Not really that insidious (googles-secret-update-software), IMHO, but, just in case:
Another consultation with surgeon again today– he’s not happy with the scarring; not happy at all. All kinds of adhesions going on in that Zone V of mine. The plan now is for another month of increasing exercises, vibration and ultrasound therapy, then, maybe, cortisone injections. At that point a determination will be made about his potentially opening me up again for remedial tenolytic work.
“It has been documented the up to 20% of patients will develop adhesions which requires tenolysis or tendon grafts ”
In most cases, full and normal movement of the injured area does not return after surgery. If it is hard to bend the finger using its own muscle power, it could mean that the repaired tendon has pulled apart or is bogged down in scar tissue. Scarring of the tendon repair is a normal part of the healing process. But in some cases, the scarring can make bending and straightening of the finger very difficult. Depending on the injury, your doctor may prescribe therapy to loosen up the scar tissue and prevent it from interfering with the finger’s movement. If therapy fails to improve motion, surgery to release scar tissue around the tendon may be required.
Ugh. We shall never know the concert pianist I might have become.
Adherent scars can significantly limit AROM and can be difficult to mobilize. It is important to mobilize this adherent scar tissue from the underlying structures. A technique I have found useful is to use dycem to increase the hold the therapist has of the scar tissue. The patient can move the involved joint while pushing the scar in the opposite direction to free the scar from the underlying tissue. For example, have the patient make a fist while the therapist uses dycem placed over the scarred tissue and pushes the scar proximally. This can be aggressive scar management so the therapist must be careful to respect the patients response and monitor their levels of discomfort.
-  The Cellular Biology of Flexor Tendon Adhesion Formation, Am J Pathol. 2009 November; 175(5): 1938–1951
-  An Overview of the Management of Flexor Tendon Injuries, Open Orthop J. 2012; 6: 28–35.
-  Outcome of early active mobilization after flexor tendons repair in zones II–V in hand, Indian J Orthop. 2010 Jul-Sep; 44(3): 314–321.
-  The resurgence of barbed suture and connecting devices for use in flexor tendon tenorrhaphy
Early Active Motion after Flexor Tendon Repair (cap. 39 Hand Surgery, 2004)
I’ve been playing with Hazel a bit recently, mostly so I can get a handle on it to support others’ usage of a simple file automation/ housekeeping application. I like it, but it is somewhat limited in not allowed nested conditional and other basic logic statements. Anyway, what Hazel does is not much more– and very frequently less– that what I’ve been doing with ad hoc cron scripts. These are not very tidy having built built up over the years. And so I Googled and I found a x-platform, ruby based Hazel alternative in maid.
Well I get a slew of errors, so:
$ ruby -v
ruby 1.8.6 (2007-03-13 patchlevel 0) [i686-darwin8.10.1]
This version corresponds to Apple’s default on early 2008 Macbook Pros which came preinstalled with Leopard (OS X 10.5). I guess this shows that although I am running Mountain Lion now on a mid-2012 MBP I have not had a clean OS install since April ’08, and I have never done so myself on my own machine. So, proof that:
- I am lazy?
- Upgrades work ‘plenty fine’, and Apple do a pretty good job in this regard?
- I’m scared of losing all the custom build of compilers, interpreters, symlinks, scripts in odd locations doing various things, settings galore… etc, etc. that make this machine mine?
Think I’ll persist on this path through Mavericks *then* start fresh with OS XI… if I am am still using an increasingly annoying Apple OS.
lrwxr-xr-x 1 root wheel 76 Jul 27 2012 ruby -> ../../System/Library/Frameworks/Ruby.framework/Versions/Current/usr/bin/ruby
-rwxr-xr-x 1 root wheel 450 Nov 18 2011 sqlite3_ruby
$ rvm -v
rvm 1.9.0 by Wayne E. Seguin (firstname.lastname@example.org) [https://rvm.beginrescueend.com]
$ ls -la /Users/yearlus/.rvm/rubies/
drwxr-xr-x 8 yearlus yearlus 272 Oct 26 2011 ruby-1.9.2-p290
$ \curl -L https://get.rvm.io | bash -s -- --version latest
$ rvm -v
A RVM version 1.21.13 is installed yet 1.9.0 is loaded.
