Friday, December 20, 2013

Ligaments, Tendons and Bumps, Oh My!

A 20 year old piano major approached me about two months ago because she was experiencing some disturbing symptoms and was wondering if I could help her.  Amy wasn't having any discernible problem playing but her plaint was when she woke up in the morning or in the middle of the night, her three middle fingers were stiff, almost locked and painful.  After she slowly flexed them a few times they were fine and they didn't give her any problems until the next morning.  Her teacher was assigning several difficult works for her to study and forcing her to play with flat fingers so I took about ten minutes to feel her hands and fingers and immediately knew what her problem was. 

Our tendons are made up of thousands of fibers all neatly bundled together, those bundles are bundled, then those bundles are bundled several times over and finally the entire massed bundle makes up a tendon about the size of a linguini and the tendon as a whole is protected in a lubricated sheath where it can glide back and forth effortlessly. 

Think of the tendon as a plastic, polypropylene, polyester or nylon braided rope.  The single rope as a whole is actually made up of thousands of smaller fibers making the whole greater than the individual parts.  Every hiker, camper or construction worker knows that when you cut one of these ropes you need to finish off the ends by melting or burning it.  This creates a little knot of melted materiel and prevents the rope from fraying.  Likewise, as the rope is used, stretched, dragged over edges and exposed to friction, along the path of the rope there will be fraying.  Shakespeare said it nicely, "Take but degree away, untune that string, And, hark, what discord follows!"  Conversely, allow a rope to constantly fray, And hark, what discord follows. 

The body repairs frayed tendons much the same, by putting little knots of scar tissue where damage has occurred.  Doctors often refer to these knots as nodules.  They can be quite painful and can eventually cause the finger to lock up.  Laymen will refer this symptom as "trigger finger."  Picture a sweater with a hole in it.  If you were to sew up the hole, there would be a little knot there.  Although the hole is now healed, the sweater won't wear as effortless as it used to.  Every thread in a sweater is connected to every other thread and every movement will pull on that knot.  That is why diagnosing hand issues is so difficult.  The pain may be in the forearm but that is where the tissue is giving way because there is a knot in the palm.

When you flex your flexor muscles in your forearm, your muscles pull your long flexor tendon which is attached all the way to the tip of your finger and your finger bends.  If there is a little knot or nodule anywhere in the sheath, usually near a joint or in the palm, the nodule can get snagged in the sheath and lock the finger.  Forcing it open can cause more tearing and the build up of even more scar tissue.  A downward spiral begins;  Hark, what discord follows.  As I felt Amy's hand, I could feel the little nodule bumps of scar tissue gliding back and forth. 

Have you ever heard about the legend of the Gordian Knot?  It was a knot so complicated that it was impossible to solve or unravel.  Thousands tried but none were successful until Alexander the Great attempted to untie the knot. When he could not find the end to the knot to unbind it, he sliced it in half with a stroke of his sword.  This technique of problem solving was called the "Alexandrian solution."  A technique many doctors use today. 

If Amy were to go see a doctor, the first thing he may suggest is to stop playing the piano for weeks or months, rest and wear a brace.  Rest in these situations is not going to help.  The body's defense against this kind of damage is to create scar tissue which is not flexible and will lock the tissue in place much like a spider web can entomb and insect.  Scar tissue is what caused her problem in the first place.  If you were to take an unraveled rope and just throw it in a pile, it would be in a tangled mess of a knot.  Letting it sit there for six months will not untangle it.  You need to slowly and patiently unravel it and straighten it out and then roll it back up neatly.  That is what our bodies want us to do.  When it comes to scar tissue, proper movement promotes healing, not rest.

A second treatment a doctor may prescribe Amy is physical therapy.  This is close to the solution because as I said, proper movement promotes healing but PT most likely will not solve her problem.  She will receive massage therapy, contrast baths, working with weights and pulleys, molding clay, wax and other muscle building techniques, but, when Amy goes home to her piano, all the physical therapy in the world won't be able to counteract the damage she will do in the privacy of her own home or practice room.  Like the Battle of Thermopylae, it doesn't matter how many Persians march through the pass, the Greeks had the upper hand.

