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The Doctor's Consultation

Agony Column

Camera Class by Snapshot

Money Matters

Life in the Laugh Lane

The Doctor's Consultation: The Ganglion (gang-glee-yon) and the bible

by Dr. Iain Corness

A ganglion is a strange ‘lumpy’ thing that generally is found on the top of the wrist, though it can be underneath or even at the base of a finger. They start being about the size of a pea and often you can only notice a ganglion if you bend your wrist downwards and up it pops. However, the lump often gets bigger with constant, strenuous use of the hand and shrinks at rest.

They can be painful if they push on nerves, though in most cases, the patient brings the lump to the doctor just because they know it shouldn’t be there! Or it wasn’t there before. And the large ones look unsightly.

The ganglion actually connects with a small sac which holds some thick lubricating fluid between the bones in the wrist. For many reasons, the sac can become larger and a ‘balloon’ extension forms and forms the pea sized lump which is pushed up under the skin. So inside your ganglion is the clear gel-like material, which is usually used as a joint lubricant.

In the good old days, when the doctor was a god-fearing soul, he kept a large bible on his desk. The treatment was to place the wrist on the desk top and without announcing his intentions, the doctor would strike the ganglion with the heavy bible, bursting it and another ‘cured’ soul would leave the consulting room. Well, at least without the lump they came in with!

These days, we are a little more scientific than that, and an X-ray is often taken to rule out arthritis or a bone tumor. Sometimes even an MRI or ultrasound scan needs to be done to find a small ganglion hidden under the skin or between the bones.

There are various forms of treatment offered, which can range from the very conservative “do nothing and wait and see”, through to a splint to stop movement at the wrist and finally surgery.

My own experience is that the “wait and see” approach generally accomplishes very little, and the ganglion continues to grow. The patient arrives expecting ‘something’ to be done, and being told to “wait and see” with no guarantees, takes quite some convincing.

By letting the gel fluid out by bursting the sac seems to work well in the majority of cases, and especially in the short term. This can be done with a large bore needle, although sometimes the gel fluid is too thick to come out. In this case, multiple punctures of the cyst and pressure over it will cause the discharge of the contents, and a pressure bandage for a few days to stop immediate refilling of the cyst will work. Some practitioners will also inject a sclerosing agent, or hydrocortisone, but there is no clear-cut agreement on this, though I found that a small amount of hydrocortisone injected after aspiration seemed to work well.

If there is a recurrence (which unfortunately does often happen) then operative removal of the cyst and its sac becomes necessary. Some orthopedic hand surgeons will do this via an arthroscope, though open operation is also carried out in some centers.

According to the Mayo Clinic in America, surgery may be recommended if the other treatments fail. This surgery is done as an outpatient procedure. During surgery, the cyst, along with a small amount of surrounding tissue, is removed. There may be tenderness, discomfort and swelling at the site following surgery, but normal activities can usually be resumed in two to six weeks. Surgery offers the best chance of removing the ganglion, but even then, the cyst may return. However, my experience is that recurrences after this are very, very few.


Agony Column

Dear Hillary,
With all the rain we have been having recently with flooding and landslides and such, do you think it would help if all the beer drinkers agreed to dispose of as much flood water as the beer they drink each day? It would have to benefit the environment, surely. What do you think, Hills?
The Flood Planner

Dear Flood Planner,
What a novel suggestion, but please don’t call me “Hills”! Now what did you want the beer drinkers to do? Get down and actually drink the flood waters, or what? You should be much more specific, my Petal. As far as I know, beer drinkers do take in large volumes, but they also have to let go of large volumes, judging by the steady line-up outside the gentleman’s loo any time I have ventured out to the local watering hole. Even if they drank the flood waters, they would later be returning them to the overflowing drains, wouldn’t they? I think you will have to work on this project a little longer. Perhaps another couple of beers in the meantime, sitting somewhere dry, will produce the answer.
Dear Hillary,
What a sad person you are. Listening to all these even sadder people dragging out all their dirty washing. I don’t believe there are really that number of sad-sacks left in the world. Would you like to confirm me?
Doubter

