In the article, he complained about the rather awkward way he had to use macros in C to maintain namespaces which he could do more elegantly in C++. In addition, the heavy use of macros that are not available to the C debugger was cited.
A pretty cruel thing to say! Some of the contributing factors for CTS are not under your control. Who knew that you were going to develop acromegaly, rheumatoid arthritis, hypothyroidism, sarcoidis, or another medical condition that can cause carpal tunnel syndrome? Is it your fault that you developed those diseases? No!
If your carpal tunnel syndrome is due to RSI, pregnancy, or oral contraceptives then maybe your behavior is partially to blame, but this is not always the case!
As for the symptoms: Over the past year, I've lost all feeling in my thumb and middle/index fingers on both hands; I can't pick up anything more than about 2 lbs without it completely slipping through my fingers; I wake up with sharp, shooting pains through my palm and wrist; and when I tap the inside of my wrist, I can feel the numbness and tingling all throughout my palm. I've been to two doctors, and they both agree it's a pretty bad case. (The Nerve Conduction Study they do, when they hook you up to a machine and zap you to see if they can tell if there's any nerve damage, is one of the most bizarrely violating medical experiences I've ever had.)
I'm sorry to say this, but it sounds like you probably have significant nerve damage at this point, some of which is quite likely to be permanent. Surgery is very likely to get rid of the pain, but the numbness and weakness are likely to recover very slowly and incompletely. If allowed to progress too far without effective treatment, carpal tunnel syndrome will lead to irreversible, disabling, damage. It is a shame that this might have been prevented by earlier intervention, as unpopular and distasteful as the idea of surgery seems. I would recommend finding a good neurosurgeon that specializes in peripheral nerves (most major cities will have at least one such neurosurgeon) although most neurosurgeons do this procedure frequently. An orthopedic or plastic surgeon with specialty training in hand surgery would also be a good choice. Good luck!
But avoid surgery at all costs. It doesn't do anything regarding the inflammation of the tendons; it only removes the pressure from the nerve (read: it numbs it)
You are correct in saying that surgery does not treat inflammation and that it only removes the pressure from the nerve. However, carpal tunnel syndrome (the symptoms and nerve damage) are caused by the pressure on the nerve in a tight carpal tunnel. Often the carpal tunnel is tight because of the inflammatory changes.
So the causative sequence is inflammation (and/or other factors) -> tight carpal tunnel -> pinched median nerve -> damaged median nerve.
Surgery relieves the pressure. If the symptoms return (they usually do not) after surgery, it is because the surgery was incomplete or because you formed excessive scar tissue over the nerve and the nerve is once again "pinched". This is why I encourage my patients to keep moving their fingers regularly after surgery so that the tendons and nerve will not get scarred into a fixed position. In difficult cases, there are substances (Adcon-L, for example) that can be placed on the nerve to prevent scarring.
Surgery should be avoided if conservative measures can control the problem. But it is not the least desireable alternative! The worst alternative is to allow permanent nerve damage to occur when CTS goes untreated too long. At that point, no treatment will reverse the damage.
I too have been seeing a chiropractor. It started off with my back because I got so bad I could barely walk. She fixed it so well and so easily (along with suggestions on how to prevent it from happening again - Sit up straight!), I went back and had her look at my wrists and ankles, which I also had problems with. I'm doing quite well now! There are crackpots out there though, so ask around. Also, don't be limited to chiropractors. Too many manipulations can be bad for you.
If you must see a chiropractor (spine manipulating health care provider) rather than a neurosurgeon or neurologist (nerve doctors) for your median nerve problem (carpal tunnel syndrome), please do not let the chiropractor pop your neck as a proposed treatment for the pinched nerve in your wrist! I've been to a chiropractor and had some manipulations. Some of them actually felt good. But they are not without risk. I've taken care of patients with dissected (torn) vertebral arteries (the arteries that run up the side of your spine and provide blood flow to your brainstem) resulting from chiropractic manipulation that suffered horrible (fatal) brainstem strokes! Chiropractic has a place, but it is not without risk - and if you have a pinched nerve in your wrist (carpal tunnel syndrome), then the risk of violent neck popping is not justified (in my opinion). Do let your chiropractor prescribe ibuprofen and wrist splints. Do ask about behavior modification.
My father had been diagnosed with CTS quite a while ago, and ended up having to have surgery on both wrists at the same time.
I perform this kind of surgery, but do not recommend having both hands done at the same time.
Due to the delicate nature of the surgery, the doctors usually don't give it too good of a success rate.
The surgery is actually quite simple and takes about 20-30 minutes. Not particularly delicate either. The sucess rate is quite good for patients who haven't responded to conservative measures and do not already have permanant irreversible damage to the median nerve. When numbness and weakness become significant, then it is likely that the nerve is damaged and not just irritated. In this situation, surgery mainly helps get rid of the pain and helps to prevent further loss of function.
Unfortunately. when he finally recovered from the surgery, he only had feeling in about 3 or 4 fingers between both hands.
In this case, either he had surgery too late in the course of his CTS (after damage to the nerve had become permanent), or something went wrong with his surgery (uncommon).
Is there a doctor out there (or anyone, for that matter) who can describe the symptoms of CTS?
Yes! As a neurosurgeon, I see a fair number of patients who suffer from carpal tunnel syndrome, some of which eventually have surgery.
