Whether you are sitting at your computer all day typing, lifting heavy objects, or throwing a ball 100 mph your arms are going to get sore and tired.  I know, I do all of these things (OK I don't throw quite 100 mph), and performing a massage with The Stick after some strenuous event is an awesome feeling.  So here is a video showing and arm massage you can perform with The Stick.  This same technique is used by many professional pitchers to reduce soreness in the elbow after throwing.

P.S. Do you know who the football player is at the end?

On the surface, this may seem like the easiest step there is. All you have to do is recognize your situation accurately and acknowledge it. That’s simple, right?

In one sense, it is the easiest step but, for more people than not, it’s by far the most difficult. It’s because you have to “admit” you’re not OK the way you are; you need help. This is very difficult for many people.

For them, it takes a long time and a great deal of heartache to be willing to seek help, but that’s what’s required. You have to admit you are not OK and will not be OK without outside help.

Step 1 is all about denial, which by the way is not a river in Egypt. Denial is telling yourself you have everything under control when you clearly do not. It’s an inability to look at your life and say, “How did I allow myself to get like this?” Those in denial say, “I’m fine. I’m OK the way I am.”

Additionally, for those who need to recover from religious abuse, it’s harder to admit “the truth” than it is for others to admit being an alcoholic or a drug addict. You don’t get put in jail because of religious abuse, and there’s no “field sobriety test” for it, which makes denial much easier.

The devastation from religious abuse is primarily internal—in your heart and in your soul, where the destruction manifests itself in negative emotions and attitudes like bitterness, anger, revenge, and hate. Unlike the effects of alcoholism, you don’t develop cirrhosis of the liver—just hard-heartedness, which can be equally devastating.

That’s why it’s so hard for some to admit their life is shipwrecked. You can’t see the destruction from the outside—from looking in the mirror. But it’s there, isn’t it? In moments of candor, you know you’re not where you want to be, don’t you? Your life lacks peace and purpose.

That’s what Step 1 is all about—changing your internal perspective. Instead of denial, you have to develop a state of mind that acknowledges reality, and you have to maintain this perspective throughout the process. It will do you no good to admit you need help one day and change your mind the next. To recover, you have to work the eleven steps as vigorously as an alcoholic works at maintaining sobriety.

If you’re ready to admit you have a problem—a serious problem, then you’re ready to begin.

Im still breathless

. . . . . . .

"it distressed Laila that she didn't know where the Taliban had buried Mariam. She wished she could visit Mariam's grave, to sit with her awhile, leave a flower or two. But Laila sees now that it doesn't matter. Mariam is never very far. She is here, in these walls they've repainted, in the trees they've planted, in the blankets that keep the children warm, in these pillows and books and pencils. She is in the children's laughter. She is in the verses Aziza recites and in the prayers she mutters when she bows westward. But mostly, Mariam is in Laila's own heart, where she shines with the bursting radiance of a thousand suns."

-Khaled Hosseini in A Thousand Splendid Suns

]]> http://missingallan.wordpress.com/?p=83 Sun, 07 Sep 2008 17:13:55 +0000 missingallan http://missingallan.wordpress.com/?p=83 it's my birthday.. sept 8, 2008.. philippine time, 1.07 am..

such a wonderful timing for me to find out that i was a big mistake.  he who i put up above all else thinks that i am a bad decision. WTF?! how do i handle this? cry? as if something will still happen. words really are powerful. they can either make u super happy.. or they can hurt you seriously!

so who the fuck wants to be called a big mistake?

thanks for making my day! thanks! as always you have your ways of making me remember you! you are indeed unique!

happy birthday to me!

The service was Rite II at 9:30am, and I got to the church grounds at about 8:30.  This parish sits on ten acres of land - and in Northern Virginia, that land is super-duper-uper valuable - and the property is absolutely gorgeous.  The church building sits at the top of the hill, with a winding driveway back down to the street.  The grounds in front of the building include an outdoor chapel, a bunch of picnic tables, a big playground for the preschool, and plenty of birds and squirrels and other little beasties.  It was peaceful and quiet - even being less than a mile from a major highway - and definitely felt like a thin place.  I took lots of pictures of the things that spoke to me, and my spirit was fed just from mindfully walking around the grounds and noticing what was around me.

