Neurostimulation

[Duke]

Has anyone ever tried Neurostimulation after their spinal cord injury.And if you have what were the results. Thx Duke

[Duke]

I was wondering that this device might not be a good idea for people with spinal cord injury.I seen the video and its saying that people who sit for periods of time have problems with this device and there are high risk for infection.I understand you will have a remote control to turn this device on and off..and the idea of this thing going off when you dont have any feeling from the waist down.If you ask me this sounds like a spinal cord injurys worst nightmare.

[This message was edited by Duke on 11-08-03 at 09:01 AM.]

[alan]

I had a spinal cord stimulator for a year. Despite three revisions of the stimulator position, it never helped.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[metronycguy]

my pain mangement doctor was just recommending it for me today, but my psyatrist says with the nerve damage i already have , any complication such as infection will cause paralysis on my my strong side. so not worth it to me. but its tempting to try

[Wise Young]

There are many studies indicating that stimulation can help some people. It is hard to predict, however, who it will help.

yonkersguy, are you referring to infection from the stimulator? I think that is rare if the stimulator is put in at a place that is experienced with placing such stimulators.

Wise.

[metronycguy]

Originally posted by Wise Young:

There are many studies indicating that stimulation can help some people. It is hard to predict, however, who it will help.

yonkersguy, are you referring to infection from the stimulator? I think that is rare if the stimulator is put in at a place that is experienced with placing such stimulators.

Wise.
maybe it was the other pain medication pump, that deliveres the pain med to the cord, they also wanted to install that... i saw where they had infection problems and some may have been caused by the medication, ot at least thats what the pump manufacots claim

[Wise Young]

Here are some recent articles on the subject:

• Krames E (2002). Implantable devices for pain control: spinal cord stimulation and intrathecal therapies. Best Pract Res Clin Anaesthesiol 16:619-49. Summary: Untreated chronic pain is costly to society and to the individual suffering from it. The treatment of chronic pain, a multidimensional disease, should rely on the expertise of varying health care providers and should focus not only on the neurobiological mechanisms of the process but also on the psychosocial aspects of the disease. Implantable devices are costly and invasive, and such efficacious therapies should be used only when more conservative and less costly therapies have failed to provide relief of pain and suffering. Spinal cord stimulation provides neuromodulation of neuropathic, but not nociceptive, pain signals and when used for appropriate indications in the right individuals provides approximately 60-80% long-term pain relief in 60-80% of patients trialled for efficacy. Intrathecal therapies with opioids such as morphine, fentanyl, sufentanil or meperidine--or non-opioids such as clonidine or bupivacaine--provide analgesia in patients with nociceptive or neuropathic pain syndromes. Baclofen, intrathecally, provides profound relief of muscle spasticity due to multiple sclerosis, spinal cord injuries, brain injuries or cerebral palsy. Pacific Pain Treatment Centers and Neuromodulation, Journal of the International Neuromodulation Society, San Francisco, California 94109, USA.

• Monhemius R and Simpson BA (2003). Efficacy of spinal cord stimulation for neuropathic pain: assessment by abstinence. Eur J Pain 7:513-9. Summary: Assessment of the efficacy of spinal cord stimulation (SCS) against neuropathic pain remains problematic. Some patients may underestimate this, as revealed by their reaction to stimulator malfunction. This study investigated whether abstinence from SCS would provide an indication of its effectiveness. Patients were invited to complete two brief questionnaires each day for 50 days including two periods of 14 days without stimulation. Pain level, sleep quality, activity level and drug intake were recorded. Of 75 patients thought to be using their stimulators, 12 did not respond to the invitation, eight had unresolved technical problems and one no longer needed SCS. Of the 54 remaining, 10 did not wish to be without SCS and 15 declined without giving a reason. Thus 29 agreed to take part but three then dropped out through illness and questionnaires were not received from 10. Ten returned completed questionnaires but failed to follow the protocol; five of these were unable to leave their stimulators off. Only six took part correctly. Twenty of the 29 had received a preliminary explanatory home visit and for nine this was done by telephone. The former produced a considerably higher yield. All six who completed the study correctly had statistically significantly lower pain scores during stimulation. Four had improved sleep but only one reduced his medication and none of the six increased their activity levels. Correlation with previous clinical assessments is discussed. It is concluded that the abstinence principle might provide a useful tool but its power is very methodology-dependent. School of Molecular and Medical Biosciences, University of Wales Cardiff, Museum Avenue, CF1 3US, Cardiff, UK.

