Reflections on the Winter Solstice

In the Northern Hemisphere this year, December 21, the day I’m posting this entry, is the winter solstice. As Catherine Boekmann of the The Old Farmer’s Almanac explained, “the winter solstice is the day with the fewest hours of sunlight…making it the ‘shortest day’ of the year.” Put another way, the winter solstice has the longest number of hours of darkness in any day throughout the course of the year.

As Boekmann noted, many cultures have placed significance on the winter solstice: “Some ancient peoples even marked the solstice using huge stone structures….” Two such places she pointed out are Newgrange in Ireland and Stonehenge in England. Other cultures have celebrated the winter solstice with feasts and festivals, and Boekmann listed as examples the feast of Saturnalia as celebrated in ancient Rome and the festival of Juul as celebrated in ancient Scandinavia.

Winter solstice Stonehenge 2004 (Wikimedia/Vicky WJ)

As the editors at History.com have explained, many of the traditional Saturnalia customs show up in modern Western celebrations of Christmas, “including giving gifts, singing, lighting candles, feasting and merrymaking….” Modern echoes of the festival of Juul (also spelled Jól or Yule) can also be found. The History.com editors have noted that “Yule celebrations involved great amounts of feasting and drinking” and “similar to making a New Year’s resolution, the swearing of oaths was a tradition at Yule celebrations.”

For me this year, the darkness of the winter solstice seems a more apt description of my mood than the joyful aspects of these ancient celebrations. Since about October, I’ve had a song running through my head that features the line “in the bleak mid-winter.” Even though October is clearly not midwinter, my sentiments have felt midwinter-like since then, dark and bleak and dreary.

The lyrics of the song are from Christina Rossetti’s poem “A Christmas Carol.” It’s only the opening stanza of this poem that has been running through my head:

In the bleak mid-winter

Frosty wind made moan,

Earth stood hard as iron,

Water like a stone;

Snow had fallen, snow on snow,

Snow on snow,

In the bleak mid-winter,

Long ago.

The words “bleak,” “frosty,” “hard as iron,” and “like a stone” seem to capture my emotions best. And the long “o” sounds throughout the stanza evoke the sounds one might make when mourning.

The tune that accompanies the lyrics is fairly dirge-like to me. It’s certainly not an uplifting, lilting tune in any case. In church when I was a kid, each Christmastime we sang the hymn called “In the Bleak Midwinter” that used Rosetti’s lyrics, and when I now imagine it being sung, the doleful, repeated “snow on snow” line strikes a chord. You can listen to a portion of the instrumental version of it on the Hymnary.org website and sing along.

All this might lead some to ask why I am feeling so bleak. The reasons are many. I’ve mentioned several in my blog posts over the past year. In January, a friend’s situation prompted me to write about relationship abuse. In April, May, and June, I wrote about emergencies, coping, and coping with emergencies, all of which were prompted by current events, such as natural disasters, wars, data breaches, political polarization, the de-funding of public media, and health emergencies like measles outbreaks, bird flu, and collective trauma from the COVID-19 pandemic.

To continue the list, July brought a post prompted by threats to the existence of the Fulbright Program. And my September and October posts focused on health writing, where I mentioned many instances of medical disinformation currently proliferating. If that’s not enough to make anyone feel bleak, I don’t know what is. But that list only covers widespread stressful events, not to mention stressors of a more personal nature.

So, this winter solstice, others might be celebrating that from this point forward those of us in the Northern Hemisphere will be enjoying more hours of sunshine each day. But I’m feeling bleak and have been for several months. And I know I’m not the only one feeling this way.

In the Power Lines podcast I listen to weekly, one of the hosts, Jon Passantino, said on December 5, 2025, “I think we’re living in Hell…” (at 0:01). His comment was in reference to investigations into recent possible war crimes and/or murder committed by the US Department of Defense. In the same episode, his co-host, Oliver Darcy, called the current moment “disturbing and…highly alarming” (24:58–25:03). His comment was in reference to current US government infringement on the freedom of the press.

I hope that despite these dire circumstances, you’re not feeling as bleak as I am. If you are, know you’re not alone. And as a way to counteract so much bleakness, let’s all try to find ways to spread some love around. Certainly we could use it.

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Announcing a New Blog Feature: Subscription Tool

I’m happy to announce a new feature on my blog: a subscription tool. In this blog entry, I’ll explain which tool I opted for, how I chose it, and why I decided to add this feature to my blog. I’ll also discuss future changes coming to my blog. I hope you find it enlightening!

Which tool did I opt for and how did I make my choice?

The subscription tool I chose for my blog is powered by follow.it, which is owned by a company called Inisev that provides open-source technology solutions and is dedicated to charitable giving. I chose follow.it based on its cost, its features, and its easy configuration. As for cost, I’m using the free version of the tool, also known as the basic plan, although paid options are available. I’m happy with the features provided with the plan I chose because I’m allowed unlimited subscribers and messages. A full outline of the features and pricing of all the available plans are on the follow.it website.