The facility is tremendous as well - two floors, with the nave and parish hall on the second floor.  Since the building is on a hill, the front doors to the nave and parish hall are only a little above ground level, and there is good wheelchair accessibility to these.  The back doors enter onto the first floor, where the preschool classrooms are.  The classrooms are full of bright colors and energy, even with the lights off and no little children at play.  There are many photos and pictures adorning the walls within the building, and letters and plaques revealing the parish's participation in a number of outreach missions.

The last folks from the early service were talking with the clergy when I made my way up to the nave, and the altar guild was preparing for the middle service.  I took the time to explore the nave and take more photos of the beautiful banners, the incredible organ, and the layout of this unique and inspiring worship space.  In time, I was able to shake hands and introduce myself to both priests, and they both exclaimed in delight that I'd been able to join them.  After that, though, none of the lay members of the congregation greeted me.  There were signs before you enter the nave asking you to keep reverent silence, but I noticed several hushed conversations.  This was okay - none of them were distracting or irreverent - but there was definitely a feeling of an "in" crowd and, well, the others.  The only nametags in evidence were those that had titles on them - Greeter, Acolyte Master - and none for ordinary folks.  My parish at home has stick-on nametags in baskets at the end of each pew, and absolutely everyone wears one.  You can buy a special magnetic nametag, but if you lose it or forget to bring it with you, then you make a stick-on one as soon as you get to your pew.

There is a definite message that the nametags give, and I didn't realize what it was until I found myself an outsider.  When nobody wears a nametag, you feel like an outsider - it feels like everyone knows each other, and you're the only one who doesn't know anybody's name.  The special titled nametags actually intensify this feeling.  You see the VIPs with their nametags, and they greet and talk with everyone else who they already know by name, and you definitely know you're on the periphery, and not one of the cool kids.  But when you walk into a place where everybody wears a nametag - and you're invited to make one for yourself, too - then you don't feel like such an outsider.  You can greet other folks by name, or at least start matching the names to the faces without feeling like a dork for not being able to remember who goes with which name.  So I've come to the powerful conclusion that a key part of the ministry of Christian hospitality has to come down to those blasted nametags.  (Dangit.)

While I was welcomed very warmly by the two priests - who, after all, had gotten an opportunity to get to know me a little bit through email over the week - I didn't feel much of a welcome from the parishioners until the service ended.  One of the most crucial jobs for a rector of a parish is to make sure that every last person in the parish knows that it is their job to exercise the ministry of hospitality.  That's right - hospitality is not a ministry of trained ushers and greeters - hospitality is the responsibility of every single person in the parish.  Of course, for those of us who are introverts, we close our ears when we start to hear these words.  We don't want to have to reach out of our comfort zone and say hello to someone we've never seen before.  But it's our job.  God is there to comfort us, but God never calls us to be comfortable.  (Dangit.)

The service was lovely, as I would expect any BCP service to be.  The music director is clearly skilled.  I don't know whether it is the worship space - which is carpeted, has hangings lining the ceiling, and is surrounded with a number of banners on the walls - or the people, but I found the singing lacking in joyful noise unto the Lord.  And I was embarrassed when I talked with both priests after the service, to have them both say they could hear my voice from the altar.  Yikes!  And I know I splatted some notes and jumped to the wrong verse on the second line of hymns.  Ah well.

After the service, I saw one lady sit down to the side of the narthex.  She hooked her cane next to her chair and closed her eyes.  I recognized the expression on her face - I don't want to miss everything, but I'm so tired of feeling this way.  I'll just sit here and watch everything, so I don't feel left out. - and I knew that she was running out of spoons.  When she opened her eyes again, I walked over to her and introduced myself.  Now, if you know me, you'll know that this is completely out of character.  I just don't go up to strangers and talk to them, even in a church.  I know, I was just talking about hospitality, and here I am saying I don't do that.  So I realized it was time for me to extend hospitality, even though I wasn't the one in my parish home.  (Dangit.  :-) )

I said that I recognized the expression on her face, that she looked miserable.  She explained that she'd just gotten out of the hospital, and that this was her first time back to church, and she raised both hands and gave a cheerful, "Yay!"  I grinned and yayed right back at her.  We commiserated about things like church, that are wonderful and that feed us, but that extract a cost from our bodies.  She is waiting for a diagnosis, and we talked about how hard that is.  No matter how awful the disease is, we just want a name for it, something to call it, so that it doesn't seem so big and vague and scary.  She would like her dis-ease to be called "GeorgeClooney-ism," and I said I'd sign up for that one, too.  We shared a laugh at how illnesses and diseases and syndromes can't have nice names like that.  As we chatted about pain and hope and hurt and prayer, I saw her eyes light up and her whole face smile.  When I stepped away from her, I touched her arm and wished her the very best over the coming days, and she smiled back at me.  Just a moment later, her husband returned and helped her up.  It lifted every part of me to spend those few moments in conversation with her, and I think it helped both of us to find someone who understands the world of chronic pain and the toll it extracts from our bodies.