• North RB and Wetzel FT (2002). Spinal cord stimulation for chronic pain of spinal origin: a valuable long-term solution. Spine 27:2584-91; discussion 2592. Summary: STUDY DESIGN: A literature review was conducted. OBJECTIVE: To review the indications and efficacy of spinal cord stimulation, particularly in reference to chronic pain of spinal origin. SUMMARY OF BACKGROUND DATA: The first spinal cord stimulation was implanted by Shealy in 1967 via a subarachnoid route. Early systems were plagued with a high rate of complications and technical problems. With the evolving technology, especially the advent of multichannel programmable systems and more precise epidural placement, the ability of spinal cord stimulation to treat various pain syndromes improved. This article reviews the literature on spinal cord stimulation from 1967 to the present. METHODS: The literature is reviewed, with a particular focus on recent studies investigating the efficacy of spinal cord stimulation for low back pain. RESULTS: Most studies are limited by the same flaws, namely, retrospective study design. At this writing, the few published randomized prospective studies have suggested that spinal cord stimulation may be superior to repeat surgery. Complication rates have declined to approximately 8%, and reoperation is necessary in approximately 4% of patients. When current percutaneous techniques are used, a lead migration rate lower than 3% may be achieved. For certain topographies, laminotomy leads may be superior, particularly with regard to low back pain. CONCLUSIONS: The ultimate efficacy of spinal cord stimulation remains to be determined, primarily because of limitations associated with the published literature. However, on the basis of the current evidence, it may represent a valuable treatment option, particularly for patients with chronic pain of predominantly neuropathic origin and topographical distribution involving the extremities. The potential treatment of other pain topographies and etiologies by spinal cord stimulation continues to be studied. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. rnorth@jhmi.edu.

• Sindou MP, Mertens P, Bendavid U, Garcia-Larrea L and Mauguiere F (2003). Predictive value of somatosensory evoked potentials for long-lasting pain relief after spinal cord stimulation: practical use for patient selection. Neurosurgery 52:1374-83; discussion 1383-4. Summary: OBJECTIVE: Spinal cord stimulation (SCS) has been used for more than 30 years in patients with intractable neuropathic pain, and global success rates have varied from 40 to 70%, according to reported series. Patient selection is currently based on a preliminary percutaneous test, which is useful but invasive, increases the risk of infection, and has yielded false-positive and false-negative results. In this study, we evaluated an alternative method of predicting the effectiveness of SCS before deciding whether to implant laminotomy electrodes-specifically, assessment of neural conduction in the dorsal columns with the use of somatosensory evoked potentials (SSEPs). Thus, we examined the value of preoperative central conduction time (CCT) of SSEPs to stimulation at the level of the painful area as a possible predictor of patient outcome after SCS. METHODS: Ninety-five patients were evaluated during a mean follow-up period of 18.8 months. Patients were classified into four categories according to the location of the lesion responsible for pain: 28 patients had lesions of the peripheral nerves, 27 had radicular lesions, 8 had root avulsions, and 32 had cord lesions. The SCS electrode was implanted through an interlaminar opening at the upper part of the painful territory without performing a percutaneous screening test. Clinical and social markers of pain relief (i.e., Visual Analog Scale scores, analgesic drug intake, work status) were evaluated prospectively 2 months after implantation and then annually. RESULTS: The global success rate in our study group, with success defined as at least 50% long-term pain relief, was 54.7% (52 of 95 patients). Statistical analyses showed a clear influence of preoperative CCT on SCS outcome. Thus, the success rate was nil in patients with significantly abnormal CCT, whereas it was 75.4% in patients with normal preoperative SSEPs. Significant differences between the two groups of patients also were observed with regard to medication intake and work status. CONCLUSION: Preoperative SSEPs provide an objective prediction of patient outcome after SCS. We suggest that if a patient's CCT is abolished or significantly altered, the patient should not undergo SCS. Department of Neurosurgery and UPRES-EA 1880, University of Lyon, Hopital Neurologique P. Wertheimer, 59 Boulevard Pinel, F-69003 Lyon, France. marc.sindou@chu-lyon.fr.

