Ballerina -

I will not make elaborate excuses for being away so long, I was most if the way through a lengthy missive to you last week when my browser had the good sense to crash under the weight of over a hundred open tabs.

Long story short, I finally have the support of a doctor who will work with me doing tDCS. After my pain doc passed last week because he prefers to work with FDA approved therapies. (When I asked him who in industry could come up with the matching funds that appear to be necessary for an NIH grant in support of the requisite multi-center double-blind study, he suggested "EverReady?")

But today I had a long appointment with my psychiatrist, during which I not only brought up tDCS for what must have been about the fourth time and cataloged the declines in my organizational abilities, short-to-medium-term memory and word recall issues, but focused on something I had come across the night before. A line from a report that was done by a neuro-psychologist who tested me late year:

His performance on verbal fluency, a measure that also assesses left prefrontal function, was in the average range (58th percentile).

That got my attention because in high school, I was winning extemporaneous speech competitions all over the place. So it occurred to me that if I was at the 58th percentile, I had probably burned through a lot of "cognitive reserve" along the way.

At which point he pulled up my 2007 brain MRI study and saw that the neuro-radiologist had noted 1 - 2 cm of "probably non-consequential scarring" on my left parietal lobe - he couldn't access a 2010 study off-hand - but that was enough to convince him that something organic was almost certainly going on (see, Neuropsychological deficits associated with Complex Regional Pain Syndrome, Libon DJ, Schwartzman RJ, Eppig J et al, J Int Neuropsychol Soc. 2010 May;16(3):566-73 http://www.rsds.org/pdfsall/Libon_Neuropsychol_2010.pdf) yet all of my other treatments were essentially palliative.

And despite the fact that his instinct is that tDCS doesn't covey a sufficiently power to alter "thalamic bursting" (see, Abnormal thalamocortical activity in patients with Complex Regional Pain Syndrome (CRPS) type I, Walton KD, Dubois M, Llinás RR, Pain 2010 Jul;150(1):41-51 http://www.rsds.org/pdfsall/Walton_Pain_2010.pdf) he acknowledges (1) the studies that have shown significant if transient improvement from a limited series of tDCS and (2) that not many SCS vendors would argue that treatment with their units must be done on anything less than a continuous, let alone, daily maintenance basis.

So on that basis he'll do it and write my prescriptions for all the stuff so it comes out as a non-reimbursed medical expense. That, and the man used to serve as an editor of J. ECT, so he's comfortable with electrode placement, etc.

Hey, I may be late to the party but I'm also the most recent arrival! (Ever see the 1973 film of Eugene Ionesco's Rhinoceros, starring Zero Mostel and Gene Wilder? On point and incredibly funny.)

Mike