A third treatment option will most likely be a cortisone shot.  Cortisone melts tissue.  If the doctor can inject the cortisone directly into the nodule he can melt it away, along with anything else which comes in contact with the cortisone.  No thank you.

A final treatment will be surgery where they will cut the sheath or scrape the nodule off the tendon and of course, the body will respond to the surgery by creating - say it with me - "scar tissue."  The good news is during the several months it takes to fully heal, with PT, you will have full control over your fingers again.  This may be a solution for the average person, however, for a concert pianist, the result could be devastating. 

So what was Amy's problem causing her symptoms?  It was simply her flat finger technique.  Now, I'm not a university piano professor so I don't want to comment on his desire for Amy to play with flat fingers.  What I do know is that the finger is made up of several bones which neatly line up and are held together by ligaments, pulled by tendons and controlled by muscle.  If I were to poke you in the eye, I would align my fingers so all the bones were in a straight line for maximum eye poking jabs.  A curved finger would not do the job as effectively.  When playing the piano, the opposite is true. 

There are two ways I teach my students to find their optimal finger alignment or kinetic chain.  The first is to lay on the floor, flat on their backs with bended knee.  With their arm to their side, gently isolate one finger and lightly press it to the floor while lifting the whole arm off the floor.  Then gently rotate, swivel and explore a circle with the finger touching one spot on the floor.  Not to get all Zen here, but as in everything in life, it is in the imbalance where we can find the balance.  If you shift too far forward you will feel the tension in the front joint of the finger, too far back you will feel the tension in the tendon beneath.  If you hyper-extend the finger, you will experience that discomfort, too.  Do this will all five fingers and upon discovering the perfect effortless alignment, look at the finger and palm and take note of the perfect curve much like the dome of a cathedral ceiling.  That is the finger at its optimal strength where the load bearing bones are properly aligned by the tendons.   A second method of finding this alignment is to stand with your arms to your side.  Shake your hands until they are loose then let them hang to your side. Without moving a single finger, raise your hand and look at your fingers and palm.  They should be in perfect alignment for optimal piano playing power. 

It is the bones that depress a key and it is the tendon which puts the bone in place to play it.  Amy's flat finger technique was forcing the tendons to play the key and as a result was fraying her tendons and ligaments like a nylon rope.   I'll repeat, it is the tendon which aligns the bone and the bone which presses the key down through the use of gravity and the weight of the arm.  Tendons are for alignment, ligaments hold the bones together, bones do the load bearing work.  Deviate from nature's design and you're going to have problems.  These ligament, bone, muscle and tendon duties are not interchangeable.  Can we do it?  Sure.  Should we?  I can rob banks and make a lot of money but eventually I'll get caught and arrested.

After only two months of study with me, Amy's symptoms have pretty much disappeared and she stopped taking lessons. That is really unfortunate for her as she has several other problems her university piano professor has not addressed.  She also has a pretty bad ulnar deviation of the wrist and she has adduction and abduction issues with her thumb.  The combination of these two movements will eventually strain the tendon in her thumb creating a leakage of synovium fluid, the lubricant within the tendon sheath, and create a ganglion cyst or, "Bible Bump."  Guess how Dr. Alexander will treat this? 

-Malcolm Kogut (not a doctor, either).

Wednesday, December 18, 2013

Others

This is an old spiritual song of inspiration that my mother used to sing to me.  She also had an old scratchy recording of Tennessee Ernie Ford singing it.   This song and my mother's example of selfless service to others was very formative for me.  Because of her example and constant encouragement to help other people, I have always sought to help people by volunteering at a homeless shelter, a suicide hotline, 211, nursing homes, the VA hospital and many other places.  I have even been in the right place at the right time to save the lives of seven people.  One was an eight year old by from drowning, a fifteen year old boy who fell from a cliff, an elderly blind woman about to walk out onto a busy highway, a diabetic man that I twice discovered him lapsed into a coma, a woman who was choking, catching a man who passed out and was about to fall and my mother herself on numerous occasions.  I also prevented two house fires, one in my own home as a teen and the other in the home of an elderly woman who forgot that she had food cooking on her stove. 