Dear Doubter,
Or should that be Doubting Thomas? I’m really not sad, Petal, I enjoy life, and when I can help people, then I do. But remember that many of the writers are not looking for advice, like you for example, but use this column as a forum where they can get some vicarious (nice word) pleasure from seeing their own words in print. Hope you have enjoyed your 90 seconds (or 2 column centimeters) of fame. Now run away and play, that’s a good boy!
Dear Hillary,
All these people who write in and complain about your advice and then go on to try and give you advice, need their own heads read, I reckon. Can’t they see that it is entertaining, but when you need to be real you do give the good advice. The poor old lonely bloke a few weeks ago for example (sorry I’ve lost the paper), but I’m sure you’ll remember it. I’m surprised that there are so many people with nothing better to do than be bitchy. I love you, Hillary! Chocs and champs next time we meet.
A Fan

Dear Fan,
Thank you very much for your lovely letter (but next time stick it to the bottle of bubbly and the chocs and I’ll be even more happy). You are correct, there are many people who spend their time complaining about everything and everyone (and not just at Hillary, if you read the letters to the editor page). These people really should get off their high horses before they slip off and break a leg. There’s too much fun in the world, my favorite Fan, to waste time with noisy complaints and getting upset about nothing. Now, having got that off my chest(s), where was that last chocolate?

Dear Hillary,
We have some people coming over at Xmas and they have heard that clothes are cheap in Thailand and they keep telling me they are bringing an empty suitcase so that they take all their new clothes back with them. The problem is that both of them are around a size 18, or just about twice the size of the local women. They are really going to stand out here. I have been looking around the fashion shops before they come, but the clothes establishments (even the designer shops) just don’t stock size 18, and “one size fit all” just doesn’t work in this case. Do you know of any places that sell larger sizes? If you don’t, how do I tactfully break the news to them?
Christian Dior

Dear CD,
I am honored! A famous designer writing to Hillary. And wanting my advice on fitting dresses to models. It’s just a pity the models in question are so large. Though what you have to remember is that Thai ladies are sizes six to ten, with most around size eight. The overseas ladies are much larger by comparison, though they do not seem so out of place in their own countries, do they? However, fortunately, Hillary has the answer for you and your friends, Petal. What you (and they) have to do is forget about buying size 18 clothes off the peg and have clothes made while they are over here in December. The clothes will still be much cheaper than they can have made in their own country. Advise them that they should bring a couple of their favorite dresses with them and have them copied here. All they have to do is to choose the material and the tailors will do the rest. Tell them that the quality of tailoring is so much better, and go from there. They will soon see that they are not going to fit into the local sizes anyway! And I’ll let you know what size I am going to need for my next champagne party dress!


Camera Class: Special filters - inexpensively

by Harry Flashman

Special Effects Photography is in the realm of the special effects filters, and can be a very expensive way of finding out what you like or dislike, but the same effects can be done very cheaply, and producing these filters makes for a great photographic project.

One of the nicest special effects is what is called “center spot soft focus”. Now this just means the center is in focus and the edges are nicely soft and blurred. This effect is used by portrait and wedding photographers all over the world to produce that wonderful “romantic” photograph. And it is all done by filters.

You can make these very easily. You will need one can of hairspray, a one baht coin and a clear piece of glass or plastic (perspex) about 7.5 cm square. This piece of perspex needs to be as thin as possible to keep it optically correct. Put the coin in the center of the perspex and then gently wave the hairspray can over it. Let it dry and gently flick the coin off and you have your first special effects filter – the soft focus center-spot.

Another way is to use a piece of stocking (pantyhose) material. Stretch it over the lens and tie it on with a rubber band. Cut a small hole in the middle and your second soft focus center-spot is ready.

Now to use this filter. If you have an SLR (single lens reflex) camera or a digital, you actually look through the lens when you are focusing and what you see is what you get (the WYSIWYG principle). Set your lens on the largest aperture you can (around f5.6 or f4 is fine). Focus on your subject, keeping the face in the center of the screen. Now bring up your magic soft focus filter and place it over the lens and what do you see? The face is in focus and the edges are all blurred! Try some different f-stops as well (it makes the center spot larger or smaller) and record the details in your trusty notebook!

You can also use these filters with any compact point and shoot camera, but it is a little more hit and miss. The reason being there’s no WYSIWYG with compacts. What you have to do is position the center of the filter over the lens and, while keeping it there, bring the camera up to your eye, compose the shot and then shoot. Takes some fiddling and manual dexterity and take a few shots as you are really flying blind.