[mike]

Dr.Young

Have you ever heard of neurostimulation working when the the insertion point is below the level of the injury? At a pain clinic that I went to, the pain doctor who was certified by the Medtronics company, recommended that I have this done. This did not make a lot of sense to me.

mike

[Wise Young]

mike, I am not personally familiar with neurostim for pain but, yes, stimulation below the injury site is often done and has been reported to be helpful. Like you and probably most scientists, I am not sure of the mechanism. Wise.

[mike]

I am a walking c5 and have had increasing CP for the last three years. My pain is primarily severe burning from the hip level down into my feet. I am on Neurontin and have had minimal relief with that drug.

I recently had a neurostimulator inplanted and it has given me some relief. Even though the insertion point is at the T level, it does provide a tingling rather then the extreme burning for most of the lower portion of my body. It is no cure, but it is some help.

I mention this so that some of you with similiar pain might want to give this a try. It costs nothing to try as a wire lead is inserted and attached to a battery pack worn on you belt or placed in your pocket. Later the battery pack and stimulation unit is placed under the skin. The surgery is about $30K and is covered by most but not all insurance.

I would be interested to hear from others who have had this procedure.

mike

[Aquitaine]

Originally posted by mike:

I would be interested to hear from others who have had this procedure.

mike

Hi mike,

I have had this procedure held out to me as a "last chance" option by my pain doc, for when I no longer get any prevention from meds. But like metro's, my doc is reluctant to perform it, based on the possibility of infection. From his experience with this invasive procedure, he still feels very strongly, that this is a major issue. So mike, I guess the $64 question is, are you having any problems so far with infection?

Thanks for sharing your experience with this device.

Never underestimate an individual, Never overestimate a bureaucracy.

[dejerine]

Hey Mike, Thanks for sharing your information. Very interesting post on paresthesia blocking dysesthesia. Would you be kind enough to indicate how long they thought your electrodes would remain in place in the cord. Also, did they tell you WHERE in the cord the electrodes would go? Eg. dorsal horn, anterior cord, intermediolateral cord? How much does the paresthesia bug you,if I might ask.

[metronycguy]

i remember i believe i got confused with the difference between the neurostim and the intracel pain pump, i believe my physiatrist was more concerned with infection with the drug pump than the electrode type, i believe the neurostim doesn't have the problems of granules being formed at the delivery point, causing infection and the problems of using improperly compounded medications as in the medication type pump,
i remember reading where some of the failure/ infection of the medication pain pump was blamed on it being used for compounds not approved , something like adding morphine or something to the anti spasm ..baclophen mix?
but i know very little on this , i just pay attention to all aspects of it..

[alan]

I had one. It was in for a year, the stimulator position in my spine was adjusted three times, and never any relief.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[mike]

Hi Dejerine. The wire was placed in the thoracic area and provides stimulation from just above my butt to the bottoms of my feet.According to my doctor the wire can stay in place as long as I get relief although I have read the the maximum is five years. In five years, who knows the research scientist might find another approach that works better.

Using the stimulator has got it's downsides. The paresthesia at higher settings can be unconfortable but not painful. I also noticed that at higher settings the stimulation affected my walking. In addition while riding in a car I noticed that the stimulation would increase based on the engine activity of the car. Haven't asked my doctor about that yet but I will.

The best effect of the stimulator was in my feet. between the burning, and allodynia my feet would be very painful. The stimulator helped that quite a bit.

I asked my doctor about infections, granule forming etc and he said that he had not heard of that happening with stimulators but had seen some of that with pumps.

All in all this appears to be a low risk procedure where you do a trial first before committing yourself to an implant.It is not a total answer but might work for some.

mike

[alan]

"I asked my doctor about infections, granule forming etc and he said that he had not heard of that happening with stimulators but had seen some of that with pumps."

One of several reasons I've stayed away from a pump. With my luck, a granuloma will form, and every other possible problem will happen, too. http://sci.rutgers.edu/forum/images/smilies/frown.gif Though I am getting desperate enough to say the hell with it, and find a way to try one. So what if I won't be able to pee? As it is, I already can barely sit or move.

In my next life, I will let myself panic and drown. Damn swimming lessons. "Just don't panic when in trouble underwater, and you'll be fine." This isn't close to fine.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[dejerine]

Dear Alan,

You can say more with fewer words than anyone I know. Powerful--leaves me speechless.