When my mother was in a morphine induced coma, I slept on the floor by her bed for about two weeks as I nursed her to new life.  It was both the most painful and beautiful thing I have ever done.  While she was in a coma, I played her Tennessee Ernie Ford record over and over for her.  Shortly after she died, in 2001, I penned this little arrangement of "Others" and I recently found it so, I thought I would upload it. 

In my mother's final year she had no money and said that she wanted to go shopping so I offered to take her.  She said that she didn't have any money so I gave her $20 (a lot in those days).  As we were driving for the mall, she told me to stop in a little thrift shop which served the poor.  She went inside and found this ugly multi-colored sweater which was marked for fifty cents.  She gave the $20 to the lady who ran the thrift shop and told her to keep the change.  She was always doing little things like that.  After she died I brought all my mom's clothes to that thrift shop, including that sweater.  Upon telling my friend Carol that story, she drove an hour to that thrift shop and bought the sweater.  It was still fifty cents.

Now, to kill this otherwise wonderful tale, the thrift shop served a lot of poor and had done a lot of good work for several decades, but it was also always under fiscal duress itself.  All of the local churches supported it with special collections.  When the woman who ran it died, they discovered that she had three million dollars in her personal accounts.  Her children inherited it and kept it. 

For a copy of the sheet music:
http://www.free-scores.com/download-sheet-music.php?pdf=59516
To hear Ford singing it:
http://youtu.be/sD7W74LQb94

Lord, help me live from day to day
In such a self-forgetful way
That even when I kneel to pray
My prayer shall be for—Others.

Refrain

Others, Lord, yes others,
Let this my motto be,
Help me to live for others,
That I may live like Thee.

Help me in all the work I do
To ever be sincere and true
And know that all I’d do for You
Must needs be done for—Others.

Refrain

Let “Self” be crucified and slain
And buried deep: and all in vain
May efforts be to rise again,
Unless to live for—Others.

Refrain

And when my work on earth is done,
And my new work in Heav’n’s begun,
May I forget the crown I’ve won,
While thinking still of—Others.

Refrain

-Malcolm Kogut.

Tuesday, December 17, 2013

Criminalizing Life in the United States

A new study came out today that said 49% of the drivers on the road text while they drive.  Another study said 4 out of 5 college students text while driving.  Of course, politicians will now want to draft new legislation to increase the penalties on top of the already existing penalties for texting while driving.  Police departments will get additional grant money to purchase more vehicles so they can peer down into your vehicle to see if you are texting in your lap.  Senators will get to appear on TV news spots so they can inform the public of the wonderful job they are doing to protect you.

Texting laws don't actually make our roads more safe, they make them less safe.  If 50% of drivers are texting, which is against the law, making another law isn't going to stop them.   They obviously don't care about the law or they think they can get away with it (those criminals).  When cell phones first came out, I used to see people texting all the time by holding their phone up in front of their steering wheel so they could see both the road and their phone.  Now that it is against the law and they don't want to get caught, they text in their laps where they have to take their eyes off the road.  This is more dangerous than playing with your GPS, radio or cruise control.  The roads were more safe when they held their phones up to the road.  These laws have probably caused more accidents than they prevented.  People who text are not going to stop texting.  Period.  It's against the law to drive drunk, too.  What about marijuana, burglary, and prostitution?  Laws only stop honest people because either they are afraid of getting caught or the are educated by the law.