Another one is the Super Sunset Filter. This one will give you that wonderfully warm “tropical sunset” which will make people envious that they aren’t over here to enjoy such spectacular endings to the day. To produce the warm glow, just take off your sunglasses and place one side over the lens. It’s that simple! Just look at the difference yourself, with and without the sunnies. The camera will see it the same way.

The next one is the super-cheap polarizer. This time you need a pair of polaroid type sunglasses. Holding the sunglasses in front of you, slowly rotate the glasses while looking at reflections in the water for example. When the reflections disappear, note the degree of rotation and then hold the polaroid glasses over the lens at the same angle. Once again, you will get a very similar result to the way your eye sees the scene.

Soft romantic effects can be produced in many ways, and here are a few tried and true methods, and super inexpensive as well. The first is to just gently breathe on the end of the lens just before you take the shot. Your warm breath will impart a “mist” to produce a wonderfully misty portrait, or that early morning mist look for landscapes. Remember that the “misting” only lasts a few seconds, so make sure you have the camera pre-focused and ready to shoot. If you have control over the aperture, try around f4 as well.


Money Matters: A brief(ish) history of Stocks (Part 2)

Alan Hall
MBMG International Ltd.

{From last week: It’s generally accepted that the Dutch East India Company or Vereenigde Oostindische Compagnie (VOC) was the precursor of the modern public company. It was a co-operative arrangement when, on 20 March 1602 the prime companies of Holland merged to form the VOC, with six chambers, each with a 75-member board of directors, of which an executive board of 17 members was elected. The original paid up share capital was 6,424,588 guilders. The key to success in the raising of capital was the decision taken by the owners to open up access to a wide public and to accept shareholders as part-owners. Thus the shares were sold rapidly, mostly at a nominal value of 3000 guilders, and they were tradable (i.e. any Dutchman could buy and sell them). This last feature was the real innovation.}

The share price was not set by the government of the country but by an independent joint-stock corporation interested in profit. The company shareholders (the term actually came into use after about 1606) had to produce the subscribed capital in four instalments called up by the VOC between 1603 and 1606. The shareholder received a receipt (Part) for the payment to the nominal value of the share (just as was to become customary at the British East India Company over 100 years later when that institution’s structure was democratised).

A share certificate documenting payment and ownership such as we know today was not issued but was instead entered in the company’s share register. Purchases and sales of shares were effected by a new entry in the VOC’s share register in the presence of two directors, who needed to confirm the share transfer by signature. Thus the Amsterdam Kontor of the VOC became the “first stock exchange in the world” by trading in its own shares.

The VOC’s start-up capital was never increased apart from a few small adjustments to 6,440,200 guilders. The company covered its short-term capital requirement by issuing bonds with a term of 3 to 12 months. Later, after 1655, capital was taken up for longer terms so that loan capital increased at times to 10-12 million guilders.

Not only did the “Vereinigte Ostindische” make history as the mother of all joint-stock companies, but so did its shares. Even before all shares had been placed, its price was 10% to 15% above par (the world’s first IPO) and by 1622 its price was 300% higher; in 1720 at the height of speculation its price was 1200% (and we think that today’s PE ratios are scary?). When the company’s difficulties became public in 1781, the price slumped to 25%. The dividend was on average 18 (read ‘em and weep)% per year and the highest dividend was paid in 1606 at 75%. Shareholders did not receive their dividends regularly and were not always paid out in cash but partly also in spices, company bonds or state bonds (in specce dividends do still exit today). Soon the shareholders were popularly known as the “pepper sacks of Amsterdam”, although they never got to see a proper balance sheet. Corporate malfeasance, corruption, inadequate accounting standards - does any of that sound familiar?

The demand for stock was of course a reflection of the commercial success of the company. Within 65 years the VOC had become the richest private company the world had ever seen, with over 150 merchant ships, 40 warships, 50,000 employees and a private army of 10,000 soldiers. It helped to finance the blossoming of Dutch civilisation: Rembrandt, Vermeer, Frans Hals, Vondel, Grotius, Spinoza, the largest publishing operation in the world in the 17th century with numerous authors and poets, some forgotten today, all the painters architects and above all the patrons. However, after 198 years of existence, the most significant company in the history of world trade was dissolved on 31 December 1799. As a result of mismanagement, debts of 110 million guilders had been run up and these were taken on by the Dutch state.

