Diabetes & Tigger Finger

I recently had the article below published by Diabetes Daily. You can find it here on their site. Trigger Finger is something I’ve personally dealt with in the past, having to eventually have minor surgery to address the issue. I hope anyone reading this finds the article interesting and informative.

Diabetes and Trigger Finger

Diabetes is a chronic condition that increases the risk for serious health problems for those saddled with the disease. Among the most common complications connected to diabetes are cardiovascular disease, neuropathy, retinopathy and depression. One of the lesser known conditions is trigger finger, or stenosing tenosynovitis.

Trigger Finger is a musculoskeletal ailment that affects the ligaments and tendons in the hand. Those dealing with this condition have a finger or thumb that gets stuck in a bent position, then the digit straightens with a snap, not unlike a trigger being pulled then released.

Trigger finger is more common in women than men and occurs most often in people between the ages of 40 and 60. The condition occurs when there’s an overgrowth or swelling of tissue in the tendon sheath of the flexor muscles. When the tendon can no longer glide smoothly through the sheath, it catches and remains bent. It releases with a painful click as it straightens.

What’s the connection?

The cause of trigger finger is unknown, but there are a number of factors that increase the likelihood of developing the condition. One of those factors is diabetes. Trigger finger gets lumped with other diabetes-related joint conditions, including frozen shoulder, diabetic stiff hand syndrome and carpel tunnel syndrome.

Trigger finger is fairly common complication of diabetes, particularly in long-standing diabetes. It’s thought that chronically elevated blood glucose levels cause the connective tissue to become glycated, which means an irreversible bond between glucose and protein forms in the tissue which damages it.

This condition affects 2 to 3 percent of the general population, but 10 to 20 percent of those with diabetes.

Trigger Finger Treatment

Treatment for this condition varies depending on its severity. Anti-inflammatory drugs like ibuprofen or naproxen may relieve the pain but typically won’t address the underlying tendon issue. Noninvasive treatments include rest, wearing a splint and specific stretches.

If the conservative treatments don’t work, doctors often suggest one of two more invasive options: a corticosteroid injection or surgery. Sometimes called a trigger finger release, the surgery is an outpatient procedure completed under local anesthesia.

Concerns with Corticosteroid Injections and Diabetes

Corticosteroid injections are commonly used to treat a variety of hand and wrist conditions. The local injection involves administering the medication near or into the tendon sheath in order to reduce inflammation and it has the potential for a definitive cure in the case of trigger finger. This option for diabetic patients comes with caveats though.

A 2007 study by the Washington University School of Medicine found that corticosteroid injections were significantly more effective in the digits of nondiabetic patients than those of diabetic patients. In patients with diabetes, the injections did not decrease the surgery rate or improve symptom relief when compared to the placebo group of the study.

Additionally, the study cited a pair of previous investigations that reported transient increases in blood glucose levels after corticosteroid injections in the hand or wrist. The study noted a varying impact on glucose control in participants.

What to do when suffering with Trigger Finger and Diabetes

If you’re suffering from trigger finger as a diabetic, the first step is to consult your physician. Your endocrinologist may refer you to an orthopedic specialist, who will evaluate the severity of your condition. Once you have a solid grasp on what you’re facing, then you can make the best decision possible.

As with all things diabetes, you should maintain vigilant glucose monitoring, and should you elect to have a corticosteroid injection, be ready to adjust your medications accordingly.

Citation

Baumgarten, Keith M.; Gerlach, David; and Boyer, Martin I., “Corticosteroid injection in diabetic patients with trigger finger: A prospective, randomized, controlled double-blinded study.”  eJournal of Bone and Joint Surgery. 89, 12.2604-2611. (2007). http://digitalcommons.wustl.edu/open_access_pubs/847

The ABDCE’s of Plot Development

So. In my creative writing class these days, we’re discussing the elements of short story. The students are preparing for and brainstorming a draft of their first short story, and over the last few class periods, we’ve focused on Plot. When considering this integral element of storytelling, I gravitate toward the work of Anne Lamott, specifically her seminal work on writing craft Bird by Bird.

typewriterAnneLamottThere are some that discuss story as being either plot-driven or character-driven. I think that distinction is an erroneous one. I tend to agree with Lamott, who in her chapter on Plot from Bird by Bird says: “Plot grows out of character” (54).

All considerations from a storytelling perspective emerge after we, as writers, have an idea of who our main character might be. Decisions about Point of View and Conflict come in the wake of deciding who it is we’re dealing with. Now, this character may change along the way, but character is the starting point for all things Story, including Plot.

Conflict is the fundamental element of fiction (we can’t have a story without it), but in order to discover this element, we need the context of Character. Lamott instruct us to “find out what each character cares most about in the world, because then [we] will have discovered what’s at stake” (55). It’s in the pursuit of this desire that Conflict, and more specifically Plot, emerges. 


The ABDCE’s of Plot

In her chapter on Plot, Lamott mentions a lecture she attended by Alice Adams, a writer and university professor who created a simple formula for Plot development. The formula she uses when writing a short story is ABDCE (Action, Background, Development, Climax and Ending).

Action

To start, we need to draw the reader in with a compelling opening. This opening action is called an “inciting incident.” It’s the moment that launches the story into it’s upward trajectory and introduces the elements of Plot and Conflict.

Background

Since Conflict is the fundamental element of fiction, we need to discover why this action and conflict is so compelling to the characters. Who are these people? How have they come together? What’s happened before the story that informs the reaction to this initial action?

Development

This section represents the bulk of the story. This is the “rising action” of the traditional plot pyramid. Here, we explore the Wants and Motives. The characters are Active and Tension builds. Each obstacle propels the characters further along the journey, and each obstacle is more difficult to overcome than the last.

Climax

The Climax is the most important moment of a story. This is the coming together, the turning point. Everything changes in the story and for the characters in the wake of this scene, this moment. After the Climax, things are different in a meaningful way.

Ending

As the journey comes to a close, as the characters come down from the emotional high of the Climax, the ending provides the necessary closure for the reader. Who are these characters now? How have they changed? Is the ending closed, or open? Did the character have an epiphany? The Ending needs to demonstrate the meaningful change that stems from the Climax.


5 Steps for Plot Development

Plot grows out of character, and Conflict is the fundamental element of fiction. When considering how our Plots will unfold, we need to remember that readers demand Unity in regards to Plot, a plausible cause-and-effect development. Also, readers demand Significance, that the story shows us something about human nature. Otherwise, what’s the point of the story?

Here are 5 Steps for Plot Development loosely based on Lamott’s ABDCE’s of Plot.

  1. Describe your story in one sentence. (If you can’t, you might not have a clear enough idea.)
  2. State what the main character wants more than anything else in life. The plot will emerge from this desire. After, stick 3 obstacles to prevent your character from obtaining this goal.
  3. Write a character description of your Protagonist. Include Look, Likes, Dislikes, Fears, Traumas, and Basic Living Situation.
  4. Arrange the events of your story on a timeline. What will happen in the Inciting Incident? In what order will your character deal with the 3 obstacles you previously development? What’s the Climax going to be?
  5. Finally, create a map of the Setting where the primary Action of your story will unfold. What’s meaningful about this place? Why is the Climax happening here? How can this Setting become a character in the story?