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Falling For Beer
Never miss a beat. Get the best beer journalism delivered straight to your inbox.
Andrew Craig is a writer, editor, and enthusiastic beer drinker living in Brooklyn.
It doesn't have to be like this.
Two Instagram Beer stalwarts pass on what they've learned.
Instead of champagne, drink beers that feature champagne yeast.
Huddle up with one of these beers to warm your soul.
Don't struggle to come up with a gift for a beer lover.
Beers have inspired many words over the years. A few legendary words have returned the favor.
It's harvest time. Make sure you try a fresh hop beer before they're gone.
Are we drinking what they're drinking in Germany this Oktoberfest?
Tied to their roots by their Cream Ale, and the Erie Canal, Genesee undergoes much needed modernization project.
Of course they brew (great sour) beer at Hudson Valley Brewery. But that's just the beginning of the process.
The city has 14 Mikkeller bars. How many can you visit in one weekend?
In town for a Nationals game down the stretch? Here's where to drink. And where not to.

subset: commoncrawl


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A few months ago, a mom called and asked if I would like her son to collect stuffed animals for seniors. Jake is a 7th grader from Bucks County. For his Bar Mitzvah project, he contacted family and friends and asked for their assistance. He sent an email out to everybody that he thought would like to help and also posted flyers at the gym.
His mom was excited to tell me that he had collected 100 stuffed animals and about 15 blankets. And, that the family would like to accompany me, on Christmas Eve to deliver the canine creatures to a nursing home in Philadelphia.
We arrived at about the same time and it sure looked like a lot more than 100 stuffed animals. When they actually counted them, they had 413 stuffed animals. And these were not any just plain old run-0f-the- mill stuffed animals – these were big, cuddly and so soft. It looked like they had 13 trash bags filled to overflowing. Pups, horses and all kinds of paws that reminded the residents of a former pet.
I know that they are a very close-knit family because Jake told me that his aunts helped out a lot with his project.
We walked in together and started passing them out in the breakfast area. These two adorable children were so sweet and kind. No nervousness, no fear of the new faces staring at them. Just two happy-go-lucky kids on a mission to bring joy with bags of shiny black fur, floppy ears, and black button noses.
As some residents held the stuffed animals, we knew it was love at first sight. We saw a few mile-wide smiles and smothering kisses.
Jake and Emmie knew intuitively who needed attention and just what kind of attention they needed. Jake smiled and the little sister watched her big brother and did the same. I guess we passed out about 50 stuffed animals in the activity areas and then the director told us about the many people who could not get out of their beds. The mom, dad and two youngsters went from room-to-room bringing joy to the bed-bound residents. Probably another 50 more.
Hi Staci, Lennie, Jake and Emmie,
Oh what a wonderful experience it was to have all of you with me on Christmas Eve. I couldn't believe all of the bags of stuffed animals – all in absolutely perfect condition. Brand new, practically and all of the beautiful blankets, too. I just loved watching Jake and Emmie interact so lovingly with everyone. The tenderness that they showed to each resident was so beautiful to watch. Your children are so loved by you…and they know how to show love to others. I am so grateful for your help with the project and so happy that you came with me. Please come anytime! I know that all of your visits to the rooms just put smiles on the faces of the lonely people. You are the best!!!! I am wishing you a very happy holiday and a wonderful New Year!
With gratitude and admiration,
Dear Trisha,
Thank you for such beautiful sentiments, Trisha! We all had a wonderful experience with you and the residents! We have been talking about it all weekend, and Jake called his grandparents that day to tell him about his day. Thank you for the opportunity.
Have a happy and healthy new year as well!
Dear Staci,
Your family is just so wonderful. Watching your sweet and beautiful children just warmed my heart. They are truly beautiful, inside and out. A credit to you and their grandparents. How about when Jake stood in the front by himself and told about his project and introduced you? And how his sweet little Emmie watched him and followed his lead – both smiling for two hours – they sure brought sunshine into that place!!!!! Loved having you with me and watching the kids do their magic!
I think that we all had a sense of fulfillment on Christmas Eve. I loved the lesson that this mom and dad were teaching their children – about acts of service. As I looked around at the residents, I wondered: Who is lonely, homesick, and too shy to socialize? Who wants to go home to a family? And who is wondering if it was a mistake to come to live here?
Emmie and Jake spoke soothingly and softly. I think that the minds of the residents drifted back to happier days.


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Posts Tagged 'brain power'
Late Nights Weaken Kids' Brain PowerTuesday, July 9th, 2013
A recent study in the United Kingdom suggests that staying up late and lax bedtime routines can blunt children's minds. The study on sleep patterns and brain power is conducted with over 11,000 seven-year-olds, which shows that kids who had no regular bedtime or went to bed past 9:00 p.m. had lower test scores for math, reading, and spatial awareness. The researchers conclude that lack of sleep may disrupt n
Walking May Help Protect Aging BrainFriday, November 12th, 2010
As people age, many may become concerned about having an aging brain that starts to works less efficiently. As people age, they tend to forget more and experience a gradual decrease in brain power as compared when they were younger. Although it may be a normal occurrence as a result of aging, there are ways to help delay it. Researchers recently found out that regular walking may help. There are new findings that


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Double-NAT Blues: Tackling Asterisk's Thorniest Problems
Whether you're new to VoIP technology or an Old Timer, nothing is quite as frustrating as wrestling with one-way audio and no audio on SIP calls either because of poorly designed NAT-based routers or poorly implemented SIP ALG solutions on low-end residential routers. To make matters worse, you get to deal with calls originating behind not one, but two, NAT-based routers neither of which complies with the basic SIP Rules of the Road. In a perfect world, SIP and RTP… Read More ›


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Who's it for? School students who are unsatisfied with the quality / pace at which they are learning at school, or with the quality / topic of discussions they have with school friends. Mentors are welcome too!
Who's it not for? If you are not a school student (and don't intend to mentor school kids) you probably won't find things interesting in this community. If you are a school student and you find your school experience to be satisfactory both in terms of the quality of teaching and in terms of the interaction with your peers, then again you probably won't find this community adding much value to your life.
What can I do here? Discuss your favorite physics concepts, chemistry experiments, mind-boggling puzzles, math problems, and even things school never talks about. If something doesn't make sense, ask the community. If you find something awesome, share with the community.
Community name: 'Learn from Home' is a play on 'Work from Home'. We welcome name suggestions for the community, we're looking for something more fun.


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The grammar school debate is ongoing, but a study by the Education Policy Institute shows that a surge in pupils attending could lower the high results these schools currently see.
The Department for Education (DfE) has said it wants the introduction of new grammar schools to help education in the local area. However, the research argues that depending on where they are based, the schools might be forced to take more lower ability pupils, which will reduce their potential to achieve the highest grades. In addition, with just lower ability pupils left in nearby schools, they too may suffer.
The government has analysed the research though, and emphasises that this specific report is focused on the binary system that grammar schools have used in the past, and this is not what it plans to develop.
While there is, as yet, no research that is able to refute the claims of this report, the BBC has reported that the DfE is conducting its own research into the impact that an increased number of grammar school places might have, in addition to running a consultation on the plans, which were announced in October.
In a statement, the DfE said: "Our new approach would ensure any new selective schools prioritise the admission of pupils from lower income households, or support other local pupils in non-selective schools to help raise standards. We are clear that relaxing restrictions on selective education can and should be to the betterment, not at the expense, of other local schools."


text: 29 Nov Hello world! NurseTB2017-11-29T09:25:19+00:00 By NurseTB Uncategorized 1 Comment Spread the loveWelcome to WordPress. This is your first post. Edit or delete it, then start writing! Share this post FacebookTwitterLinkedInGoogle +Email Author NurseTB Comment (1) A WordPress Commenter Reply Hi, this is a comment. To get started with moderating, editing, and deleting comments, please visit the Comments screen in the dashboard. Commenter avatars come from Gravatar. November 29, 2017 at 9:25 am Leave a Reply Cancel replyYour email address will not be published. Required fields are marked *Comment Name * Email * Website


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Goldfinch Report Is Good This Year! I've made a goldfinch report at various times in the blog. I've written about years where the feeder traffic was enormous and other years where it was very sparse. There's nothing really different about years except possibly the weather. I'll talk about the reasons why I think the goldfinch report varies and some tips to make sure you're … [Read more...] about My 2018 Goldfinch Report
Why I Love Titmice
As we tend to our feeders, we realize we're helping out our friends by giving them a ready source of food, water, cover and sanctuary. What we tend to forget sometimes is how much they give us back in return. One of my favorite back yard visitors is titmice. Let me give you a few reasons why this is. They Put You In Your Place How many times have you snuck up on a feeding … [Read more...] about Why I Love Titmice
The Hummingbird Incident
My Hummingbird Story If you're looking for a "meaty" how-to post, you can skip this one. If you want to have a little hummingbird sunshine in your life today, by all means, READ ON! News In The Shower So, July 4th this year started as any other day. Did some studying for a blogging business course I'm doing called "Blog Mastermind". Caught up on some entrepreneurial … [Read more...] about The Hummingbird Incident
The Downy Woodpecker That Changed My Life
Warning: Experiences Like This Are Likely To Change Your Life! It is amazing how we humans can get caught in tunnel vision. Things happen in our lives and we just use it as evidence that everything is about us. You have a challenge. Whether it's health or finances or family or everything at once; we're so quick to listen to our egoic minds and only see how it affects us. … [Read more...] about The Downy Woodpecker That Changed My Life
What Kind of Birder Are You?
In my never ending quest to learn more about you, my readers, I like to ask questions. I'm trying to figure out what kind of content you value most or if your interests are all over the map. It would help me be more helpful to you if I knew what level of a birder you are. For the purposes of this article, I am going to break them down into three categories and then explain … [Read more...] about What Kind of Birder Are You?
When Survival Seems Unfair
The Intelligence At Work Sometimes, we birders have to witness things that break our hearts. Nestlings getting killed by birds competing for the space. Seeing the odd bird dead on the side of the road while walking our dogs. Seeing squirrels who've been hit in the road. The list goes on. What keeps us going is we know that these things are all part of the beauty we see and … [Read more...] about When Survival Seems Unfair
Start With A Bird Bath
Water Is An Easy Start To Feeding If you're like me, you want to get the most enjoyment out of your back yard with the minimal amount of fuss. After all, when you're not spending time in your back yard, you don't want to be worrying about how you're going to keep up with it all. That's one of the reasons I like more permanent fixtures over portable ones. For instance, I love … [Read more...] about Start With A Bird Bath
Spring Nesting Tips For Back Yard Birders
In most parts of the US, old man winter is starting to give way to at least small peeks of Spring. That means your back yard visitors are looking (or will soon be looking) for places to nest and raise their young. You can help them in ways you've maybe not thought of. Here are my spring nesting tips to help make your back yard a preferred spot for nesting birds. In no … [Read more...] about Spring Nesting Tips For Back Yard Birders