If our politicians rescinded the texting law and promoted education about the dangers of texting while driving, our roads would be more safe because the people who don't care about their own life or your life will at least be texting back up in the open where they can  maintain partial eye contact with the road.  This way, also, the taxpayer won't have to foot the bill for police departments to purchase new undercover SUV and vans used to catch people texting.  There will also be less arrests, court costs, incarceration, fines, increased insurance rates and the ancillary burden to the pocketbooks of the people who don't break the law.

Our politicians are excellent at creating laws that don't work and cost us more than they save.  Skylar Capo was 11 years old when she rescued a woodpecker who was about to be eaten by a cat.  Since the bird was injured, she wanted to nurse it back to health and she carried it to a local hardware store to get a cage for it.  While there, a USFWS agent issued a $600 ticket to Skylar and informed her that she faced up to one year in prison for violating a federal law against transporting migratory birds. 

Carey Mills procured all the state and local permits to build a camp on his waterfront property.  The day he began clearing for what was to be the foundation, the EPA arrested him for violating the Clean Water Act and he did 21 months in prison despite getting permits from the state. 

Steven Kinder ran a caviar business on the Ohio River which forms the Ohio-Kentucky border.  Mr. Kinder was arrested because he reported that his business was in Kentucky but was seen harvesting from "Ohio waters."  He faced $250,000 in fines and five years in prison.  He took a plea deal for three years probation and a $5,000 fine.

Lisa Snyder was a say-at-home mom and as a favor to her Michigan neighbors, would watch the local children for 15 minutes every morning until they caught the bus - because the bus stop was in front of her house.  When the police caught wind of this, she was threatened with 90 days in jail for operating a daycare and offering "babysitting services" without a license. 

Jeff Counceller and his wife found an injured baby deer and nursed it back to health.  Jeff was charged with possession of a deer and the animal was to be euthanized per state law.  Fortunately it "escaped."  The greater lesson is not to post pictures to Facebook.

Eddie Anderson of Idaho took his son camping where they found an "Indian" arrowhead.  He found himself facing two years in prison for theft of archaeological resources and  a $1,500 fine but took a plea deal for one year of probation.  The greater lesson is not to post these finds to Facebook.

Nancy Black operates a whale watching business and had videotape of a crew member whistling at whales to get them to stay near the boat.  After viewing the footage, NOAA burst into her home demanding the unedited tapes of the day in question.  She is facing 20 years in prison for withholding evidence.  The greater lesson is not to post your life to Facebook.

Ashley Warden was fined $2,500 after her three year old son Dillan pulled down his pants to urinate in his front yard.  A police officer spotted him committing this crime of exposure and he was facing charges and being put on the sex offender registry. 

Ann videotaped her husband changing their grandson's diaper.  Grandpa tickled the boy's "new-no" as he wriggled with glee and laughter. After posting pictures on their Facebook page, Ann was charged with distribution of child pornography and her husband did five years for molestation.  They are now registered sex offenders and were forced to move from their home of 40 years due to residency restrictions.  

Gary Harrington dug three ponds on his property to control rain water and snow runoff.  Gary was sentenced to 30 days in jail for collecting rainwater without a permit, which is against the law in Oregon.  He is now forced to continually drain his ponds.

Abner Schoenwetter of Florida shipped some marginally small lobsters in plastic bags to prevent leakage.  By law, lobster can only be transported in cardboard.  Abner was sentenced to eight years in prison because he didn't know of this regulation. 

Wallerstein and Wylie conducted a study of 3,000 New Yorkers who have never been arrested and found that 91% of them have "innocently" committed felonies but were not caught.  100% of them committed a misdemeanor of some type.  The next time you go out in public, know this, you are most likely walking among criminals. 

What can you do to reverse the orvercriminalization caused by politicians who feel they have to do SOMEthing in order to justify their high salaries?  Sign up for email updates from Heritage.org, NACDL.org, RightOnCrime.com, ACLJ.org, JusticeFellowship.org, ACLU.org, ALEC.org, FAMM.org.  Share your concerns with your elected representatives.  Demand that they focus on rescinding laws rather than pyramiding more laws on top of more laws.

