Writer's Cramp Episode

Yesterday I interviewed for a position as a clinic adminstrator (interview went well, but not sure if I will move to that position...not enough compensation to justify it) and I noticed, much to my chagrin, that I was required to fill out a four-page application that included, among other things, a half page on which I was to write a paragraph about myself and my aspirations, goals, etc.

As I've indicated here before, I make all attempts to avoid having to write anything due to the complications that arise (including pain) from my medical writer's cramp. Ordinarily I am completely unable to get past about a line or two without serious cramping in my hand and wrist and the writing rapidly begins to fall down into illegible scribbling.

Since I didn't want my application to appear to have been written by a mental patient, I focused every bit of energy I could into keeping my hand as steady as possible, and each word as neat as I could make it. Writing that paragraph was so difficult that by writing's end, I was actually sweating and my hand ached so that even this morning, the middle of the back of my hand between the tendons still feels bruised and sore.

I found this article on the treatment of writer's cramp using Botox injections...and it reports a significant improvement in the symptoms and can provide relief for up to 6 months:

http://www.medicalnewstoday.com/medicalnews.php?newsid=59603

"Botox"' the popular anti- wrinkle treatment, can also ease writer's cramp, suggests a small study published ahead of print in the Journal of Neurology Neurosurgery and Psychiatry. "

I am thinking of speaking to the neurologist who diagnosed me...to see if this treatment is available to me. I also read that acupuncture can provide relief for some patients...but I've always been a little skeptical of it.

I also read that pain and aches from writer's cramp are not common...and, according to Dystonia Foundation at this site: http://www.dystonia-foundation.org/pages/more_info/54.php, pain symptoms associated with this form of dystonia may be more frequent when the dystonia is SECONDARY.

Thus: "Cramping or aching of the hand is not common....If the writer’s cramp is secondary, there may be a greater frequency of pain."

And: "Secondary: Those forms of dystonia that are attributed to an outside factor such as physical trauma, exposure to certain medications, and additional neurological or metabolic diseases.

That means, if I am reading correctly, that the writer's cramp dystonia may simply be a by-product of some other neurological condition that the patient already has. In my case, perhaps it's the Essential Tremor neurologicaly condition I was also diagnosed with.

The Dystonia Foundation also reports that Botulin injections may be the best route for relief. The best results they found for drug therapy is about a 5% improvement:

"A multitude of oral drugs has been studied to determine benefit for people with writer's cramp, but none appear to be uniformly effective. About 5% of people's symptoms improved with the use of anticholinergic drugs, such as Artane® (trihexyphenidyl), Cogentin® (benztropine).

Botulinum toxin injections into selected muscles are helpful in treating writer's cramp, especially when significant deviation of the wrist or finger joints is present. Although this treatment is not effective for all people, significant improvement in writing and reduction of pain is seen in at least two-thirds of those persons treated."

I think all of this information justifies my exploration of the Botulin route of treatment.

Cho Seung-Hui's Parents

It just occured to me, while I was watching the coverage of the Memorial Service of the Virginia Tech victims...what must the parents of Cho Seung-Hui be going through?

If you are a parent...can you imagine the horror of knowing that the child you brought forth into the world some years ago...the child who, no doubt, brought you countless hours of laughter, happiness and joy...the child you watched grow up and for which you had dreams of greatness...the child you lifted on your shoulders, tickled before bedtime...the child who was once a symbol of hope, the future and possibility...now stands as a symobl of such misery and horror that his actions are deemed the worst shooting tragedy in American history.

Because of the child you brought into the world...the President of the United States is making a speech about 32 young people dead. Your child killed them.

Because of the child you brought into the world...a new page of indelible tragic history will never be forgotten. Your child wrote that page...and his face will always be associated with death and misery.

How could you ever celebrate the birth of your child again? How could you keep out photos of him as a smiling, laughing baby, understanding that those photos represent a brief time when his life would ultimately apex in a crazed moment of murderous outrage, outdone by any criminal before him?

How could you do anything...but now wish to God that he was never, ever born.

Think about it.

As a parent, I can't imagine how difficult that must be. So, my heart goes out to them, as well as the victims.

Neurologically Related?

I never thought about it much before, but I think it's possible that the neurology behind stuttering could be related to the neurology that surrounds the two other conditions that I have (but rarely mention). Two years ago, I was diagnosed with both Essential Tremor (http://en.wikipedia.org/wiki/Essential_tremor ) and Medical Writer's Cramp...a form of dystonia (http://en.wikipedia.org/wiki/Dystonia ).

