are plastic, meaning that if one route of transmission to or from the brain is blocked, new connections through other neurons will eventually be created. If the message is constantly being sent, it will find a way to reach its destination.

Your reply to my assertion that there is absolutely no research linking nerve damage to the signs and symptoms of RSD (CRPS-I or CRPS-II), cites the Oaklander and Albrecht studies, but neither of them make that link.

Oaklander found destruction of C-fiber nociceptors (pain sensory nerve endings), but did not suggest a cause for this destruction. My arguement that RSD is the result of blockage of arterial blood flow to a large number of cells in RSD affected areas offers a scientific explanation for such nerve destruction; 25% of our C-fibers are not getting adequate oxygen or nutrients, so they die.

Albrecht, et. al., report neuropathic dysfunction in the peripheral and sympathetic nervous systems. Evidence of this is not evidence that it is caused by a peripheral nerve injury, and contradicts the idea that RSD is maintained by central sensitization; which no one claims can mediate physical alteration of nerves in the body.

They report a loss of vascular endothelial [cell] integrity, then go on to claim this must be the result of neuropathic changes. Nonsense! Please refer to my first post in reply to Sydney's thread asking about HBOT. In it, I go into some detail describing a scientific fact; that the immune response to trauma always results in a temporary loss of endothelial cell integrity, and in ishcemia-reperfusion injury, the material needed to restore this cell integrity simply cannot reach the damaged cells. Without repair, this loss of integrity becomes permanent.

Now, at last, doc S, the RSD guru: In my long and checkered history I have had the opportunity to meet and talk to some really talented con-men; from "carnies" who make a few bucks to one person in particular who defrauded people of millions. The really good ones always come across as caring and compassionate; concerned for improving the quality of life of their victims. Your description of doc S does not automatically exclude him from being a fraud.

In the past, doc S has used the word "permanent" to describe remission of RSD following sympathectomies; long after everyone in medicine knowledgeable about RSD knew that these operations were anything but permanent.

In an editorial, Explaining RSD in the journal Pain, he described "research" involving a single subject who purportedly suffered from RSD, as "...an elegant study", Balderdash! This "elegant study involved a young man diagnosed with RSD only two weeks after the injury that caused the purported RSD.

This "research" discovered that at only two weeks post injury, the central nervous system was already involved. I believe you posted the link to this "elegant study" at the other forum, but I don't think you understood the implacations or the flaws within at the time.

I had read the abstract much earlier, and my b**l-s**t detector went from standby mode to warp drive in an instant. It wasn't science, it was (and is) a "splivet"; ten pound of horse manure in a five pound sack.

Further evidence that this is a hackneyed study is the fact that the subject being studied soon fully recovered, without any discussion of any intervention that might have led to his recovery. A study that finds lots of new facts about RSD from a subject who probably never had this disease is anything but elegant; but it furthered doc S' agenda, trying to link RSD to central sensitization, so the old fraud used it.

I knew doc S was willing to play fast and loose with words a long time ago, but I didn't conclude that he is a fraud, pure and simple, until he wrote, without any evidence at all, that both CRPS-I and CRPS-II are the result of a peripheral nerve injury.

My conclusion was confirmed when he went on to try to link RSD to central sensitization (CS) when he knew that nothing learned in research into CS had any connection to RSD pain, and that CS does not explain, cannot explain, and in fact excluded any patient who showed any objective signs of an active injury or disease process.

Osteoporosis; loss of 25% of C-nociceptive fibers; abnormal hydrosis (sweating); hair loss and inhibited nail growth; symptom migration; loss of endothelial cell integrity and; cyanosis are all objective signs of an active disease process. Any one of these signs would be sufficient to exclude a subject from research into CS. Those investigating CS were looking at pain that appears to have no cause.

CS, however, sells ketamine, and not coincidentally, doc S sells ketamine. He is nothing less than a deliberate fraud out to make money from patients in severe pain. He cares not a whit that they may have taken a 2nd mortgage on their home, hoping they will be the exception. That doc S says it's possible that ketamine may provide years of remission. He sells ketamine at an outrageous price and that is the only thing he cares about.

Yes, my friend (and adversary), this sanctimonious old fraud will continue to publish "research". I take comfort in the word "old" in my previous sentence. He is old. Hopefully so old that he will die soon.

I don't wish death on people who simply annoy me; I celebrate that Saddam Hussein has been sentenced to death and look forward to his execution. Using him, and doc S as examples of my criterion for wanting to see certain people taken off the planet because it will be a better place without them; I'm sure others can accurately guess about others I prefer not to see continue to waste oxygen.

Perhaps, when he dies, the big lie about RSD will die with him, but I don't plan to sit idly by waiting for doc S to "exit, stage left". I will continue to advocate for the science supporting IRI as the only rational explanation for this disease.

I hope my small contribution will help advance the date when this explanation finally becomes the last diagnosis for causalgia/RSDS/CRPS and long term remission from, if not outright cure of this awful disease becomes a reality for everyone who must now suffer with it.

If that day comes before doc S dies, I won't have any reason to continue keeping him on my "better dead" list. If it happens this way, he will no longer be the single greatest barrier to effective treatment of RSD; he will simply become irrelevant...Vic

P.S. This thing ended up to be yet another long Vic post. Such posts will happen in the future; I can try to edit out the stuff you don't absolutely need to know, but sometimes my judgement of what you need to know will require lots of words.

In this instance, I had to answer Mikes citations of several journal articles, and I think I did that pretty well. I could not do it by offering one paragraph refutations, however. In order to show the reader why Mike's citations did not fulfill the promise of proving the unprovable, I tried to use as few words as I possibly could. Sometimes as few words as possible still require a lot of words.