The simplest way to conceptualize carpal tunnel syndrome is to think about it as a problem of proportions: The median nerve must pass through the carpal tunnel in order to reach the hand. If the carpal tunnel is too small (for any number of reasons) or the median nerve is swollen or enlarged (again, many possible causes), then you may develop the symptoms of carpal tunnel syndrome, since the median nerve is essentially being "pinched" as it passes through the carpal tunnel. Nerves really do not like to be pinched!
There are many possible contributing factors which can lead to such a situation, some of which can be improved with medications or behavior modification, and other which cannot.
Some Contributing Factors
You were born with a small carpal tunnel (congenital) and are predisposed to the syndrome. Sorry!
Pregnancy - hormonal changes in the mother lead to widespread changes in the tissues of the body, many of which are quite noticeable. CTS often results, but usually improves or resolves after delivery. Some women on oral contraceptives will develop CTS for similar reasons.
Hypothyroidism
Major Wrist Trauma - i.e. wrist fracture. The geometry of the carpal tunnel can be unfavorably altered by the fracture.
Repeated Minor Trauma - also known increasingly as Repetitive Strain Injury (RSI) for those of you who are buzz-word compliant. Repetitive minor trauma to the median nerve/carpal tunnel complex may lead to a swollen nerve and secondary inflammation that causes thickening of tissues. This is a fairly straightforward concept that is really just common sense. Joggers with bad technique will wear out their knees, pitchers with bad techniqe will wear out their shoulders or elbows, etc. Why does hacker X get CTS when he types just like hacker Y, who doesn't get it. Answer: Hacker X may have other factors at play (smaller carpal tunnel, more active inflammatory response to minor injury, etc.) other than the repetitive strain that predispose him to CTS. Hacker Y may type with bad technique all his life and never get CTS because he does not have enough other contributing factors to develop a pinched median nerve. Then again, some people smoke like a chimney and never get lung cancer.
Rhematoid (and other types of) Arthritis - excessive inflammation leads to thickened tissues and a tight carpal tunnel.
Acromegaly (Giantism)- excessive growth hormone leads to thicked tissues.
Certain types of tendonitis - inflammation
Sarcoidosis - another inflammatory condition
Diabetes - nerves are more sensitive than in non-diabetics
Renal Failure
Others..
Symptoms
Pain
Numbness
Weakness
Clumsy Hand
Since it is the median nerve that is affected, the pain and numbness will follow the course of the median nerve. Although there is variability, this usually means the "thumb side" of the hand - the thumb, index, and middle finger - and to a variable degree the ring finger. The pain and numbness are usually exacerbated (made worse) by certain activities. If the median nerve is sufficiently irritated, you may also have pain in your forearm. Sometimes the pain and numbness are constant. Often, patients will wake up in the middle of the night with pain when their unsupervised wrist gets into a bad position. Weakness in the grip or thumb may occur, especially the abductor pollicus brevis (a thumb muscle). When weakness and numbness are combined, your hand's feedback and execution are off, and you may experience clumsiness. You might find yourself dropping things that you thought you had a good grip on. In advanced cases, the muscles of the hand become atrophied, which can be disabling. Atrophy of the thenar eminence (the "mound" of muscle between the base of your thumb and your wrist) is characteristic of advanced disease. You do not want to let it get to that point, since a full recorvery is unlikely despite any treatment when atrophy exists.
Diagnosis
Examine for weakness, numbness, atrophy
Tinel's sign - tap the middle of your wrist a few times. Did you reproduce your pain or get a painful shock in your fingers?
Phalen's sign - push the back of your hands together so that your wrists are forcibly flexed. Hold that position for a minute or two. If your pain is reproduced, the sign is positive.
EMG/NCV - electrical tests of nerve and muslce. Prolonged motor or sensory latencies are suggestive (delayed transmission due to abnormally slow conduction though the pinched portion of the nerve). In advanced cases, you may see "dennervation potentials".
Not all of these findings are present in every case of CTS - and no one single finding is sufficient to make the diagnosis.
Treatments
Behavior modification - this is where the RSI stuff fits in. Sometimes this is sufficient to turn the tide, other times not.
Anti-inflammatory medications - most causes of CTS lead to at least some degree of inflammation, which can lead to thickened tissues when it becomes chronic.
Wrist Splints - helps prevent motion of the wrist. Especially helpful for keeping wrists straight at night when you are not awake to supervise them.
Surgery
What does surgery do?
Surgery entails an incision over your wrist and a portion of the palm of your hand. The transverse ligament, which is the "roof" of the carpal tunnel, is then cut so that the median nerve is no longer trapped inside a tunnel. The tunnel becomes a ditch. The nerve breathes a sigh of relief. The degree of tightness is often quite impressive, and often the nerve is visibly swollen or even discolored. In those unfortunate enough to have waited too long, the nerve is visibly atrophied.