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'Nobody Touches Me With Impunity'
Whenever Robert Abady, a slender, intense artist and breeder of immense working dogs known as bouviers des Flandres, appears at a dog show, no one knows what to expect. Once, when Abady feared he would be late with a dog at an outdoor show, he shot his car around the admissions gate, swept by several rows of startled officials, gunned across an open field, bounced over a log—nearly demolishing the Popular Dogs stand in transit—and slammed on the brakes at ringside. After giving his dog, Ch. Marc de la Thudinie, to an embarrassed handler, Abady raced the car around the ring, parked in front of the Popular Dogs stand and coped with the angry army descending upon him by cautioning, "If you have something to say, say it in gentlemanly fashion. Otherwise I'll report you to the bench show committee."
Abady, symbolically, lives in Stormville, N.Y. but he was educated in French schools and is all gall. Doggy people either love him or loathe him. The latter group includes the American Bouvier des Flandres Club, which steadfastly refuses him membership. "They won't let me in because they know I'd wipe the floor with them," he says.
To just about everyone in dogdom, the American Kennel Club is the ultimate power seat, the White House, Vatican and Kremlin rolled into one, but to Abady the AKC is "a dilettante organization" composed of "pompous idiots" who do not have the true advancement of the breeds at heart. In 1965 the AKC suspended him for life for allegedly striking a woman handler and kicking her dog at a show in Connecticut. Among other things, this penalty made dogs from his kennel, Vuilbaard Bouviers, ineligible for AKC registration, but Abady sued in federal court and won reinstatement—an unprecedented victory.
Abady gives unhesitating voice to his opinion that the dog-show game is shot through with stupidity and politics. In his gentler moments he says most judges are "semi-Mongolian idiots." Once, when a judge who had been brought over from Europe rendered what Abady, who speaks 11 languages including Arabic, deemed an absolutely rotten decision, he offered to debate the judge on all the points involved. "I challenged him in French, in Flemish or in any language he wanted," says Abady, afire at the memory of it. "It didn't make any difference to me. The guy backed down. I told him he was obviously an incompetent. When I get an audience, I am really at my best." But all Abady got that day was a kick in the shins from one of the judge's supporters.
Abady's controversial convictions reach beyond the show ring. It is his deep belief that "most people involved in dogs are fruitcakes," and he adds that the average American dog, be it family pet, show dog or field dog, is in "miserable condition." Abady's admirers, though they may cringe at his outspoken assaults on the canine Establishment, hail him as a great guru of dogs, a true authority on the breeding of dogs, the health of dogs and dog nutrition. "I think Abady is the most important thing that has happened in the dog business in the last 10 years," says Jacquin Sanders, a breeder of bull mastiffs. "His nutritional ideas are extremely advanced. His dogs are in fantastic condition. The breed looks completely changed from five years ago when I saw bouviers limping around the ring."
A number of guard and attack dog enthusiasts regard Abady as a seer, and his attack-trained bouviers fetch several thousand dollars each. "Every time there is a murder in New York City, Cleveland or Chicago, we're inundated with phone calls," Abady says. "So that's good for business."
The bouvier des Flandres, native to Belgium, the Netherlands and northern France, is a shaggy, bearlike dog with cropped ears and tail and a heavy beard. In Belgium a show championship cannot be awarded to a bouvier unless it has won a prize for tracking or as an army, police or guard dog. The male is big, up to 140 pounds, very strong and agile. It is a good jumping breed. A bouvier holds the world record for scaling a wall: 16 feet. Originally bred in Flanders to herd cattle—bouvier literally means cattle dog—the dog is supposed to be of calm temperament. "The bouvier does not have a chip on his shoulder," says Abady's wife, Isabel, an assistant professor of French at Vassar. "He does not want to be nasty. He is gentle and friendly and marvelous with children. He is only aggressive when someone threatens his people or his property. Our kennel motto is Nemo me impune lacessit [Nobody touches me with impunity.] The bouvier protects not because he's vicious, but because he is your dog. He does what is needed."
As an example of the dog's measured response to a situation, Abady cites the time a plumber came to his house a day late when no one was at home. "There were seven dogs in the house," Abady recalls, "and the plumber was pinned to the living-room wall for eight or nine hours. When we came in, he was ashen. The dogs didn't hurt him, they just wouldn't let him move even though he was only a foot and a half away from the door. Of course, he should have come the day he said he would."
Then there was the time Abady went into Manhattan with Picot, an untrained year-old male. "I took him into the Figaro, a coffeehouse in Greenwich Village," Abady says. "You could take a dog in there, eat, drink coffee and play chess in a relaxed atmosphere. A guy who seemed about eight feet tall and wearing an orange motorcycle suit came in and sat at the next table. He ordered a hamburger and French fries. Picot was curled up at my feet. When this guy's order came, he got up and leaned across me to get the ketchup. It was a very irritating and insolent gesture, as though he wanted to pick a fight. I did nothing. Shortly after that, he came back for the pepper and salt. I did nothing. As he was eating, he dropped one of his French fries on the floor and kicked it toward Picot. I kicked it back. He kicked again. I picked it up and said, 'Don't feed the dog without the owner's permission.' I threw the French fry back at him and, by accident, it landed on his plate. Get the picture? He stands up and pushes the table aside. I stand, and suddenly I hear this high-pitched shriek from this huge guy. I didn't know what was going on. The place was absolutely still, and all I wondered was how a big guy, an enormous guy like this, could scream in such a high voice.
"What had happened was Picot had grabbed the guy by the hand. The guy fell over a bannister, his hand bleeding, rushed into the bathroom and then shot out of the Figaro. There wasn't a sound in the restaurant. Not a sound. It was eerie. I didn't know what to say. Should I offer to pay his check? The waitress comes over, silently gives me my check, I pay and I leave with Picot. I didn't know whether I could ever go back, but a few weeks later a friend of mine went in there and he told me, 'Hey, there's this legend about this guy who went into the Figaro with a bear! And the bear tore this motorcyclist guy apart! The guy was all covered with blood after the bear chewed him up, and they had to carry him on a stretcher to an ambulance.' " It turned out the manager was delighted, because motorcyclists had made the place a hangout and annoyed his customers.
Abady, who is 32, was born in Curaçao in the West Indies. He is of Dutch, French and English extraction. His father was a wealthy entrepreneur who invested in various enterprises ranging from ranches and department stores in Latin America to tea in India. Abady spent part of his childhood in Egypt; later his family moved to France and Italy. But wherever they went, Abady had horses and dogs. He credits a great deal of his knowledge of dog anatomy and structure to his experience with horses and also to his artistic training. "Robert's forte is his artist's eye," says Isabel. "He is extremely visual."
Abady's education was classically French, and when the family moved to New York he attended the Lycée Fran√ßais, which was for him "a terrible school. It was too rigid and I was basically rebellious." Once when he was briefly living on his own after a spat with his father, he was called in by the headmaster and informed he was going to be expelled. "I said, 'O.K., I won't pay the bill.' " He remained in school.
When Abady was 16, he had his final break with his family. "My father told me there was a big place waiting for me if I wanted to get involved in his affairs. He told me what they were, but they were not too engaging to me at the time. I was torn between medicine and art. My father didn't think very much of physicians generally, and when I told him I wanted to be a painter he thought I was insane. I packed my bags, rented an apartment and took a job as a salesman. I wasn't much of a salesman so they suggested I look for other work. Those were troubled years for me. I didn't know how hard it was to make one's own way in the world. I worked at various jobs and gradually I started to sell paintings. Little by little I didn't have to work part-time."
Abady studied with Maximilian Aurel Rasko, whom he regards as "one of the last great masters of the century." From him Abady absorbed the principles of harmony, composition and design, elements that are lacking, he says, in modern art, which he considers a "hoax." At 18, Abady's work was presented at a number of big shows, including that of the National Academy.
Abady's father died shortly after he left home and a quarter of a million dollars was placed in trust for him until he reached 21. Fearing that the trust fund was being mishandled, he sought to get his money. "I got a few thousand here and there to keep me quiet," he says. "Then I was told that's it." Knowing that he was due a considerable sum from one of his father's former business associates in Curaçao, Abady went there. "I realized there was no way I could get the money legally," Abady says, "but I knew that this man was tremendously superstitious, so I began a campaign of terror. In the evenings I planted speakers in his garden just outside his bedroom, and I would hide in the shrubbery with a mike and say, 'This is the great spirit speaking.' He was a Rosicrucianist or something. I would speak in Papiamento, which is a dialect I picked up at the time, and I would say, 'You've been a very bad man. That fellow Robert is such a nice boy, a young man at the beginning of life, and you're taking his money. He's really trying to work hard, and he's going to school. Do you realize your soul is going to burn?' This guy got so scared he capitulated."
Comfortably fixed, Abady went to Germany and Holland. There he studied and painted and came to know the bouvier. In 1963 he returned to the U.S., where he met Isabel in a Philadelphia junk shop while he was seeking objects for still life. Isabel, who had studied for her doctorate at the University of Montreal, was then teaching at St. Joseph's College. They bought bouviers, got married and purchased a farm in Quebec.
"Soon the whole place was crawling with bouviers," Abady recalls. "They were all terrible. I was very disenchanted. I had started to learn about bouviers in a creative way. They were supposed to be courageous. These were very shy. I was determined to find out if the dog really had the character that his heritage suggested. We sold the farm, sold all our dogs or gave them away and started from scratch."
The Abadys moved back to the U.S. and settled in Stormville, 50 miles north of New York City. Passionately committed to raising better bouviers, Abady got in touch with breeders in Belgium and flew over to buy dogs. He was discouraged at the first kennel he visited. "The dogs were much handsomer than the ones here, but they were very, very timid," he says. "I looked at them in complete disgust and just walked away." At the next kennel he visited, Posty Arlequin, he paid several thousand dollars for three handsome bitches, and then he saw Marc, a 2-year-old male at the Thudinie kennel of Justin Chastel. To see if the dog had courage, Abady donned a protective suit of heavy canvas and leather and asked Chastel to send the dog on the attack. "Marc barreled into me, knocked me over and tried to kill me," says Abady. "I knew this was the dog I wanted. This was the beginning of a new strain." Chastel did not want to sell Marc, who was the sensation of show rings in Belgium and France. But after five cognacs he agreed to let the dog go for a bit less than $6,000, including shipping.
In the U.S. Marc promptly won his show championship. "Marc won a lot," Abady says. "But not until Dog World ran a story on Marc did he get the recognition he deserved. When the article appeared, he started winning working groups almost overnight. That is how susceptible many judges are to publicity. Before that, no one looked at him much because he was a bouvier and bouviers hadn't won in many, many years. Marc is a great dog and he should have won on his own merits." Marc, along with other Vuilbaard Bouviers, has been handled in the ring by J. Monroe Stebbins Jr. "He's an excellent handler," says Abady, "but he wishes we wouldn't show up at ringside. He has no desire to be associated with the dramatic side of our kennel."
Although Abady has bred a dozen champions since he bought Marc, he remains skeptical of the show circuit. "It is obvious to me," he says, "that it is impossible to make judgments that are absolutely concrete because of the system. Judges are not really trained, they're not schooled in esthetics and they're not schooled in structure. There are no classes to explain dynamics and all the principles that exist in dogs. To become a dog judge, you have to become a busybody and get involved with a breed club. Eventually you get assignments and are considered an expert by a lot of other nonexperts. There are no standards that are really plausible. There are some good judges, judges who seem extremely knowledgeable. These are people who have done a great deal of research on their own. A lot of handlers become judges. Some know something here or something there, but they usually do not have the cohesive overall ability to go over a dog in detail. We've seen some outrageous things happen; top working dogs that have been lame, lame for years, some judges will throw out of the ring and other judges will confer the highest awards on them.
