Abnormal Hand Movements

It’s time for another physical diagnosis discussion. Four weeks ago we talked about abnormal gait. Today let’s discuss abnormal movements of the hands, and let’s limit the discussion to tremor. There are other abnormal movements of the hands, but most of them will occur in people with severe neurological or metabolic disorders, and not in people who are out in public, committing crimes, or solving crimes, i.e. characters in your stories. There are also tics, habits, and “unusual” movements of the hands which are under voluntary control, and are therefore “normal.”

Hopefully this discussion will be of value with description, and being specific.

So, let’s get started. What is tremor? The medical definition is “rhythmic involuntary movements.” Note that it can involve other parts of the body besides the hands.

In practice, when a physician sees someone with “the shakes,” the first thing he/she will do is to differentiate between Parkinsonian tremor and Benign Familial Tremor. They are two different neurological disorders, with far different prognoses and treatment.

Parkinson Tremor

The Parkinsonian tremor has a regular rhythm of four to six cycles per second. It is best seen when the patient is moderately relaxed, and disappears during sleep and complete relaxation. It also decreases with voluntary movement. It has been called a “rest tremor.” It can affect the hands, the feet, and the mouth. It is most commonly seen in the hand, where the thumb beats rhythmically against the flexed fingers, thus called a “pill rolling tremor.”

The onset of the tremor is often asymmetric, affecting one limb more that the other. Other clues that this is Parkinson’s disease include slow movement, shuffling while walking, flat facial expression, and rigidity to flexion and extension of the affected limb. Parkinson’s disease is also associated with dementia.

Benign Familial Tremor (now coded as “essential tremor”)

I prefer the old name, because it is more descriptive of the cause and the prognosis. This is a very common condition, affecting about four percent of the population. It is often mild and goes undiagnosed. And there is often a family history of the same tremor.

The tremor is described as affecting the fingers, particularly in the outstretched hand. It can also cause rhythmic oscillations of the head (titubation, or “head bob”). The tremor is fine, rapid, and accentuated by activity or emotional stress. I like to call it a “vibratory” tremor. And, because it is worse with activity or trying to suppress it, it is also described as an “intentional” tremor. It is not associated with dementia. And, unlike Parkinson’s Disease, it may not progress.

Others

Other common conditions that may be associated with a similar tremor, and may actually be uncovered, otherwise asymptomatic, Benign Familial Tremor, are the following:

• Excessive thyroid – either hyperthyroidism or excessive thyroid replacement
• Excessive caffeine intake – we’ve all seen that one
• Sleep deprivation
• Decongestant use such as pseudoephedrine (Sudafed)
• Use of stimulant drugs – either for attention deficit or illicit drug use
• Anxiety
• And any combination of the above

So, now you are prepared to describe in detail the tremor of that suspect sitting across the interrogation table from you. If you get a chance, grab his wrist and see how smoothly his arm flexes and extends at the elbow. Make him reach for something and see if the tremor ceases or is accentuated. And if his tremor is bizarre, get a neurological consultation. If that doesn’t yield a diagnosis, call a psychiatrist.

Okay, it’s your turn: What memorable characters with a tremor have you read about in a novel, or seen in a movie? What characters have you created with a tremor? Or, if you prefer, what would be an ideal situation to display a character with tremor? And, hopefully, it’s not your hero trying to aim his gun.

Border Collie Syndrome (not Border Collie Collapse)

Transitioning to a Writer’s Life

Dear Writer,

Background

I recently retired from a busy job/occupation and began “settling in” to what I had long desired, a “writer’s life.” The only problem, I was having trouble settling in.

I looked around and saw things that I should have done 10-20 years ago, and I was tempted to work on them. (I didn’t say I did them.) I was distracted by other creative pursuits I wanted to work on. But most of all, I felt like I should be busy every moment—continuously—industriously. Doing something “productive.”

Family

My wife and I saw something similar in our youngest son when he graduated from basic training in the Air Force. He was off base with family for the first time in weeks. He was nervous, constantly checking that his shirt was tucked in correctly, that his pants weren’t wrinkled. He didn’t want to sit down. He couldn’t relax.

Stockholm Syndrome

He acted like a prisoner set free who didn’t know how to feel or act. Was that what was happening to me? I thought of post-prisoner syndrome. Oh, yeah, Stockholm Syndrome. But that was prisoners identifying emotionally with their captors. And Stockholm Syndrome wasn’t actually an official syndrome in the psychiatric diagnostic codes. Plus, I wasn’t a prisoner of a captor. I had been the boss at work. Hmm. Maybe I was a prisoner to myself.