If pain and intermittant numbness were the only symptoms, then there is a very good chance for an excellent recovery after surgery. If, on the other hand, there is 'round-the-clock numbness or weakness prior to treatment, then this suggests that the nerve may be permanently damaged, and a complete recover is less likely. In these cases, the pain will usually resolve fairly quickly postoperatively, but the numbness and weakness may take months to recover, and may not recover completely. Recovery in these cases is slow because the median nerve has actually lost some of its fibers (axons), and they must regrow. The axons begin in the spinal cord or a ganglion in the neck and extend all the way down the arm into your fingers. When there has been prolonged CTS and associated inflammation of the median nerve where it was pinched, there may exist scar tissue within the nerve which prevents the axons from crossing that segment as they try to regrow though the wrist to the hand. So the moral of the story is: try conservative measures if you are having pain or intermittant numbness. If the conservative measures do not work, and the CTS is interfering with your life, or if you develop 'round-the-clock numbess or signs of weakness then you should consider surgery. Most cases will not require surgery, but it is a sad thing to see when CTS is allowed to progress to the point at which damage to the nerve is permanent.
There seems to be a lot of talk on the internet lately about carpal tunnel syndrome as a mysterious entity that only a select group of doctors that treat famous musicians understand. Simply untrue. Family physicians see CTS all the time. Any neurosurgeon and most orthopedic surgeons (and some plastic surgeons) will be intimately familiar with CTS, as it is really quite common and is treated by a relatively minor procedure when conservative measures fail. The risks of surgery are small, but they include
damage to the median nerve leading to further numbness or weakness
infection
failure to completely free the nerve from compression (i.e. compression of the nerve beyond the extent of the incision).
In my own personal biased opinion, I favor the "open" approach with an incision over part of the palm of the hand and wrist over the "endoscopic" approach which allows a smaller incision. I believe that the traditional larger incision provides superior visualization of the nerve, and thus more control over what is and isn't being cut.
The other popular take on CTS these days on the net is that RSI is somehow being misdiagnosed as CTS. This is actually becoming a very popular misconception. The critical thing to keep in mind is that RSI (repetitive strain injury) is one of many mechanisms that can contribute to carpal tunnel syndrome. We don't tell patients that they have Repetitive Smoking Injury (another RSI!) when they have a stroke, heart attack, or lung cancer, even though smoking can certainly be a cause of those problems. It would be silly to say "You don't have lung cancer, you've got repetitive smoking injury". Similarly for RSI and CTS. If you have the signs and symptoms of carpal tunnel syndrome, then you have carpal tunnel syndrome. Repetitive strain injury may have been an important contributing factor and you may be able to help your symptoms by taking altering your behavior. The increased public awareness of repetitive strain injury (RSI) is, IMHO, a good thing because it can lead to changes in behavior that help to avoid CTS and other problems - just like increased public awareness of the dangers of smoking can lead some people to quit. But let's try not to confuse our terms! RSI is a general mechanism of injury to tissues that contributes to problems thoughout the body. CTS is a specific problem with your wrist in which RSI may or may not be a contributing factor. I hope this has helped to explain RSI and CTS!
Well, I can't think of any Edisons, but there are a few pop star geeks....:
Tom Scholz(excellent guitarist of Boston) was an engineer and certifiable geek (Mechanical Engineering, MIT) before he hit it big, and has subsequently engineered a lot of cool sounding musical gear.
Tommy Tutone ("Jenny Jenny, etc...867-5309") is a software engineer.
I'm sure there must be others. Can anyone name some others?
So they gave her Haldol and hoped she would be quiet.
Reading that line chilled my heart. This is the age of the anti-depressant wonder-drug. All the doctors are prescribing them for just about anything, as if they are candy with no ill effects. Just last month my wife went to a neurologist because of an enormous headache that lasted 5-6 days. He said it was a migraine and prescribed zoloft. We went for a second opinion, the other doctor said it was a low-pressure headache, they happen rarely and almost never reoccur. No drugs needed, no further treatment needed as long as there is no more pain. You have to wonder what kind of lazy doctor that first guy was to just offer up the "latest and greatest" drug with hardly any critical thinking at all.
As a matter of fact, Haldol is not an antidepressant, but rather an antipsychotic drug that has been around for many years. Far from a "latest and greatest" drug. Good for people with paranoid delusions and other problems with reality. Not sure if the girl needed it or not from the description of things though.
Also interesting, many of the "antidepressant" drugs are useful for many other things than depression. Many types of chronic pain are treated with "antidepressants" - even if the person is not depressed. Certain types of "antidepressants" work for obsessive compulsive disorder. Others work for childhood bed - wetting. The list goes on, and is ever expanding. Headaches are notoriously difficult to diagnose and treat. Whether zoloft was appropriate for your wife is difficult to say - it is not the usual first line treatment for migraines. It does however, have fewer side effects than other migraine medications.
I think we've basically put a stop to human evolution with all these new ways to "save human life". Evolution is "survival of the fittest", and if no "unfit" people are allowed to die... humans won't evolve.
Probably better to think of evolution as "reproduction of the fittest" since mere survival means nothing. People with medical problems requiring modern medicine for survival as infants are less likely to be normal, healthy, reproductive people. Conversely, many of the infants or children that are saved by modern medicine have disease that do not necessarily impact intellegence (congenital heart defects, severe pneumonia, leukemia, etc). They might go on to be productive members of society, or even geniuses. Those with intracerebral hemorrhage, hydrocephalus, or congenital problems with the nervous system that may impact intellegence are less likely to reproduce later in life. However, some of these people are "normal" by testing years later. Also, even if they do reproduce, their disease is not necessarily transmitted to their progeny, so the impact on evolution is questionable.
Simply put, there is plenty of stupidity out there in the gene pool already - the effects of saving infants with previously terminal diseases on evolution is negligible.
