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I feel that I shouldn’t ask him to do too much buy plaquenil 200 mg free shipping arthritis medicine for cats, taking me out to places generic plaquenil 200mg online arthritis symptoms neck upper back, because he has so much else to do. Spencer rarely left her home except for doctor’s appointments, although her three grown sons lived nearby. Dynamics often differ depending on whether the husband or the wife has the mobility problem, especially among older couples. Husbands more than wives will hire outside help to perform tasks vacated by the disabled spouse, so husbands typically “experience less role strain” (Olkin 1999, 119). Some husbands, in particular, learn as much as possible about their wife’s disease to help devise mechanical solutions. He got all this information about MS and made himself as well-versed as he could. I was getting to the point where, if I wanted to go shop in a mall, I got really tired. I was still doing all the grocery shopping because I had the grocery cart to hang onto. He forbids anyone other than Nelda to assist with his routine activ- ities or pick him up when he falls. Either I left him and felt bad about leaving him, or I’d stay in the room, too. Certainly, Tina DiNatale lamented being carried by Joe, apparently to save himself time. Like whenever we go to the mall, my wife will get out of the car and start walking toward the entrance. Sometimes I wish she would offer to help even though I’d refuse; it’s just nice to be offered. Clearly, such complaints carry risks, of appearing ungrateful, selfish, en- titled, although some are probably valid. She overcame her personal terrors—agoraphobia or fear of the outdoors—to accompany him to doctor’s appointments, vis- its with friends, and cross-country medical quests. Yet she needs time for herself: 98 / At Home—with Family and Friends I work at a women’s shelter that I don’t want to give up. I found that if I can’t keep doing these things, that I’m really going to get angry and bitter, and I don’t want to. After Tom’s retirement, the Nortons retreated to a stone bungalow on a bluff overlooking the northern Atlantic coast. Life now centers around Tom, but Nelda Norton had once kept time for herself. I showed him where the pots and pans were, where the cans were, the can opener. While I was gone, he was going to take his daughters out to dinner anyway. You have to have someone who will sit by your bed, so that when you wake up about three in the morning and say, ‘I cannot move my leg,’ they will move it for you. When he is out in the yard, I’m always wondering where he is, whether he’s fallen and hurt him- self. The second generally arrives later, with concerns about whether and how children should help out. Studies have examined families with dis- abled young children (Curry 1995; Olkin 1999, 92–111), but few have At Home—with Family and Friends / 99 looked at how chronic diseases and disability affect adult filial relation- ships. Society seemingly views fully functioning legs as essential prerequisites to meaningful parent- ing, despite scant evidence that children of disabled parents suffer (Olkin 1999). Public consternation reflects two erroneous expectations: unless fully ambulatory, parents cannot care effectively for children; and when parents fail (as seems inevitable), responsibility will devolve to the state. Given these concerns, mothers with mobility problems attract the greatest hostility; fathers presumably have wives who do what’s needed. Many women cannot even find physicians willing to counsel them on birth control, pregnancy, or childbirth (Fine and Asch 1988, 21). Six obstetricians turned away one woman wheelchair user before a seventh agreed to de- liver her baby. Most hurtful was the censure of her now-former best friend, who asserted that her pregnancy was selfish and she would “ruin” her child’s life. Her baby is now one year old, and she acknowledges the usual ups and downs of new parenthood.

Use different styles of arrows to indicate different relationships be­ tween topics buy generic plaquenil 200mg on-line arthritis pain in arm. Use colour to distinguish between different levels of information – so the central idea would be in one colour generic 200mg plaquenil free shipping arthritis in back dog, all the subtopics in another, and a third colour used for all the supporting details. Pattern notes These are similar to spider web notes, with the core theme or idea written in the centre of the page (Taylor 1992). Supporting details or a further break­ down of the topic is listed alongside the relevant line. This process aids learning and also encourages the student to put ideas into his or her own words. Disadvantages ° It is only possible to record a limited amount of information. Tips on using pattern notes effectively Use the whole of the page for your diagram. Use colour or different styles of lettering to differentiate between main topics and subtopics. NOTE-TAKING 161 Note-taking in different contexts Lectures You will be more able to cope with new information if you have done some preparation before your lecture. Make sure you know how and where the lecture fits into your course outline, and complete any recommended pre­ paratory reading. This includes making time to reread notes from any pre­ vious lectures or related clinical experience. This is more likely to help you focus your attention by making you an ac­ tive participant rather than a passive recipient of information. Alternatively you can try some lateral thinking during the class by writing the questions you think the lecturer is trying to answer in his or her talk. As stated above it is not a good idea to try to write down everything that you hear or copy every diagram and drawing. It is very unlikely that you will be able to keep up with the pace of the lecturer, and it is difficult to listen at the same time as you are writing. You must therefore make deci­ sions about which pieces of information to note. Burnett (1979) reminds us that it is the ‘point’, not just the words, that needs to be recorded. What point or message do you think the lecturer is attempt­ ing to communicate? The lecturer will often help you by giving verbal and non-verbal cues about the importance of an item and how topics link together. Listen out for prompt phrases that signal a main point, for example, ‘this is the key concept’ or ‘there are three principles’. Other phrases, like ‘in contrast’ or ‘simi­ larly’, tell you about the connection between ideas. Non-verbal cues will also give you information; for example, speakers often pause before an im­ portant point. Make a conscious selection from the explanations, examples and refer­ ences used to support the lecturer’s main arguments. Thinking of your own examples is one way to help make sense of the information. Set aside 20 minutes to review your notes as soon as possible after the end of the lecture. This task is often more usefully done in conjunction with another student or in a study group. Check you have all the main points and look out for any informa­ tion you have omitted or were unclear about. Try to fill in the gaps or iden­ 162 WRITING SKILLS IN PRACTICE tify where you can follow up information. This may be in a tutorial or a reading session, or you may need to go back to the lecturer.