So this morning, I was blessed.  I was blessed to be welcomed into a congregation in a strange place, invited to feast at God's table, wrapped up in community with my brothers and sisters in Christ.  And I know I'm tremendously blessed by my parish family back home.  I hope that you find blessings today, because they are all around you, just waiting to be noticed.  Peace be with you, my friend!

I finally got the V5 (ownership document) through for my car yesterday. My Mum has got a new car, and passed her old one onto me. However, everything has taken longer because my Mum has a personalised plate, which had to go onto her new car and I then had to be issued with a registration plate. This meant all the documents had to be sent off to the DVLA, who processed them, whilst going on strike at the same time, and sent them back out. I then rang my insurance company to change the registration number (as the car was insured from last month under my Mum's registration plate) to discover it was £14.50 to change the registration plate as they charged an admin fee! They also had picked up that on a previous quote for insurance I had put down that the car had exterior modifications (a sunroof) and my policy doesn't mention these (as I since discovered that factory fitted extras don't count as modifications). I tried to explain this to the Indian guy in the call centre but to prove it I have to get a letter from a garage stating the car has no exterior changes. This isn't a problem as the car is going into the garage tomorrow to get the new number plates fitted and a new rear windscreen motor. It's just the bureaucracy that infuriates me.

My Dad is back home. He arrived back yesterday morning looking fairly sheepish but acting as if nothing has happened. This is his typical routine. He'll be meek and helpful and skirt round the issue until he thinks people have forgotten whereupon he'll revert to type. I just wish my Mum and him would make a decision about who was going to live where. The house is up for sale but no one seems to want to buy a very nice family house in South Kensington. Given the news, I don't think people want to buy any house.

I still haven't cut. Despite sitting for 3 hours in tears on my bed last night with a blade pressed to my leg. In the end I put it away, poured myself a large vodka and went to sleep. The alcohol wore off at about 1am where I was awake until 5.30am. This is partly my own fault, as I haven't seen the doctor to tell her that the mirtazapine isn't having any sedative effect anymore, and because it isn't sedating me I have reverted to type and have been taking Nytol continuously for the last 3 weeks or so, in rather large quantities. I now have no Nytol left and haven't been out of the house today or yesterday to buy anymore. I hope when I see the GP she gives me some zopiclone or temazepam as I cannot cope with the feeling perpetually tired but not being able to sleep sensation I currently have.

The assessment with the CMHT is a week tomorrow and at this stage I feel there is absolutely no point in trying to get it moved forwards. Seven days is neither here nor there to wait and I am resolved to see the GP tomorrow so I'll see what she suggests. I have been so close over the last few days to overdose (I found a prescription for a month's worth of venlafaxine that I had forgotten to take to a pharmacy) or to cut myself. I also have been feeling the urge just to walk into A&E and break down. I know that none of these things will prove to be any use. I will still be in the same circumstances, just with my Mum worried about me, and she is depressed enough at the moment without me adding to her mood.

Ruth

copyright 2008

This was different because there was no solution, just pain. The only solution was to accept the pain and forgive. This was going to be hard, still is hard but I am on the road now.

The first step was to take control of my life again by telling people how I felt and what they did to me made me feel bad. I was not prepared for the reaction to this. I told my mother that I was in pain and she was taking all my positivity away, her negativity was ruining my life and it had to stop. She had to realise I was not the person she thought I was and she had to accept some things. I sort of anticipated the outcome but hoped it would not of been so final. Currently she has lied to anyone that will listen telling them I am mentally ill, when all I said to her was “your unhappiness affects me at a metaphysical level, it upsets me so much because I love you” she then ended the call and said she felt sick. Since then she has done everything in her power to tell people I hate her and am a bad person. I am not angry, I am just sad that she felt that her only option to deal with things.

But now I am released, I cannot explain it. My energy has returned, I feel like me again, Dion Fortune would call these people “Psychic vampires” and I think that is what she has been doing to me.

