Freude

Die Traurigkeit lies nach
Als ich im Traume hörte
Kristallne HarfenKlänge
Von Engeln selbst geschlagen

Und wenn dies enden wird
Kommt auch mein Ende bald
Werd's dann erkennen doch
Dass nichts ein Ende hat

Fibromyalgia: Multimodal Therapy

Fibromyalgia: Multimodal Therapy at the Rheinische Rheuma Zentrum

Multimodal doesn't simply mean to add different therapies. Our team has worked a long time together and regularly meets to discuss the needs of the patients. The team consists of a nurse, physical therapist / physical education teacher, at times an occupational therapist, a psychologist (behavioural therapist, pain specialist), and a rheumatologist. The success of the therapy depends on the cooperation of the Department of Psychology and the Department of Rheumatology, and in the orientation at behavioural therapeutic principles of the team.
The therapy is change oriented; patients should be enabled to increase their self-help capacity.

Patients must fulfil certain requirements as no pending social welfare lawsuit, command of the German language, motivation to change, no medication that affects the central nervous system (like benzodiazepines, tilidin, and others), and no other disease needing special attention at the same time, able to take part in a group therapy.
We had patients with migratory background (Turkey, Poland, Italy, Russia, Kazakhstan, Croatia ...), but were fluent in German. We had patients with concomitant inflammatory rheumatic diseases, but these were in remission at the time of the therapy. We also had one patient with both hips replaced within a year, but half a year after the last operation she was able to take part in the therapy.

Patients are in the day clinic, meaning weekends and evenings they're out of the hospital. ..., but they get homework. They apply, what they learn, in real life. They agree to stop talking about pain.

Day starts with rounds: group with rheumatologist and nurse, sometimes the psychologist joins. The nurse records non-verbal pain behaviour. Then the patients do aquatic training or aqua jogging, training therapy, gymnastics, walking (activities change). The pivotal point is: not every patient is alike, some are depressive avoiders, who need to be activated, and some are merry sustainers, who need to restrained, sometimes like in ice hockey 2 minutes on the penalty bench.

Later in the day they train progressive muscle relaxation (Jacobson). But the two sessions with the psychologist per day are the core of the therapy. They use stress coping and problem solving techniques.

We started with this therapy about 12 years ago. It isn't something mystical; you could find the ingredients elsewhere as well. Save, you must be very consequent, fill in loop holes, and look also that no other disease will get too much attention (e.g. a common cold).

Instant pain relief isn’t our goal; we look for less pain constantly in and over longer periods of time. We monitor with a battery of psychological tests and the FIQ.

We had a long waiting list, so that we had to close it. We'll be through with our list be next year and await the patients. We expect too many patients for our capacity, but there won't be a lottery like for green cards.

Written 03.11.2010, revised 19.11.2010 2.0

Lustig ist die Jägerei / Piff! Paff!

Lustig ist die Jägerei / Piff! Paff!

Es war noch früh im Jahr, aber schon ein warmer Tag, als ich In der Issel (Meerbusch – in der Nähe von Düsseldorf bzw. der A44) durch die Auen schritt. Da hörte ich es: „Piff! Paff!“ Die Jäger übten sich im Waidwerk. Weiter stapfte ich durch die feuchten Wiesen – da schreckte ich etwa ein- bis zweihundert Wildgänse (Kanadagänse) auf, die sich erhoben und über den Rhein das Weite suchten. Ich aber ging weiter und traf auf die beiden Jäger, die sich hinter Buschwerk und Tarnnetz versteckt hielten. Am Feldrain erblickte ich die erschossene Krähe, im ihrem Blute lag sie am Boden – tot. Mit der Flinte in der Hand machte man den Vorschlag, ich solle woanders weitergehen, welch gute Idee! Schnell hätte es wieder „Piff, paff!“ machen können und ich mochte nicht auch blutend am Boden liegen – neben der Krähe. Warum aber steht 200-300 m entfernt ein Schild, man solle vorsichtig fahren – der Kinder zuliebe? http://bit.ly/bqdwoP
Wer schon inmitten eines Naherholungsgebietes jagt, sollte auch für Absperrungen sorgen, wie z.B. bei der Kölner Philharmonie, wo grün gekleidete Ordner aufpassen, dass niemand während einer Aufführung auf dem Dach steppt. So könnte man das Terrain sichern und Arbeitsplätze schaffen. Oder ganz und gar mit dem Blödsinn aufhören!
Wenn auch die Jäger in Wort die Krähe als Raubzeug abwerten, so sehe doch darin ein überflüssig beendetes Leben. Oder hatten diese Jäger In der Issel nur Hunger. Ja, dann: „Wohl bekomm´s!“