Please do one of the following:
* 'rvm reload'
* open a new shell
$ rvm reload
$ rvm -v
rvm 1.21.13 (latest) by Wayne E. Seguin <email@example.com>, Michal Papis <firstname.lastname@example.org> [https://rvm.io/]
$ rvm use 1.9.2
$ which ruby
I could fsck with .profile, but will keep flexible for now. Could also use the default flag:
$ rvm list
rvm rubies=> ruby-1.9.2-p290 [ x86_64 ]
$ rvm install 1.9.1
Searching for binary rubies, this might take some time.
No binary rubies available for: osx/10.8/x86_64/ruby-1.9.1-p431.
Continuing with compilation. Please read 'rvm help mount' to get more information on binary rubies.
You requested building with '/usr/bin/gcc-4.2' but it is not in your path.
[cc_dos]$ sudo rvm requirements
Error: Failure while executing: git pull -q origin refs/heads/master:refs/remotes/origin/master
Failed to update Homebrew, follow instructions here: <a href="https://github.com/mxcl/homebrew/wiki/Common-Issues">https://github.com/mxcl/homebrew/wiki/Common-Issues</a> and make sure `brew update` works before continuing.
Requirements installation failed with status: 1
Following worked (outputs omitted):
$ sudo chgrp -R admin /usr/local
$ sudo chmod -R g+rwx /usr/local
$ sudo chmod -R o-w /usr/local
$ cd /usr/local && git reset --hard && git clean -d -f/
$ sudo gem install maid
$ sudo gem update
Butterfly stitches out now…. Still in the Duran-friendly dorsal blocking splint, wrist cocked @ 20º. More exercises! Largely these are Duran/ modified Duran protocol, i.e. passive flexion, semi-active extension. The three main rehab protocols seem to be:
- Duran: Controlled Passive Motion Methods
- Kleinert: Active extension, passive flexion by rubber bands
- Strickland: Early active ROM (range of motion)
And it would appear that external stitches of the Bruner incision counted 30, not the 25 I’d mentioned earlier.
In his exit speech on Jan. 17, 1961 Dwight D. Eisenhower warned us to be wary of the growing military industrial complex. Prescient words:
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
Well, I am hereby sort of claiming “narcojudicial complex”, and I am more than a little surprised that it or its hyphenated form “narco-judicial” does not produce many Google results. I don’t think I really need to define it. We all are aware of the huge size of the US prison population, the demographics of which include a very great number of non-violent, poor, drug offenders. Are dugs a social scourge? Very probably. Is mandatory incarceration for “dime-bag” worth it? I doubt it, but there see to be companies doing very well out of the privately run for-profit gaol system.
narcojudicial complex, narcojudicial complex, narcojudicial complex, narcojudicial complex, narcojudicial complex, narcojudicial complex, narcojudicial complex, narcojudicial complex, narco-judicial complex, narco-judicial complex, narco-judicial complex, narco-judicial complex.
24-hour analog dial
Now I want one! But @ basically $50 I think the Pegasus 6NN63 Clock, Quartz, Round is a little too pricey. Frankly there’s not really any point since we all use “military” time in this house anyway; it’s only purpose would be to remind the boys that there are many ways to visualize so common an object as a clock face… and maybe fsck with American visitors.
They took out 25 stitches today and replaced them with the butterfly stitches to reduce superficial scaring. Nice of them, but skin scars do no really matter much to me.
Anyway the big stuff:
- Flexor Digitalis Superficialis @ 2, 3 and 4 was completely severed as was the Flexor Carpi Radialis and the Flexor Digitalis Profundus of 3.
- FDP-2 and FDP-4 cut but not severed
- FDS-5 was damaged.
- A portion of FDS-3 was transferred and sutured to FDP-3.
No damage to nerves…. that’s good news! Damed close call on the radial, however.
Back on July 23 to see the surgeon, and in the meantime I have hand therapy scheduled for this July 11 and the following Monday (July 15).
Fingers and wrist are immobilized in a splint– and will be for another six weeks, except for scheduled exercises.
Still fucking painful; still feels like molten lead is flowing through my forearm!
