Friday, December 27, 2019

Referred Pain From Trigger Point (simple explanation)

OK, for folks that suffer from pain in your hands which does not seem to make sense, maybe this explanation can help (with diagram). I suffer from myofascial pain syndrome which results from bits of hardened connective tissue called trigger points. You can often feel them by palpation (this will likely hurt!). For me, this is connected to a larger condition with trigger points all over my body, but trigger points can also result from local injuries and old trauma. But few people seem to understand how they work. Doctors often do not understand either or may understand at a cerebral level but fail to explain them to a patient. (Sports medicine folks sometimes do the best job with both recognizing the problem and making it make sense to the patient.)
[Disclaimer: I am not a doctor; I am not your doctor.]
A trigger point in the upper arm can refer pain to the lower arm and hand. [Eric Vought]
A trigger point in the upper arm can refer pain to the lower arm and hand. [Eric Vought]
So, I have a trigger point in my upper arm (one of many), shown roughly in my diagram. The trigger point is in the connective tissue. There is a major junction of a nerve, an artery, and a vein between it and the muscle. Open the Gray's Anatomy diagram below for more (and better) detail. This is a pulse point and a good pressure point for controlling bleeding. You might be able to feel the pulse change a bit as you move your arm up and down. As the muscle tightens, it moves the artery and changes the pressure of your finger on the blood vessels.
Gray's Anatomy, Brachial Artery (Public Domain)
Gray's Anatomy, Brachial Artery (Public Domain)
This can be why your hand hurts, why you rub your hand or put liniment on your hand and the pain is not affected. This can be why taking NSAIDs doesn´t make your hand feel better. Your hand is not where the problem is.
Recall that the trigger point is a hardened bit of connective tissue. When the muscle tightens, the nerve and blood vessels between it and the muscle get trapped and pinched. This can reduce blood flow back from the hand and it can cause the nerve (which travels down to the hand) to register pain. It also tends to make you move your arm differently (even if you do not realize it), put tension on tendons, etc, and this affects the way you use your lower arm and hand, the way you grip, etc., causing pain or loss of function. The symptoms in your hand may not seem to make sense. But dealing with the trigger point in your arm may relieve the pain in your hand (or at least help).

The exact same process can happen in any of dozens of places in your body, causing a variety of unusual symptoms or (seemingly) inexplicable pain.

If you have trigger points like this, Travell and Simons´ "The Trigger Point Manual" may help your doctors understand how this works and will explain at a level that I could never do, especially in a blog. That book provides detailed diagrams of where trigger points occur, the satellite symptoms they may cause, and why. When I walk into an office and see a copy of this book, it makes me feel more comfortable that a practitioner will understand my condition. For yourself, Starlanyl and Copeland's "Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual" is targeted at the individual sufferer who is trying to understand and cope with a bewildering condition. That book, given to me by a friend and fellow sufferer now gone, is what allowed me to get a handle on why my life was suddenly falling apart.
Learning to recognize where the pain is and why it happens helps to find relief. In the past, I would try to rub something into the hand or take an antiinflammatory. Now I know that often will not work. I find, personally, that concentrated capsaicin (from say, Capzasin-HP) on the trigger point will make my hand feel better. Capsaicin (from hot peppers) is absorbed through the skin and numbs the underlying nerve. It causes local pain (it burns a bit!) and skin irritation if I use it too much. But if I can use my hands more, it is a net win. If you have pain like this, learning more about it may help you find ways to live just a bit better. (Just wash your hands very well before you rub your face...) Massage and physical manipulation can also help or even correct trigger points. Just be careful and learn what you are doing (or find a good professional!) because doing the wrong thing can cause further harm. There are several old quack treatments for trigger points which did no good and left patients in agony, including "work hardening", surgery, and (some, older) trigger point injections.

Saturday, June 15, 2019

Blackboard Excercise of Psalm 52 (תהלים ל֞֞ב) in Hebrew and English: Why Hebrew Grammar is Necessary

[Partial Draft 0.2]

Writing Out Hebrew Verb Forms For Practice, קאל קטל וקאל יקטל (Blackboard photo)

Those of you who follow my doings on Facebook know that I regularly do language exercises on a blackboard in my kitchen, particularly Biblical Hebrew. I work through verses in the Torah, Proverbs, Psalms, etc., in a somewhat haphazard way, once in a while wandering back to an old set of verses after I learn more. I copy the verses in Hebrew, often in a parallel text, mark it up, and write notes. I intersperse with vocabulary and grammar practice. and try to work on something every week.