Friday, December 6, 2013

The Sound of Music




In case you missed the live NBC staged performance of "The Sound of Music," featuring Carrie Underwood as Maria, it was, well, watch this:

Thursday, December 5, 2013

Forgive or Hate?

It has been a sad day today.  First, Nelson Mandela died.  However a bigger story on my local news is the sentencing of a 23 year old man to five to fifteen years in prison.  A year ago he was driving while intoxicated and crashed into another car carrying four teenagers.  Two of them died. 

What is very sad is that the family and news media are outraged that the 23 year old (I'll refrain from using his name) did not get more time.  They were quite angry and demanded that the Governor increase the prison penalty for those convicted of DWI and manslaughter. 

What saddens me is the degree of hate and revenge the family and friends had at the news conference following the sentencing.  One of them said that they hope that the hell this 23 year old will face in prison is a foretaste to the hell he will face in eternity.  The only thing this press conference was doing was making things worse, fueling anger and stressing one another even more making the old adage "misery loves company" all the more true. 

Nelson Mandela once said "Resentment is like drinking poison and then hoping it will kill your enemies."   When someone can't let go, when they hold onto anger and dedicate their life to revenge, it changes everything;  It changes their relationships, their attitudes and everything they do in life.  There is much to lose when you hate.  You don't lose a thing when you forgive because it is not a sign of weakness to forgive someone who hurts you, it's a sign of strength, in fact, you'll have much to gain.   Now this does not mean you have to become best friends with the person who hurt you, it simply means that you will no longer be caught in a downward spiral of anger and hurt which you may take out on other people such as family and friends.

Anger, bitterness and hate is more than a negative outlook on life.  It is a destructive and self destructive power like a cancerous cell or dangerous mold that thrives in the darkness of the heart.   It can be physically and emotionally damaging.  As the great Buddha once said, "He who opts for revenge should dig two graves." 

I don't know the young man convicted nor his remorse, rehabilitation or guilt, but in refusing to lay aside hatred, the family and friends are continuing to let him exert his influence over them.  Meanwhile he will spend the next five or ten years oblivious to their pain, in his state imposed Ashram, exercising, making new friends, studying at the school for crime, and learning to hate society for hating him.  When he gets out he will most likely be worse than when he went in and a continued burden to tax payers.  Under house arrest, he and his family would bear the burden for the cost of incarceration.  In prison, the taxpayer will be forking over about $30,000 per year to punish him.  Nobody wins. 

Someone once said that life is ten percent what happens to you, and ninety percent what you do with it.  Imagine if all the hate and energy being put toward destruction and lobbying for more laws was put into restorative justice, education and awareness.  These are not the last two teens who are going to be killed by a drunk driver and all the hate in the world directed at the 23 year old isn't going to save them.  Education and awareness of the evils of alcohol may.  But it seems these people wish to take revenge - on themselves because that is what hatred does.  Forgiving someone who hurts is us hard but everything is hard until you do it, then it becomes easy.  Then we will be inspired to do something - something good.  Maybe that is the scary part, it is easy to be angry and get other people to do something.  Bad things will always happen, but a bad thing can be a blessing in disguise to those brave enough to forgive and do something.   

For those of you who are religious, millions of people will recite the Lord’s Prayer in church this weekend.   They will pray, “Forgive us our trespasses, as we forgive those who trespass against us.”  I often wonder whether we really mean what we say when we repeat these words, and whether we sufficiently consider their meaning.   What do you think God thinks of us when we don't hold up our end of the bargain?  And we wonder why atheists think the church is full of hypocrites. 

In the Sermon on the Mount, Jesus teaches us not only to love our enemies, but even to “bless” those who persecute us.   While on the cross, he prayed for those who prosecuted and sentenced him, “Father, forgive them, for they know not what they do.” So did Stephen who prayed the same thing as he was being stoned to death: “Father, do not hold this against them.”