Another reason why I chose to use follow.it is its easy configuration. With only one step causing me confusion, I found the process of creating the subscription form and embedding it into my blog to be fairly simple. The one difficulty I had was with the step called “feed claiming.” However, my difficulty was resolved through just one email exchange with customer service.

If you’d like to learn more about how to use follow.it, I recommend checking out the company’s help pages. I read through every topic before making my choice, and I found the material easy to read and understand. I think you will, too. I should note that I’m not a paid endorser for follow.it or its owner Inisev, although Inisev does offer endorsement opportunities if you’re interested. That said, you may find that other subscription tool options are better for you.

The follow.it logo (displaying this logo in no way implies a relationship, affiliation, or endorsement by follow.it of my product, service or business) (follow.it Brand Assets/Inisev)

Why did I add this tool to my blog?

With the addition of this tool, readers can have each new blog entry I write delivered directly to their email inboxes. I subscribe to several Substack newsletters, and I enjoy finding out right in my email inbox when updates to these newsletters are available. I thought that such a feature might be helpful for my readers, too.

Another reason I’ve added this tool is to eliminate my reliance on social media to announce my new blog posts. Until now, I’ve relied on announcements to Facebook and LinkedIn to let readers know a new blog post is available. Because several years ago I took steps to make Facebook work better for me, trying to avoid its more negative aspects and focus on its positive ones, I felt my system of announcing my blog posts through social media was working well. However, over the past year, that opinion has changed, and I now find myself wanting to rely less on Facebook as a means of communication. In fact, I’m considering the timing of when I will exit the app entirely (I have enough to say about this that it could be its own blog post in the future!). Because I want to exit Facebook, I needed to find an alternative method for announcing my blog posts, and this subscription tool seemed to be a good solution.

Another factor I considered in adding this tool was whether subscribing might be onerous to my readers. I suppose if I posted to my blog multiple times each day every day, subscribers could feel overwhelmed by receiving too many email notifications. However, because I post to my blog roughly once per month, subscribers can expect to receive just one email monthly, which hopefully won’t seem onerous to anyone. And the sign-up procedure is simple, too. Just find the tool in the right menu of my blog, enter your email address, and click subscribe. Or, you can scroll to the bottom of a blog entry, click "subscribe," and follow the steps. Easy!

Future changes to my blog

My desire to exit Facebook comes amid a reexamination of all my technology use. I first became concerned about using Facebook when I realized how wealthy Mark Zuckerberg, the CEO of Meta, which in turn owns Facebook, has become. According to Forbes’ daily list, at the time I'm writing this he’s the third richest person in the world, with a net worth of $235.5 billion. I don’t begrudge anyone monetary success, but to me, this seems excessive.

When I thought more about this issue, I realized that Zuckerberg is not the only tech leader to have amassed huge wealth. According to the Forbes daily list that cites him as the third richest person in the world, as of the time I’m writing this, nine of the top ten richest people in the world are in the technology industry, and they are all worth $150.5 billion or more. What business practices have these people followed to compile such wealth? And what are they doing with that wealth once they’ve compiled it?

I haven’t been happy with the answers to those questions. In many cases, the ethical choices I would make in their situations have not been the choices they’ve made. As one example, many of the donors contributing to destroying the East Wing of the White House and replacing it with a ballroom are involved in the tech industry, as reported by The Hill, a non-partisan print and online news source focused on government and business. Amazon, Apple, Google, HP, Meta, Micron Technology, Microsoft, Palantir Technologies, and T-Mobile are all tech companies included in the list of donors. I oppose this action to destroy a part of American history and the way it has been carried out, so I oppose these companies financially supporting it.

Interestingly, I use products from several of these companies in creating, posting, and publicizing my blog. I’ve already mentioned my use of Facebook, which is owned by Meta. I write on an HP computer using a Microsoft operating system and software. (Apple could be a viable alternative to the Microsoft operating system and software, but like Microsoft, Apple is on the list of donors.) My blog platform is powered by Google, and I embed my blog into my website, which is also powered by Google.

How much I will be able to avoid these technologies going forward and what that will mean for my blog remains to be seen. For now, I’m taking steps to avoid Meta in announcing my blog posts, and I’ll be investigating alternatives to the other technologies I use as well. As my mantra goes: one foot in front of the other. Stay tuned for future announcements as I figure out which changes I will make and how.

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Prolotherapy: An Alternative Treatment for Pain

These days, medical disinformation is widespread. Since my previous post, in which I bemoaned falsehoods about COVID-19 vaccine efficacy, COVID-19 vaccine availability, COVID-19 deaths, childhood vaccines, medications for depression and anxiety, funding for rural hospitals, causes of autism, and the MMR (measles, mumps, and rubella) vaccine, the spread of medical disinformation has continued. Recently, autism, the medications Tylenol,and leucovorin, the Hepatitis B vaccine, the MMR vaccine, and childhood vaccines in general, have been the subject of false information.

