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Let's Talk About Hands
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I worked with victims of Hansen’s Disease many decades ago when there were still lepers and leper colonies around the world. Leprosy is a biblical disease completely eradicated now, although Central Florida is a hot spot for leprosy, report says | CNN, it seems to spring up occasionally. I wouldn’t worry about it much, it is treatable. Leprosy is caused by Mycobacterium leprae, and if I recall it right, it is treated with a course of drugs: Rifampicin, Lamprene and Dapsone. Once it is treated it becomes non-infectious and the infection requires skin to skin contact. What I recall about this disease are the deficits and deformities it causes. Most of these deformities are due to the damage caused by the bacteria to superficial nerves and cartilages. They include - foot drop due to involvement of the peroneal nerve. Multiple hand deformities ranging from claw hand to ape hand to mallet finger to wrist drop. The most common superficial nerves are the ulnar nerve leading to the paralysis of the ring and little finger, forming the Jesus Christ Benediction ( I wonder if Leonardo Da Vinci recognized the impact of the nailing of Jesus wrists that could have damaged the ulnar nerve to draw what we all know as Christ with that deformed hand).
claw hand
mallet finger
radial palsy + wrist drop (usually)
Ulnar Claw hand or Benediction
claw hand/benediction
ape hand
In the rehab and hospital where I used to work, hand problems were predominantly treated by Occupational Therapists. Occasionally I was assigned a hand or a shoulder in outpatient settings.
Hand therapy remains one of the most important components of rehab. Imagine losing the functions of your hands if you were a pianist, a surgeon, a mason, a writer, a painter, a cabinetmaker, a computer repairman, a sportsman and many other professionals. Imagine placing food with the aid of a fork in your mouth with shaking hands. How would you comb your hair, send a text, brush your teeth, button shirt, tie shoelace, hold a cane or walker, shower, dress, put shoes on, and the tasks go on and on and on?
Opening a door
Using a scissor
Combing hair
Eating with spoon or fork
You may take your hands for granted until they fail to move no matter how much you tell them to. You suddenly become dependent on someone else for these otherwise automatic and normal functions. Just to require somebody to clean you up after the bathroom and change you after the shower can pull a punch at your dignity and independence. I constantly dealt with previously independent people who woke up one morning without the ability to use their hands. The shock is often translated to the usual Denial, Anger, Bargaining, Depression, Acceptance stages of grief. Some can be stuck with Anger; some can get stuck with Depression. None of them are acceptable to the patient most of the time. They do accept the disability eventually but would not be happy.
What are the events leading to loss of hand functions today? In my experience, the major debilitating causes are neurological and orthopedic. Neurological damage transitions the muscle tone: Flaccidity, Emerging Spasticity, Dominating Spasticity, Start of complex movements, Waning of Spasticity, Normalization of movements. These were first described by Brunnstrom.
This website tries to simplify discussions so it would seem to be a layman talking to another layman, spasticity is the tightening of the muscles because the brain loses control over them. The muscles are in a contracted state. Flaccidity on the other hand is absence of tone in the muscles rendering them paralyzed. Once again, some patients may get stuck with flaccidity or spasticity. A few lucky ones can jump from flaccid (absent tone akin to paralysis) to normal. A lot of these outcomes depend on the severity of the neural damage. Or how long the recovery is. The most common stage that require extensive Rehab is the spastic stage of a stroke with a flexion synergy pattern. Near drownings could also result in brain anoxia (or lack of oxygen in the brain) leading to catastrophic damage to hand functions. The victims shake in tremors every time he tries to use his hand. Drug overdose is also an increasing menace that leads to brain damage that causes hand dysfunctions. Others to consider are bleeding of the brain, either subdural or subarachnoid, tumors, nerve damages such as radial, ulnar, brachial plexus etc. Same thing with temporary (or not) paralysis from Guillain Barre Syndrome.
Typical Hemiplegia after stroke. Notice the position of the arm.