The idea quickly caught on and the maritime powers of the day, Madrid, Amsterdam, Lisbon and London were soon home to other publicly traded companies (the British East India Company mentioned above was a joint stock company that preceded the VOC by 2 years but was a poorer example of open market capitalism being limited to 125 shareholders and a capital of ฃ72,000).

Stock trading followed the patterns established by the commodity markets over 300 years earlier in Bruges, where commodity traders used to gather inside the house of a Herr Van der Bourse, and in 1309 they had institutionalised this until now informal meeting and started the “Bruges Bourse”.

The idea quickly spread around Flanders and neighbouring counties and “Bourses” soon opened in Ghent and Amsterdam. The commodity traders hadn’t actually come up with the idea themselves - les courratier de change in 12th Century France managed, regulated and ultimately traded or brokered the debts of agricultural communities on behalf of the banks. By the middle of the 13th Century Venice bankers also began to trade with government securities (so successfully that in 1351 the Venetian Government outlawed spreading rumours that were intended to lower the price of government funds - again there’s a ring of familiarity there). Pisa, Verona, Genoa and Florence (all independent city states not ruled by a duke but a council of influential citizens, which is why they were able to do so) also began trading with government securities during the 14th century.

The above data and research was compiled from sources believed to be reliable. However, neither MBMG International Ltd nor its officers can accept any liability for any errors or omissions in the above article nor bear any responsibility for any losses achieved as a result of any actions taken or not taken as a consequence of reading the above article. For more information please contact Alan Hall on [email protected]


Life in the Laugh Lane: Go Fly A Kite

by Scott Jones

Years ago when Thailand meant nothing to me more than The King and I, Siamese cats or twins, and someplace very faraway, I watched folks flying amazing kites in the USA. I said, “Wow!” That was the first Thai word I uttered correctly, meaning “kite” in Thai.

Wow! Guards and God don’t seem to care for these at all.

These were stunt kites, aerodynamically designed with high-tech nylon and carbon plastic sticks flown on two strong strings attached to a handle in each hand, capable of spinning, diving and soaring to speeds over 150 kilometers per hour. With an immense four meter kite, or with several flown together, you can even water ski, sand ski or be lifted off the shore and deposited on sharp rocks down the beach. If you want to get rid of small children or girlfriends, just get the Velcro grips, hand them the kite and watch them disappear into the sunset.

A born-again kite fanatic, I had to bring one to Asia. A bright kite in the sky is a sweet site. A disassembled kite in an airport, transported in a caution yellow, meter-long, nylon sheath is a danger signal to every security guard within 7,000 miles. They stare suspiciously, their eyes widen or narrow depending on the personality or paranoia of that particular person, and before they can ask, I proactively say with a smile, “It’s a kite!” or “Wow!”

Once arrested for joking during a security check, I don’t say: “It’s a very thin machine gun. I work for the US Post Office.” “It’s a machete. I harvest bananas.” “It’s my custom-size condom.” “My wife’s in here on a serious diet. She’s trying to get down to her original weight: 125 grams.” I do say, “Everyone I know just tells me to go fly a kite, so I’m taking their advice.”

Once inspected rigorously, we’re all in a pretty good mood. Kites are pretty and good and fun for young kids, or very old kids, and the guards are remembering when they flew them, or maybe they just watched other people fly them, got jealous, turned bitter and became security guards so they could tell people not to fly kites here because: “There are power lines and you’ll die.” “It blocks the view of over here for the people that are back there and they’ll complain, I think, probably.” “If you run with it, you’ll poke out your eye.” “Why? Because I said so. It’s the law.” They’re secretly hoping to confiscate the kite, take it home and be kids again.

At a Hawaiian park with ancient ruins, major wind and a huge open field, the kite came out to play. A young worker ant cum security guard wannabe told us, “You can’t fly that here.” It was a perfect kite day with no one around but us and God, which was the very problem. We protested meekly since he said it so matter of factually like it was beyond the law. He said, “You can’t do it in front of the ruins. They are sacred.”

With the kite sadly sheathed, we walked away wondering why he could be making a cell phone call where we couldn’t fly a kite. Where does God draw his lines? How does little laborer wishing he were Security God know? Did God call him and tell him to stop us? Did he call God to ask? If he has God’s phone number, I’d like to get it from him so I can find out how God really feels about it.