During this time I felt like I was awaking from a dream. I felt things I had not felt in a very long time and I felt attuned to everything around me like I used to. It is hard to explain but I felt energy around me again. I had the power within me to make things better.

I looked at my husband while he was asleep and knew what he needed to make him better. This sounds like madness I know, it is! But I do feel and see it! My hands tingle and when I place them in an area that needs work sometimes it is like a lightning bolt through my hands. Sometimes my hands shake, sometimes they go on fire, other times go cold but most of the time they tingle. Watches have never worked on me and I get electric shocks everywhere I go. I have suffered with pins and needles in my hands and other hand problems for years, all this I believe is a consequence of me not using them correctly.

As I have tuned it to this feeling it has got stronger every day. I see peoples pain everywhere I go. I wish it was not their pain and was joy but unfortunately most people are unhappy with something or are unwell. But I also know I can fix it.

It does not make any sense to me and I am not sure what I can do with it but it seems a great shame to keep it all to myself.

The human body is a social, spiritual and scientific enigma. Like the proverbial onion, the body has many layers and as each one is peeled back for closer inspection, the complexities are marvelous. The ten series Rolfing "recipe" has the ability to impact multiple myofascial layers, differentiating functionally and structurally, yet maintaining a wholistic intent. Rolfing can generate responses locally or system wide for ease of movement in space as well as functionality in time.

The ten-series is an order of events protocol with specific principals, goals, and anatomically specific sites with some variables because of the Anterior/Posterior models with associated anomalies. This article serves as a brief exploration and journey into the Rolfing Ten-Series as seen by John Barton, a Certified Rolfer & is designed to be brief & informative.

First hour: adaptability and preparation (1-2-3) 3d: x, y, and z axis-static. "Preparing the body to receive order precedes establishing order. Changes introduced anywhere in the body must be capable of being integrated and sustained by the whole"-Jan Sultan and Jeffrey Maitland. The client’s natural pattern & asymmetry must be identified first. The goals of the first hour are freedom of breath, initiate resolution of asymmetries of both girdles, spine, arms, & hands. Develop a sense of "who the client is" & review intake evaluation.

By assessing the client standing or sitting the practitioner gains insight into how the shoulder girdle moves or doesn't move and how this affects the ribs and the breath. Movement and lack of movement in the arms is included in a decision of first-hour intention for Postural or Structural Integration.

Freeing the breath sends a system wide signal to begin adapting and preparing for more change and is manifest in the fascia as rel-ease. Working with client supine, practitioner can assess the ribs and diaphragm involvement, the rate of inspiration and expiration of breath, and which is preferred part of cycle. The lines of tension in the arms will be addressed here for the way they transmit into the shoulder girdle and neck.

Practitioner should observe rhomboids/pectoralis minor relationship towards glenohumeral junction as well as diaphragm/serratus relationship at the ribs. With client now sideline practitioner moves to assess space between the pelvis and femur and if they move like a block or differentiated elements, creating space if necessary. Lengthening hamstrings is first-hour protocol differentiating the two. Neck and back work is broad and connecting from occiputs to c7 erectors to sacrum. Practitioner ends first session with pelvic lift.

The Certified Rolfing Ten Series has the ability to reduce pain and release tension in the connective and myofascial tissue of the body associated with TMJ, CTS, RLS, Fibromyalgia, Sciatica, Fascitis, Bunions, Scoliosis, and Cerebral Palsy. Fascial asymmetries can cause foot, leg, knee, hip, back, shoulder, neck, arm, hand, and head pain; integration therapy is necessary. Orthopedic, Chiropractic, Physical, and Massage Therapist recognize Rolfing and Rolf Movement as premium pain management utilizing Structural, Functional, and Postural Integration. Bioceuticals are an alternative,natural and non-toxic method of effectively addressing health and wellness through the lense of Bioceutical nutrition.

 John Barton, Certified Rolfer® and Rolfing® Fort Worth-TX-Dallas-Austin-Arlington-Denton-Texas.

www.certifiedrolfing.com

www.certifiedrolfing.com/Rolfing

www.certifiedrolfing.com/FAQS

www.rolfmovement.com,  

www.rolfmovement.com/rolfing

www.rolfmovement.com/FAQS

At a point in history that is saturated with self help books, get rich gimmicks, and exercise infomercials, it is no wonder that Budokon purposed to emerge in our culture. Budokon is philosophy, science, and art for the spirit, body, and soul. It’s literal Japanese translation is  “ way of the spirit warrior’ and it represents a conscious decision to no longer chose “more of the same”.  It is said, “In the beginner’s mind there are many possibilities, but in the expert’s there are few”. The merging of yogic and martial movements combined with limbic re-integration techniques enables the human species to engage in health and wellness not known since the human movement potential era. It far exceeds the sum total of components needed for fitness and enables the whole person to awaken to a new potential organically. It has been heralded as “the most intelligent practice on the planet”; it is indeed a functional revolution.

