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

Three-Dimensional Character Building

So. I teach my students there are four primary elements of storytelling: Character, Conflict, Plot, and Point of View. And I argue that perhaps the single most important element of storytelling is Character, because each of the other elements emerges from what an author does with Character.

AoDW
Buy The Art of Dramatic Writing on Amazon.

Lajos Egri, a Hungarian playwright and creative writing teacher who lived and worked in the United States during the first half of the 20th century, argued that the heart of any drama is its characters. Egri is most well-known for his treatise on playwriting, The Art of Dramatic Writing, which was originally published as How to write a Play in 1942 by Simon & Schuster. It was later revised and published as The Art of Dramatic Writing in 1946.

Egri worked with a number of playwrights and screenwriters, including a 63-year-old grandmother, but his most famous student was Woody Allen. In his biography by Eric Lax, Allen admitted: “I still think [Egri’s] The Art of Dramatic Writing is the most stimulating and best book on the subject ever written, and I have them all” (Lax, 2000).

In his book, Egri argues that the most important question, the absolute KEY to fundamentally understanding a character is “WHY.”

“We want to know why man is as he is, why his character is constantly changing, and why it must change whether he wants it to or not.” (Egri, 2004).

Well-rounded, dynamic characters provide the audience with excitement and emotional investment. Egri claims that there are three dimensions from which characters are fleshed out: the physiological, the sociological, and the psychological.

So when fleshing out characters, we should approach our work from these three dimensions. Here’s some of the information we need to put together during this process.


PHYSIOLOGY 

  • Sex
  • Age
  • Height and weight
  • Hair, eyes, skin
  • Posture
  • Physical Appearance (good looking, pleasant, sketchy?)
  • Physical Defects (birthmarks, scars, diseases, etc.)
  • Heredity

SOCIOLOGY

  • Class (lower, middle, upper)
  • Occupation (what do they do? how does it affect them? Pay? Suitability?)
  • Education (amount, favorite subject, aptitudes, marks?)
  • Home life (Normal? Neglectful? Broken?)
  • Religion
  • Race, Nationality
  • Social Standing
  •  Political affiliation
  • Amusement, hobbies

PSYCHOLOGY

  • Sex life, moral standards
  • Personal premise, ambition
  • Frustrations, chief disappointments
  • Temperament (extrovert, introvert, ambivert?)
  • Attitude towards life (defeatist, militant, passive?)
  • Complexes (obsessions, superstitions, phobias?)
  • Abilities (physical, mental, emotional?)
  • Personality Traits

As writers, we need to flesh out these parts of our characters. Not all of them will make it into our work, but we should know them to bring an authenticity to the character development. We also need to remember that emotion has physical effects as well.

Whatever happens in our stories needs to come from the characters. They need to be strong enough to prove the premise without forcing it. Fleshing out our characters using this three-dimensional approach allows us to frame plot developments in a believable way.

We need to know WHY the characters are doing what they are doing, and this WHY must be believable. Egri’s three-dimensional approach is a tool we can employ to ensure a characters’ motivation is real, and that their reaction–how they act on the motivation–is what these characters would truly do.


Egri, L. (2004). The art of dramatic writing: its basis in the creative interpretation of human motives. New York: Touchstone.

Lax, E. (2000). Woody Allen: a biography. New York: Da Capo Press.