Retirement Syndrome (“CEO Blues”)

I looked up Retirement Syndrome. Now, here was something that was beginning to fit, at least some components of it:

• Loss of public exposure and contact
• Loss of influence and control
• Loss of steady income

I certainly missed contact with people. And, even though my wife and I had saved for retirement, I worried about the end of a steady income. I had worked to support myself for over fifty years. There was something about letting go that was a little scary.

Workaholic Syndrome

What about Workaholic Syndrome? For many years I worked ten-hour days, and still went home to paperwork in the evenings. I was self-employed. If I didn’t do it, it wouldn’t get done, or wouldn’t get done right. Yes, I fit the mold of feeling compelled to work, and that work had gotten in the way of my family life and social life. My ex-wife had definitely convinced my two oldest sons to not even consider a career in medicine.

Border Collie Syndrome (not Border Collie Collapse)

And finally, I remembered something I had learned about dogs. My wife decided she wanted to have a dog, and raise it from a puppy. She researched the different breeds and was intrigued by the intelligence of Border Collies. She visited a local breeder who screened prospective buyers of her puppies very carefully.

“Do you have plenty of room for your dog to roam?” was the first question.

My wife answered yes.

“Do you have work to keep your dog busy, like herding sheep?” was the second question.

My wife answered no.

“Oh, Honey,” the lady said, “if your Border Collie doesn’t have work, he’ll find or make work, even if it’s chasing cars.”

Conclusion

Well, it was all beginning to fit together. I had Workaholic-Retirement Syndrome with underlying Border Collie Syndrome as a co-morbidity.

Fortunately, I’m learning to “settle in.” I look at the unfinished projects and shrug my shoulders. I’ve been able to stay away from my office for three days at a stretch. I’ve given up the evening paperwork. And…I’ve stopped chasing cars.

P.S.

Since writing the rough draft for this post, I’ve pulled out some books and reread them. I’m happy to announce I’ve had my mirror moment. I’ve seen the light.

Transitioning to a writer’s life is not “retirement.” It is a “transition.” It’s not about “settling in.” No, it is about girding up your loins for battle. (The Art of War for Writers, James Scott Bell)

I love what Olin Miller said. “Writing is the hardest way of earning a living, with the possible exception of wrestling alligators.” (The 101 Habits of Highly Successful Novelists, Andrew McAleer)

So, Dear Writer, if you’re considering “retiring” and “settling in”  to a writer’s life, stop right there. We must reprogram your thoughts. Remember, it is “TRANSITIONING.” “Settling in” will hereby be removed from acceptable vocabulary.

And if you are still determined to “transition,” please buy/borrow and read the following:

• The Art of War for Writers, James Scott Bell
• How to Make a Living as a Writer, James Scott Bell
• Writing the Novel from Plot to Print to Pixel, Lawrence Block
• The 101 Habits of Highly Successful Novelists, Andrew McAleer

P.S.S.

Dear Writer,

If after reading the above books, you still choose to follow this ill-advised journey, please take two aspirins and call me Monday morning. We will schedule an appointment for a long discussion. And if that does not dissuade you, we will arrange for a psychiatric consultation.

On a more serious note:

Questions:

• For those of you who have already transitioned to a writer’s life, please share with us the barriers you had to overcome. What advice would you offer to those who are contemplating such a change?
• For those of you who are dreaming of or contemplating transitioning to a writer’s life, what questions would you like to ask? Here’s your opportunity to ask a great group of writers.

Abnormal Gait

Does your old scruffy sailor limp down the dock, slap down the dock, reel down the dock, or totter back and forth on a peg leg?

When we were taught description, the advice was to be specific. We didn’t drive down the street, we raced west on Elm Street. Today we are going to add some possibilities for ways to walk abnormally. If you (or your daughter or granddaughter) grew up with Barbie dolls, you know there are a million packages of “accessories” that can be purchased to dress your doll in style. I believe my wife bought a sack of nearly one hundred shoes for the granddaughters. I just kept my mouth shut and shook my head.