So much time and energy is exhausted plotting how to look, feel, and get better. The emphasis is on the quantity and not the quality, on doing something instead of being something, as if there is a boundary separating the thought, the word, and the action. “How much can I shove into my day because I am busy getting somewhere”, is how most of us live our lives, and it is said that, “the way we do anything is the way we do everything.” The structural and functional differential states that quanta filters into sensation, then e-motion, into belief, and finally into expression, in other words our perception of “other” or our circumstances predicate our movement. When the pressure starts to mount in life or on the mat how do we keep the drama or the functional differential at bay? What if there was a way to approach all of our personal ideals as if they were already available in the form of latent potential waiting to be unearthed? Budokon is a system of somatic awareness that presents itself in the yogic, martial, and living arts with a premise of self-accountability, patience, and mastery by practicing just to practice. Weight loss, tone body, clear mind, better coordination, increased strength are not goals of Budokon, they are benefits. The nervous system that governs the functional differential does not normally change quickly but progressively by diligent, attentive practice it changes slowly and subtlety.  Practice just to practice. It encompasses the components of nutrition, fitness, health and wellness desired by our culture and ultimately navigates each person to a more authentic expression, a functional evolution.

The movement science of this practice is purposed to cultivate bio-mechanic potentials that are consistent with structural and functional ideals. What distinguishes Budokon movement from all other yogic or martial systems is its recognition and subsequent utilization of the spinal engine. The spinal engine theory suggests that all biomechanical movement, walking, running, yoga, etc… originates in the small muscles of the spine that initiate movement. The origin and insertion of these tissues initiate and accommodate movement in the sagital, frontal, and transverse planes, thus when the activation for movement begins it expresses from the spine, through the core, into the appendicular. Since we are designed to live in a dynamic, fluid filled body it makes perfect sense that a practice cultivate uninhibited movement in all three planes with flexion-extension, side bend, and rotation. Movement in life is the sum total of all three primary planes and associated movements in these planes operating synergistically, so our practice is more fruitful if it acknowledges these potentials. Budokon also provides a dynamic approach to medial/internal and lateral/external rotation of the pelvic and shoulder girdles, with core activation enabling the spinal engine to transmission into full expression extending in to an open or closed kinetic chain. The kinetic chain is an energetic potential that transmissions from the spine, core, or Mu into the appendicular or limbs of the body. If a limb is grounded the chain is closed, sending system wide signals of stabilization and containment and if a limb is not grounded but extended with direction into infinity it is open. The nervous system is designed to operate in terms of survival and predictability and activation can be voluntary or involuntary. The limbic brain is where the body houses these maps of movement predictability for survival and as we discussed earlier its change is slow and subtle or sub-cortical. These changes happen when they are discovered not discussed so it seems that when one allows the opportunity to play with movement as an exploration into something new and unfamiliar as apposed to analyzing and repeating something taught, that spontaneous change can happen. Limbic re-integration is a vital component to Budokon that enables each individual to play and explore bio-mechanic potentials buried under the yoke of cultural and social stigmas. Gorilla, kimodo dragon, bull frog, panther, lion, crocodile, spinning monkey, and many others can provide a gateway to a new movement potential by offering the opportunity to play with homologous, homo-lateral, and contra-lateral movements.

Philosophy plus science equals art. The artistic value of Budokon emerges through movements like rolling wave, floating frog, dancing dog, flying warrior and dancing lion. Budokon is a yogic and martial system teaching basic movements that can augment into a more advanced expression by making movement fun, exploratory, and efficient. The merging of the yogic and martial movements into a practice is a way for complete new comers to engage in learning and exploring basic stand up and ground budo with out the threat of failure. Art is adaptation and although there is form that is essential to efficiency of movement, it is the exploration of innovating the form that creates the fertile ground for artistic value. Budokon instructors are specific to teaching form while allowing the opportunity to play, explore, and innovate. When movement is sloppy and unrefined it is not innovation it is laziness, it is the predictable pattern of movement that is no longer desired and Budokon will not enable more of the same. It will provide the framework for a new potential and allow each individual to create a different and more satisfying option.