Orthopedic causes are usually accidents (vehicular, falls, physical altercations, being battered are examples) that lead to spine and other bony part damages. There are a few rheumatoid arthritis sufferers. Carpal tunnel and its post-surgical rehab land on my treatment table. Same thing with Colles fractures from a fall landing on an outstretched hand. Spinal cord injuries, especially the high levels involving the neck and thoracic spine, are pretty much common in my rehab setting as well. Old age problems of neck spondylosis or compression fractures or simple wear and tear can cause hand problems. Hand burns.
Ok, before I get carried away and talk like everyone is a therapist here. PTs and OTs pretty much know what I am talking about, but they are not the target of this blog LOL. What I am driving at is this: the hand and its functions are necessary in our daily lives. It is important to take care of them.
If your job requires extensive use of hands, learn how to give them a rest. If you are a pianist, writer, surgeon, manual and massage therapist, a dentist, even a teacher who writes on chalkboard, or a driver, please take a few minutes now and then to rest your hands. The best way to relax the hands is to make them move in different directions including the fingers and wrists.
Gentle bending of finger joints until forming a fist
Digital Opposition
Abduction and Adduction of fingers and thumb
Thumb Opposition
Tubing Exercises for wrists, elbows (flex/ext, pronation)
Do hand and finger strengthening exercises. There are many tools from therapeutic bands and hand grips and small weights to help you in this. Examples:
Retirement and Ikigai
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[these are my distances and HR readings in my jogs last week. notice how my heart can reach up to 158 when i increased speed]
I woke up today at around 4 am, lingered on my bed before getting up to meditate. I meditate through written words as I cannot do it mentally (unlike the great meditators who sit quietly and direct their concentration in their minds) as my brain lacks the discipline for that. But writing my thoughts seems to work out. People call it journaling. I usually talk with the Supreme Being about all the things happening around me.
My garden has started to pull my attention again. I find it a little challenging at times, much like my exercises. But it is fulfilling. I surveyed my quarter acre lot to take a mental picture of how to clean and add more color to it. I trimmed the plants that are growing aggressively at the expense of other plants. I am rearranging and modifying their placements. They do respond to my tweaking. I noticed my young jacaranda sprouting new branches after I cut it to size. All the cuttings I started a few weeks ago have sprouted and are replanted and thriving. All is well, I think. But it can be exhausting. All the watering and weeding and replanting can take a lot of your energy.
Another activity I am enjoying is working out. I have avoided the gym since the pandemic, but I am gradually getting back to it. I prefer a very early morning gym workout to avoid the crowd and my sessions are each 1-hour tops. I usually prefer the gym for strengthening, lifting weights, and occasional aerobics, mainly ellipticals and stationary bikes. I would do aerobics in the gym if the weather were bad, but I want my cardio done outdoors all the time. Nothing can beat the fresh wind hitting your face, the sun peeking between the sky clouds, birds twittering and tree canopies dancing alongside me.
[i am back to my favorite leg machines]
I think my right knee is recovering. I am slowly jogging at a more age-appropriate pace. Roughly between 14 to 18 minutes pace, a far cry from the 9 to 10 min pace I used to enjoy as a younger man. There are two things I pay close attention to during my cardiovascular workouts - heart rate and pain. I stay as close as possible to 80 to 90 percent of my maximal heart rate, roughly between 130 -140 beats/minute. I occasionally push my heart a little but not as much as I did when I reached up to 170s heart rate as a young man. One approach I employed to lessen the stress on my knees during my current jogs was to stay on the flat surfaces to run on and shorten the strides.
I will turn 62 in a couple of months and for that, I am preparing myself for what amounts to my new normal. A lot of us imagine retirement as putting an end to work or job as we know it. We imagine staying in bed as long as we want and doing things at a slower pace. But the more I think about it, retirement should be a transition from the usual regular day to day job to another, but this time the new job is easy, light, something we love to do and hopefully can be monetized in the future.
Interestingly, the Japanese have a term for this active retirement. Ikigai.