Some reporting has occurred to counter this recent disinformation, including reporting aiming to correct the record about autism, Tylenol, leucovorin, and childhood vaccines in general. Other reporting has focused on providing accurate information about the MMR vaccine in particular, while still other reporting has aimed to set the record straight about the Hepatitis B vaccine. Only time will tell whether these attempts at sharing accurate medical information will outweigh people’s belief in the disinformation.

My own medical writing, like the reporting aiming to counter medical disinformation, aims to present understandable, factual information about conditions and treatments. In the past, I’ve provided information about thoracic outlet syndrome, quadrilateral space syndrome, and hydrodissection. In this post, I’ll present information about a treatment called prolotherapy, a type of injection known to help with pain relief.

What is Prolotherapy?

As reported by Healthline, “prolotherapy involves injecting a dextrose [sugar] or saline [salt] solution into an injury site to promote a healing response.” This article explained that “these injections aim to trigger the body’s inflammatory healing process in the area.” The article noted that “in theory, the solution acts as an irritant, which may stimulate the growth of new tissues.”

As described by an article published by the American Society of Regional Anesthesia and Pain Medicine, “most [prolotherapy] injections are done in an office setting, and patients may receive topical local anesthetic solutions or subcutaneous lidocaine [delivered under the skin by needle] at the site of injection. Using ultrasound as a guide, articular spaces [joints] or tendons and ligaments are identified and the proliferant [a substance causing rapid growth of cells] is injected.” This article also explained “it is important that patients who are going to receive prolotherapy do not take anti-inflammatory medications, because they would prevent the inflammation that is required for cell regeneration.”

It should be noted that a doctor I spoke to in doing research for this blog post explained that receiving prolotherapy and avoiding anti-inflammatory medications afterword can be quite painful. However, the period of intense pain caused by the prolotherapy treatment should be relatively brief, lasting about a week to ten days, after which pain relief should occur. Those considering this treatment option should be aware of the pain the treatment causes before embarking on it.

Unlike surgical treatments, which remove or replace injured body parts such as joints, disks, or tendons, prolotherapy aims to treat body parts in place. And, whereas other treatments such as steroid injections, topical ointments, or pain-relieving tablets, that treat body parts without removing them have the aim of reducing inflammation, prolotherapy aims to cause inflammation. This is because inflammation is the means through which the body heals itself.

An article published in the journal Anesthesia and Pain Medicine explained the process of healing triggered by prolotherapy in this way: “The injected proliferant causes a healing process that is similar to the body’s natural healing process….” In this healing process, “…a local inflammatory cascade is initiated, which triggers the release of growth factors and collagen….”

The biology of prolotherapy. (Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability/Danielle Steilen et al.)

In other words, prolotherapy relies on the body’s natural response to an injury. This response uses inflammation to send healing cells to the injured site. By creating a minor injury with the injection of sugar and/or salt water, prolotherapy can promote the healing of injuries.

What is the History of Prolotherapy?

Prolotherapy has been around for a long time. As explained by an article in Clinical Medicine Insights: Arthritis and Muskuloskeletal Disorders, “prolotherapy has been used in clinical practice for more than 80 years to treat various chronic musculoskeletal conditions.” The article noted that the treatment was “formalized by Dr. George Hackett in the 1950s.” Some researchers, such as the authors of the article provided by the American Society of Regional Anesthesia and Pain Medicine, date Hackett’s work to 1937. Whichever date is correct, the treatment is not new.

Over the past few decades, as noted by the Clinical Medicine Insights article, interest in prolotherapy has grown. This is because scientific research into its use and effects has blossomed. It’s also because this research has shown both the usefulness of the treatment and a lack of serious negative side effects accompanying the treatment.

Who Can Benefit From Prolotherapy?

In speaking with a doctor about prolotherapy, I learned that the area making up the quadrilateral space in the back of the shoulder can be treated with prolotherapy. Other body parts that can benefit from prolotherapy as noted by the Healthline article include tendons, muscles, or ligaments that have been strained or sprained; joints such as knees, hips, or fingers affected by arthritis; or spinal discs that are degenerating. Seemingly a wide range of body parts can be treated with prolotherapy.

Research studies back up these generalized assertions about where prolotherapy can be effective. For example, the article in Anesthesia and Pain Medicine reviewed “10 studies involving 750 participants” that participated in “randomized controlled trials which compared the effect of…prolotherapy with that of other therapies….” The conditions the patients in those studies were treated for included knee osteoarthritis, rotator cuff tendinopathy, chronic plantar fasciitis, chronic low back pain, osteoarthritis in the thumb and finger, and osteoarthritis in the first carpometacarpal [the joint at the base of the thumb].