There is so much more that can be written in an attempt to discuss Budokon and its life altering benefits, but again true change can not be discussed it has to be experienced. To list and identify all of the components of Budokon and the practice would create a lengthy article and it is not the focus of this article to overwhelm the reader with everything but just enough of the philosophy, science and art so that an individual can make an informed decision to no longer chose more of the same.

Budokon and the Certified Rolfing Ten Series have the ability to reduce pain and release tension in the connective and myofascial tissue of the body associated with TMJ, CTS, RLS, Fibromyalgia, Sciatica, Fascitis, Bunions, Scoliosis, and Cerebral Palsy. Fascial asymmetries can cause foot, leg, knee, hip, back, shoulder, neck, arm, hand, and head pain; integration therapy is necessary. Orthopedic, Chiropractic, Physical, and Massage Therapist recognize Rolfing and Rolf Movement as premium pain management utilizing Structural, Functional, and Postural Integration. Bioceuticals are an alternative,natural and non-toxic method of effectively addressing health and wellness through the lense of Bioceutical nutrition.

By Saturday morning, the glands had grown even larger and more tender, with the area in front of my right ear now having a hard knot of swelling.  Now the real pain was starting to set in -- so I thought.  At A.H.'s house for the day, the pain nearly had me in tears.  She gave me ear drops with Benzocaine in them.  They made the ear start hurting worse.  Not supposed to happen that way.

As the day progressed, I was nearly in tears.  The side of my face had started to swell and could not be even gently touched.  A.H. gave me an IB800 and an anti-biotic (I'd taken Biaxin prior for a bad sinus infection and from what I remember, it kicked the shit out of it -- I now have a full 7-day course of it).  An hour later and with the pain still worsening, C.H. gave me a hot towel to put over the area.  I don't know if the IB finally kicked in, or if the heat helped, but the pain finally started to lessen.

I got home and the IB wore off.  Oh my gods.  I had to go to bed early, I couldn't take it.  My daughter was lovely enough to bed down herself, seeing how much obvious pain I was in, but first came to quietly rub my back asking me if there was anything she could do to take the pain away.  Oh I love her so much.  By then I was in tears with another hot towel, having taken another 600mg of Ibuprofen and another Biaxin before lying down.  She attempted her Reiki, but I could not stand even the slightest touch, so she let me be.

Every two hours, I woke up, the pain worse each time.  I have gotten scarcely any sleep.  The right side of my face feels like it is on fire from my eye to my jaw.  I could barely open my mouth enough this morning to take another 800 of IB and another antibiotic.  Talking and smoking a cigarette are out of the question.  Taking a drink of tea just about floored me.  Even putting my glasses on is painful.  The swelling can only be described as horrendous.  The pain - just flat out intense.  I had a lot of ear infections as a child, and have had surgery on both ears a total of 7 times as a child.  I don't remember *any* of my ear infections causing this much swelling and pain though.

I hope to God the meds I took this morning start working soon.  It's almost unbearable.

Confiding in a dear friend last night, he tells me it sounds bacterial, and that the antibiotics should start working within 48 hours.  He says if it's the "right type of bacteria," then the Biaxin will work.  He is near deaf in one ear because of all the ear infections he had as a kid.  I have about 40% hearing loss due to all my ear infections and subsequent operations (tubes, etc).

My official diagnosis and patient info-sheet states:

Otitis externa

Also known as external otitis and swimmer’s ear, otitis externa is an inflammation of the skin of the external ear canal and auricle. It may be acute or chronic, and it’s most common in the summer. With treatment, acute otitis externa usually subsides within 7 days (although it may become chronic) and tends to recur.

Causes

Otitis externa usually results from bacterial infection with an organism, such as Pseudomonas, Proteus vulgaris, streptococci, or Staphylococcus aureus; sometimes it stems from a fungus, such as Aspergillus niger or Candida albicans (fungal otitis externa is most common in the tropics). Occasionally, chronic otitis externa results from dermatologic conditions, such as seborrhea or psoriasis. Predisposing factors include:

❑  swimming in contaminated water (cerumen creates a culture medium for the waterborne organism)

❑  cleaning the ear canal with a cotton swab, bobby pin, finger, or other foreign objects (irritates the ear canal and may introduce the infecting microorganism)

❑  exposure to dust, hair care products, or other irritants (causes the patient to scratch his ear, excoriating the auricle and canal)

❑  regular use of earphones, earplugs, or earmuffs (traps moisture in the ear canal, creating a culture medium for infection)

❑  chronic drainage from a perforated tympanic membrane.