How I wish I could help, but all I can do is pester Elias Zerhouni at the National Institutes of Health. I hope the squeaky door idea keeps working. He just gave six million to one researcher who studies the glutamate receptor. Pretty generous.
___________________

Model letter,

Elias Zerhouni, Chairman
NIH
Bethesda Maryland

Dear Dr. Zerhouni

We are dying of pain. Our Central Pain does NOT respond to opiates. We burn terribly all over our skin surface and in the viscera. Please help us.

Sincerely yours,
Creature from the Nav1.3 Lagoon.

[dejerine]

Thanks Mike,

Do you happen to know in a cross sectional aspect, WHERE the electrode(s) went. Were they aiming for the front of the cord, the side, or the back. Are there bilateral electrodes?. Sounds like they had good aim irregardless if you are getting some relief. Glad for you.

[mike]

Dejerine, the wire inserted had four electodes which enabled the doctor to stimumlate different areas. For me this was a test, not an actual implantation. There are still areas in my legs and thighs that I am not getting any relief. The doctor feels that another test with further fine tuning will help those areas as well. My doctor feels that unless he can reduce my pain by 70%, the procedure is not worth doing. His experience is that patients will somewhat adjust to the stimulator so that an initial high level of pain relief will go down over time. In any case I will keep the group posted as things move along.

mike

[alan]

Keep us posted. Dejerine.

Good luck with the stim, Mike.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[alan]

More words:

I wish I had a way to put myself out of my misery (lack of hand function is so limiting.) Not that I'd necessarily do anything now or soon - I just think that having the knowledge that I have the power to end this torture would improve my mental status somewhat. As it is, I have maybe 40 years of further worsening pain and scoliosis to look forward to, plus all the problems of aging, most of those years without my mother to help handle things (with my inability to concentrate and do activities of daily living, I can't see myself handling the care of a home, bills, etc. Heck, I may not only be homebound by pain but bedbound as well down the down the road.) And the medical profession can't see the urgency of my problem - I feel like all my skin is scraped off, and the bones in my back are compressed and compound fractured (short synopsis of my sensations), but doctors can't see these injuries on me, just as I can't. If I came into a hospital with actual road rash and compound fractures, there'd be no doubt of the need for immediate care and pain relief, but these feelings are all in my brain. No brain equals no pain, as we spinal cord injured know all too well, being that dysreflexia results from pain that the brain doesn't get to record and have us react to. Central pain is the exact opposite - the brain gets messages of severe pain from areas that wouldn't and shouldn't be painful without the central nervous system damage. But our brains can't be removed, as we need them, and we can't clone a replacement without the CP sensations ingrained, just as we can't clone a new spinal cord to replace our damaged one.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[dejerine]

Dear Alan,

Here is what I expect to happen. The cost of health care is the fastest rising segment of the economy. Mathematically this can't go on. The research is funded by NIH, stolen by drug companies (82% of all drugs courtesy of U.S. taxpayers via NIH, but the money virtually NEVER goes back to fund more scientific research at NIH) and the drugs are then made OVERSEAS! Sound like a good system? I say keep the patents, bypass the US drug companies and contract with companies overseas to make them at cheap prices, and send the profits back to NIH scientists. If the CEO's are so crazy about outsourcing, lets outsource the CEO's and get someone overseas to make NIH scientists some money.


There is at least one fulltime drug company lobbyist for every elected Sen and Rep. They are said to be the best in the business. Rep. Gutknect, the Republican Congressman who tried to include a phrase in the Medicare bill to allow collective drug bargaining only to have it made ILLEGAL, of all things. No corruption here. (cf. The Military and VA collectively buy cheap drugs all the time).

As to HMO hospitals, monopoly factories who don't care about pain, after the CEO's have all gotten their Swiss bank accounts bloated, the US will realize HMO's have ripped them off and demand something else. Health care premiums cannot keep doubling every five years. Medicine got along perfectly fine before HMO's and they could ship all the business types to McMurdo Sound tomorrow and we would never miss them. Doctors are perfectly capable of delivering medical care without any business types around to buy paste wax for the hospital floor. Administrators in healthcare are A VAST FIELD OF PARASITES. The administrative overhead in medicine is now 37%. That could drop to 2% (where it was before) if we just revoked the HMO bill Wallace Bennett was duped into introducing. Before that it was illegal for corporations to practice medicine. We were stupid enough to give them hospitals and clinics and subsidies without demanding cheap care. We have the worst aspects of private medicine (ie. it isn't private--its HMO) and the worst of Nationalized care (ie. we don't have it). How stupid are we. These things tend to change as soon as the public becomes aware and they will.