Are you going to look one of these "unfit" kids or their parents in the eye and tell them that they should be "allowed" to die so that evolution can progress?
Actually, I've known a lot of musicians - some of which are quite sucessful. They have the same type of focus and concentration on their music that hackers have with their computers. They have their own little world of music which belongs to them. Some of them are actually a little withdrawn when they are off stage. I would go as far as to say that most people who are very accomplished in their field would need to have above average focus and concentration - which is a feature of the "mild autism" being discussed. Case in point - the "artist" formerly known as Prince - if this guy doesn't have a touch of autism, nobody does. If you've seen an interview with the guy, you might think he belongs in an institution. His interpersonal skills are pretty poor. But he's extremely focused on hig music, and has been able to approach things from a different angle. No, I don't own any of his stuff and am not particularly a fan - just the first example that popped into my mind. Then again, maybe he's schizotypal.
I would rather think of the "mild autism" attributes as features rather than bugs! Maybe that's because I see some of them in myself.
I find it much easier to say something like: echo "nameserver 192.168.1.1" >/etc/resolv.conf than to spew several lines of XML header followed by the arbitrary, possibly multiline contents of a tag or nested set of tags.
It wouldn't be much harder to type something like:
xset network.resolv.nameserver 192.168.1.1
The xset program would replace your echo command, and intellegently parse the DTD's and make sure that you are making a valid change. With the proper system tools created or modified to use xml, you really won't have to go through much more trouble, and you gain the ability to do validation or use GUI tools easily. If you want to edit the xml with vi you could do that too. And emacs....I'm sure there's a way to get it to work gracefully with xml config files (it does everything else already!).
I can see where this sort of thing would be very useful for keyboards and synths, effects modules, mixers, and so on, but I'm not quite sure what it buys someone who is playing a guitar.
If you put the A/D converters into the guitar, then you avoid a lot of the noise and hum associated with guitar cords. Despite high quality construction and shielding, there is still a lot of electrical that gets into a conventional cord, especially longer cords. Even if you get back to the analog domain in your tube amplifier, you still win by using a digital cord.
I think there will be a steady need for new features as broadband reaches more and more people.
This is certainly true. I think, however, more of the software will be running on servers or distributed invisibly to run on the client as an applet (Java or otherwise). Once the browser capabilities are fully fleshed out, the internet will become a big multimedia and database application server. The endless cycle of upgrades will continue unabated - on the servers. The brower will be the main app to update on the desktop. I rarely use anything on my home computer these days other than netscape, vi, telnet, ftp, and gimp. Other than the horrible memory leaks in netscape, I'm not really unhappy with anything on my desktop machine. My servers, on the otherhand, are constantly being upgraded and tweaked.
Java servlet are just *too* difficult for the average (non slashdot reading) coder - PHP, PERL, ASP & CF are all about the right level for these people, i like PHP, ASP breaks, CF is limited and Perl is a mess.
Since most web sites and their databases are primarily concerned with text, it's really a no-brainer to use a language such as Perl that excels in text processing. Playing with text in lower level languages such as Java (C++ made childproof) is like trying to eat soup with chopsticks. Why waste 10-20 lines of Java doing what Perl does in 1 or 2? If it simply has to be faster than Perl bytecode, then write the critical functions in ANSI C.
Also, Perl is only as messy as you want to make it. You decide which idioms to use.
The Jazz stars Malone and Stockton have patented the "pick and roll". Other NBA teams are now forbidden to use this play unless they pay the Jazz with 6 free throws or 4 personal foul exemptions. College teams may use it for exhibition games.
In order to gain competitive advantage, the SF 49's have patented the quick slant pass to Jerry Rice. If other teams were allowed to copy this play, say Rice and Young, they would lose their competitive advantage.
Litigation was brought today concerning patent infringement against the Brazillian soccor team for using a "head the ball off a corner kick" set play that has been patented by the American soccer team.
I don't see how it hinders society. In fact scientific and technology progress has never been so good as the past 50 years. All this time patents have been around. They have allowed companies to cash in on their inventions.
And the scientific control used to support this claim is what? I could have just as easily said "All this time rock 'n roll has been around", and then attributed our progress to rock 'n roll. Or perhaps our advancing knowledge is due to monosodium glutamate, bikini bathing suits, or highly absorbent paper towels. Or maybe knowledge grows exponentially acconding to the differential equation K'=a K. Perhaps in a parallel universe, where there is an identical United States without patents, we would all by flying around in cheap air scooters and carrying wristwatch communicators with terabyte object databases inside. Do you think that people would stop trying to innovate and bring new products to market, and that companies would stop in house research if there were no patent protection? That would be naive thinking.
Tough luck if you invent something that has already been patented. Do better research next time because nobody benefits from reinvented wheels. In all other cases it is just plain theft of an idea and protection of it seems a very wanted feature just to protect individual freedom.
I hardly see how "tough luck" addresses the issues. Why should the rights of an individual to their ideas be removed simply because someone else, who had a similar idea, got to the "patent office" first? Can the "little guy" afford to thoroughly research all potential infringements that his software might make? Can he afford to defend against a suit from the bigger companies that inevitably buy up all the patents and use them to intimidate and litigate upstart competitors out of business?
And why do ideas need to be protected anyway? Protected from what? If I steal your idea, and then try to corrupt or otherwise destroy it, do you not still have the intact idea in your possession, still unhindered by anything that I might have tried to do with the idea?