Signs and symptoms

Acute otitis externa characteristically produces moderate to severe pain that’s exacerbated by manipulation of the auricle or tragus, clenching of the teeth, opening of the mouth, or chewing. Other signs and symptoms include fever, foul-smelling aural discharge, regional cellulitis, and partial hearing loss.

Fungal otitis externa may be asymptomatic, although A. niger produces a black or gray blotting paper–like growth in the ear canal. With chronic otitis externa, pruritus replaces pain, which may lead to scaling and skin thickening with a resultant narrowing of the lumen. An aural discharge may also occur. Asteatosis (lack of cerumen) is common.

Diagnosis

Physical examination confirms otitis externa. With acute otitis externa, otoscopy reveals a swollen external ear canal (sometimes to the point of complete closure), periauricular lymphadenopathy (tender nodes in front of the tragus, behind the ear, or in the upper neck) and, occasionally, regional cellulitis.

With fungal otitis externa, removal of growth shows thick red epithelium. Microscopic examination or culture and sensitivity tests can identify the causative organism and determine antibiotic treatment. Pain on palpation of the tragus or auricle distinguishes acute otitis externa from otitis media.

With chronic otitis externa, physical examination shows thick red epithelium in the ear canal. Severe chronic otitis externa may reflect underlying diabetes mellitus, hypothyroidism, or nephritis.

Treatment

Treatment varies, depending on the type of otitis externa.

Acute otitis externa

To relieve the pain of acute otitis externa, treatment includes heat therapy to the periauricular region (heat lamp; hot, damp compresses; heating pad), aspirin or acetaminophen, and codeine. Instillation of antibiotic eardrops (with or without hydrocortisone) follows cleaning of the ear and removal of debris. If fever persists or regional cellulitis develops, a systemic antibiotic is necessary.

Fungal otitis externa

As with other forms of this disorder, fungal otitis externa necessitates careful cleaning of the ear. Application of a keratolytic or 2% salicylic acid in cream containing nystatin may help treat otitis externa resulting from candidal organisms.

Instillation of slightly acidic eardrops creates an unfavorable environment in the ear canal for most fungi as well as Pseudomonas.

Chronic otitis externa

Primary treatment involves cleaning the ear and removing debris. Supplemental therapy includes instillation of antibiotic eardrops or application of antibiotic ointment or cream (neomycin, bacitracin, or polymyxin, possibly combined with hydrocortisone). Another ointment contains phenol, salicylic acid, precipitated sulfur, and petroleum jelly and produces exfoliative and antipruritic effects.

For mild chronic otitis externa, treatment may include instilling antibiotic eardrops once or twice weekly and wearing specially fitted earplugs while showering, shampooing, or swimming.

Special considerations

If the patient has acute otitis externa:

❑  Monitor vital signs, particularly temperature. Watch for and record the type and amount of aural drainage.

❑  Remove debris, gently clean the ear canal, and then dry gently but thoroughly. (With severe otitis externa, cleaning may be delayed until after initial treatment with antibiotic eardrops.)

❑  To instill eardrops in an adult, pull the pinna upward and backward to straighten the canal. For children, pull the pinna downward and backward. To ensure that the drops reach the epithelium, insert a wisp of cotton moistened with eardrops.

To prevent otitis externa:

❑  Suggest that the patient use custom-fitted earplugs to keep water out of his ears when showering, shampooing, or swimming.

❑  Warn the patient against putting any objects in his ears, such as cleaning the ears with cotton swabs or other objects.

❑  Urge prompt treatment of otitis media to prevent perforation of the tympanic membrane.