Well, let’s get out the accessory package for “abnormal gait.” I explored an old medical textbook on physical diagnosis. Here’s what I found:

Parkinsonian Gait – (the shuffle)

• Body held rigid
• Trunk and head bent forward
• Short, mincing steps
• Arms do not swing
• Other clues it’s Parkinson’s – face void of expression, hands with pill-rolling tremor

Ataxic Gait

• Diseases of cerebellum, brain, and cerebellar tracts
• Resembles alcoholic intoxication
• Patient staggers or reels
• Possible causes: stroke, infection, tumor, or trauma

Slapping gait (or Steppage Gait)

• Pathology in the posterior column of spinal cord
• Tabes dorsalis – caused by tertiary syphilis
• Loss of sense of position
• Broad based, feet wide apart
• Raises legs high, then slaps feet on ground
• Eyes fixed on ground
• Manages well in light, but great difficulty in dark
• Other diseases: diabetic neuropathy, untreated B12 deficiency, other peripheral neuropathies

Hemiplegia (weakness on one side of body)

• Example – stroke, trauma
• Drags affected leg around in a semicircle
• Holds arm on same side rigid against chest wall
• Knee held stiffly, ankle extended

Spastic gait

• Multiple sclerosis
• Jerking, uncoordinated movements

Scissors gait

• Spastic paraplegia, spastic cerebral palsy
• Walks with thighs held tightly together

Hysterical Gait

• Bizarre
• Delicate balancing movements are present that allow patient to walk in a bizarre fashion

Antalgic limp

• Caused by pain
• Irregular hopping gait
• Hurries to shift weight to nonpainful side
• Muscle or tendon strains can cause shortening of stride on affected side

Uneven leg length limp

• One leg shorter
• Compensates by walking on toe on short side or by dropping pelvis on short side
• May be wearing one shoe with a thick sole

Ankylosed gait

• Restricted joint motion
• Patient who needs hip replacement “drags” the affected leg as he swings it forward

Gluteal limp

• Example – polio myelitis
• Caused by paralysis or shortening of the gluteus medius muscle
• Trunk swings over the weakened side during stance phase to maintain balance

Okay, now it’s your turn. Tell us about the gait of one of your characters, or create a new one. Hysterical gaits could be great fun to invent. Strut him or her down the fashion runway. We’ll all watch and cheer. See that little thumbs up button on the bottom left of your screen? Vote for the descriptions you like, or you can even tell us how much you would pay for such an accessory if it were on sale by a “fashion designer” of gaits. Be kind.

Past, Present, and Future

Leave a Legacy

By Steve Hooley

It is the time of year when we reflect on the past, give gifts during the holidays, and plan for the future. So, how does that relate to writing? Can we learn from the history of writing to plan for the future of our writing? It has been said, “Those who fail to learn from history are doomed to repeat it.” (Winston Churchill, 1948, a paraphrase from George Santayana, 1905). And from geometry we learn that it takes two points to define the trajectory of a line. Could those two points be the past and the present? And does the trajectory of that line give us any clues about the future?

The Past – Reflection

For the past, we turn to British and American literature. Now, I am out of my element on this topic. I studied math and science in college. So, those of you English and literature experts, please help me out here.

For a listing of the periods or eras in British and American literature, I turned to Wikipedia. Here is what I found:

British Literature – periods and eras

Old English lit. – 658-1100

Late Medieval – 1066-1485

Renaissance

• Elizabethan era – 1588-1603
• Jacobean period – 1603-1625
• Late Renaissance – 1625-1660

The Restoration – 1660-1700

18^th Century

• Augustan age – 1701-1798
• Roots of Romanticism – 1750-1798

Romanticism – 1798-1837

Victorian lit. – 1832-1900

Twentieth Century

• Modernism and cultural revival – 1901-1945
• Late modernism – 1946-2000

21^st Century lit.

American Literature

Colonial lit.

• Early prose
• Revolutionary period

Post-independence

• First American Novel

19^th Century – Unique American style

Late 19^th Century – Realist fiction

20^th Century prose

• 1920s
• 1930s – Depression era

Post WWII fiction

• Novel
• Short story

Contemporary fiction

I have gone back and reread “classics” from the 1800s in my attempt to educate myself. I have been surprised repeatedly by how much styles have changed from then until now. Many of those books contain techniques which we are now encouraged to avoid: omniscient POV, head-hopping, author intrusion, slow pace and entry into the story, lengthy description, tell don’t show, etc.

There were many cultural, societal, and economic reasons why those styles worked then, but wouldn’t work now. What can we learn from them?