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He was a founding member of both the Hip Society in the United States and the International Hip Society discount plaquenil 200 mg free shipping arthritis diet and gout. In 1966 plaquenil 200mg free shipping arthritis knee weight training, he received the Governor’s Award as Florida Physician of the Year, and he was selected as Citizen of the Year by the St. In 1993, he received the Lifetime Achievement Award from the Joint Implant Surgery and Research Foundation, in commemoration of 60 years of surgery. Leinbach decided to study medicine because it deals with human life, and he derived Emile LETOURNEL a lot of pleasure from life. In his office hung a small plaque with the inscription: “The funda- 1927–1994 mental principle of medicine is love. He had been working regularly in the out- his monumental achievements in surgery of the patient clinic of the Bay Pines Veterans Adminis- pelvis and acetabulum is unrivaled in modern tration Hospital until a few days before his death. Leinbach was survived by his wife, Alice; nized as the conclusive source of extensive three daughters: Jenni Adams of Orlando, Judy experience and innovative techniques in the Meserve of St. Petersburg, and Troy Kassing of management of severe pelvic and acetabular Indianapolis; eight grandchildren; and five great- trauma. His only son, Tyler, died in a tragic standing of the complex acetabular fractures and cave-diving accident in 1960. Leinbach once techniques required to treat these difficult injuries said: “I have flown high enough to enjoy looking have defined the predominant principles of surgi- down on the clouds, and my great wife has been cal excellence of fracture surgery. The presentation of his experience in the development of diagno- sis and surgical management of acetabular frac- tures was extraordinary. It was given to a packed audience in the advanced course upper lecture room of the Kongress Halle in Davos. The par- ticipants were in awe of his surgical technique and ability to reduce difficult and extensive fractures. His presentation included numerous examples of anatomic reduction of complex associated acetab- ular fractures with excellent 10–20 year results. These radiographs demonstrated long, twisted reconstruction plates curving around areas of the pelvis (that the majority of the course participants had never visualized), creating a singular educa- 191 Who’s Who in Orthopedics tional experience and a standing ovation. Emile These latter two textbooks are the primary continued to be an immutable participant in the sources of information on surgery of the acetab- advanced courses in Davos and participated in ulum in the English literature and are considered countless AO courses throughout the United the “Bibles” of acetabular surgery. His unique personal- resulted in a complete transformation of our ity and energy were legendary, and he was always understanding and treatment of fractures of the available to answer the most trivial question from acetabulum. His passion and love of Emile Letournel was born on the French island teaching extended worldwide as his results of St. Pierre et Miquelon, situated between New became universally acknowledged. Emile’s per- Foundland and Nova Scotia, on December 4, sonality and professional camaraderie were 1927. He never spoke English while growing up quintessential Letournel, and his dedication to and after finishing secondary school in St. Pierre teaching his techniques to conferences all over the he obtained a scholarship to the French Institute world was the underlying virtue of this great man. During this time period, the war There are many instances in the history of in Europe was at a climax and for safety reasons orthopedic surgery in which an individual the French Institute was moved to Hullswater surgeon has made a significant contribution to a Lake, Cumberland Scotland, near Edinburgh for particular area of surgery that has stood the test the duration of the war. There are very few instances of a sur- et Miquelon alone at the age of 16 on July 27, geon contributing to the specialty of orthopedic 1944 to cross the Atlantic and attend school in and trauma surgery in the complete and life- Scotland. At the time of his departure, he did not long manner that was characteristic of Emile speak English and had never seen a train or a big Letournel. Pierre, “Le Cap tion of the correct radiographic and anatomic Bleu,” to Nova Scotia (24 hours) and then to diagnoses of acetabular fractures and progressed Montreal by train (36 hours). He left Montreal on to a logical classification of these injuries into ele- August 7, 1944 in one of the largest convoys of mentary and associated fracture types. On his ship, continued with development of two major surgi- “The Jamaica Planter,” no one spoke French and cal exposures, reduction techniques, instruments all his personal belongings were confiscated until and implant designs used in every operating the boat arrived in Scotland 28 days later. Though there have studied for a year at the French Institute and been refinements over time and contributions by received his Premier Bacalaureat.