I do this for a number of reasons, including the simple fact that I learn language best when I can incorporate reading, writing, and speaking. I do copy work on paper often, but the blackboard has the advantage of being centrally located: I have to walk by it several times a day, every day, looking at the piece in progress, reading and thinking about it subconsciously, noticing mistakes, picking up the chalk to make small notes, sometimes stopping to read (or sing!) the verses aloud. Sometimes it becomes a focus of family discussion. The blackboard becomes a centerpiece to daily, continuous study.

My weekly posts are usually just photos of the piece and whatever snippets of thoughts I happen to have. The blackboard exercise which is at the center of this post is a bit more involved. Over a period of weeks, I have written and rewritten it, walked away, worked on aspects of grammar and come back several times. Part of the reason for that is that this time, instead of bypassing aspects of grammar and, especially, Hebrew verbs that I did not understand, simply taking the word of translations or commentaries, I finally had the tools to tackle them head on and, well, not conquer exactly, but at least end up holding the field. It has therefore become a crystallization of why I went down this road in the first place.

So, this time, by going through the blackboard exercise, I am going to use it to explain exactly why learning at least a critical mass of Hebrew grammar is necessary in the first place, why parallel translations, keyed texts, concordances, and a good dictionary are not, by themselves, enough. Nor am I-- or does everyone have to be-- a trained Hebraist. There is a point in-between where we can usefully muddle as we go without having to be all that and a plate of latkes.

(This is not targeted at a Hebrew scholar. You don't need to know anything at the start. Skim over what you don't understand and try to soak in why it might be useful to know more.)

The Text of Psalm 52 v 7-9

The exercise text is take from Psalm 52, verses 7 through 9. It is written in the blackboard with the English Revised Version (ERV) text on the right and the Biblia Hebraica Stutgartensia (BHS) Hebrew text on the right. Since English flows left-to-right and Hebrew right-to-left, this is a convenient form for verse numbers on the left and right edges and a center divider. The English text and the Hebrew text (or at least a very close one-- a subject for another day) are available at Bible Hub.

Note: If you read Hebrew numbers, you may notice that the Hebrew and English verse numbers do not actually match up. This is normal in the Psalms as the Hebrew Bibles generally count the prologue of the Psalms differently. If you do not read Hebrew numbers, what you don't know will not hurt you for now: the blue highlighted verse numbers in the Biblehub link I give match the King James versification.

Start With the Visual

Start just by looking at the verses in English and Hebrew, whether or not you can read any Hebrew words or even understand the letters. Notice that the Hebrew is quite compact, taking up considerably less room. The Hebrew characters represent consonant values with small markings called nikud or 'pointing' for the vowels and punctuation. The nikud is a relatively recent invention (Medieval period) and were not written in the original ancient text. A fluent Hebrew reader would have had to remember those details from their familiarity with the language, text, and tradition, jst as yu cn ryd ths yf yu fmlyr w/Englsh. The Hebrew is also compact because it chains small prefixes and suffixes to add preposition, subjects, object, etc., to a root word. A single word in ancient Hebrew might take most of an English sentence to express. "I will give thanks to thee" in the English here is all represented with "אודך" in the Hebrew, just four characters! We'll come back to that phrase later. A waw character (ו) is used to prefix a word with "and", which the Hebrews liked to use quite often to separate ideas, almost like punctuation. You see this in the beginning of verse 8 which starts with "ואני" or "But I". All these things give the Hebrew a unique character visually.

Next, note that these verses are part of a Psalm, a Hebrew prayer book or hymnal. Each verse is set in two parts which I break up in four lines. There is a Hebrew mark called a munach which looks like a carrot (^) under the logical midpoint of each verse. This is poetry folks, and that is often not reflected in the English at all! An English translation has to try to convey meaning, context, structure, idiom or imagery, poetic arrangement, etc., and different translations choose which of these to try to get across. That means, straight off, the question of which translation to use is always "it depends".

Using a Keyed Text Helps, But...

Some people use keyed study Bibles, usually using Strong's Numbers in small notations alongside the English words. These keyed texts are extraordinarily helpful, but, as we will see, have serious limitations as well. The next image shows these versus in my King James Hebrew-Greek Keyed Study Bible which I was given as a gift over twenty years ago. If you look at the word "man" in such a text, it has a helpful notation "1397" which is the Strong's Concordance number for the Hebrew word "גבר", often translated as "strong man" or "warrior". These words are defined in the dictionary in the back of the keyed Bible, but these days you can generally simply type "Strongs" followed by a number into your browser search bar and get a definition.

The key tells you that the Psalmist was not using the name "Adam" which is often used generically for "a human", nor the form of Enosh commonly used ("fallen man") but the word for a beefy self-reliant manly man. You may (or may not) be able to see that I use the same numbers on my blackboard, drawing connecting lines between English and Hebrew words or phrases noted with the Strong's numbers. In some cases, I write the number and definition at the bottom of the board. These standard numbers are probably the most helpful tool ever invented for basic study of the Hebrew Bible.