"The whole dog game should be reorganized. The American Kennel Club should be completely divested of its autocratic power. The AKC treats everyone like little children. There should be rules of conduct at shows, I agree with that. But there should also be the possibility for people who have serious grievances to bring them to a board that is independent.
"People want to know that the winning dog is the one after which the breed should be patterned. That's essentially what showing should be all about. But breeds take turns for the worse because winning dogs sometimes shouldn't win. People read that this dog has six best-in-shows or 50 group wins, and they'll send their bitch over to be bred and the dog could have 10,000 faults. This does a tremendous disservice to purebred dogs. It is perpetuating dogs for reasons that have nothing to do with dogs. It has to do with politics. It has to do with money. It has to do with influence. So dogs don't make the progress they should."
Although Abady has a poor opinion of the showing, he regards attack training as superb sport. His only difficulty is finding a steady supply of "villains." A villain is the fellow who serves as the bouvier's object of attack. He should weigh at least 200 pounds, because a hurtling bouvier can easily knock down a lighter man. Once the villain is knocked flat, the dog can burrow underneath the protective suit and do severe damage. "You find villains anywhere you can get them," Abady says. "Anyone who talks big and thinks he has guts. We pay $4 an hour, but when a villain sees an enraged dog coming at him for the first time, he wants to raise the price."
It takes about a year to train an attack bouvier, and only the most stable dogs are taught. The first thing that the bouvier must learn is how to bite properly. Abady trains his dog to bite the calf, the thigh, the arm and the crotch. "When we say a bouvier bites," says Abady, "it doesn't mean the dog just puts his teeth into someone. A bite is a trained procedure. A bite is a lethal assault. For a dog to bite, it is not enough to slash or nip. A dog is not really effective that way. For a dog to bite effectively, he must apply pressure and break bones and tear muscles and not let go and quit. When you first start training a dog to bite, he may exert 100 pounds of pressure. That's meaningless. A bouvier that has been taught to bite will exert up to 1,000 pounds of pressure per square inch, and it takes only about 300 or 350 to break the average human forearm. The bouvier has to learn to throw his weight into the bite, his shoulders into it, his neck into it. And he really has to tear. The first time he shakes his head, everything goes with it. This is our whole concept. If a bouvier gets you in the thigh, you'll be unconscious in about five seconds. You couldn't stand the pain. If a dog comes in and slashes, you have a chance to break his head, but if a dog comes in and holds and starts tearing and breaking things, then it's all over, because you can't get him off you.
"A bouvier bite is a studied thing. It really doesn't matter where he bites you. If he got you on the big toe, you'd probably lose consciousness. Shepherds and Dobermans are slashers; they have a longer jaw, so instinctively they want to let go. They do not have the same jaw structure as the bouvier." Abady speaks from experience about the bouvier bite. While photographing an attack lesson in France, he got a little too close to the villain. The bouvier wheeled off target and grabbed Abady in the thigh. A doctor used 27 stitches on the wound and Abady limped for months.
In the early stages of training, the bouvier is held on a special leash of whale hide or latigo leather. "The leash is very pliable," says Abady, "and its vibrations will give you an idea of what's going on in a potential attack situation. You can feel the bouvier quiver and tense up. It's as though an electric signal is given through the leash. He should do nothing unless there is direct assault on you or unless he is commanded. I don't use complicated verbal commands. The command to be on guard, the last step before an all-out assault, is 'Cha,' which is said just under my breath. It means nothing in any language. 'Cha' is enough, and the dog is like a live wire. The command to attack, very good insofar as it's so subtle that no one would ever know what is happening, is 'Tsk, tsk.' That's it. Suddenly the dog turns into a cannonball."
Dr. Stephen Wilder, a Manhattan psychologist who walks through Central Park because he lives oh the West Side and practices on the East, has two of Abady's bouviers. "Bouviers are very much a part of my life in the city," Wilder says. "I think Robert's bouviers are the best of all the dogs I've seen, and I've tried shepherds, Dobermans, rotweillers and Rhodesian ridgebacks. None has the stability or temperament of my two bouviers. You have to have a dog that is very calm. City living is complicated. If the dog went at everyone who looked or acted strange, he'd get you into an awful lot of trouble very easily.
"Bouvier attack training requires a very complex set of discriminations. Why should the dog attack the 101st stranger and not the first 100? The bouvier has two attributes that are seemingly contradictory. One, a tremendous amount of stability, and two, a predisposition to protect, to bite without hesitation when required. These dogs have a deep sense of territory. When I let them off the leash, they're never more than 40 feet away from me. With my wife, the dogs are never more than 10 feet away."
A year ago, while walking home through the park one evening, Dr. Wilder found himself being followed by a group of teen-agers. They caught up to him and demanded money. "When I refused, one kid reached into his pocket and flicked out a switchblade knife," Wilder recalls. "It was like a signal and they started to surround me. I had Rocco, my trained bouvier, a young bouvier pup and another dog with me. I didn't want to challenge these kids, but I suggested that the first one who came at me probably would die and that three or four others wouldn't go through life looking the same. Rocco had oriented himself in a certain way. He doesn't rave or jump around. These dogs have an understated way that people don't understand. Rocco's neck arches, his ears stand, his gait changes. I started walking backward, and Rocco kept doing figure eights around me to make sure no one came close. No one did."
Abady recalls the occasion on which he drove to the East Side of Manhattan to deliver a painting, leaving a bouvier bitch to guard the car. "I parked the car about a third of a block away," he says. "It was a warm evening, and I left the dog inside with another painting and a few odds and ends on the front seat. I delivered my painting and it was getting dark when I came out. I remember passing a row of cars and seeing a man trying to get into a car that I had thought at first was mine, but in the dusk I figured I had made a mistake. I tried to remember exactly where I had parked. I knew it was on this street, and I went back again.
"All of a sudden it dawned on me that the guy had been getting into my car. I looked, and he seemed to be in the same position he had been three or four minutes before when I first passed him. I was very puzzled. All of a sudden the terrible thought occurred to me that something was going on with this guy's arm. The car was shaking and quivering. Here was this guy moaning as though he was in pretty bad shape. The dog had nailed him right in the shoulder. I tried to extricate him, but I couldn't get him out. I went inside and tried to get her to release him, but she wouldn't. She was just braced in there.
"I figured I better get a cop. After a good five or six minutes, I finally got the police. Here they came in a patrol car. They get out as big as life. 'O.K., where's the guy?' they asked. I said, 'He's in there.' So a cop opened the door, grabbed him and said 'O.K., c'mon, buddy.' Then the cop said, 'God, what's in there?' I said, 'That's my dog.' One cop said, 'That ain't no dog, that's a bear!' The familiar bear nonsense. I said, 'You just hold him and drag, and I'll get in the car and release him.' But the cops jumped in the patrol car, slammed the door and rolled up their windows. Can you imagine that? Then one cop rolled down his window a little bit and said, 'When you get him out, call us.'
"Finally I got the guy's arm loose. It was an ordeal. I had to pry her and coax her and tell her she was a good girl. She was very bloodthirsty this dog, in any case. Finally, the cops got the guy and took him away. He was delighted to be arrested."
In the course of the last six years, Abady has spent almost $250,000 on his kennel and now makes a good living from dogs. "Most of the money is from the peripheral activities that concern dogs," he says. "Training, of course, is very lucrative, and word of good training spreads fast. Up to now we have trained only bouviers, but we are expanding to take in any dogs. Boarding is very important. We have a lot of consultations on nutritional problems, and we have a mail-order business selling nutritional supplements."
To a growing number of dog fanciers, Abady is a recognized expert on condition and nutrition. Not long ago he visited an acquaintance who was very proud of his Labrador retriever. Abady looked at the dog, felt the stomach, checked the coat and peered down the throat as the owner beamed. "Your dog is not well," Abady said. "He has tonsilitis, the gums look pale, the coat is terrible and he lacks vigor. Have your vet check for worms." The veterinarian reported that the dog had the start of an infestation of hookworms.
"You hear this country has the best nourished people and everyone is healthy," says Abady. "Then you see people who are nervous wrecks, they tire easily, they're not healthy. It's the same thing with dogs. Dogs are not always in top shape. For the most part they are in awful shape. They are eating rations that are inadequate. Dog owners and veterinarians are brainwashed by big companies. The rations are helpful in the sense that they are balanced, but over a long period of time I would say no dog can really do well on them. Let's assume that a dog has worms. The intestine is upset, and the dog can't synthesize vitamin C normally. So he starts to develop certain serious symptoms that are not picked up by a vet because he is not nutritionally oriented. The B complex is interfered with. This becomes chronic, and you start to see the results: wear on the inside of the gum, pigment is lacking, the dog lacks luster, he starts to have bad breath, which is mostly caused by niacin deficiency.
"Because the dog has bad breath, the modern notion is to give him chlorophyll. No one bothers to think that maybe the dog has some trouble with his intestinal tract. Then the dog becomes susceptible to certain diseases and infections. This is automatic. Say the dog picks up a mixed bacterial infection. Essentially dogs are very hardy, and they generally have much better defenses than people do. But unless the dog has enough proper nutrition in his rations, the infection is going to take hold and attack various organs. Say he gets tonsilitis. You go to the vet, and he says, 'O.K., your dog has tonsilitis.' He may not realize it's an ascending infection coming up from the intestines. So he treats the dog for tonsilitis, the symptoms disappear temporarily and the dog is still in as lousy shape as before.
"Or maybe the vet will give him cortisone, the big panacea now. Cortisone is a very dangerous drug and most veterinarians don't know the side effects of it. I'm not saying one should not use cortisone—it's been a lifesaver—but you better know what you're doing. When you inject cortisone, you establish a tremendous imbalance between cortisone and deoxy cortisone, which is one of the hormones secreted along with cortisone by the body. Then you have big problems. The deoxy cortisone's function is to isolate bacteria and keep them encapsulated. When you give a lot of cortisone you reduce inflammation quickly and take away obvious symptoms, but what you are also doing is releasing all the bacteria that have been encapsulated, and then very often the dog is overwhelmed by the infection."
Abady has his own laboratory. "I was forced by circumstances to become my own vet," he says. "Our mortality of newborn puppies is maybe 2%. It was 60% when I didn't do the work and when I wasn't my own vet." There has been such a demand for Abady's nutritional supplements that he is planning to start a company to sell them in packaged form. The first half dozen kennel-tested supplements are specifically formulated to meet various needs or problems. There is a supplement to increase the stamina of hunting dogs, another for pups of large breeds ("to give them the chance to grow up to their genetic potential"), supplements for breeding dogs, a supplement for lactating bitches of all breeds and supplements for dogs under stress or in a diseased condition.
"We're not interested in making money for money's sake," Abady says. "We want to break new ground. We are always looking for things that will work better than anything has before."
Meanwhile, no one had better give him any trouble. Robert Abady's bark is no worse than his bite.
The Abadys: Isabel, Robert, Roberta and bouvier, to which you don't say, "Tsk, tsk."
A bouvier getting his basic training goes for the padded arm of a hired, hesitant "villain."