That's a moral position you take here, I and many others don't share it. This is the key issue here. You belief in giving away stuff for free bu that is just not how our society works.
I believe the poster didn't imply we should give away stuff for free, just ideas.
. In a communist society patents wouldn't make much sense but in our capitalist society where everything (like it or not, personally I don't like it) boils down to money it is an important tool.
In a communist society, you may get your stuff for free, but the ideas are not usually so free. Our capitalist society should be based on free ideas and money for goods and services that you yourself cannot, or do not have the time to, produce or perform for yourself.
If concepts are not property then how do copyrights not invade basic personal freedom? Why should I not be allowed to photocopy Steven King's newest book and sell it? I'm not stealing his property.
You confuse concepts and their implementations. Pirating Steven King's book should, indeed, be illegal. It should not be illegal, however, to write your own scary story with similar characters and similar plot. If the basic "story lines" could be patented, we would not have any new books.
Hypothetical situation: Sometimes a small company "A" invent something incredibly useful. Of course "A" deserves to profit from that invention.
Why do they deserve to profit already? Does company "E", who independently invented the same thing 3 weeks later deserve to profit any more or less?
But because there is no patents, the BIG company "B" just steals my invention, and makes millions, and squeezes A out of business, because it is so much larger. This isn't "society benefit"..
Well, the men and women of society have access to the wonderful product, as sold by "B", do they not? If the small company "A" can do it better, for cheaper, then we will benefit even more. Or perhaps small company "C" would like to try their hand at it. Maybe 37 different small companies and 16 other large companies would be free to implement and sell the product. The product is much more likely to advance when anybody can run with the idea. Society benefits when the original idea is advanced and developed as far as possible, rather than when the idea is "shackled" to a single company that controls its fate.
the patents exist because the original inventor, person or corporation, deserves to profit from their invention.
Again, why does someone deserve to profit from an idea? Why should an idea be a ticket to a windfall when we all know that business is 1% inspiration and 99% perspiration (pardon the cliche). People should profit from selling goods and services that other people cannot (or don't have to time to) manufacture or perform for themselves. If people want to buy your goods and services, then you should profit. You shouldn't be allowed to profit simply by denying others use of an idea.
... no, software patents give a developer a choice in whether or not to go open source or to protect his or her intellectual property.
Not trying to flame here, but at what point should an idea become the exclusive property of one person. What, other than the patent system, makes it his or her intellectual property? Is it really because he or she, out of all of the millions of people here, say that they thought of it first?
It seems that the patents on "intellectual property" are philisophically untenable because they prevent people from acting on their own ideas. Instead of a fluid flow from idea to implementation, we instead are yoked with the obligation to exaustively search existing patents and pending patents for "intellectual property" that may be used in a future lawsuit against you. This takes excessive time and money, and has the potential to really stifle progress in the software industry.
I'm not sure how the book examples access MySQL, but I use DBI.
The book uses DBI in their database examples. I'm sure everyone is also aware of the Apache::DBI module, which keeps persistent database handles available for each child process of apache.
Slashdot Mirror
In the article, he complained about the rather awkward way he had to use macros in C to maintain namespaces which he could do more elegantly in C++. In addition, the heavy use of macros that are not available to the C debugger was cited.
Phantom limb pain. Sorry.
A pretty cruel thing to say! Some of the contributing factors for CTS are not under your control. Who knew that you were going to develop acromegaly, rheumatoid arthritis, hypothyroidism, sarcoidis, or another medical condition that can cause carpal tunnel syndrome? Is it your fault that you developed those diseases? No!
If your carpal tunnel syndrome is due to RSI, pregnancy, or oral contraceptives then maybe your behavior is partially to blame, but this is not always the case!
I'm sorry to say this, but it sounds like you probably have significant nerve damage at this point, some of which is quite likely to be permanent. Surgery is very likely to get rid of the pain, but the numbness and weakness are likely to recover very slowly and incompletely. If allowed to progress too far without effective treatment, carpal tunnel syndrome will lead to irreversible, disabling, damage. It is a shame that this might have been prevented by earlier intervention, as unpopular and distasteful as the idea of surgery seems. I would recommend finding a good neurosurgeon that specializes in peripheral nerves (most major cities will have at least one such neurosurgeon) although most neurosurgeons do this procedure frequently. An orthopedic or plastic surgeon with specialty training in hand surgery would also be a good choice. Good luck!
You are correct in saying that surgery does not treat inflammation and that it only removes the pressure from the nerve. However, carpal tunnel syndrome (the symptoms and nerve damage) are caused by the pressure on the nerve in a tight carpal tunnel. Often the carpal tunnel is tight because of the inflammatory changes.
So the causative sequence is inflammation (and/or other factors) -> tight carpal tunnel -> pinched median nerve -> damaged median nerve.
Surgery relieves the pressure. If the symptoms return (they usually do not) after surgery, it is because the surgery was incomplete or because you formed excessive scar tissue over the nerve and the nerve is once again "pinched". This is why I encourage my patients to keep moving their fingers regularly after surgery so that the tendons and nerve will not get scarred into a fixed position. In difficult cases, there are substances (Adcon-L, for example) that can be placed on the nerve to prevent scarring.