Loving and forgiving those who hurt us is the key to the solution for the problems in our world.  Hate begets hate.  Darkness doesn't drive out darkness.  Only light can do that.  Love is the only force capable of turning an enemy into a friend.  Hate destroys and tears down but by its very nature, love creates and builds up. Love transforms.  The art of being wise is the art of knowing what to overlook and to forgive.

I once came home to discover that my dog pooped on the floor.  I yelled at her and she cowered in the corner.  I then realized that I was the one who left her alone in the house for ten hours so in my baby voice I called her over to me.  She was hesitant but her tail was wagging.  When she reached me, I petted her and she danced around me and kissed me.  All was forgiving from both of us.  I cleaned up her mess as she watched with a sideways glance.  Then we went outside for a nice run.  Nelson also once said that action may not bring happiness but there is no happiness without action.

Tuesday, December 3, 2013

Holiday Shopping

Has your Thanksgiving transformed into Thanksgetting?  It is ironic that when Columbus got lost and landed in Hispaniola and, two hundred years later the Puritans landed in Plymouth, their true intentions were to rape, pillage and plunder the land and its aborigines - which they did with aplomb.  400 years later, we do much the same in department stores and malls across the country on Black Friday.  Pushing, shoving, knocking, yelling, trampling and pepper spraying seems to be de rigueuer for holiday shopping. 

Most of the "deal" items for which we fight over and wait in long lines for are electronic items built from inferior components which won't last long, but, a $98 32" TV is a $98 32" TV. 

There are also brand items listed at sale prices but those sale prices are usually the store's target price to begin with.  A store may pay $5 for an item.  They want to get $15 for it so they charge $30.  If you pay $30 for it at any time during the year, they win.  If they take 50% off on Black Friday, they still win.  They're actually getting what they wanted in the first place.  If they take 75% off, they're still making money.  They depend upon the ignorance of the consumer to overpay year round. 

JC Penny once tried charging their lower targeted price for their merchandise but people stopped shopping there.  People want sales because they think they are getting a bargain.  They would rather get a 50% discount and pay $15 for an item than pay full price for it at JC Penny and pay $15.  JC Penny quickly raised their prices and began offering discounts shortly thereafter.

The other holiday trap is the recommendation.  Reviewers, reporters and celebrities get free stuff all the time with the hope that they will plug the item to their legions of followers and fans in return for the gift.  I was watching the news and a reporter did a segment which proffered holiday shopping ideas and bargains.  First of all, why was this news?  Second, what qualifications did this 24 year old reporter have to offer advice on electronics and comparative shopping?

She said that a hot item this year is the tablet.  Without discussing anything else, she said the best tablet on the market is the iPad.   Of course she did.  She probably got one for free.  What if I only want to listen to audio books or read ebooks on my tablet?  Do I still need the most expensive tablet on the market or will the $89 tablet work for me? 

Even if you want to use a tablet for surfing the net, checking email, playing games, watching movies and reading books, do you still need the most expensive tablet on the market or would one of the less expensive brands suffice?  Do you get more because you pay more? 

Of course there are dozens of variables and options ranging from memory, speed, screen size, touch variations, free apps, OS, accessories, etcetera.  Each variable can add or subtract from the cost.  You need to know what you want to do and if that particular tablet can do it.  Do you want to pay more for features you won't use?   If you don't live near the Autobahn, do you need a Bugatti which can travel at speeds over 250 mph?  If you do live near the Autobahn, would you be happy with a Aixam Coupe or Tata Nano?  When it comes to buying and using computers (and cars), I would rather drive a slow car fast than pay a fortune to drive a fast car slow.

I'm not ashamed to admit that I have a Zenithink C97 and C93 tablet.  They have no limitations as a tablet for my needs, and for the crafty shopper, you can pick them up for as low as $100 and $150.  However, if Apple would like to send me a free iPad, I may change my mind.