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Dupuytren's Contracture
Discussion paper prepared for
The Workplace Safety and Insurance Appeals Tribunal
July 2002
Prepared by:
Dr. Lawrence N. Hurst MD FRCS(C)
Plastic, Reconstructive, Hand & Microsurgery
Dr. Lawrence N. Hurst graduated from the University of Toronto in 1965. He did post-graduate training in plastic surgery at the University of Toronto from 1966 to 1971 and was granted his fellowship in surgery in 1971. In 1972, he did a fellowship year at Stanford University Medical Centre in California and is American Board-Certified in Plastic Surgery. He joined the University of Western Ontario faculty in 1973 and held the rank of Chairman, Division of Plastic and Reconstructive Surgery. His clinical and research interests were in plastic, hand and micro surgery. He has published widely in these areas. He was Program Director, Residency Training Program of Plastic and Reconstructive Surgery from 1992 to 1997 at the University of Western Ontario and he currently holds the rank of Professor Emeritus.
WSIAT literature search reviewed by Dr. J. Duff in 2010, who is of the opinion that this paper still provides a balanced overview of the medical knowledge in this area.
This medical discussion paper will be useful to those seeking general information about the medical issue involved. It is intended to provide a broad and general overview of a medical topic that is frequently considered in Tribunal appeals.
Each medical discussion paper is written by a recognized expert in the field, who has been recommended by the Tribunal's medical counsellors. Each author is asked to present a balanced view of the current medical knowledge on the topic. Discussion papers are not peer reviewed. They are written to be understood by lay individuals.
Discussion papers do not necessarily represent the views of the Tribunal. A vice-chair or panel may consider and rely on the medical information provided in the discussion paper, but the Tribunal is not bound by an opinion expressed in a discussion paper in any particular case. Every Tribunal decision must be based on the facts of the particular appeal. Tribunal adjudicators recognize that It is always open to the parties to an appeal to rely on or to distinguish a medical discussion paper, and to challenge it with alternative evidence: see Kamara v. Ontario (Workplace Safety and Insurance Appeals Tribunal) [2009] O.J. No. 2080 (Ont Div Court).
Dupuytren's contracture is a fibroproliferative condition that primarily affects the palmar and digital fascia and can cause contractures of the metacarpal phalangeal and interphalangeal joints of the hand.
The palmar side of the hand can be thought of as a series of layers. Most superficially is the skin. Immediately under the skin is the palmar fascia which is a thin layer of fibrous tissue. Under this layer of fibrous tissue is a layer of tendons, nerves and blood vessels. The final and deepest layer is composed of muscles and bones.
The second layer down, the palmar fascia, starts to grow in Dupuytren's disease and initially forms a painful nodule in the palm [Figure 1].
Figure 1: New Palmar nodule
The discomfort resolves spontaneously in several months. The fibrous tissue continues to grow and forms a pretendinous cord or hard band, detected on palpation, stretching from the palm to the base of a digit [Figure 2].
Figure 2: Pretendinous cord with flexion contracture of ring finger MP joint
The ring finger is most commonly affected first, followed by the small finger. The pretendinous cord can contract or shorten and cause a contracture of the metacarpal phalangeal joint (MCP). As the disease progresses, the contracture may involve the proximal interphalangeal joints and, rarely, the distal interphalangeal joints. The patient can always flex the fingers into his hand, but cannot fully extend them. The natatory cord can cause adduction of adjacent digits to the extent that they cannot be passively abducted. The inability to spread the fingers apart can cause skin maceration between the digits [Figure 3].
Figure 3: Natatory cords with inability to spread the ring and middle fingers
A severely contracted digit greatly interferes with both hand function and such routine activities as wearing gloves. The progress of the disease can be predicted to some extent and is determined by the patient, the presentation, and the associated conditions.
|No family history
|Strong family history
|Minimal involvement
|SBilateral involvement
|Late presentation
|Early presentation
|No intercurrent disease
|Intercurrent disease (e.g. epilepsy,
diabetes, alcoholism, infection with HIV)
|No associated conditions
|Associated conditions (e.g. knuckle
pads, plantar fibromatosis,
Peyronie's disease)
|Patient compliant with rehabilitation
|Patient not compliant with
rehabilitation program
The fibroblast in the fascia structurally changes to the myofibroblast described by Majno (1). This cell has the ability to actively contract and is responsible for the contractures seen in Dupuytren's contracture.
The incidence of Dupuytren's contracture varies widely among races and is high among the descendants of the Celtic race which originally inhabited Northern Europe and the British Isles. McFarlane (2) reported a survey in which 82 percent of the patients with Dupuytren's disease were from Northern European families. There was a higher incidence among males with a male to female ratio of 82:16 which was consistent in all countries. Bower (3) reported that the incidence of Dupuytren's disease among individuals with human immunodeficiency virus (HIV) exceeds that of the general population.
Dupuytren's disease is a genetic disease and is inherited by means of an autosomal-dominant gene with variable penetrance (4). The expression of the gene is less complete in females, which accounts for the lower incidence and later onset among the female population (5). The onset of Dupuytren's disease usually occurs in the fifth decade in males and the sixth decade in females, and the disease is gradually progressive.
Trauma is often cited as a causative agent, but McFarlane (6) believes that evidence from epidemiological studies is insufficient to support this conclusion in most cases. However, a causal relationship may be considered in young patients who develop Dupuytren's contracture within two years of sustaining a single injury.
In 1996 Liss and Stalk (7) reported that there is good support for an association between vibration exposure and Dupuytren's disease, but weaker evidence for an association with manual work. McFarlane thoroughly reviewed all the papers that have related both vibration exposure and manual work to Dupuytren's disease and concluded that vibration injury has only a possible relation and that a relation to manual work is unproven. This information is documented in the report "Dupuytren's Disease: The Relation to Manual Work, Vibration Exposure and a Single Injury to the Hand". This was an update requested by the Workmen's Compensation Appeals Tribunal submitted by Dr. Robert M. McFarlane, December 1996.
Microtrauma is a term coined by Dr. Skoog in 1948 to draw attention to microruptures in the palmar fascia. He regarded them as a result of multiple injuries contributed to by hard work. Larson in 1960 found the same histological pattern in experimental ruptures of the palmar fascia in apes as in Dupuytren's disease in man, but none of the apes developed a finger contracture. Consequently, the study was unable to show that microtrauma has any relationship to Dupuytren's contracture. Dupuytren's contracture and carpal tunnel syndrome can occur in the same patient; however, no cause and effect relationship has ever been shown between the two diseases.
Dupuytren's contracture is associated with other malformations of fibrous tissue proliferation, including knuckle pads [Figure 4].
Figure 4: Knuckle pads over the dorsal PIP joints
The knuckle pads appear as nodular thickenings over the dorsum of the PIP joints. They can be tender, but do not cause contractures and sometimes regress spontaneously. The deposition of fibrous plaques on the dorsum of the penis in Peyronie's disease causes a painful penile contracture in response to erection. The plantar fascia proliferates in plantar fibromatosis in a fashion similar to that of the palmar fascia in Dupuytren's contracture. Flexion contractures rarely occur in the toes (8), but nodules may appear in the plantar fascia, usually in the instep [Figure 5].
Figure 5: Plantar nodule
Houston (9) described the clinical features of patients with particularly aggressive Dupuytren's contracture, which include a positive family history, the appearance of disease before the age of 40, knuckle pads, plantar fibromatosis, and severe bilateral involvement. Such patients have a strong Dupuytren's diathesis and therefore should be identified because of a strong tendency for the disease to progress and recur after treatment.
A greater incidence of Dupuytren's contracture occurs among individuals with epilepsy (10). In these patients, the disease presents at an earlier age, has a normal distribution on the ulnar side of the hand and is bilateral and aggressive. The incidence increases with the age of the patient and the duration of the epilepsy. Individuals with idiopathic and traumatic epilepsy are affected equally; consequently, the increased incidence among this population is thought to be caused by the long-term effects of barbiturate therapy (11).
Dupuytren's contracture is common among individuals with diabetes, and the incidence increases with the age of the patient and the duration of the diabetes (12, 13). The distribution of the disease is more radial in the hand, with nodules typically appearing at the base of the middle and ring fingers. Involvement is mild and mainly in the palm with few contractures of the fingers. Surgery may not be required. The connection between diabetes and Dupuytren's contracture is most likely related to the diabetic microangiography, which causes disturbances in the structural macromacules in the extracellular matrix and results in the inappropriate deposition of connective tissue (12).
The association of Dupuytren's contracture with alcoholism, with or without cirrhosis, has been studied by many authors (14, 15, 16), and reports show an increased incidence of Dupuytren's contracture among alcoholic patients. The distribution of the disease in such patients mainly involves a thickening in the palmar aponeurosis without significant contractures; however, the disease can be very aggressive, leading to severe joint contractures in some cases. The association may be related to the amount of alcohol ingested and its effects on the microcirculation. Dupuytren's contracture has been strongly associated with both smoking and HIV infection (17).
Non-surgical treatments, to date, have not been successful. Standard splints cannot prevent or reverse contractures. Ultrasound, laser therapy, and radiation have been ineffective, and vitamin E and enzymatic fasciotomy have also not been proven to be of long-term value unless combined with surgical treatment (18, 19, 11). However, Ketcham (20) has produced beneficial results by the injection of steroids into early painful palmar nodules to reduce symptoms. Skeletal traction has also been effective in reversing joint contractures in the preoperative patient (21, 22). Dr. Lawrence C. Hurst, an orthopedic surgeon from Stoneybrook, New York, is presently engaged in a multi-center trial of collagenolytic agents. His preliminary studies are very encouraging for the non-surgical release of joint contractures.
Current research is focused at the cellular level to investigate such parameters as macrophage growth factor, oxygen free radicals, and the possible role of hypoxia and cytokines. Perhaps with a clear understanding of cellular biology, we may improve control of the cellular activity. Currently, we are in the "stone age" with regard to the treatment of Dupuytren's contracture. Rather than carve out diseased tissue, genetic engineering should allow us to control the development of the disease. Until this type of control is possible, however, surgery is our most effective treatment.
The development of a palmar nodule or a pretendinous cord in the early stages of Dupuytren's contracture is not necessarily an indication for surgery. However, some manual workers, such as carpenters and mechanics, have difficulty because the palmar nodule can be painful and can interfere with their hand function and occupation. If steroid injection of the nodule is ineffective in reducing symptoms, a limited excision of the painful nodule allow can allow the patient to continue working. The nodules become asymptomatic with time, but some patients require symptomatic relief. Houston's (23) "table top test" determines when a patient has reached the stage of being unable to place the hand flat on a surface because of MCP joint contractures. Early MCP joint contractures may be followed, but a MCP joint contracture of 30 degrees or more should be released (24). Even severe MCP joint contractures can usually be completely corrected; however, contractures of the PIP joints are not as easily corrected. A PIP joint contracture of 30 degrees or more is an indication for surgery (25) as is a severe adduction contracture which can cause skin breakdown because of the patient's inability to separate the digits. Figure 6 and 7 show a preoperative patient with a flexion contracture of the small and ring finger MP joints and the small, ring and middle finger PIP joints. Figure 8 shows a preoperative patient still able to make a full fist.
Figure 6: Preoperative patient with a flexion contracture of the small and ring finger MP joints and the small, ring and middle finger PIP joints
Figure 7: Preoperative patient with a flexion contracture of the small and ring finger MP joints and the small, ring and middle finger PIP joints
Figure 8: Preoperative patient still able to make a full fist
It is important to educate patients regarding the surgical treatment and rehabilitation of Dupuytren's contracture so that their expectations are realistic. The goal is to correct both the contracture in the fingers and the cords in the palm. Surgery cannot cure the disease itself. As previously indicated, correction of the MCP joint contractures is usually successful, but PIP joint contractures are much more difficult to release; cannot always be fully corrected; and have a higher recurrence rate, particularly in the small finger (25).
Regional fasciectomy is the most common fasciectomy performed for the surgical treatment of Dupuytren's contracture. This procedure completely excises the diseased fascia in the palm and digits, but spares the normal-appearing fascia. This operation can be performed under block or general anesthesia with tourniquet control and loop magnification. The most commonly used incision is the zigzag or Bruner incision (26), but the mid-axial, straight-line, longitudinal incision may be used and closed with multiple z-plasties to break the straight line. Figures 9 and 10 show a postoperative patient following a palmar fasciectomy to release his left ring and small finger flexion contractures. Figure 11 shows the same postoperative patient making a full fist.
Figure 9: Postoperative patient following a palmar fasciectomy to release his left ring and small finger flexion contractures
Figure 10: Postoperative patient following a palmar fasciectomy to release his left ring and small finger flexion contractures
Figure 11: Same postoperative patient making a full fist
The radical fasciectomy is reserved for patients with extensive disease such as those with Dupuytren's diathesis as described by Houston (9). Both the disease and the normal appearing fascia are excised from the palm and affected fingers. This more extensive resection is accompanied by increased postoperative morbidity because of swelling and stiffness.
Dermatofasciectomy was described by Houston (27) for patients with an aggressive diathesis and skin involvement. Both the diseased fascia and the overlying skin are excised. The tissue defect is replaced by a full thickness skin graft. According to Houston, the skin graft decreases the recurrence rate (28).
The open palm technique described by McCash (28) involves transverse incisions in both the palm and the fingers that are not closed but rather left open to spontaneously re-epithelialize, usually in 4 to 6 weeks. This technique avoids hematoma formation, is painless, and allows immediate mobilization of the fingers. In this procedure, though, daily dressings are required for an extended period.
Skeletal traction (22) has been successfully used to straighten contractures. Rapid recurrence takes place after the traction is removed unless it is followed by surgery. The technique is useful for facilitating fasciectomy in severely contracted digits.
Surgical resection of the involved fascia cannot cure the disease, but it attempts to control its symptoms. Both recurrence and extension of the disease occur, and Gonzales (30) found that no patient followed longer than 10 years after the initial procedure was free of disease. Secondary disease presents a far more difficult problem than primary disease. Normal tissue planes are lost after the initial operation, and incisions are generally dictated by the previous scars. Elevation of the skin flaps over the newly-formed diseased fascia necessitates an exacting technique. The neurovascular bundles are frequently very superficial in some areas. They require identification in virgin tissue first, and subsequent meticulous dissection into the diseased fascia. The patency of both the radial and ulnar vascular bundle should be checked because one or the other may have been previously damaged. Unfortunately, normal anatomy does not exist.
Amputations, as secondary procedures (particularly of the little finger), may result in many problems including lack of extension, neuroma formation, and phantom limb symptoms. Jensen (31) advises alternatives to amputation; however, in specially selected patients who have both aggressive recurrent disease and severe contractures of the PIP joint of the small finger, I have found amputation to be very effective. The normal dorsal skin of the middle phalanx is used to cover the defect from the excision of the skin and diseased fascia over the palmar aspect of the proximal phalanx. This technique completely frees up the MCP joint. Patient satisfaction has been very high when this technique has been used. Moreover, the full width of the palm is retained which helps stabilize tools such as hammers and wrenches during power grip.
Most patients undergo surgery as outpatients and return to the clinic the next day. The preoperative educational program is most beneficial at this time because the patient expects to conform to the protocol that was carefully explained at the initial consultation. The dressings, splint, and drains are removed, and the hand is fully checked for early problems such as undue swelling, hematoma formation, or wound complications. It is most unusual to encounter any of these potential difficulties at this stage. A light dressing is applied, and the patient's care is immediately referred to the hand therapist.
The therapist already has a preoperative, well-documented baseline of the patient. Additional information from the surgical procedure such as the amount of correction gained at surgery, the degree of any remaining contractures, the extent of the wound, and the reaction of the patient and the tissues to surgery is recorded. The splinting requirements of the patient are assessed on an individual basis. Isolated palmar involvement without contracture does not require splinting, and a range of motion program with light hand use is initiated on the first postoperative day.
The hand of the patient with early disease may be easily positioned in extension with a volar-based hand splint. A forearm-based splint is used when there is more extensive involvement.
Therapy programs are tailored to each case. The patient is instructed to remove the splint for dressing changes with skin care as directed and to perform (4 to 6 times per day) specific, gentle, and active range of motion exercises including composite flexion and extension. The patient's progress is carefully monitored, and the program can usually be upgraded at the end of the first week. The sutures are removed two weeks after surgery, and the patient's rehabilitation program progresses and is monitored by the therapist.
Complications occur frequently. A large multi-center survey reported a complication rate of 19 percent (24) which include hematoma formation, skin loss, infection, nerve or arterial division, loss of flexion and reflex sympathetic dystrophy. First, the incidence of hematoma can be decreased by ensuring that the patient discontinues aspirin, anticoagulants, non-steroidal anti-inflammatory agents, vitamin E, vitamin B12, and any other agent known to affect coagulation before surgery. These agents may be restarted on the first day after surgery.
Flap necrosis can be caused by a neglected hematoma, devascularization of the flaps, or a button holing of the flaps while reflecting the skin at the start of surgery. Dissection is made more difficult by palmar pits, severely contracted joints, or recurrent disease. Magnification loops are invaluable in these situations because they allow the surgeon to remove all diseased tissue while preserving normal structures. Infection is rare, but can accompany a hematoma. The hematoma is treated by draining, culturing the wound, and using appropriate systemic antibiotics with repeated local dressing changes. Swelling from an infection is accompanied by joint stiffness: thus, appropriate, guarded therapy should be started early.
Nerve and vessel injuries can occur in the most expert hands, particularly during secondary procedures. Such injuries must be immediately recognized to avoid resection of nerve and vessel, which may compound the problem. A nerve injury should be repaired before closure by microsurgical technique. Even after uncomplicated fasciectomies, when the nerve is in continuity, the sensation to the digit is often decreased. In a multi-center survey, decreased flexion was reported to occur at a rate of 6 percent (25). Reflex sympathetic dystrophy has been reported in 4 percent of male patients and 8 percent of female patients (30). Dystrophy should be differentiated from the flare reaction that reflects soft tissue response to the trauma of surgery. Complaints of swelling, stiffness, and burning pain, sometimes occurring several weeks after surgery, should cause the surgeon to suspect reflex sympathetic dystrophy. Active therapy in conjunction with the use of non-steroidal anti-inflammatory agents, elevation, and sympathetic blocks are useful and help to alleviate these symptoms.
Rivers (32) found a statistically significant difference in the mean improvement in proximal interphalangeal (PIP) joint extension in patients who complied with the postoperative extension splinting program, compared with patients who did not comply. The metacarpal phalangeal joint can usually be significantly corrected, but the interphalangeal joints are rarely completely corrected, particularly in the small finger. The small finger proximal interphalangeal joint is frequently affected by more severe disease (24).
Healey (33) reported the development of a "statistically valid outcome measure for assessing symptom and function scores and patient satisfaction after surgical correction of Dupuytren's disease" using the SF-36 questionnaire. Patient satisfaction strongly correlated with improved postoperative function scores, improved postoperative symptom scores, and surgery on the dominant hand.
Management of the patient with Dupuytren's contracture encompasses the whole spectrum of care of the surgical patient. Dupuytren's contracture is not life-threatening, but also is not curable. Education is essential to ensure that the patient understands the natural history of the disease and the limitations of current treatment methods. At present, though, for a patient with debilitating Dupuytren's contracture, a surgical procedure immediately followed by a rehabilitation program can produce an excellent improvement in hand function.
|Figure No.
|Figure 1
|New Palmar nodule
|Figure 2
|Pretendinous cord with flexion contracture of ring finger MP joint
|Figure 3
|Natatory cords with inability to spread the ring and middle fingers
|Figure 4
|Knuckle pads over the dorsal PIP joints
|Figure 5
|Plantar nodule
|Figure 6 & 7
|Preoperative patient with a flexion contracture of the small and ring finger MP joints and the small, ring and middle finger PIP joints
|Figure 8
|Preoperative patient still able to make a full fist
|Figure 9 & 10
|Postoperative patient following a palmar fasciectomy to release his left ring and small finger flexion contractures
|Figure 11
|Same postoperative patient making a full fist


