Jammin' with Cindi Lauper for that crick in the neck? 跳舞的歌手 @Taipei 643 新年快乐

Craniofacial Ramblings 跳舞的歌手: Lessons from a Yemeni group 新年快乐!

Introduction: Large volume surgeons face frequent episodes of pain in the cervical spine and shoulders. A one year fellowship in craniofacial surgery,or microsurgery, does provide its fair share of occupational hazards for operation theatre staff.The crick in one's neck-shoulder area which is annoying at first, gets progressively worse, if ignored over long periods of time.* This light hearted study posits that a few good moves in the right directions and correct posture, will reap immense benefits for the heavy duty surgeon.
"I would like to suggest some shoulder shrug exercises, every now and then with Cindi Lauper,alias 跳舞的歌手? Might just be what the physician(in this case the musician,who is also a physician) ordered, for those painful moments. Shrug your shoulders a few times between sets and you are gonna be fine! And don't forget to look up to the blue yonder,for that extra sense of wonder**(to paraphrase the one and only JB Mulliken)."
According to Sir Gilles und Herr Obwegeser,and that new guy from Kalamazoo at Dr Bean's clinic in Kilimanjaro, you caint treat no problem if you aint got your diagnosis right.*** So what's up for you four plus, non blondes? You know from your own premonitions that the potential diagnosis can be pre treated.
Not everyone follows the "hup-ein-zwei-drei-gut!" protocol of Bach.Roll over twice Beethoven and give Chaikovsky the news. Craniofacial majnoon (crazy) dances from Yemen and Cyndi Lauper are here to stay. The manoeuvres just might save your neck.

Materials and methods:
The aim of this proposal is to strictly come dancing,to treat that crick in the neck.‘‘Readers should not have to guess your study purpose.’’****
Prerequisites for performing the stints,(or stunts) are a good sense of humour and some acquired choreoathetotic moves.For the less enlightened,there is this relentless, soul overkill called Psy in Korea and the more subdued sixties icon, Chubby Checker.
Some do go ballistic after a few aperitifs,so restraint would be in order here for obvious reasons. The sanctity of the operation room has to be upheld. 
I would like to propose an enjoyable algorithm to loosen up one's frayed nerves in the operation room:
Step 1: Close your eyes;inhale and exhale a few times. For those of you in remote access missions,please make sure that either the isoflurane,halothane or the nitrous oxide (laughing gas) tube is not leaking.Mission docs do feel groggy or even euphoric after operations in some of these remote regions.
Step 2: The technical details of the  shoulder shrug. Crank up the volume of the accompaniment video below.
1. Shrug your shoulders a few times to warm up
2. Turn neck to the left and shrug a few times,
3. Turn neck to the right and shrug a few times,
4. Look up to the operating lights and shrug a few times,
5. Circumduct and shrug again.

Video Song: Cyndi Lauper et Yemen Amigo:-)#

Heartaches by the number-Cindi Lauper, # Docbona Guitar College CA (GIT/MI)2013 https://www.99centguitarlessons.com/playlists.html
Step 3 : This step is largely optional. It includes the iodine starch test for participants who have hyperactive armpit pheromones.The scent of of  a man's sweaty armpits is no longer accepted as part of inclusive criteria in today's post-viking scale of male attractiveness. For those with the positive iodine-corn starch test, may I humbly  suggest intradermal treatment with Botox 50 units in each armpit*****.
Armpit clearance with the go ahead wave from onlookers might increase the chances ,over the next six months, of being included in the next gala party. On the other hand, the Japanese technique of shaving off the sweat glands via a transverse incision in the axilla can also successfully address the obstacle.
Fig: The Minor starch-iodine test for axillary sweat glands

The Minor test (starch-iodine qualitative test for sweating test) described by Minor in 1928.
An iodine solution is applied to the skin and allowed to air-dry. Once dry, the area is dusted with cornstarch. Sweating is then encouraged with exercise.When sweat reaches the surface of the skin the starch and iodine combine causing a dramatic color change (yellow (hypohidrosis) -> dark blue(hyperhidrosis), allowing sweat production to be actively visualized.
( Minor V. "Ein neues Verfahren zu der klinischen Untersuchung der Schweissabsonderung", Dtsch Z Nervenheilkd, 1928;101302-7.)