Prosection by me, 1994. All this wrist surgery nonsense got me to dig around old files…
Had surgery today to repair the severed tendons in my wrist yesterday. Full-on, no holds barred general anesthetic and two and a half hours under the knife of a very well respected orthopedic surgeon working out of New England Baptist Hospital. General anaesthetic worked like a charm, but I wish that i had more time to enjoy it. About 5 minuted of pre-anaesthesia sedative and then some pure oxygen. The last number I remember counting to was only 3!
The pic. here is the temporary suturing done at Newton-Wellesley ER after clean up and glass removal, a small infusion of blood and my first experience with percocet. Sunday June 23, 2013, a day not to be forgotten. It’s a teaching hospital, and Mr. K. asked for my consent to have videos/ photographs taken of the proceedings for later classroom use. I agreed on the proviso that I get copies of any materials so used.
I wish I had the foresight to take a photo before these temporary stitches were put in. As I watched the physician stitch away I was quite taken with the depth of the wound, and the weirdness of trying to wiggle my fingers knowing that the index, middle and ring fingers were not actually connected to flexor muscles anymore.
Follow up meeting in two weeks time. Until then it’s Rest, Ice, Compression, Elevation, and lots of HBO reruns with my new best friend Percocet 5/325. The nerve block on the right brachial plexus before seeing me home last night is starting to wear off. That’s good in that I can move my arm, bad in that it feels as though molten lead is pouring through my veins.
Since typing is a royal pain in the arse, I’m just going to copy “what happened” from a FB message I sent to a friend:
Going to the toilet, middle of the night. Used ambient light to see my way back to bed as I always do. Stepped on a f^cking kids’ toy. Put my hand out to catch my fall… found a 8×8 glass pane instead.Un-f^cking-believable! All the sh1t I’ve punched (glass and otherwise) when either angry or drunk and nothing happens. Then sober and sleepy I completely sever tendons. I think it’s true what they say: God really does protect the intoxicated.
1.1/1.2 Myth (Μυτηος):
- A falsehood
- “bucket” containing all that is important to a given culture– may be universally true; it certainly is specific to a given cultural identity
- Something fundamental (or primal) about our condition. Also primal as in “old”, “primitive”
- μυτηος– literally speech; later a narrative speech/story; still later, specifically a false story; later still– a tall tale, but with some elemental truth
- Constantly re-invented for the ages/different cultures; always a re-telling. E.g Hercules from Heracles.
Mediterranean– “the corrupting sea” (book of same name). There is no cultural/linguistic purity. The Med. is a great interconnecting force leading to the mingling of cultures and ideas, of stories and languages and ways of interpreting the world.
Oedipus– metaphor for man’s quest for knowledge, ever asking.
1.3 Some ancients on myth
Plato (Πλάτων ca. 428 – 348 BCE): Generally critical of the poets, largely considered myths to be pretty indecent, having a powerfully deleterious effect on culture and cultural values. Myth constructs culture.
Xenophanes of Colophon (Ξενοφάνης ὀ Κολοφώνιος ca. 570 – 475 BCE): Almost the reverse of Plato in that it is our culture, environment and experience that shapes our myths. He notes that egyptian gods are black, and that if cattle could speak and reason, so their myths would be cattle-like. Culture reflects/constructs myth.
Metrodorus of Lampascus (Μητρόδορθς Λαμπψακησος 5th BCE): Myths are symbolic (allegoric) representations of deep truths and understandings of the world. As such they might be considered “pre-scientific”. E.g. Achilles is the Sun, Helen the Earth, Demeter the liver, Dionysus the spleen. Allegory.
Aristarchus of Samothrace (Ἀρίσταρχος ca. 220 – 143 BCE): Established historically important critical editions of Homer… hence the modern lit. crit. term “aristarch” for a judgmental critic. Believed myths to be literally stories for stories’ sake, and that they had no hidden meaning. Literary/ anti-allegorical.
Euhemerus (Εὐήμερος 4th BCE): Myth is based on real events, places and peoples that over time have taken on unreal or exagerated tones. Like, perhaps, the Bible. In the sense that the gods are deified mortals/heros one might consider beatification/canonisation a similar process… Euhemerism.
Of these beliefs, euhemerism and allegorical interpretation held the majority sway in the pre-modern, post-antique era. During the medieval period the graeco-roman myths and legends were generally just considered fabulae, tall tales with perhaps a nuggets of wisdom therein.