text:
While it would be a travesty to visit London's vast array of sights with your attention totally focused on your mobile device, smart phones have made life easier. Gone are the days when you would see harassed travellers from all corners of the globe huddled on street corners fighting to locate destinations on maps, and then battling to refold them.
Mobile apps can ensure you have an altogether more effortless stay in England's capital city, without missing a thing. There are many to choose from, but here are five that you may want to download for London insights and help.
Google Maps/Citymapper
Google Maps is universally used for navigating by foot or car, but visitors to London find Citymapper highly useful. For example, it can help to simplify London's sometimes overwhelming public transport system. It can also help you to plan and measure your routes, including travel times, whether you use the Tube, taxi, rail, bus or your own two feet. Citymapper's multiple route suggestions even sometimes include a recommendation for the best way to stay dry when it rains.
Uber or Taxi App
For business and leisure visits to London, there are going to be times when you need a quick and reliable driver to get you to an appointment and next destination. Or, maybe to whisk you back to your beautiful serviced apartment in central London. There are many apps you could choose for this, including Uber which has some 15,000 drivers available in every part of the capital.
National Trust
One of the primary reasons that millions of people chose to visit London and its bountiful surrounding countryside, is its architectural heritage and natural beauty. This makes the National Trust app a valuable addition to your phone. It can guide you to many sites and sights, that show this part of England at its historical finest. Everything from Tudor homes to breath-taking gardens. It will also keep you updated of What's On in London's National trust owned properties.
Here's one that tends to be best known by Londoners themselves. OpenTable is a great way to find the best places to eat, drink and enjoy events. It also provides exclusive deals at local pubs and restaurants. It uses your location and preferences to suggest suitable options but also provides tips on some the emerging stars of the London hospitality scene.
Trail Tale – UK Explore, London Guided Walks
For the more adventurous among us, this app offers a chance to take several guided tours around London. There is also the opportunity to 'explore nearby' so it can be used wherever and whenever you like. This will satiate any city explorer with fascinating walking routes and handpicked hidden gems in London….all for free!
Post-mobile – the switch-off!
Making the most of London using the wonders of modern technology, is great. However, after a tiring day exploring and soaking up all its wonders, it's lovely to shut your door and enjoy the comfort and traditional values of beautiful & private accommodation. At Merino, we would be "app-y" to ensure that your London stay is as relaxing and memorable as possible.