The article in Clinical Medicine Insights reviewed 33 studies examining the use of prolotherapy. In addition to some of the conditions listed in the article in Anesthesia and Pain Medicine, this article listed a few others that can benefit from prolotherapy. They included Osgood-Schattler disease (a disease of the patellar tendon at the base of the knee), patellar tendinopathy, temporomandibular joint (TMJ) syndrome (a condition affecting the jaw joint), Achilles tendinopathy, lateral epicondylitis of the elbow (also known as tennis elbow), groin pain, discogenic leg pain (leg pain originating from a spinal disk in the low back), spine pain (in the neck, torso, or low back), and pain in the pelvic, coccyx (tailbone), or sacroiliac region.

Still another article, this one in the Journal of Rehabilitative Medicine, focused on osteoarthritis. It listed, in addition to the studies about knee and hand osteoarthritis I’ve already mentioned, a study focused on hip osteoarthritis involving 23 participants where prolotherapy had good results. Overall, the sampling provided by these articles offers a glimpse into the wide range of body parts that can be treated with prolotherapy.

How Many Prolotherapy Treatments are Required?

As noted by the article provided by the American Society of Regional Anesthesia and Pain Medicine, treatments generally follow “a protocol of solution injection in 2-to-8-week intervals over the course of several months.” The doctor I spoke to who uses prolotherapy as a treatment in his practice indicated that most studies indicate a total of six or seven treatments can be used, after which a long pause of six to twelve months should be allowed before more prolotherapy is administered. A review of the research studies I looked at confirms this.

For example, the article in the journal Anesthesia and Pain Medicine reviewed 10 articles that used an “injection interval [that] ranged from weeks to months.” Specifically, the studies reviewed in this article reported using a low of two injections to a high of six and spacing of the injections ranging from a low of one week apart to a high of two months apart. The same range in the number and spacing of injections was reported by the article in Clinical Medicine Insights, which reviewed 33 studies. The article in the Journal of Rehabilitative Medicine reviewed 14 studies with a low of one injection to a high of six and a low of spacing the injections one week apart to high of two months apart.

As for having more injections if full pain relief isn’t achieved by the initial protocol, two of the articles I reviewed mentioned this possibility, with the article in the journal Anesthesia and Pain Medicine noting a low of a three month wait time for additional treatments to a high of a six month wait time. Of the studies reviewed by the article in Clinical Medicine Insights, those that mentioned additional injections after the initial protocol indicated a low of a one month wait time to a high of a six month wait time. One study reviewed in this article provided additional treatments with no wait time. This seems to be an outlier.

Overall, it seems there is variability in treatment plans. Each provider likely considers each case and determines which protocol to follow and whether to allow additional treatments after the initial protocol is completed. If you are considering this treatment for pain, you will need to consult with your provider to find out what to expect about number and spacing of injections.

Who Provides Prolotherapy?

A range of providers can administer prolotherapy. As noted by the article published by the American Society of Regional Anesthesia and Pain Medicine, prolotherapy is often offered by doctors practicing at pain clinics. Authors of the other articles I’ve drawn on in writing this post were doctors working in physical medicine and rehabilitation, cerebellum medicine, regenerative medicine, and anesthesiology. The doctor I spoke to in preparing this post was a doctor of sports medicine.

This range in types of providers can be both helpful and confusing at the same time. On the helpful side, patients seeking prolotherapy as a treatment might find several specialists providing the treatment in several different specialty clinics. However, on the confusing side, patients might need to try reaching out to several doctors in different specialties to find someone local who provides the treatment.

What Makes Prolotherapy an Alternative Treatment?

It should be noted that prolotherapy is considered an alternative treatment option. This is because “this therapy is not approved for use by the Federal Drug Administration (FDA),” as explained by the article provided by the American Society of Regional Anesthesia and Pain Medicine. To be more specific, “Dextrose proliferant has been approved for injection by United States Food and Drug Administration but not for prolotherapy; thus, it is currently used in prolotherapy as an off-label substance,” as elucidated by the article in Clinical Medicine Insights.

Despite the alarming feeling patients may experience when told a treatment they are considering for pain relief is not approved by the FDA, this state of affairs does not mean such a treatment is not safe. None of the 57 studies I read about in the articles I looked at in writing this post reported any injuries caused by prolotherapy treatment. At worst, some patients did not achieve full pain relief.

For this and other reasons, many medical providers and institutions are moving away from the label “alternative” for non-FDA approved treatments. As the Cleveland Clinic put it, the term “alternative” is “becoming outdated as providers turn to an ‘integrative’ approach instead.” This type of approach incorporates “different types of evidence-based therapies to care for all of you.” Such an approach “can be especially helpful if you have a long-term (chronic) or complex condition.”