❑  If the patient is diabetic or immunocompromised, evaluate him for malignant otitis externa (drainage, hearing loss, ear pain, itching, fever). Appropriate treatments include antibiotics and surgical debridement.

last year was hell.  the relationship was hell.  and so i ended up a lunatic - punching my own head and so forth ... it shocked me, i'd thought cutting myself was bad enough.  i wrote a handful of poems about it, and sang along to seether's 'breakdown' with rage and misery, but i didn't tell a soul.

she did, of course.  they always do.  chased after all my mates, stole my taste in music, art - shit like that.  threw tantrums all over my home-for-a-decade online, threw tantrums at me.  and lied, lied lied ... so many lies.

you try to understand wounded people, you try to have compassion, you try hard not to get wounded by it all yourself.  somehow it doesn't pay off and suddenly you find you've lost some more friends, gained a few more scars.  but it's ok, it's all going to be fine.  it's just life and you're only responsible for your own shit, not hers.

yet, it keeps chasing after me, or was I looking for it... kawan, there's more to it than just sticking around, having good times or keeping secret. when i consider someone as my friends, i always get emotionally involved with them.

i shouldn't. i wouldn't get too emotionally involved with anyone. i promise, ill try my bestest. i have to be independent.

A friend should try to understand each other.. but why lie if the truth is already known. Easy, just dont tell, i'm fine with that.  and dont pretend, if you're no good... Kept pretending when i've told you to stop somehow scarred me, making me feel as i was forcing you to let me get something that you refuse to let give. Was i that bad?

she reached out a lifetime to her beloved hero dada, but he stood silent, unmoved, even angry when in weak moments she allowed herself to show tears... she mustnt ever appear weak... but how to be strong? she had no idea... 

she once wrote a little note to mum - do u love me, mum? she asked - but mum berated her for being silly... why was this silly? did not mummy love me? i guess she doesn't...

dada terrified her... sullen, silent, brooding, unpredictable mood swings... yet he fascinated her... sharing in his hobbies and interests became her life... it was only in these moments that she found some kind of cold approval, for her abilities rather than for her personality and feelings, but any approval was better than none, so she hid her heart and displayed her mind... and she adored her dada... even though he was so cruel, so heartless, so incomprehensible... she loved him to the very end...

mama was always at odds with her... never ever quite in tandem... until now... until dada is long gone... she has found peace with mama at last... no, not close lovingness, but good easy comfortable peace... and this is enough for her... for both...

a dichotomy of extroversion and introversion - she'd force herself to excel socially, the life of the party, the bright wit and the style princess... but deep inside, a disdainful dislike of crowds, she'd rather be alone with her thoughts and dreams... 

yet, friends she has a handful and very very faithful loyal smart capable friends... what did she do to deserve their undying loyalty and love? she has no idea... why do they love and adore her so much... why do they say things like she is a good friend, loving, kind, wonderful, beautiful, talented, faithful, giving... good qualities? then why dada just didnt see them at all, even tho she tried so hard?

and the blue frog... he cannot even remember her... the her that he said he loved... he has forgotten all his words to her... now he only sees that she is annoying... irritating... upsetting... neurotic... stupid... beyond reasoning... yet he is better than dad... scolding and criticising is far better than cold hard silence... far far better... yet... it is tiring and painful... and she wonders why she always does so much wrong?... 

if only she knew... she is not a child anymore, she is a woman, and women ought to know, don't they? .... but she is clueless... still... just as she was before... swimming in a sea of debris she cannot recognise...

rocking on her heels... wondering... wondering... wondering... what have i done to be so wrong?... how can i make things right again?... if ever...???

I also have chronic pain..all day, every day, everywhere on my body. I don't even want my kids to sit on my lap because it hurts me. It started when I was pregnant, maybe even before that i'm not quite sure. I just thought it was pregnancy, then it was because I just had a baby, then it was because i had postpartum depression, then it was because i was gaining weight, and then we are up to now..and i still hurt..I'm active and it hurts. The more I move, the more i hurt. and it sucks. The doctor put me on a medication that is supposed to help the pain but it makes me very tired..the first night i took it ( i was kidless of course) i slept for over 9 and 1/2 hours! yeah can't do that with kids! even the doctor said not to take it when i was alone with the kids, which is about half the week! grr..

I'm disconnected from my kids. I'm not feeling like I have much of an attachment to them. I'm not sure why. I can watch them and not care. I can also "listen" to Landen when he's talking and not hear anything he is saying and not really care either. I'm beginning to think that i"m a bad mom...

I don't know why I'm doing this, really, I don't want to. I love being a mom..but at this moment, right now, I could run away and not look back, at least for a while. i hate feeling that way. I try so hard all the time to enjoy my kids and not look forward to when they are alseep but i can't help it. I feel like I'm on the brink of a breakdown and no where to turn..

I just want to feel good again. I want to love my kids and be happy that i'm their mom and that they are my kids..I want happiness, i don't want to be so sad all the time..