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When your loved one died you had no choice because you were not in a position of control. Tears flow and again you are not in control. Others around you take over and although they are trying to help, again you feel that you are not in control and maybe it didn't matter because you did not even care.
Time has passed and slowly you need to regain a sense of control so that you can get back in balance. Start writing down all the things you are responsible for. Say "I choose" to do this task. There is something about saying the words "I choose" that will bring your control back.
Choosing not to do something is also a choice and as long as you take note of that choice you are still taking control. "I choose not to be upset when my married friend doesn't call" is actively taking control of your emotions.
At night take a look at your day and see what you did. Even if it was only one thing, celebrate that one thing. Say to yourself, "I can and will do the next task on my list tomorrow" and then do it. Before you know it your list of things to do is done and they were done on your time schedule. Assume control of your life and you will be happier.
Old age will be hard on me if I don't learn to accept myself, in other words, I do more of what I want and worry less about what others think. Aging is a humbling experience as not everything works as good or as fast as it did when I was younger. It has a way of making me face my limitations. I stopped comparing myself to others and that helped me gain self-acceptance for who I am – just as I am.
The Delai Lama says "If you don't like what's happening in your life, change your mind." Great advice because we can't change the fact that we are widowed or that we are getting older but we can change our response and not be a victim to life.


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Seabrokers are engaged in ship broking, property development, facility management, construction, sea surveillance and secure lifting operations. Amongst others, they own and operate five buildings in western Svanholmen in Forus, Stavanger, Norway. The tenants are high profile companies, and the buildings are often referred to as "gullrekka" (the golden line). The tenants of these five buildings are Statoil (two buildings), Gas de France, Sandnes Sparebank and ENI.
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Center of Gravity of Product Development Shifting to EDS Model
Saturday , April 01, 2006
During my recent trip to India, Wednesday March 1, 2006 was memorable for me. I woke up to read the finer details of a fine National Budget from the crafty Finance Minister P Chidambaram who put India's GDP into a steady state of 8 percent growth. On its front page "The Hindu" had published a classic picture from celebrated French photographer Henri Cartier-Bresson. The timeless photograph was of the cone of a rocket being wheeled to the launch site on the back of a bicycle at Thumba in Kerala, taken in 1966.
This powerful visual symbol captured everything about India and its slow long journey into big leap of Science and Technology outsourcing segment.
Successful entrepreneurs will emphatically state that the most important ingredients to any successful enterprise are clear vision and freewheeling creativity. Twenty-five years ago, the creators of Electronic Manufacturing Services (EMS) companies dared to dream, forging a vision of separating manufacturing from product OEMs into a service offering. With creative methods of fine-tuning costs via materials aggregation and labor location, the result was the birth of a multi-billion industry where publicly traded companies like Solectron, Sanmina-SCI and Jabil are operating from many locations around the globe.
Ten years back, innovating on the EMS success strategy, visionaries of outsourced product engineering, proposed to the technology industry that while core research would continue to necessarily be done internally, there were several areas of product development that could be safely and securely outsourced to an Electronic Design Services (EDS) company. Ever since, the electronic product OEMs and semiconductor companies have been increasingly relying on EDS companies to bring products into the marketplace with tremendous cost savings and time efficiency.
Now, ten years later, big players across the "Flat World" are flocking to get a piece of the EDS pie as they now sense the potential in this billion dollar opportunity. While some of them had strayed into this space from their Information Technology (IT) focus, others have been here looking for a foothold in the fast-growing EDS market. This however has created a new business opportunities for EDS companies in India. From my experience, I can see the following areas of technology and product development outsourcing to India with great success: Board Design, PCB Design, FPGA Design ASIC Design and Embedded Software.
Breadth of services in the above mentioned areas will help EDS companies to mitigate the risks associated with the technology industry cycle of booms and busts. In this cutthroat game of survival, one should always keep evolving-in terms of technology, market demands, and the vision for the future. Finally, EDS companies are no longer "Design Houses"; now they are mainstream industry stakeholders whose contributions and performance will determine the future of 50 year-old electronic product businesses in a big way!
Gopakumar K. Periyadan "Gopa" is the VP & GM, System and Software Business Unit and Co-Founder of GDA Technologies Inc. based in San Jose, CA.