Surgery should be avoided if conservative measures can control the problem. But it is not the least desireable alternative! The worst alternative is to allow permanent nerve damage to occur when CTS goes untreated too long. At that point, no treatment will reverse the damage.
If you must see a chiropractor (spine manipulating health care provider) rather than a neurosurgeon or neurologist (nerve doctors) for your median nerve problem (carpal tunnel syndrome), please do not let the chiropractor pop your neck as a proposed treatment for the pinched nerve in your wrist! I've been to a chiropractor and had some manipulations. Some of them actually felt good. But they are not without risk. I've taken care of patients with dissected (torn) vertebral arteries (the arteries that run up the side of your spine and provide blood flow to your brainstem) resulting from chiropractic manipulation that suffered horrible (fatal) brainstem strokes! Chiropractic has a place, but it is not without risk - and if you have a pinched nerve in your wrist (carpal tunnel syndrome), then the risk of violent neck popping is not justified (in my opinion). Do let your chiropractor prescribe ibuprofen and wrist splints. Do ask about behavior modification.
I perform this kind of surgery, but do not recommend having both hands done at the same time.
Due to the delicate nature of the surgery, the doctors usually don't give it too good of a success rate.
The surgery is actually quite simple and takes about 20-30 minutes. Not particularly delicate either. The sucess rate is quite good for patients who haven't responded to conservative measures and do not already have permanant irreversible damage to the median nerve. When numbness and weakness become significant, then it is likely that the nerve is damaged and not just irritated. In this situation, surgery mainly helps get rid of the pain and helps to prevent further loss of function.
Unfortunately. when he finally recovered from the surgery, he only had feeling in about 3 or 4 fingers between both hands.
In this case, either he had surgery too late in the course of his CTS (after damage to the nerve had become permanent), or something went wrong with his surgery (uncommon).
Yes! As a neurosurgeon, I see a fair number of patients who suffer from carpal tunnel syndrome, some of which eventually have surgery.
The simplest way to conceptualize carpal tunnel syndrome is to think about it as a problem of proportions: The median nerve must pass through the carpal tunnel in order to reach the hand. If the carpal tunnel is too small (for any number of reasons) or the median nerve is swollen or enlarged (again, many possible causes), then you may develop the symptoms of carpal tunnel syndrome, since the median nerve is essentially being "pinched" as it passes through the carpal tunnel. Nerves really do not like to be pinched!
There are many possible contributing factors which can lead to such a situation, some of which can be improved with medications or behavior modification, and other which cannot.
Some Contributing Factors
Symptoms
- Pain
- Numbness
- Weakness
- Clumsy Hand
Since it is the median nerve that is affected, the pain and numbness will follow the course of the median nerve. Although there is variability, this usually means the "thumb side" of the hand - the thumb, index, and middle finger - and to a variable degree the ring finger. The pain and numbness are usually exacerbated (made worse) by certain activities. If the median nerve is sufficiently irritated, you may also have pain in your forearm. Sometimes the pain and numbness are constant. Often, patients will wake up in the middle of the night with pain when their unsupervised wrist gets into a bad position. Weakness in the grip or thumb may occur, especially the abductor pollicus brevis (a thumb muscle). When weakness and numbness are combined, your hand's feedback and execution are off, and you may experience clumsiness. You might find yourself dropping things that you thought you had a good grip on. In advanced cases, the muscles of the hand become atrophied, which can be disabling. Atrophy of the thenar eminence (the "mound" of muscle between the base of your thumb and your wrist) is characteristic of advanced disease. You do not want to let it get to that point, since a full recorvery is unlikely despite any treatment when atrophy exists.Diagnosis
- Examine for weakness, numbness, atrophy
- Tinel's sign - tap the middle of your wrist a few times. Did you reproduce your pain or get a painful shock in your fingers?
- Phalen's sign - push the back of your hands together so that your wrists are forcibly flexed. Hold that position for a minute or two. If your pain is reproduced, the sign is positive.
- EMG/NCV - electrical tests of nerve and muslce. Prolonged motor or sensory latencies are suggestive (delayed transmission due to abnormally slow conduction though the pinched portion of the nerve). In advanced cases, you may see "dennervation potentials".
Not all of these findings are present in every case of CTS - and no one single finding is sufficient to make the diagnosis.Treatments
What does surgery do?
Surgery entails an incision over your wrist and a portion of the palm of your hand. The transverse ligament, which is the "roof" of the carpal tunnel, is then cut so that the median nerve is no longer trapped inside a tunnel. The tunnel becomes a ditch. The nerve breathes a sigh of relief. The degree of tightness is often quite impressive, and often the nerve is visibly swollen or even discolored. In those unfortunate enough to have waited too long, the nerve is visibly atrophied.
If pain and intermittant numbness were the only symptoms, then there is a very good chance for an excellent recovery after surgery. If, on the other hand, there is 'round-the-clock numbness or weakness prior to treatment, then this suggests that the nerve may be permanently damaged, and a complete recover is less likely. In these cases, the pain will usually resolve fairly quickly postoperatively, but the numbness and weakness may take months to recover, and may not recover completely. Recovery in these cases is slow because the median nerve has actually lost some of its fibers (axons), and they must regrow. The axons begin in the spinal cord or a ganglion in the neck and extend all the way down the arm into your fingers. When there has been prolonged CTS and associated inflammation of the median nerve where it was pinched, there may exist scar tissue within the nerve which prevents the axons from crossing that segment as they try to regrow though the wrist to the hand. So the moral of the story is: try conservative measures if you are having pain or intermittant numbness. If the conservative measures do not work, and the CTS is interfering with your life, or if you develop 'round-the-clock numbess or signs of weakness then you should consider surgery. Most cases will not require surgery, but it is a sad thing to see when CTS is allowed to progress to the point at which damage to the nerve is permanent.