1.4 Some moderns on myth
Bernard de Fontanelle (1657 – 1757): Myths grew to explain the natural world, helping to explain the unexplicable. In this sense he considered myth to be proto-science.
David Hume (1711 – 1776): Slap-bang in the middle of the high Enlightenment he was impatient with myth, and discounted myth as primitive and superstitious thought, the result of comforts and erroneous and irrational assumptions now superseded by logic and rationality. Myth is an Irrational response to fear of the unknown.
Christian Gottlob Heyne (1729 – 1812): A classicist in the, err, classical sense. Was generally interested in the ancient world, and one can’t understand the ancients without trying to understand every part of them, especially the ‘background’, that myths provide. Myth is not so much driven by fear of the unknown as with Hume, but with awe and wonder of nature. Resurrected μυτηος for use instead of the much more limited fabula. Myth is the concretization of the abstract.
Johann Gottfried Herder (1744 – 1803): Somewhat anti-elightenment, and a precursor ro the Romantic spin on graeco-roman myths and legends; viz. myth undergird profound truths about the human spirit, express an innate characteristic of humans identical to poetry, music, art, and religion. Romantic.
Walter Burkert (1931 – ): scholar of Greek myth, U. Zurich. Myth is a traditional tale told with secondary partial reference to something of collective importance told by someone for some reason. Definition used in this course.
1.5 / 1.7 Trojan War / Reading Homer
- Trojan War — 13th BCE
- Homer — 8th BCE
- Athens — 5th BCE
- (Classical) Rome — 1st BCE/CE
Heinrich Schliemann (1822 – 1890) unearthed in the 1870s the remnants of a city in Asia Minor (Turkey) consistent with the age and location of Troy; also “Priam’s Treasure” in 1976, a stash of gold and ornaments and such.
Trojan War takes place over ten years, the Iliad compresses these to about three days. Helen’s face said to launch 100 ships, therefore approx. 100, 000 Greek warriors. First word is Μῆνις (wrath), and in the Epic tradition the first word sets the tone for the rest of the poem. The wrath in question might rightly be Menelaus’ (from whom Paris abducted Helen, Menelaus’ wife), Agamemnon’s (who as Menelaus’ brother also feels his shame), or more likely Achilles’. Achilles’ wrath is all encompassing, although he does bend a little toward Priam, assenting to allow him to perform the customary funereal rites on his son, Hector.
“Prequel” for the Iliad is Helen’s abduction. Paris feels free to do this because of a bargain with Aphrodite. At the wedding of Peleus and Thetis (a sea nymph, nereid) the pantheon is invited except Eris (goddess of discord, lit. “strife”). She tosses an apple “for the fairest” (τῇ καλλίστῃ) amongst the guests. Aphrodite, Athena and Hera ask Paris to choose, and he in return gets something. He chooses Aphrodite who promises the most beautiful mortal woman to him. … Athena is somewhat maltreated later by the Greeks– he palladium is stolen from her temple at Troy (thus removing Athena’s aegis of protection over that city), and Ajax rapes princess Cassandra on her altar.
By and large Homer does not gloss over Greeks poor behavior in the Iliad; his recollection of event is not particularly complimentary, with the internal squabbles and the various profanities to Athena and Neptune. Homer has no problem relating that the Greeks went too far, even by their own standards.
The Nostoi (from νοσςος, home): journeys’ home. Nestor gets an easy ride home. Menelaus gets blown of course to Egypt. Agamemnon faces horros on his return. Odysseus faces trials and tribulations on his way back, recounted in the Odyssey… first word “man”, Ανδρα, thus indicating that the Odyssey is about what it is to me a man.
Homer writes in dactylic hexameter, some 15k lines in the Iliad, 12K in the Odyssey. Dactyl is long-short-short, and a spondee (long-long) may replace a dactyl. He write in several dialects, principally Ionic and Aeolic. He was probably writing very shortly after the arrival of the alphabet from the Phoenicians that supplanted the (Cretan) Linear A and Linear B, pictographic systems not used for literary works, but rather for recording events and tracking accounts and such.
First ten lines of Odyssey and Illiad encapsulate each poem.