Disclaimer

As with my other pieces of medical writing, I offer this one as informational only. Before undertaking any medical treatment, you should check with a doctor or other licensed medical professional.

Hydrodissection: A Minimally Invasive Option for Nerve Pain Treatment

At the moment, disinformation about medical care is proliferating. For example, in one US Senate hearing, falsehoods were spread about COVID-19 vaccine efficacy, COVID-19 vaccine availability, COVID-19 deaths, childhood vaccines, medications for depression and anxiety, and funding for rural hospitals. Disinformation about the causes of autism has also been spread lately, with unsupported claims gaining traction that the use of acetaminophen by pregnant people and vitamin deficiencies in pregnant people cause autism. (If you’re interested in more details about the falsehoods being spread about autism, FactCheck.org, a publication of the Annenberg Public Policy Center at the University of Pennsylvania, provides a detailed analysis.) Not too long ago, a lot of disinformation was being spread about the measles, mumps, and rubella (MMR) vaccine.

In contrast to these examples of medical disinformation, in my medical writing, I aim to provide easy to understand, accurate information about medical conditions and treatments. A few years ago, I wrote about a rare condition called thoracic outlet syndrome. I followed that up with a blog post about another rare condition called quadrilateral space syndrome. This time, instead of focusing on a condition, I’m focusing on a treatment: hydrodissection.

What is Hydrodissection?

As explained by the Sports Medicine Center at the University of Washington (UW) Medical Center, hydrodissection is a minimally invasive procedure that aims to decompress nerves entrapped by surrounding tissues. These entrapments can result from scarring or tight muscles caused by injuries. To eliminate the entrapments, a provider with specialized training injects liquid into the tissue surrounding the affected nerve in order to break up the entrapments and allow the nerve to glide smoothly. The procedure is performed in a medical office under ultrasound so the provider has a clear view of the affected tissue and nerve. As described in the Journal of Pain Research, the needle used ranges from 50 mm–100 mm (about two to four inches) long, and it can be repositioned while inserted during the procedure to direct the liquid effectively.

The UW Sports Medicine Center indicates that the liquid injected into the tissue is often a combination of numbing medicine, saline, and cortisone, with each provider determining the best liquids to use in each case. Other options, as reported in the Journal of Pain Research, replace the saline and cortisone with sugar water, a type of enzyme called hyaluronidase, or platelet rich plasma. This report also notes that not only scarring and tight muscles can be the culprit in causing nerve entrapments but that fascia can cause entrapments as well. As described by the Cleveland Clinic, “Fascia is a sheath of stringy connective tissue that surrounds every part of your body….When your fascia is healthy, it’s flexible and stretches with you. When your fascia tightens up, it can restrict movement and cause painful health conditions.”

Hydrodissection procedure. (A) Prone position for the ultrasound-guided ulnar nerve in-plane injection with the elbow flexed and hanging over the examination bed. (B) The same procedure as described before in detail. (C) Supine position for the ultrasound-guided ulnar nerve in-plane injection; the patient is positioned on the examination bed with the elbow flexed and hand over the head. (D) The same procedure as described before in details. (Ulnar Neuropathy at the Elbow: From Ultrasound Scanning to Treatment/Kamal Mezian et al.)

Which Nerves Are Treated With Hydrodissection?

Several studies have investigated the use of hydrodissection to treat various nerves. For example, some studies have focused on the nerves that pass through the wrist. One study published in the journal Current Sports Medicine Reports examined the use of hydrodissection in radial tunnel syndrome, which affects the radial nerve as it passes through the wrist. Another study, this one published in the Journal of Clinical Medicine, focused on the use of hydrodissection for treating carpal tunnel syndrome, which affects the median nerve as it passes through the wrist.

Other studies have focused on other areas of the body. For example, a study published in Springer Nature’s Scientific Reports investigated the use of hydrodissection on the tissues surrounding nerves in the neck. An article in the Baylor University Medical Center Proceedings presented data related to the use of hydrodissection for the peroneal nerve in the knee. And, a study published in the Journal of Women’s Health and Gynecology examined the use of hydrodissection to treat the tissues surrounding nerves in the pelvic floor. Additionally, in speaking with a provider who uses hydrodissection in his medical practice, I learned that hydrodissection can also be used to treat the tissues surrounding the axillary nerve, a nerve that passes through the back of the shoulder and upper arm. These are just a few examples of the many nerves in the body with the potential to be treated with hydrodissection.

How Many Hydrodissection Treatments are Required?

The articles I’ve cited range in the number of hydrodissection treatments used. The lowest number of treatments mentioned that resulted in a positive effect was just one treatment in the article published by the Journal of Pain Research, and the highest number was six treatments over six weeks in the article published by the Journal of Women’s Health and Gynecology. The doctor I spoke with who uses hydrodissection in his practice mentioned that the literature supports using up to six or seven treatments, after which a significant break of six months to a year should be taken before resuming. Overall, it seems a wide range of treatment practices are observed, and patients should consult with their doctor about the best course of action for their case.