Ikigai is a Japanese concept that refers to the source of value in one's life or the things that make life worth living. In Japanese, "iki" means "life," and "gai" indicates "worth" or "value." Ikigai is about finding joy, fulfillment, and balance in the daily routine of life, essentially finding one's "reason to live" or "raison d'être." It's a unique approach that combines personal passion, mission, vocation, and profession, leading to a fulfilling life. The concept emphasizes the importance of having a purpose that brings satisfaction and meaning to life (source: Bing definition).
Ikigai also appears related to the concept of flow, as described in the work of Hungarian American psychologist Mihaly Csikszentmihalyi. For Csikszentmihalyi, flow occurs when you are in your “zone,” as they say of high-performing athletes.
Flow is a string of “best moments” or moments when we are at our best. These best moments “usually occur when a person’s body or mind is stretched to its limit, in a voluntary effort to accomplish something difficult and worthwhile” (Csikszentmihalyi, 1990).
Flow can be said to occur when you are consistently doing something you love and that you are good at, with the possible added benefit of bringing value to others’ lives. In such a case, flow might be seen as in tune with your ikigai, or activities that give your life meaning and purpose.
(source: The Philosophy of Ikigai: 3 Examples About Finding Purpose (positivepsychology.com)
The way I see it, I am not embarking on something radical at retirement. My days will still involve workouts, meditating, and maybe a few hours of work here and there. I may include gardening now on days I have more time. My afternoons will be reserved for reading, writing, and programming using different computer languages. All these are my favorite activities with or without pay.
Each retiree has a favorite routine, and mine is unique. Others may want to enjoy time with their family or spend more time with longtime friends. Others would like to travel and perhaps share with the world (social media) their trips. There are others who’d like to focus on spirituality or more learning or even sharing their knowledge through teaching and writing and the latest now is through vlogging. The one thing I’d caution retirees is against investing in businesses they know nothing about. I’ve heard of many sad stories about people who lost a lot of money because they tried and failed in businesses, they thought were easy to manage and earn money but lost everything instead. Remember that when you were young it was easy to fail because you still have all the time to start all over again, a luxury no longer available when old and retired. The best investment a retiree should consider is health improvement. No amount of money can match the ability to wake up one day knowing you can still do what you want to do without limits, or without worrying about the next maintenance pill to make or the next chemo, or the next MD appointment because something needs to be attended to in your body. I’ve also been warned about the boredom of retirement if you didn’t prepare for it, and I am preparing for it. A few people might think that retirement is a complete cessation of work. It should be more like a transition from heavy work to light work, not the other way around. But work, whether paid or not, is still an active lifestyle. I have no idea yet of what kind of work I would pursue. I have an IT degree which I focused on programming in my remote past so that is most likely where I will bury my head into. Someone may suggest that with AI, programmers are now twelve a penny, but I don’t care. There is beauty in figuring things out through mental calisthenics and programming has an edge in that area. I will be doing it to challenge my brain, not to be an expert or an important person.
No one knows the future. Two weeks ago, there was a sudden change in my workplace, and I was ‘forced’ to handle a role that required more responsibilities. I used to be a fast learner but not anymore. Instead of dealing with only two subtasks to an evaluation job I do, I have to add 3 more. This takes time and I am not used to the extra time I now allot to my work on a daily basis. There is a future relief, however, as a new boss to replace the old boss is about to join our team in a week or so. All I need at this point is to hold the fort for a few more months and it will be alright.
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- On Bad Blood
- Take Care of Your Heart: A friendly Reminder from the American Physical Therapy Association
- Morning Has Broken
- Reaction to Quiet by Susan Cain
- Stroke Part 5 : The Bleeding Pipe
- Reaction to the book 'The Beginning of Infinity (part 2)
- Book Reaction: The Beginning of Infinity(part1)
- Stroke Part 4: The good, the bad, and the bad (Cholesterol)
- Let's Take a Walk on the Wild Side
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