The results are predictable as anticipated, despite the initial,embarrassing moments with those sweat glands.  
 As the neck and shoulder muscles loosen up,one feels an exhilarating sense of calm and relaxation after a few vigorous attempts to release inner chi and other feelings.
If there was ever such a thing as the alertness index in an operation room,the manoeuvres would definitely reach a high score in all participants,compared to non-participant,sedentary controls( p> 0.0003). Active participants are significantly more alert than controls who may have acquired blepharoptosis and OSA symptoms peri op.
For obvious reasons, the innovative axillary, pheromone sniff index (how mild or strong the  scent of man is) is being suggested as a way of  gauging safe close encounters during our study. On a scale from 0-5 , the following is suggested for calculating a safe distance:

Grades of the  Axillary Sniff Index (ASI)

Grade 1: 0-1 tolerable and requires little or no treatment   :Safe Distance (1-2 feet,SD****** +/ - 2)
Grade 2: 2-3 mild perspiration;would require fresheners   :Safe Distance( 3-5 feet,SD +/- 1.)
Grade 3: 4-5 moderate/severe  odour;need cornstarch test :Safe Distance (over 7-9 ft)

Discussion: Who hasn't heard of that famous shoulder shrug,especially during freezing winter days? Shoulder shrug does keep your blood circulating and also helps you stay warm. So this winter,make sure you shrug your shoulders every now and then. Neck and shoulder exercises are definitely helpful for those of us who are into heavy duty surgery.Mind you,when the  operation gets a wee bit messy,you are gonna shrug your shoulders anyway,so why not make it a habit even when your operations are going fine? Most participants are able to perform this ritual once every week with ease. The benefits are promising, if one follows the rules. 
One can always have fun and save that chi for another rainy day.Keep on rocking and dancing,then . To your own tune,not others.

"Surgeons who use loupes and headlamps were found to spend extensive time periods working in non-neutral head–neck postures. These postures, and the use of loupes and headlamps, were found to be associated with an increased loading of the cervical spine, which might cumulatively contribute to occupational neck musculoskeletal disorders.*"


The author would like to thank Professor John Mulliken for advising him on correct head position and posture for the operating surgeon during cleft palate surgery ( Childrens Hospital MA, August 2012)

pic:With John Mulliken,Childrens MA August 2012.The importance of correct head position!

Moral: " correct your head position and posture as a surgeon."

Special thanks to the Smile Train family ,41 Madison Avenue, New York City 
" Those were the days"

Conflict of interest: NA
Funding: NA

( used in Vancouver style here)

( this blogsite has no font superstrike ,so * is used instead; * is read as superstrike 1 and so on)

1.*Neck Postures and Cervical Spine Loading Among Microsurgeons Operating with Loupes and Headlamps Ashish D. Nimbarte,Marsha Chapman,11E Transactions on occupational ergonomics and human factors,p215-223, 12 Sep 2013

2.** A sense of wonder Mulliken JB MD, Plastic and Reconstructive Surgery Vol 110:5,p 1353-1359, Oct 2002
3. *** Hugo L. Obwegeser (1920–2017)The father of modern orthognathic surgery,Farhad B. Naini ,Journal of Orthodontics, 44:4, 317-319,2017
4.**** Writing a scientific paper is not rocket science  Thomas B Dodson DMD J Oral Maxillofac Surg 73:S160-S169, 2015
5.*****del Boz J, Padilla-Espa˜na L, Segura- Palacios JM. Técnica de infiltración de toxina botulínica en hiperhidrosis axilar. Actas Dermosifiliogr. 2014;105:517---518.
6.******Understanding statistics:a guide for medical students James Gupta Medical Student, University of Leeds, Communications Officer, NSAMR 2013

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