Who Provides Hydrodissection?

As evidenced by the articles I’ve cited, doctors researching hydrodissection work in several areas of medicine, including musculoskeletal medicine, physical medicine, rehabilitative medicine, orthopedic medicine, pain medicine, and sports medicine. Sometimes, the authors of the articles performed the hydrodissection treatments themselves, meaning practitioners of hydrodissection can be found among this same list of medical specialties. Other times, the authors of the articles reported on case studies carried out by other doctors. In these instances, the doctors who carried out the hydrodissection treatments represented a similar list of specialties, with the addition of neurology, radiology, and anesthesiology. Overall, then, patients have a wide variety of options for seeking out a practitioner who provides this treatment.

Who Can Benefit From Hydrodissection?

Anyone with a nerve injury caused by entrapment in a location that can be reached by a needle can benefit from hydrodissection. As reported in the Journal of Pain Research, one type of person who might experience this phenomenon is someone who has suffered a sprain or strain that has stretched a nerve in the injured area. The report additionally notes that nerve stretch injuries can occur during surgeries. Someone who has had a surgery with pain lingering beyond the expected time for healing could be a good candidate for hydrodissection..

As also reported in the Journal of Pain Research, someone with bone spurs, tendinosis (an injury to a tendon), or ligamentosis (an injury to a ligament) could also benefit from hydrodissection. The report also notes that fractures can cause injuries to nerves and that these injuries can be candidates for treatment with hydrodissection. Someone who has suffered a fracture and is experiencing lingering pain could therefore benefit from the treatment.

Some syndromes can also cause injuries to nerves, such as radial tunnel syndrome as reported on in Current Sports Medicine Reports, carpal tunnel syndrome as reported on in the Journal of Clinical Medicine, and quadrilateral space syndrome as mentioned by the doctor I spoke with in researching this article who has used hydrodissection to treat the axillary nerve that is a factor in this condition. Anyone with one of these conditions might want to consider hydrodissection as a treatment option. Neck pain, knee pain, and pelvic floor pain have all been treated with hydrodissection, as reported in Scientific Reports, Baylor University Medical Center Proceedings, and the Journal of Women’s Health and Gynecology. Someone with one of these types of pains could benefit from hydrodissection.

These are just a few examples of the types of conditions that could be treated with hydrodissection. If you have chronic pain that hasn’t responded to other treatments, you might consider hydrodissection as a treatment option. Of course, you should consult with a doctor before embarking on any treatment, ideally getting several opinions. When looking for doctors to interview about this procedure, it took me six tries before I found someone who provides hydrodissection in his practice. Although doctors with many medical specialties can offer hydrodissection, not all are trained in the procedure, so if you aren’t able to find a provider on your first attempt, keep trying. You might find someone with your next attempt.

August Interlude

Occasionally, I like to share nature photos in my blog. Why?

One reason is that spending time in nature or looking at nature has been found to be good for human health. I shared information about the connection between health and nature in my blog about the benefits of birding. I like the idea of sharing nature images as a way of boosting the well-being of my readers.

Another reason is that by sharing photos of nature, I can raise awareness about the irreplaceable beauty of the environment. As I noted in a post a few years ago about overloading on negativity, I’m concerned about the destruction of the environment. Maybe by seeing photos of the beauty of nature, some of my readers will be inspired to take action to preserve our environment.

Yet another reason is that sometimes words escape me. As I explained in the blog I wrote about this situation, one cause of this phenomenon is being overwhelmed with topics to write about. At the time I wrote that blog, my list of possible topics included the COVID-19 pandemic, the global economic crisis, racial unrest, and environmental protection rollbacks. Those topics still seem relevant today, more than five years later. By sharing nature photographs, I’m able to communicate without words when I’m feeling at a loss for them.

So just as I did in November 2020 with photos of fall scenery, July 2021 with photos of summer sightseeing, and April 2022 and March 2024 with photos of springtime flowers, in this blog, I’m sharing photos of nature. I hope they provide you with a pleasant interlude in the midst of your day-to-day life!

How to Make a Pre-Recorded Webinar Using PowerPoint and YouTube

Over the years, I’ve shared writing of various genres in my blog. These have included the following:

• Interview
• Medical writing
• Call for proposals
• Fitness writing
• Listicle
• Travel writing
• Public service announcement
• Poetry
• Review
• Checklist

With this post, I’m adding another genre to the list: webinar. Specifically, I’m sharing information about how to make a pre-recorded webinar. I’ll be letting you know how to use PowerPoint to record a webinar and post it to YouTube.

