Dear Vic -

It is good to hear you sounding so well. (At least when you stay away from personal attacks, which brings out a definatively darker side.) I have to say that it sounds as though you're doing something right.

And for what it's worth, I haven't been in touch with Dr. Schwartzman in a couple of years. When I had a small (non-transmural) MI - which I personally attribute to inflammatory cytokines known to be produced by RSD, among them Interleukin 6 - I was no longer a candidate to participate in his research studies, and hence there was no point in flying across the county just to see his smiling face.

No, most of what I get today is from my docs in LA, specifically the part about dystrophic changes being a function of more than just loss of oxygen. There is at least in the classical model, a loss of some nerve signal that, in and of itself, contributes to a shrinking of muscle mass.

Now I know that you feel that you have shot down every article that has tried to show some damage to nerve cells in CRPS I. That said, I think it would serve you well to carefully re-read to full text of Dr. Oaklander's article, "Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy), Pain 2006; 120:235-243, a copy of which is attached. Put it another way, I know that you feel that you've previously taken care of her thesis down in a couple of sentences, but you might want to look at the article a little more carefully, where it not only survived peer review prior to publication, but has been widely hailed since it came out. Or if you just want to develop your point in further exchange with me, that's fine too.

Having said this, never say I didn't give you anything. Please find attached "Tissue hypoxia in complex regional pain syndrome," M. Koban at al, Pain 104 (2003) 149–157. I'm pretty sure you're already familiar with it, but here it is in any case.

I guess what I'm trying to say is that I don't take issue with the fact that tissue hypoxia is terribly important here, and I've felt that way since I started experiencing debilitating leg cramps, all in the absence of any blue-ish skin. I just think it's not the only answer, not when there really is evidence of nerve damage associated with CRPS I, and not when I had a non-transmural MI with no known risk factors, but one that could be explained by an immunological model. And you are well on record as having extolled the anti-inflammatory properties of grape seed oil. So why not at least take the plunge and start checking out some of the immunological literature? (The water's fine.)

Just to see if it's of any interest, check out "Mast cells are involved in inflammatory reactions during Complex Regional Pain Syndrome type 1," Frank J.P.M. Huygen et al, Immunology Letters 91 (2004) 147–154, a copy of which is also attached.

Be well.

Mike

Attached Files

	Evidence of focal small-fiber axonal degeneration in complex regional pain sybdrme-I.pdf (168.4 KB, 992 views)
	Tissue hypoxia in complex regional pain syndrome.pdf (205.1 KB, 1116 views)
	Mast cells are involved in inflammatory reactions during CRPS-1.pdf (96.8 KB, 1372 views)