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Families. Some families are all about love. And some are filled with aggravation. More likely, if yours is like mine, they are filled with both. And, what better time to show both sides than at family get-togethers. But, I got a shock this year. Because I had a surprisingly pleasant Mother's Day.
Generally, our holiday dinners have a pattern. Visit with sister, nieces argue either with her or each other, possibly Sis and Bro-in-law argue over something petty and something political gets discussed making a mess.
But, this year, everything seemed to bend to our will.
I usually do the driving. Leaving my house in the pouring rain, I added extra time to allow for the slower traffic.
Nope. 9 minutes. Nine. I don't think I've ever had a run that quick. Certainly not on a holiday and in the rain.
My Dad and Stepmom are in their upper 80's. She has some ailments that make her somewhat unsteady and even Dad is slowing a little these days. So, I'm extra careful on slippery and wet surfaces.
But, nicely, the rain stopped by the time we got to my Sister's, so, although the walkway was wet, everyone could go in unencumbered.
My younger nieceling was there, which was nice, because I thought she was working. She was able to stay for an hour before leaving. She missed dinner, but not the grandparents. Plus, she got along with her Mom.
That's the point I knew something special was happening.
Elder nieceling came later. Through her boyfriend, my Dad had purchased steaks for the dinner (his gift). Her boyfriend, a meat manager, finagled unbelievable prime quality filet mignon steaks for us. When I say "melts like butter" it is descriptive, not hyperbole.
During the meal, strangeness continued – no one argued. There was laughter, good-natured ribbing and genuine affection. It was like a greeting card. Seriously, a surprisingly pleasant Mother's Day.
Of course, after the pies and cake, Dad had to throw a Trump comment out there and as my Bro-in-law began to respond, I stood up from the table and began shooing the parental units to the door.
We escaped without the instigator (Dad) causing any real damage. Nice cards, hugs and kisses and finally goodbyes.
Despite pouring rain throughout the meal, the rain stopped before we left. Another timely gift.
So, yeah, without equivocation, a surprisingly pleasant Mother's Day. Here's hoping everyone brings that with them to my birthday BBQ later this month!


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The One Factor, by Doug Sauder, is a series of short stories that make it clear that our lives impact others. There is no escaping it. We will all leave many a mark that will carry on with ripple effects for generations. The power of this book in our frenetic-paced society is to help us grasp the concept the title gives away, with the encouragement to make a God-glorifying impact in the lives of others. The stories are heart-warming, gut-wrenching, motivating, clarifying, delightful, maddening, and more. After I read The One Factor, I found my 9 year old daughter curled up in bed reading it...we both found it compelling. We have an extra copy we'd like to share so we're going to do a GIVEAWAY...I'll send the book to whoever wins after gathering snail mail info (if I don't already have it).
Here is how you can get your name in the drawing for a free copy of this book:
1. Become a follower of this blog (if you are not already).
2. Tell me you'd like to be in the drawing (you can email me, FB me, or leave a comment below).
You're in. It is THAT easy!
To get you name in the bucket more than once, you can:
* Facebook about it. For each DAY that you do it (and you let me know you did), you get an entry.
* Blog about our giveaway (again, let me know that you did this).
We will aim to pick the winner on October 11th so you have one week folks...
Monday, October 4, 2010
A Giveaway: The One Factor
5 comments:
Oh, I'm already a follower, and I'd love to read the book!ReplyDelete
And I put a link on facebook. :)ReplyDelete
I love books!!! I want to win! Also I am now a follower. Thought I was, but now I officially am <3ReplyDelete
I'm a follower, and I'd like to win. :-)ReplyDelete
Posted a link on Facebook! :-)ReplyDelete
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Local councillors have expressed concern regarding rumours that the board of An Post are considering closing the Athlone Mail Centre.
The board have commissioned McKinseys to carry out a report on the status of the mail centres in Athlone, Portlaoise, Cork, and Dublin. Their findings will be presented shortly, with the closure of a Midlands mail centre reckoned to be a likely recommendation.
This is causing huge concern and worry for the centre's 183 workers, most of whom are young with families and mortgages.
Fianna Fáil councillor Frankie Keena said: "I am absolutely shocked and horrified that they could be even contemplating closing the Athlone Mail Centre. Geographically, Athlone Mail Centre is ideally located in the heart of the Midlands with excellent transport links to all parts of the country.
"It serves the longest An Post transport links in the country from north Donegal to the southern tip of County Clare. This is the most efficient mail centre in the country and proof of this is shown by the fact that it has won four out of five internal An Post 'Top Mail Centre' competitions from 2011 to 2015."
Cllr Keena also noted that there are key customers serviced by the centre, such as the Department of Education & Skills and the State Examinations commission.
"It's unthinkable what the future holds for the State Examination Commission in Athlone if the mail centre closes," he warned.
Fianna Fáil's Aengus O'Rourke said he has met with staff from the centre, whom he described as being realistic.
"I accept, like the staff do, that changes are necessary and efficiencies have to be found in order to secure the future of the company," he said. "However, management and Government must ensure that staff are consulted with, are kept informed and are given options. In my view the best ideas can and will come from the staff if engagement is genuine from all sides.
"For example, rather than the company taking a sledgehammer to the problem, they could first of all offer a round of voluntary redundancies to staff and see what this yields. My information is that the company might be surprised by the numbers willing to consider this option."


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Our food wholesale brand, Musgrave MarketPlace, has announced a generous €2.5 million investment to upgrade its Robinhood store in Clondalkin, and a €1m upgrade of its Duncrue store in Belfast.
The investment is just another way that Musgrave MarketPlace is committing to deliver first-class service to customers and to allow for a pleasant and innovative experience for customers.
Never being ones to slip behind the times, the stores will be home to new state of the art technology allowing visitors the best experience possible when visiting the stores.
They don't stop there; four new roles have been created to cover all areas of fresh food, alcohol and equipment, along with a new in-branch butcher to advise on specific cuts of meat for customersand growth in the fresh fish offering and much more to keep up with consumer trends. Sounds like they're really raising the steaks!
All of the products in store will also be available online to add to customer convenience. Musgrave MarketPlace chose the products based extensive research of international and local trends to ensure their customers can stay bang up to date.
Noel Keeley, Managing Director of Musgrave Wholesale Partners said; "We are delighted to announce the upgrade to both the Robinhood and Duncrue stores following the hugely successful renovation of our Ballymun store. The business of food and drink is constantly evolving and as a business, we need to ensure that we continue to innovate and respond to growing trends that impact our customers' needs."
Watch this space, the upgrades are part of an ongoing commitment to deliver refurbishments across all branches nationwide.