He wrote contacts across the Channel led to a mastery of numerous articles cheap plaquenil 200mg otc arthritis pain and relief, and always spoke clearly cheap plaquenil 200mg online climacteric arthritis definition, spoken English. Some remarkable wartime tutors intelligently, and with a delightful sense of humor. Robert just He was a devoted, radiant, and generous person, missed active service in 1918 but soon turned to loved by countless friends, among whom were his adventurous mountaineering, which eventually many patients and associates. William Darrach died on May 21, 1948, experience of a fractured femur treated by trac- after a brief illness. Early on in the rigorous training in general surgery of that period, Robert found that his pro- fessors paid scant personal attention to fractures and other lesions of the limbs. It was only in his fourth year as a junior resident aged 27 that he came under the influence of a surgeon, Paul Lecène, with a deep interest in skeletal disorders. Two years later Lecène proposed coauthorship of a work on elective orthopedic surgery but almost at once died tragically from typhoid fever. The next year Robert made a long pilgrimage to Böhler in Vienna and then another to Putti in Bologna. These visits were the main source of a recurrent dream of such treatment equally well organized all over France. Meanwhile he had to concentrate hard on general surgery in order to 84 Who’s Who in Orthopedics attain the coveted rank of chirurgien des hôpitaux elled widely, especially in Great Britain and North in 1936. America, always seeking advances, often lectur- The declaration of war in 1939 and the long ing and generally acting as a roving orthopedic retreat of 1940 found Merle d’Aubigné as Captain ambassador for France. Not only did tion he worked in Paris under the double strain of it provide every facility for practice and for teach- belonging to the resistance and of protecting his ing, but also accommodation for an excellent first wife, Bibka, from deportation. When at last center of documentation (Meary’s brainchild) and Paris was liberated, he was promoted Colonel in for the secretariats of the Society, its library and charge of the medical services of the French its journal. Robert became full-time at Cochin and Forces of the Interior and given an office at the the transformed service ran smoothly from the Ministry of War. His own main surgical interests were in With the aid of his old friend Jean Cauchoix, he the hip, leg lengthening and bone tumors, but assembled a small but strong team ready to open by virtue of frequent consultation he kept well a Centre de Chirurgie Réparatrice in a private informed on all the special subjects of his large hospital requisitioned by the Army. Then in 1969, as President personality, thirst for knowledge and fluent of the Society, he had the prospect of a congress English guaranteed him a hearty welcome. That very years later, he recalled with special gratitude summer the terrorist assassinations at the Watson-Jones on theater technique, Seddon on Olympic Games caused many members to plead peripheral nerves, McIndoe on plastic surgery, either for cancellation or for a change in venue. Guttman on paraplegia and Frank Stinchfield on Courageous as ever, he would have none of it: the rehabilitation. His nately the much larger Hôpital Foch became dreams of 1930 had been fully realized. Services available and the expanded service attracted eager to the army and the resistance had won him many young surgeons, among them Michel Postel, decorations, learned societies had honored him. Jacques Ramadier, Robert Meary, Raoul Tubiana, In Great Britain, it was Honorary Fellowship Jean Benassy and Jacques Evrard, each of whom of the Royal Colleges of both England and was encouraged to concentrate on a special Edinburgh that gave him the most acute plea- subject. In France a supreme distinction was his All too quickly the approaching return of election to Membre de I’Institut. Hôpital Foch to its pre-war owners foretold an Retirement for Robert was a blend of sheer end of the center. To Robert the only hope of pleasure out of doors and brain work indoors. He retaining his team was to win the chair in adult and his second wife Christine enjoyed two homes, orthopedics becoming vacant in 1948 at Hôpital one near Paris and another in Alicante: the dis- Cochin, even though the accommodation in its tance between seemed not to matter. He won by a given him calm assistance with operations during very close margin. Around this time—1950— the hurried retreat of 1940 and again years ample state funds became available for the plan- later at Cochin; now it was companionship, ning and construction of a modern center, which whether sailing, tending their orange grove or in the event took 10 long years. Over this period of restraint, Robert gave The brain work was mainly literary. Robert enthusiastic support to the rapidly expanding already had six standard works to his part or French national society and to its renamed journal whole credit, with two more to complete. He also trav- he proudly fathered International Orthopedics, 85 Who’s Who in Orthopedics the journal of SICOT. Then he encouraged the He was responsible for the introduction of iodized board of La Revue to produce an edition in table salt. He also wrote two autobiographies, one made contributions to most branches of surgery.

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