Looking at the keyed text, it is clear that not all of the words are noted (nor could they be without making a mess), and there is little indication of the problem of prefixes, suffixes, and whole phrases being glommed together in a handful of Hebrew characters. It is very difficult to see, that the "But I" in verse 8 is one word and that neither "am" nor any equivalent appears in the Hebrew (linking verbs-- essential in English-- are usually entirely absent). Although "will praise" is keyed here with 3034, it does not show that "thee" is included as a suffix. Finally, if you look up that key, it is very hard to have the foggiest clue how to go from the Hebrew yada (ידה) to an English future imperfect (actually, Hebrew verbs have no past-present-future tense at all as we understand it in English but something strange and subtly different).

Learning Enough Hebrew To Use a Lexicon/Dictionary

The next step deeper is to learn to read enough of the actual Hebrew characters to recognize and look up individual words. The compact dictionary at the back of the keyed text is a start, or you can try to do online searches, or sit down with a copy of a decent lexicon like the Brown-Driver-Briggs (BDB). There is no practical difference between 'lexicon' and 'dictionary', by the way: one word is Greek and the other Latin, but they both mean a list of words and their meanings. In any case, you will need to actually learn what the Hebrew letters mean, and train yourself to read them right-to-left. This takes work, clearly, but it is rewarding and can be fun.

Do not bother much with transliteration, being able to read and recognize 'bara' for 'he creates', for instance, except as very short-term training wheels to learn the actual alphabet (Aleph-Bet א-ב). Transliteration was never standardized, so the same word can be written several different ways. Searching for a transliterated word will just frustrate you. Nor will the transliteration tell you how to correctly pronounce the Hebrew without adding all kinds of phonetic symbols which end up being more work than just learning the letters correctly. Trust me: just learn the Hebrew Alphabet and learn to sing the song in your head, just like you may still do in English while alphabetizing files.


Monday, February 4, 2019

La Iglesia San Miguel Arcangelo and a Prayer of Saint Martin

When we were recently in Cozumel, we visited Iglesia San Miguel Arcangelo, the Church of Saint Michael the Archangel, on Benito Juarez. It has a beautiful and famous statue of the Archangel there which is the subject of various stories and an interesting history aside from the legends. As it happens, Michael the Archangel is my name-saint (my middle name, not my first), so I took some time exploring the church and the statue.

There were people there quietly praying, so I did not want to disturb them taking photographs inside. I did, however, sit in an alcove dedicated to San Martín de Porres (variously "St. Martin of the Fields" or "St. Martin of Tours" in English) and copy down a prayer displayed there by hand. St. Martin was a Roman knight who cut his own cloak in two to clothe a freezing beggar outside the gates of Amiens. He had a dream that night of Christ wrapped in his torn cloak, leading to Martin's baptism. He was a soldier who showed courage throughout his life but who also sacrificed to bring peace (party responsible for the Armistice being signed on his feast day, 11 November, which is now Veteran's Day). He became a patron of veterans, of volunteers, and of auxiliaries; his torn cloak is borrowed in the logo of our local Sheriff's Auxiliary as an emblem of personal sacrifice in the service of others.

In any case, having copied down the prayer, I promptly misplaced the paper. It reappeared yesterday in a vest pocket. It appears to be different from the typical Catholic devotionals for San Martín:

Oracion del San Martin de Porres
¡Oh! San Martin, atiéndeme.
En mis penas y tribulaciones, consuélame.
En mis dolencias y enfermedades, socorreme.
Dame la salud si me conviene y librame de calquiar mal del alma y cuerpo.
[English Translation:]
Prayer of Saint Martin de Tours
Oh! Saint Martin, attend me.
In my sufferings and tribulations, console me.
In my pains and my infirmities, assist me.
Give to me health if it is suited to me, and free me from the faint impressions of the soul and body.

I try to translate "calquiar mal" as "faint impressions" here, given that "calquiar" (an unusual verb) means to copy a drawing by tracing on top of it. I may have also made a copy error here, myself, but there are no alternative verbs which seem a likely candidate for a simple handwriting mistake (comments welcome). There may also be idiom or imagery I am simply missing. It may refer to us being made in the image and likeness of God, but a faulty and imperfect likeness which leads to frailty and sin.