Lodotra - my problems with the new miracle weapon against rheumatoid arthritis

Lodotra can´t adapt as well to different dosages as prednisone. It is a drug predominantly for a fixed dosage level and not easy to be tapered. E.g. half mg steps are impossible. Treatment goal is remission and afterwards maintenance with minimum of medication. The first step should be the tapering of glucocorticoids.
Depending on the dose, the price of Lodotra varies between four to sixteen times the price of prednisone.
I think it inappropriate, if the chief investigator of the pivotal study, F. Buttgereit, is a member of the EULAR Committee for recommendations on glucocorticoids in the treatment of rheumatoid arthritis at the same time. Study at: http://bit.ly/9KkkcA. EULAR recommendations see: http://bit.ly/aJvZX0.
But perhaps there are even patients, who might benefit from Lodotra; it would be detrimental, however, if only the manufacturer would be profiting.


(Text originally in German. Calculations on German basis – Rote Liste 2010.)

Lodotra – meine Probleme mit der neuen Wunderwaffe gegen die rheumatoide Arthritis

Lodotra lässt sich nicht so gut in der Dosis adaptieren. Es ist eher ein Präparat für eine feste Dosis und nicht zur Dosisreduktion. Halbmilligramm Schritte sind unmöglich. Das Ziel in der Therapie der rheumatopiden Arthritis ist die Remission und dann der Erhalt mit möglichst geringer Menge an Medikatien und als erste Maßnahme sollten Glukokortikoide reduziert und abgesetzt werden.
Je nach Dosis liegt der Preis zwischen dem 4-16fachen von Decortin.
Ich finde es unpassend, wenn der federführende Rheumatologe der Studie (Chief Investigator), F. Buttgereit, auch gleichzeitig Mitglied des EULAR Komitees für die Empfehlungen zur Glukokortikoidtherapie ist. Studie unter: http://bit.ly/9KkkcA. EULAR Recommendations unter: http://bit.ly/aJvZX0.
Die Weltneuheit ist meines Wissens immer noch nur hier in Deutschland erhältlich. Warum eigentlich, wenn es so ein wichtiges Medikament ist? http://www.finanznachrichten.de/nachrichten-2009-04/13617042-weltneuheit-lodotra-r-ab-sofort-in-deutschland-erhaeltlich-007.htm
Aber vielleicht gibt es ja Patienten, die von Lodotra profitieren, denn es wäre fatal, wenn der Profit nur beim Hersteller läge.



Leicht geändert und ergänzt am 09.05.2012

Secret - or how to loose money

In case you want to loose money contact him - otherwise have a hearty laugh!


Von: DAVID RICHARD [mailto:david.richard@btinternet.com]
Gesendet: Dienstag, 18. Mai 2010 23:19
Betreff: DEAREST ONE.

Hi,
I am a British soldier currently in Afghanistan. I am with the 40th Regiment Royal Artillery in Afghanistan. We hijacked a suspected Van painted black between the border of Pakistan and Afghanistan. The Door gunners sitting behind machine guns in the Black Van tried shooting at our direction but we lunched a combat backup attack on the Black Van none of the Taliban survived the attack.

We discovered other currencies including US dollars of about $ 16 million loaded inside the Black Van with so many types of machine guns. We want to move this money out of this place, before we declare other items in the van to the international press. This place is a war zone you will keep our share pending the end of our assignment here in Afghanistan.
We will take 70%. You take 30%. No strings attached, just help us move it out of Afghanistan, Afghanistan is a war zone. We plan to use secured logistics courier to ship the money out in a large box.
If you can help to receive the box for us, I will send you the full details. Kindly send me an e-mail signifying your interest including your most confidential telephone/fax numbers for quick communication also your contact details. This should be a secret and must be a secret between us.

Respectfully,
Gen Sir David Richards (right)

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