The state of Maine has done a perfectly good job recently of setting up a health plan that works and is cheap and the lady who did it is NOT a suit. She is a human being who refuses to be bullied or bribed by HMO's.

Many people are going to visit Canada for drugs and realize Toronto and Montreal have better medicine than we do. Why else would Hopkins get all their neuro and pain staff from Toronto.

We NEED to have in place the concept that people with CP may very well need extended care facilities. I am proposing this right and left, but pain clinics don't have the concept.

On the scientific front, it is entirely up to funding. Doctors currently researching have the power to unravel the cascade of pain chemicals. They want to block glutamate at chronic pain NMDA receptors, eliminate Substance P, and block protein kinase C or A. Any of these steps SHOULD end CP. However, they MUST have money. We will get in under the orphan drug plan since there are about 125,000 with Central Pain. If they fund the research, it would take two to ten years to get the basic stuff done. Then two years to get it through FDA. Some of us may be in the clinical trials.

The very best thing to happen would be this new pain center at NIH. We could lobby them like mad to make spine hospitals have special wards for pain patients. Once this step has been accomplished, we wait for the NIH to fund scientists. They do the job, and we celebrate and mankind has won the victory over pain.

It WILL be done and COULD be done today. About a fifteen year plan is needed before CP patients will be legitimized and care authorized. It will be a fight all the way.

But I believe it will happen because it will be done in other countries first and then we will have leverage. We are NOT ahead of other nations in CP research.

So I think in about fifteen years, CP will be both ended and care available. It is always possible someone brilliant will surprise us if NIH will fund the new pain research center. The people involved are fully smart enough to stop CP but also smart enough to know they need more money.

I hate to be political but I feel humans are cheated everytime we see our money get blown off into something that won't help disease.


Anyway, that is how I see it. I could be wrong of course, but I think the pace is about where the scientists say it is. Money is the accelerator. It is all perfectly doable. It is just chemistry after all. We don't have to grow new brains, we just have to shut off a few little switches. Its not like cancer where they don't understand what makes cells keep growing. They KNOW what stops CP and can do it in rats predictably in at least three ways.

You inspire me and you break my heart and we all love and admire you Alan.

[This message was edited by dejerine on 03-25-04 at 05:27 AM.]

[alan]

In 15 years, I'll probably be a drooling lunatic in a nuthouse. There's only so much torture a person can endure before he cracks. And I'm driving my sainted mother loco, too.

Lobbying is big business. Every issue spawns lobbyists on both sides, and they all get paid big bucks. Money is always the oil that greases the wheels. How much money has this unnecessary Iraq war cost, and the "War on Drugs" - imagine
if all that money went and was going to medical research? CP, SCI, other conditions would be cured, or well on their way to being cured.

Doc is trying Effexor again, because my mood is so low. Spring depresses me, because I want to get out, and my body won't let me due to the back and abdomen pains (plus, when one can barely drive an electric wheelchair, one is really screwed - I've already tried the control on both sides.) I'll make some attempts, anyway - I still have teeth to grit and lips to bite (they're used during range of motion.)

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[Aquitaine]