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Having a bit of a Cindy moment!
How hot isn't she in this photograph taken by Michel Comte for Vanity Fair April 1992? Gorgeous! Also, the photo is brilliant, a total wow factor all over!
You agree?
Yesterday, I had quite the chilled out day, was dreadful weather outside, so foggy, dark and cold all day, so gladly stayed indoors and sorted out some blog stuff.
And In the evening I wrote THIS for the brilliant The Fashionography
Btw, watch that episode of Seinfeld yesterday when Elaine freaks out about exclamation points, so now I can't help myself to nerd about if I do too many exclamation points when I write here, think I am abusing the exclamation points…but I do love em and NOBODY CAN STOP ME DOING THEM!!!! well well just a little fun fact I wanted to share with u all, let's move on..
pic: wearesodroee.wordpress.com


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There is no way I can write a complete commentary of each chapter or passage each week, but I will bring summaries of other commentaries mixed in among my own thoughts. Some passages I will go verse by verse, others will be sections of Scripture.
Romans is different than all of Paul's other letters. Paul had nothing to do with the origins of the church and he had never been to the church.[1] Paul often wrote his letters in response to issues in churches, but this letter is different. This letter seems to be much more about the "theology of Paul."Paul wanted to visit the church in Rome and hoped to someday make it there, but either way he had words he needed to share with them. These are those words.
"William Barclay argues that you can divide the letter into 4 parts:
- Chapters 1-8, which deal with the problem of righteousness.
- Chapters 9-11, which deal with the problem of the Jews, the Chosen People.
- Chapters 12-15, which deal with practical questions of life and living
- Chapter 16, which is a letter of introduction for Phoebe, and a list of final personal greetings".[2]
- 1-7: "Paul, a servant of Christ Jesus, called to be an apostle and set apart for the gospel of God— 2 the gospel he promised beforehand through his prophets in the Holy Scriptures 3 regarding his Son, who as to his earthly life[a]was a descendant of David, 4 and who through the Spirit of holiness was appointed the Son of God in power[b]by his resurrection from the dead: Jesus Christ our Lord. 5 Through him we received grace and apostleship to call all the Gentiles to the obedience that comes from[c] faith for his name's sake. 6 And you also are among those Gentiles who are called to belong to Jesus Christ.
7 To all in Rome who are loved by God and called to be his holy people:
Grace and peace to you from God our Father and from the Lord Jesus Christ."
Paul begins this section as many of us would if we were writing to a people we did not really know. We would begin with a brief description of who we are. Every time I am invited to speak somewhere someone usually does an introduction, but if the introduction doesn't really tell them about me then I add enough that hopefully the audience feels as if they know me a little bit. Then I usually tell them why I am there. I don't tell them the whole story up front, but enough that they might listen. That is where Paul begins.
(We don't want to miss that Paul calls himself a "slave" to Christ.[3] This will be addressed more at another time)
Paul quickly jumps to reminding the church in Rome that this letter is all about the gospel. The "good news" that God came to earth in flesh and that His Kingdom has come. He is reminding them that this good news has been foretold for a long time and that God is who He says He is.
Paul gives a rundown of the fact that Jesus was foretold in the Scriptures (It cannot be overstated the connections that Paul continually makes, not just in Romans, but in all of his writings the connection that the Scriptures were always pointing to Jesus.), was a descendent of David (a reminder that Jesus is the rightful King of Israel, the rightful king of God's people). This King is not just king of Jews, but is King of all and all are invited into His Kingdom. Both Jew and Gentile are invited in. This idea of all people, Jew and Gentile, being a part of God's Kingdom is a central tenant to Paul's theology. This idea of Jesus being King is set through a lense that says he is the "son of God" and that would sit a little uncomfortably in Rome where Caesar is the son of god.[4]
We know he has conquered death and sin and through his Spirit he wants to do some new things in the world. God has already done a new thing and the good news transforms us because God is King through Jesus and we are invited into this life changing story.
We are, as Paul writes in verse 7, all invited to share the story of the "good news" that God's Kingdom is here! Paul was writing to the church in Rome, but we get to listen in and are called to be participants in telling this good news.
8 First, I thank my God through Jesus Christ for all of you, because your faith is being reported all over the world. 9 God, whom I serve in my spirit in preaching the gospel of his Son, is my witness how constantly I remember you 10 in my prayers at all times; and I pray that now at last by God's will the way may be opened for me to come to you.
11 I long to see you so that I may impart to you some spiritual gift to make you strong— 12 that is, that you and I may be mutually encouraged by each other's faith. 13 I do not want you to be unaware, brothers and sisters,[d] that I planned many times to come to you (but have been prevented from doing so until now)in order that I might have a harvest among you, just as I have had among the other Gentiles.
14 I am obligated both to Greeks and non-Greeks, both to the wise and the foolish. 15 That is why I am so eager to preach the gospel also to you who are in Rome.
Paul makes sure that the people of the church in Rome are aware that he has heard about them, likely just as they heard about him. In other words, we hear the stories of the great things that are happening. Paul then shares that as he is sharing the message of the good news of Jesus he hopes that he can join them for a season and partner with them.
Paul is still setting up the credibility for what he is going to write to them in this letter. He wants to make sure they know that he doesn't want to just to tell them how to live, but to share in life together. This is because Paul knows that it takes more than just words to reflect a life that has embraced the good news of Jesus. Paul ends this section with reiterating the fact that the message that Jesus brought of God's redeeming work is for all people.
In verse 10 we see Paul making it clear that as a part of his life of worship, prayer is integral.[5] He counts it his duty to be in prayer for the church. Not just the church in Rome, but all churches. It should be noted that this would seem a wise use of time for all people who call themselves disciples of Jesus.
16 For I am not ashamed of the gospel, because it is the power of God that brings salvation to everyone who believes: first to the Jew, then to the Gentile.17 For in the gospel the righteousness of God is revealed—a righteousness that is by faith from first to last,[e] just as it is written: "The righteous will live by faith."
Paul does not want anyone to miss that Jesus came for all. It is obvious that he came to the Jews first, for he was a Jew. But, just as John the Baptist baptizing in the desert represents, Jesus came for all and the birthright no longer mattered. He came first for the Jews because they were supposed to be the blessing to the world and in many ways were so stuck on a nationalistic faith that they had missed God's work as not seeing nation or race as important.
What Paul wants to make clear is that God's expectation is righteousness. This is a righteousness that cannot be gained through the sacrificial system that the Jews had embraced, but a righteousness that is only gained through faith. A faith that comes through Jesus and His Kingdom breaking in, and reaching its culmination in the resurrection of Jesus.
The wrath of God is being revealed from heaven against all the godlessness and wickedness of people, who suppress the truth by their wickedness, 19 since what may be known about God is plain to them, because God has made it plain to them. 20 For since the creation of the world God's invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that people are without excuse.
21 For although they knew God, they neither glorified him as God nor gave thanks to him, but their thinking became futile and their foolish hearts were darkened. 22 Although they claimed to be wise, they became fools 23 and exchanged the glory of the immortal God for images made to look like a mortal human being and birds and animals and reptiles.
24 Therefore God gave them over in the sinful desires of their hearts to sexual impurity for the degrading of their bodies with one another. 25 They exchanged the truth about God for a lie, and worshiped and served created things rather than the Creator—who is forever praised. Amen.
26 Because of this, God gave them over to shameful lusts. Even their women exchanged natural sexual relations for unnatural ones. 27 In the same way the men also abandoned natural relations with women and were inflamed with lust for one another. Men committed shameful acts with other men, and received in themselves the due penalty for their error.
28 Furthermore, just as they did not think it worthwhile to retain the knowledge of God, so God gave them over to a depraved mind, so that they do what ought not to be done. 29 They have become filled with every kind of wickedness, evil, greed and depravity. They are full of envy, murder, strife, deceit and malice. They are gossips, 30 slanderers, God-haters, insolent, arrogant and boastful; they invent ways of doing evil; they disobey their parents; 31 they have no understanding, no fidelity, no love, no mercy.32 Although they know God's righteous decree that those who do such things deserve death, they not only continue to do these very things but also approve of those who practice them.
Paul mentions the creation of the world because he is thinking of the fact that in his day no one believed the world happened by chance. The truth is that very few in our day believe the world happened by chance. Whatever method God used to create, whether it was a literal six days, some type of theistic evolution with Him fully involved, or something in between these two modes of creation we believe God is creator. Paul uses this idea and contrast it with the fact that there is the beauty of creation, but there is no way around the picture that has been painted through sinfulness in the world.
In God's love he lets us go where we want to go. His desire is for us to come to Him, but we often choose things that we like instead. It is like the teenager who has done something that they know their parents will not approve, but rather than ask for forgiveness and seek to reconcile the relationship they ignore it. The teenager hopes the parent will never find out and if they do not find out then it must be okay. That is not what usually happens.
There comes a day when the parent lets the child go and live the way the child wants. The parent always hopes that the child will choose a way of life that the parent tried to instill in them, but often the child chooses a way of life that leads to destruction. The parent is heartbroken.
Paul then lists some of the things that break God's heart. He writes in verse 24 Therefore God gave them over in the sinful desires of their hearts to sexual impurity for the degrading of their bodies with one another. 25 They exchanged the truth about God for a lie, and worshiped and served created things rather than the Creator. What becomes apparent is that God did not force them to live lives that brought them near to Him, but instead loved them enough to let them go where they wanted to go.
God did not cause the rift that then came into the relationship. All of us, at one time or another, have chosen things that are not of God over a right relationship with Him. We have chosen sin. Just like when we have chosen to do something that causes a rift among our families and we must go apologize and reconcile the relationship, so too is God waiting, desperately I might add, for us to want to make our relationships right with him.
Paul in chapter one is laying the groundwork for his theological treatise. He is laying the groundwork to tell of how God, through Jesus, is reconciling all and helping all people to become righteous. The righteousness is for all who choose to embrace the God who is waiting as a great parent with outstretched arms. Paul has much more to say.
[1] Barclay, xxi (All references to Barclay will be from "The Daily Study Bible: The Letter to the Romans" by William Barclay)
[2] Barclay, xxv
[3] Greathouse, 39 (All references to Greathouse will be from "NBBC Romans 1-8 A Commentary in the Wesleyan Tradition)
[4] Wright, 4 (All references to Wright will be from "Paul For Everyone: Romans, Part 1 or 2" by NT Wright)
[5] Greathouse, 51.