There seems to be a lot of talk on the internet lately about carpal tunnel syndrome as a mysterious entity that only a select group of doctors that treat famous musicians understand. Simply untrue. Family physicians see CTS all the time. Any neurosurgeon and most orthopedic surgeons (and some plastic surgeons) will be intimately familiar with CTS, as it is really quite common and is treated by a relatively minor procedure when conservative measures fail. The risks of surgery are small, but they include
- damage to the median nerve leading to further numbness or weakness
- infection
- failure to completely free the nerve from compression (i.e. compression of the nerve beyond the extent of the incision).
In my own personal biased opinion, I favor the "open" approach with an incision over part of the palm of the hand and wrist over the "endoscopic" approach which allows a smaller incision. I believe that the traditional larger incision provides superior visualization of the nerve, and thus more control over what is and isn't being cut.The other popular take on CTS these days on the net is that RSI is somehow being misdiagnosed as CTS. This is actually becoming a very popular misconception. The critical thing to keep in mind is that RSI (repetitive strain injury) is one of many mechanisms that can contribute to carpal tunnel syndrome. We don't tell patients that they have Repetitive Smoking Injury (another RSI!) when they have a stroke, heart attack, or lung cancer, even though smoking can certainly be a cause of those problems. It would be silly to say "You don't have lung cancer, you've got repetitive smoking injury". Similarly for RSI and CTS. If you have the signs and symptoms of carpal tunnel syndrome, then you have carpal tunnel syndrome. Repetitive strain injury may have been an important contributing factor and you may be able to help your symptoms by taking altering your behavior. The increased public awareness of repetitive strain injury (RSI) is, IMHO, a good thing because it can lead to changes in behavior that help to avoid CTS and other problems - just like increased public awareness of the dangers of smoking can lead some people to quit. But let's try not to confuse our terms! RSI is a general mechanism of injury to tissues that contributes to problems thoughout the body. CTS is a specific problem with your wrist in which RSI may or may not be a contributing factor. I hope this has helped to explain RSI and CTS!
Yes, but not becauase of medical life support!
I'm sure there must be others. Can anyone name some others?
He was faking it! Just toying with the examiners for the sake of fun and games, as he did with everything else...
He was probably one of the more socially facile geek geniuses in history!
Reading that line chilled my heart. This is the age of the anti-depressant wonder-drug. All the doctors are prescribing them for just about anything, as if they are candy with no ill effects. Just last month my wife went to a neurologist because of an enormous headache that lasted 5-6 days. He said it was a migraine and prescribed zoloft. We went for a second opinion, the other doctor said it was a low-pressure headache, they happen rarely and almost never reoccur. No drugs needed, no further treatment needed as long as there is no more pain. You have to wonder what kind of lazy doctor that first guy was to just offer up the "latest and greatest" drug with hardly any critical thinking at all.
As a matter of fact, Haldol is not an antidepressant, but rather an antipsychotic drug that has been around for many years. Far from a "latest and greatest" drug. Good for people with paranoid delusions and other problems with reality. Not sure if the girl needed it or not from the description of things though.
Also interesting, many of the "antidepressant" drugs are useful for many other things than depression. Many types of chronic pain are treated with "antidepressants" - even if the person is not depressed. Certain types of "antidepressants" work for obsessive compulsive disorder. Others work for childhood bed - wetting. The list goes on, and is ever expanding. Headaches are notoriously difficult to diagnose and treat. Whether zoloft was appropriate for your wife is difficult to say - it is not the usual first line treatment for migraines. It does however, have fewer side effects than other migraine medications.
Probably better to think of evolution as "reproduction of the fittest" since mere survival means nothing. People with medical problems requiring modern medicine for survival as infants are less likely to be normal, healthy, reproductive people. Conversely, many of the infants or children that are saved by modern medicine have disease that do not necessarily impact intellegence (congenital heart defects, severe pneumonia, leukemia, etc). They might go on to be productive members of society, or even geniuses. Those with intracerebral hemorrhage, hydrocephalus, or congenital problems with the nervous system that may impact intellegence are less likely to reproduce later in life. However, some of these people are "normal" by testing years later. Also, even if they do reproduce, their disease is not necessarily transmitted to their progeny, so the impact on evolution is questionable.
Simply put, there is plenty of stupidity out there in the gene pool already - the effects of saving infants with previously terminal diseases on evolution is negligible.
Are you going to look one of these "unfit" kids or their parents in the eye and tell them that they should be "allowed" to die so that evolution can progress?
I would rather think of the "mild autism" attributes as features rather than bugs! Maybe that's because I see some of them in myself.