Given my Catholic upbringing (I became a Lutheran some years ago), the devotion to the saints which is still very much alive in the Hispanic churches interests me. I do not necessarily agree with a veneration of the saints to the extent it elevates them to a semi-divine status, but I do believe that trying to live by the example of the saints and using them as meditations for the understanding of our own troubles has a practical value in trying to live a good life. As Dietrich Bonhoeffer (WWII Lutheran theologian and martyr, executed by the Nazis), this may be something the Protestant churches have wrongly discarded.

Thinking of the saints as potential mediators between us and God (as in this prayer) may be a useful tool when we feel so low that we cannot approach the divine directly. We know that they were mortal, that they failed, that they fell down and got back up. But in many ways, that is also the meaning of Christ's ministry to us: Jesus is fully God and fully human. He knows what it is to experience the trials of the flesh, to suffer, and even to pray for relief. In Him, we can always find a bridge back to where we belong. But in any case, the reverence for the saints, their constant remembrance in the Hispanic Catholic devotions, impresses me. It gives me hope that an imperfect man, with a healthy dollup of God's grace and assistance, might remain imperfect, but nevertheless do "OK" in the end.

Πεποιθως αυτο τουτο οτι ο εναρξαμενος εν υμιν εργον αγαθον επιτελεσει αχρις ημερας Ιησοθ Χριστου; [Phillippians 1:6 ABP]
Being confident of this very thing, that he which began a good work in you will perfect it until the day of Jesus Christ; [Phillipians 1:6 ASV]

Saturday, February 2, 2019

Actually, Terrorists Are Terrible at High-Tech

When I went to pick up the key for a library meeting room recently, it had a stack of sale books. I tend to monitor mainstream writing on terrorism, so, for a few peanuts, I picked up a book by Berry Davies BEM called "Terrorism- Inside a World Phenomenon". So far, I have gotten to page 3 and have a list of things that are misleading, misinformed, or just plain nonsense. Unfortunately, some of the claims are fairly common. Here is one:

Terrorists now use aircraft as smart bombs to destroy buildings and human suicide bombers to kill and mutilate the innocent. Moreover, terrorists have acquired an intimate knowledge of sophisticated modern weaponry, making the threat of a nuclear, chemical, or biological attack on a major population center inevitable.

There is no source for the 'intimate knowledge' statement. I can, in fact, find such claims in official government sources... going back to the 1950s. There have been people who have been quivering in fear of some two-bit terrorist with 'intimate knowledge' unleashing Armageddon from a rucksack for not-quite seventy years (usually connected to funding requests). Obviously, it hasn't happened, and although we do have a few rare examples of plots by sub-state actors involving Nuclear, Biological, or Chemical (NBC), such as the Tokyo Sarin gas attack, the few attempts are notable mostly for stunning failure. The Tokyo plot involved five attacks on three lines of a major subway, causing a total of twelve fatalities. There will likely be as many routine murders in Chicago between the time I write this and the time that you read it.

Now read the two quoted sentences together. The reason that the perpetrators of 9/11 used aircraft (piloted aircraft are, by definition not 'smart bombs') was because they lacked 'intimate knowledge' of 'sophisticated modern weaponry', let alone easy access to such weapons. They did not even have access to heavy aircraft without hijacking them or sufficient flight skills to fly them without sending people to the US for training (which caught the attention of an observant Minnesota FBI agent who was, nevertheless, ignored).

This is the same reason we know terrorists often turn to suicide bombing in the first place. Ahlamm Tamimi, the planner of the Sbarro Massacre in Jerusalem (2001) makes it clear that she used a suicide bomber because her previous attack failed due to a faulty timer and detonator. This is quite common. Even beyond timers and detonators, terrorists routinely screw up the explosives themselves. A common but highly-unstable terrorist explosive, TATP, has the distinction of killing at least as many bomb-makers as it does people they target.

This long string of failures is why they often plan from the start to fall back on firearms, knives, arson, trucks, etc., when the technical approach does not work. In the Paris Attacks, even though the explosives were made by ISIS' expert bomb-maker (Saleh Abdeslam, now dead), at least one vest did not explode. In the Orlando "Shooting", the explosives set by the attackers failed. In Nicé, the attacker didn't bother and just used a truck. Time and time again, terrorists demonstrate that they are not capable of using even fairly basic military technology.

This, of course, does not mean that terrorists are not a threat and that we should not try to stop them.

Certainly, someone willing to die in the attempt can do significant damage even with crude technology. Maybe some day a terrorist with more advanced technology will break the losing streak and will use NBC to some effect. The fear-mongers will crow at that point that they were right, but what it really would prove is that they have been wrong every day for well-over half-a-century. Terrorists are a threat, but not the kind of threat they are made out to be. By constantly trying to make them into something they are not, we are doing their job for them. After all, they are the terrorists: it is their job to make us afraid. So why do we keep churning out publications which do their PR-work?