Hi Alan,

There are few words that would make any real difference for your situation, all I can do is listen, and relate my own feelings and experiences. They are not the same surely, and yet there are similarities. Today I had a meeting with a new urologist, because of the morphine I've been taking, my sister takes me most places now. After the examination, I was dressing and the doctor met my sister in the waiting room. He told her I was an "inspiration" to him, etc. Of course while my sister was relating this to me, she just kind of rolled her eyes, and I laughed. Not because we didn't appreciate his very kind comments, but we knew that I was just a common person, shoved into a very uncommon set of circumstances, trying to get through each day, one day at a time, just like everybody else. If I had to give myself some sort of qualitative expression, I'd use what my uncle once called me, "one tough old bird". And from what you've expressed about your life, it sounds like you also have a pretty tough quality. There's an old saying that "the best revenge is surviving" and has always been a favorite of mine, maybe we're in a heck of a lot of pain, but we're still here. I don't know about you, but I've out-lived many of my doctors, including several who had no idea what pain management was and made me think hard about ending it many times. But, I'm still here, and my life has gone through many cycles, both good and bad, and I can only say that I wouldn't have wanted to give up one day of it, even the worst of it, because life always seems to cycle back. And there comes along something good to get me through the bad again. Whether its watching a niece get married or a nephew receiving a diploma, even if its from a wheelchair its a victory. I hope you're able grit your teeth through life for a long time yet, not because it makes you a hero, but because it gets you past another day. Maybe the day you need that cycles your life back to a better time, because everything changes, whose to say it won't change for the better? Positive thinking BS? Maybe. But if I had to lay odds, I'd say you'll get through this, cause "tough old birds" just never seem to know how to give up, for some reason they keep on fighting. Your comments about wheelchair control reminded me of a funny story about a young guy I knew in the rehab hospital I was in 28 years ago...

"Tommy" was a 16 yr old quad who had broken his neck in a diving accident. The biggest thrill he had while I knew him was receiving his new powered wheelchair that had a breath controller. I don't know if you've seen these, but to go forward you blow hard, right, blow soft, left, suck soft, backwards, suck hard. For days he was running over people's feet while trying to figure this thing out. The chair had 3 speeds, slow, normal and fast, and of course the nurse's made sure the switch was always set to slow. Everyday, he would beg me (and anyone who would listen) to set the switch to fast. Finally one day there were four of us sitting around waiting for the physical therapist to show up, three paras and Tommy. He was begging for us to set the swithch up again, and knowing the crashes he had already, neither of the other guys wanted to help him with it. But no one else was around, and the hall was empty, so I finally relented, saying, 'ok but its your funeral', and flipped the switch all the way up, figuring 'how fast could this heavy chair really be anyway?'. Well he pulled himself up as straight as he could, to breathe easily, and blew into that tube just as hard as he could. The front wheels came almost a foot off the ground as he wheelied down the hall. Our jaws all dropped as we watched him race off, I grabbed my wheels and tried to catch up to shut the switch off. At the end of the hall were elevator doors and of course, just as he got there, the doors opened and this poor indian guy, who could barely speak english, started coming out. He was bringing the lunch carts up (these are large rolling cabinets that hold a couple dozen food trays each). Tommy was now sucking with all his might, but the chair was already going at least 8-10 mph, and he hit the lead cart at full speed. There were a couple other people in the elevator and one guy (the physical therapist) had jumped around the cart and was already next to the doors. The lead cart was pushed sideways into a large cigarette ash can (the kind that look like a small trash can, but have sand in them, they don't have them anymore because of no-smoking laws, but back then they were everywhere). Most everyone in the elevator ended up with hospital food all over them, the physical therapist was also baptised by sand, and all of this, including Tommy ended up on the floor with the elevator doors banging against the food carts, tring to close. It was quite a picture. The indian hospital worker went off, yelling at no-one in particular, saying nothing anybody could understand. We never saw him again after that, don't know if he quit or what. Anyway, Tommy was laying on the floor laughing harder than I had ever heard him. Once I knew he was ok, I quickly leaned over and flipped the switch back to slow on the wheelchair, and when they asked Tommy what happened he told them the chair just lost control. The two other paras rolled up behind me and backed up the story, we were all just teenagers, so it was 'us against them' and we would lie for each other constantly. But we never touched the switch on that wheelchair again.

Hope that gives you something humorous to think about when you're cruising around in your chair. I'd recommend trying the breath controls, but now you know how hard (and dangerous http://sci.rutgers.edu/forum/images/smilies/biggrin.gif) they are to learn. Best of luck Alan, you are an inspiration, not because you're doing heroic things, but because your doing ordinary things in an extraordinary situation.

Never underestimate an individual, Never overestimate a bureaucracy.

[alan]

That was a funny story. I hope no staff members from that place visit this site. )

I'd type more, but my back is a mess.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

[dejerine]

Aquitaine,

Great story. You bay area guys rock.

[This message was edited by dejerine on 03-27-04 at 02:32 AM.]