But first, some background. In June of this year, I made a webinar for the North Carolina chapter of the Fulbright Association. I serve on the board of the chapter and also as the chapter’s webmaster. Those of you who have been reading my blog for a while already know how impactful I’ve found my involvement with the Fulbright Program. For those who are new to my blog, you can read a two-part blog post about my Fulbright experience as well as a blog I wrote containing information about an article I published in Fulbright Chronicles. I also published a brief story about my Fulbright experience on the Fulbright Association’s website.

The webinar I made focused on the experience of publishing in Fulbright Chronicles. In the webinar, I provided an overview of the journal, outlined the submission guidelines, reflected on my experience publishing with the journal, and called on other Fulbrighters to publish articles with the journal as a way to #StandForFulbright. For those who aren’t aware, the Fulbright Program currently faces extreme challenges, including the resignation of members of the Fulbright Foreign Scholarship Board and proposed steep cuts to the program’s funding. Fulbrighters are doing all they can to advocate for the continuation of the Fulbright Program, and publishing in Fulbright Chronicles is a great way for Fulbrighters to lend their voices to this advocacy effort.

Screenshot from the webinar "Publishing in Fulbright Chronicles." (Personal collection/Karen P. Peirce)

Whether you want to make an informational webinar, a webinar focused on advocacy, or one that achieves both goals, as I did, you can use the following steps to make a webinar in PowerPoint that you can record and post online for your audience to view at their convenience. In my case, because I’ve made videos using these steps before, my webinar took about a weekend to create. You might find it takes you longer or shorter depending on your previous experience.

Without further ado, here are the steps to follow!

1. Open PowerPoint and choose a design for your slides.

2. Fill the slides with the visual information you want to share. Keep in mind the following tips:

• Use images to capture your viewers’ attention.
• Use as few words as possible on the slides. Slides are meant to supplement, not replace, your narration, so as much as possible, include only a few keywords on each slide.

3. Write your narration. I did this using the notes portion of the PowerPoint slides I made, but you can write out your script in a separate document if you prefer. If you use a separate document, be sure to indicate in your script which portion of the script corresponds to which slide.

4. Next, record your slide show. In my webinar, I chose to only record only audio narration to accompany the slides, not video, but you can do both. The recording will capture your narration as well as all your slide advancements and animations. Detailed directions are available at https://support.microsoft.com/en-us/office/record-a-slide-show-with-narration-and-slide-timings-0b9502c6-5f6c-40ae-b1e7-e47d8741161c. Here are a few helpful tips to remember while recording:

• You can pause your recording, so if you need a break, that’s fine. You can pause and then re-start after you take a drink of water or the like.
• You can re-record slides, so if you make a mistake, or if your phone rings in the middle of recording, or something similar, you can have a do-over.

5. Next, save your recording in video form. While you can keep your recording in PowerPoint and either play it for your audience live in person or share the PowerPoint file with members of your audience, saving it in video form can be handy. This way, your viewers do not have to have access to PowerPoint to view the show, and it can be streamed on demand online. Detailed directions for saving a PowerPoint show as a video are available at https://support.microsoft.com/en-us/office/turn-your-presentation-into-a-video-c140551f-cb37-4818-b5d4-3e30815c3e83. Here are a few tips to keep in mind:

• Depending on the length of your show, converting the file to a video can take a while. Be sure to plan ahead and give yourself enough time if you’re working to a deadline.
• I chose to save my file as an MP4, but you can choose WMV format instead. Both are commonly used.

6. Create a YouTube channel. Because I already have a Google account and YouTube is owned by Google, I chose YouTube as my video hosting service. You could choose another. If you do choose YouTube and you don’t already have a Google account, you’ll need to start there. Here are the steps to follow to create a Google account: https://support.google.com/youtube/answer/161805. Once you’ve made a Google account, or if you already have a Google account, you can proceed to creating a YouTube channel. Directions are at https://support.google.com/youtube/answer/1646861. Here are a few tips for creating your channel:

• Decide whether you want a personal channel or a business channel. A personal channel is only accessible by one person, whereas a business channel can be managed or owned by more than one person.
• You’ll be asked to create both a channel name and a YouTube handle. If you later want to change the handle, this is possible.

7. Upload your video to your YouTube channel. This is the final step! Uploading your video to a video hosting service like YouTube means your video can be streamed over the internet on demand. Directions for uploading your video to YouTube can be found at https://support.google.com/youtube/answer/57407. Here are a few tips:

• Don’t forget to publish your video after uploading it.
• There are limits to the file size and length of your videos on YouTube. See details at https://support.google.com/youtube/answer/71673.  

That’s it! If you’ve followed these steps, you’ve created a pre-recorded webinar in PowerPoint that you’ve uploaded to YouTube. Your last step is to share it with your audience. Here you can see the webinar I made: https://youtu.be/tbnYUBx7Ozc. I hope you enjoy it!