I began to notice, years ago, that my hands naturally shake when I perform tasks, like bringing a cup of coffee to my mouth or putting a pencil into a sharpener. The closer to the sharpener or to my mouth that my hands would go, the more noticable the tremor. My co-workers began to notice it when in meetings, if I held up a piece of paper to read...it would shake pretty badly. Most thought I was just nervous or had had too much coffee.

Add to this, the fact that, since about school age, I've had a very difficult time writing more than 3 sentences in a row. After the first line, my hand would literally begin to ache and I would be unable to relax it to write smoothly. After about 3 sentences, my writing became erratic and virtually illegible. I got marked off on my grades for being "sloppy" and my early school teachers would give me handwrting assignments to try to improve my handwriting. To no avail.

Once I got into high school, I did everything I could to convince teachers to let me type all of my papers...rather than write them. And by college, I never hand wrote anything...and still don't to this day.

Keeping a journal is something that appeals to me and even have about 5 of them I have collected. None have more than one page filled, however. I simply can't do it. Additionally, when I work out at the gym...certain exercises are funny to watch. For example, when I do the machine for building up my front-thigh muscles, my legs vibrate very strongly when I lift the weights. It's almost embarrassing.

When I was diagnosed for Essential Tremor, the neurologist asked me if I had difficulty with writing. I said that I did and he gave me a simple writing test to determine the extent of my problem. The test consisted partly of beginning in the middle of a piece of paper and slowly drawing a spiral, working my way out. By the third revolution, the spiral disintegrated into a warbling, jumbled mess.

Interstingly, I am almost ambidextrous (born left-handed, early teachers forced me to write with my right hand)...and if I write with my right hand, there is no noticeable tension and I can write smoothly, though it's very time consuming, since it's not as natural. Also, the handwriting appears to be that of a school-aged kid. Very structured and loopy.

So, he prescribed Proponolol for the tremor and offered that I might have surgery for the Writer's Cramp...or injections of some kind...can't remember what. Maybe Botox. I declined both.

I'm just wondering if there might be some connection between the neurological condition that causes my stuttering...and these other conditions.

I'm An Outlaw Stutterer!

Are all police officers morons or is it just in America? So, I'm pulled over for an alleged minor traffic violation...I didn't come to a full stop in a residential stop sign...and this burly cop with too much after-shave an over-sized neck knocks on my window. He was wearing Ray Ban sun-glasses, which I think are standard issue in California. Apparently, they think it's cool...as if wearing fashionable sunglasses will make up for the fact that they all look like idiots with more gadgets attached around their belt than Batman.

So, I roll down the window and he asks me if I know what I'm being pulled over for...like I'm on a game show or something and if I answer correctly I win a prize. I noticed that he had beefy forearms that would rival those of Popeye...which I found hilarious. He obviously spent a considerable amount of time in the gym, working on those formidable appendages. I thought about telling him that perhaps he ought to have spent some of that valuable time working on the area just below his chest and right above his belt...but since his ego is probably directly proportional to the size of his gut, I didn't risk the remark.

I answered that I did know...and he proceeded to give me a truncated seminar about the dangers of rolling through stop signs. Apparently there is some kind of out-of-control epidemic of old ladies and school children being mowed down by cars traveling at the outrageous speed of 2 miles an hour.

He then asked me where I was headed and I hesitated in my answer, facing a particular nasty stuttering block...and right away...he jumped to the conclusion that I was either lying or hiding something...or maybe drunk. Or all three. I finally said that I was headed home. He asked me if I was sure, since I hesitated and I told him I was a stutterer. I'm guessing that they teach pharmacology at the police academy, because he then asked the brilliant question, "Are you taking medication for that?"...like this was relevant, as if an over-dose of some stuttering medication causes people to commit minor traffic violations.

I wanted to ask him if he was taking his daily idiot pill, but instead just said that I wasn't. He then walked to the back of my SUV and peered in the rear window, presumably looking for bodies or automatic weapons or something equally dramatic. I think he was disappointed to only find my work-out clothes and a case of bottled water because he came back to my window and asked me for my driver's license and proof of insurance. "Is this your vehicle, sir?"

No, it belongs to my pimp, you pinhead.

"Yes, and it's paid for, as well." That was a lie, but since my current monthly payment was already made, I figured I could squeak by on a technicality if it came up as an issue at my criminal trial.

I lucked out, though, because he let me off with a warning and a final few words on the dangers of violating traffic laws...and then he sombered back to his cruiser and drove away.

I've never been accused of lying or being drunk because of my stutter...so I thought the entire incident was a bit amusing.