It wouldn't be much harder to type something like:
The xset program would replace your echo command, and intellegently parse the DTD's and make sure that you are making a valid change. With the proper system tools created or modified to use xml, you really won't have to go through much more trouble, and you gain the ability to do validation or use GUI tools easily. If you want to edit the xml with vi you could do that too. And emacs....I'm sure there's a way to get it to work gracefully with xml config files (it does everything else already!).If you put the A/D converters into the guitar, then you avoid a lot of the noise and hum associated with guitar cords. Despite high quality construction and shielding, there is still a lot of electrical that gets into a conventional cord, especially longer cords. Even if you get back to the analog domain in your tube amplifier, you still win by using a digital cord.
This is certainly true. I think, however, more of the software will be running on servers or distributed invisibly to run on the client as an applet (Java or otherwise). Once the browser capabilities are fully fleshed out, the internet will become a big multimedia and database application server. The endless cycle of upgrades will continue unabated - on the servers. The brower will be the main app to update on the desktop. I rarely use anything on my home computer these days other than netscape, vi, telnet, ftp, and gimp. Other than the horrible memory leaks in netscape, I'm not really unhappy with anything on my desktop machine. My servers, on the otherhand, are constantly being upgraded and tweaked.
Since most web sites and their databases are primarily concerned with text, it's really a no-brainer to use a language such as Perl that excels in text processing. Playing with text in lower level languages such as Java (C++ made childproof) is like trying to eat soup with chopsticks. Why waste 10-20 lines of Java doing what Perl does in 1 or 2? If it simply has to be faster than Perl bytecode, then write the critical functions in ANSI C.
Also, Perl is only as messy as you want to make it. You decide which idioms to use.
And the scientific control used to support this claim is what? I could have just as easily said "All this time rock 'n roll has been around", and then attributed our progress to rock 'n roll. Or perhaps our advancing knowledge is due to monosodium glutamate, bikini bathing suits, or highly absorbent paper towels. Or maybe knowledge grows exponentially acconding to the differential equation K'=a K. Perhaps in a parallel universe, where there is an identical United States without patents, we would all by flying around in cheap air scooters and carrying wristwatch communicators with terabyte object databases inside. Do you think that people would stop trying to innovate and bring new products to market, and that companies would stop in house research if there were no patent protection? That would be naive thinking.
Tough luck if you invent something that has already been patented. Do better research next time because nobody benefits from reinvented wheels. In all other cases it is just plain theft of an idea and protection of it seems a very wanted feature just to protect individual freedom.
I hardly see how "tough luck" addresses the issues. Why should the rights of an individual to their ideas be removed simply because someone else, who had a similar idea, got to the "patent office" first? Can the "little guy" afford to thoroughly research all potential infringements that his software might make? Can he afford to defend against a suit from the bigger companies that inevitably buy up all the patents and use them to intimidate and litigate upstart competitors out of business?
And why do ideas need to be protected anyway? Protected from what? If I steal your idea, and then try to corrupt or otherwise destroy it, do you not still have the intact idea in your possession, still unhindered by anything that I might have tried to do with the idea?
That's a moral position you take here, I and many others don't share it. This is the key issue here. You belief in giving away stuff for free bu that is just not how our society works.
I believe the poster didn't imply we should give away stuff for free, just ideas.
. In a communist society patents wouldn't make much sense but in our capitalist society where everything (like it or not, personally I don't like it) boils down to money it is an important tool.
In a communist society, you may get your stuff for free, but the ideas are not usually so free. Our capitalist society should be based on free ideas and money for goods and services that you yourself cannot, or do not have the time to, produce or perform for yourself.
You confuse concepts and their implementations. Pirating Steven King's book should, indeed, be illegal. It should not be illegal, however, to write your own scary story with similar characters and similar plot. If the basic "story lines" could be patented, we would not have any new books.
Why do they deserve to profit already? Does company "E", who independently invented the same thing 3 weeks later deserve to profit any more or less?
But because there is no patents, the BIG company "B" just steals my invention, and makes millions, and squeezes A out of business, because it is so much larger. This isn't "society benefit"..
Well, the men and women of society have access to the wonderful product, as sold by "B", do they not? If the small company "A" can do it better, for cheaper, then we will benefit even more. Or perhaps small company "C" would like to try their hand at it. Maybe 37 different small companies and 16 other large companies would be free to implement and sell the product. The product is much more likely to advance when anybody can run with the idea. Society benefits when the original idea is advanced and developed as far as possible, rather than when the idea is "shackled" to a single company that controls its fate.
the patents exist because the original inventor, person or corporation, deserves to profit from their invention.
Again, why does someone deserve to profit from an idea? Why should an idea be a ticket to a windfall when we all know that business is 1% inspiration and 99% perspiration (pardon the cliche). People should profit from selling goods and services that other people cannot (or don't have to time to) manufacture or perform for themselves. If people want to buy your goods and services, then you should profit. You shouldn't be allowed to profit simply by denying others use of an idea.
Not trying to flame here, but at what point should an idea become the exclusive property of one person. What, other than the patent system, makes it his or her intellectual property? Is it really because he or she, out of all of the millions of people here, say that they thought of it first?
It seems that the patents on "intellectual property" are philisophically untenable because they prevent people from acting on their own ideas. Instead of a fluid flow from idea to implementation, we instead are yoked with the obligation to exaustively search existing patents and pending patents for "intellectual property" that may be used in a future lawsuit against you. This takes excessive time and money, and has the potential to really stifle progress in the software industry.
The book uses DBI in their database examples. I'm sure everyone is also aware of the Apache::DBI module, which keeps persistent database handles available for each child process of apache.