Before we move from past to present, here is a link to John Gilstrap’s post from three days ago. John’s post It is a fantastic history of the publishing industry over the past quarter century.

The Present – Giving

We give gifts in the present. Do you consider your books and stories a gift to the future? If a gift is handed down to descendants and it is considered to be of value, it is a “legacy.” Are your books a legacy? Do you want them to be a legacy?

On a side note, but still about giving, today is “Goose Day.” If you investigate the secular tradition of “The Twelve Days of Christmas” and gift giving, you discover that we start with the 12^th gift on December 13^th and work our way down to the 1^st gift on December 24^th. This is December 19^th, so if you are looking for a gift for your “true love,” it’s six geese a layin’ today. And hopefully, some of those geese will be layin’ gold eggs. Now, that’s a legacy.

The Future – Planning

If we wish our books/stories/wisdom to be a legacy, of value for the future, and maybe for us if we’re still around, how do we plan for that? Does our writing, or the way we publish, need to change? Can we predict trends for the future based on what has happened in the past and what is happening now? How will writing, publishing, and reading change? And how do we best position our writing to be ready for those developments?

1. What era/period from the past would you choose to write in, if you could choose?
2. Why did you pick that era/period?
3. What new developments for writing/publishing/marketing/reading do you see coming in the future?
4. Do you plan to position yourself for coming trends? How?
5. Publishers Weekly says it’s about “what’s new and what’s next.” If you subscribe, what can you share about expected coming trends?

By Steve Hooley

It was college prep English class, junior year, in a little high school in rural Ohio, when I was first infected with the virus.

We had a new teacher that year, Miss Linda Warner, fresh out of college with a degree in English and teaching. She was only six years older than we were, which is probably why the boys paid such close attention. Plus, new teachers were supposed to be tested. Right?

We soon discovered that we weren’t the only ones paying attention. A new student, John Kauffman, showed up that year. We had never seen him before, and have never seen him since. In fact, we didn’t see him when he was with us. He was either invisible or a ghost.

He had to have been present though, because he turned in assignments on time and on topic. Somehow, his papers became shuffled in with the other students’ papers and ended up on the teacher’s desk. We didn’t actually know John was in the class until Miss Warner began reading his papers.

Apparently, she fell in love with John’s writing, because she read his papers to the class nearly every day. John pushed the boundaries of acceptability with his writing, and the class loved it, laughing and cheering. Junior English became a favorite class that year.

John stayed for the whole year and got an A in English. He apparently enrolled in band as well, where a new teacher gave him a B for the year. The rest of us never heard a note he played or saw his instrument.

By the next year, our senior year, John had disappeared. The mystery of his identity was never solved. I often wondered what became of him. I say John was real, and he was sent there to infect us with the bug, the virus, Scribophilia (the love of writing). Some of us never recovered and now have the chronic disease, Scribophiliosis.

For me, the disease went into remission for decades, as I studied math and science, medicine, and finally woodworking. But, in 2009 the virus recurred when I edited my father’s memoirs of his service for the United Nations during WWII. He was descending into dementia, his manuscript was nearly lost, and he was turning 90 that year. I spent the summer organizing his story, had the book printed, and presented him with a box of his books on his 90^th birthday. While I stood and watched my father sign books with a confused smile, the virus got me again.

I took some correspondence courses from the Institute for Writers (then called Long Ridge Writers Group). I thought I would write magazine articles for the woodworking journals, but quickly fell in love with fiction.

I tried my hand at Science Fiction, but had no success.

I returned to the Institute for Writers and, under the tutelage of Carole Bellacera, took the novel writing class and completed my first novel.

I found James Scott Bell’s books and began seriously studying the craft of writing. I joined the ACFW and began attending conferences. And then, from a fan of the authors here, I learned about The Kill Zone blog.

I learned from Joe Hartlaub the pitfalls of publishing contracts when a small publisher offered me a contract for my first book, then quickly went bankrupt. Joe helped me retrieve my copyright before it was lost forever.

About four years ago, after hearing JSB preach about Indie publishing, I decided to go that route. Two unpublished books, four anthologies, three published books in a children’s fantasy series, and the virus is still clinging to my DNA. And happily, I am not interested in a cure for my disease.

So, how about you? Can you remember when you were first infected with the virus? What were the circumstances? Is there a teacher, relative, or friend you would like to thank (or curse) for encouraging your interest in writing? Or, has there been a particularly memorable milestone along your writer’s journey that has shifted you into a higher gear?