Coping with Emergencies, Again

My two most recent blog posts have been about preparing for emergencies and coping with stress. Not too long after uploading my entry about coping with stress, I came across a comic on the National Public Radio (NPR) website about coping with emergencies. It combines information about emergency preparedness and coping strategies that my earlier posts covered. What serendipity! It’s almost as if the producers at NPR were reading my mind.

And no wonder, for as I noted in my “Coping Strategies Revisited” post, “Reports about stress abound.” The comic was published as part of NPR’s Life Kit podcast and newsletter, which means it’s offered in both visual/textual and audio forms. What a great supplement to my two posts, which are primarily textual.

Images-Fonts-Sounds-Music (Mu/Nicholas H. Tollervey)

So, without further ado, I offer here a link to the comic “Don’t Panic! 6 Strategies to Keep You Calm in a Crisis” as featured on NPR’s Life Kit. If you enjoy visuals, you can look at the comic, and if you prefer listening to stories, you can click play on the podcast. In case NPR has been de-funded by the time you’re reading this and its website is no longer active, here’s a link to the comic on the Wayback Machine.

Coping Strategies Revisited

Back in January, I noted it was Mental Wellness Month in the United States. It turns out the month of May in the US is Mental Health Awareness Month, with the American Foundation for Suicide Prevention (AFSP) being one of its main promoters. Taking my cue from reports about high levels of stress in society today, this blog post focuses on causes of stress as well as some coping strategies. I hope you find it helpful!

In my recent blog post on emergency preparedness, I wrote about some of the many stressful situations people might encounter, including natural disasters, armed conflicts, health crises, and theft. It seems I’m not the only one noticing reasons for stress. Reports about stress abound.

Bryan Robinson, writing for Forbes in February, reported on a study conducted by Moodle that showed “66% of American employees are experiencing some sort of burnout in 2025.” In addition “81% of 18 to 24 year olds and 83% of 25 to 34 year olds [reported] burnout.” But it’s not just Americans feeling the stress. Mental Health UK, reporting in January on a study carried out by YouGov, indicated that 91% of the 4,418 UK adults surveyed “experienced high pressure or stress at some point over the last year.” It seems stress is a global phenomenon. And why not? We’re all human, after all.

It's not weak to speak about mental health. (American Foundation for Suicide Prevention)

What are some of the current causes of stress? Kayla Levy, in an article written on behalf of Charlie Health and distributed to the Brookings Register via Stacker in February, called “political polarization” a “significant source of stress for many Americans.” She referred to a study by the American Psychological Association (APA) that “found the future of the nation was the leading cause of significant stress among adults.” That 2024 study by the APA also found “the economy was the second most common…source of stress.” Other stressors noted in the study were “health care, violence and crime, the environment, global tension/conflict, gun laws and regulations, housing costs, mass shootings, the spread of false news, and social divisiveness.”

About a year prior to its 2024 report, in its “Stress in America 2023” report, the APA found another significant source of stress: “collective trauma” caused by the COVID-19 pandemic. That report noted that “psychologists with APA say a superficial characterization of day-to-day life being more normal is obscuring the posttraumatic effects that have altered our mental and physical health.” The report also noted that “widespread trauma has not been limited to the pandemic. Global conflict, racism and racial injustice, inflation, and climate-related disasters are all weighing on the collective consciousness of Americans.”

Whew! That’s a lot of stress! So what are we supposed to do about it? For that, I’d like to return to a post I wrote early in the COVID-19 pandemic: Coping with COVID-19. In it, I provided a list of coping strategies offered by the AFSP along with some reflections on how I was applying those strategies at that time. I updated that post when I wrote Overloading on Negativity. I’d like to update those reflections again now given the change in circumstances.

1- Separate what is in your control from what is not.

The first time I wrote about determining what I could control in a stressful time, I focused on actions I was taking that seemed in my control in the midst of a pandemic I had little control over. I mentioned not being able to control advice about masking, whether people were practicing social distancing, and the number of deaths occurring. Actions I could control included meeting work and volunteer deadlines, teaching my mother to grocery shop online, finding patterns for homemade face masks, and putting a teddy bear in the window as a sign of comfort and cheer.

Now, I find myself feeling stressed by current events such as wars, deportations, mass firings, cybersecurity lapses, and the like. Educating myself about these events is one proactive action I take to try to deal with the stress of uncontrollable things. Twice every day, I read the news from NPR, UPI (United Press International), Reuters, and the AP (Associated Press) to keep abreast of what’s happening. I find if I check on the news more often than that, it increases my stress. Checking twice daily keeps my stress in check because it helps me keep knowledgeable about what’s happening and lets me know if there are any new situations arising that I should take action to control in my life.

For example, when I first heard about potential cybersecurity lapses surrounding bank account information that taxpayers had submitted to the US Department of the Treasury when they paid taxes, I set up alerts through my bank to let me know when any activity occurs in any of my accounts. That way, if any unauthorized activity takes place, I’ll know about it within 24 hours. Although I can’t control access to my personal data from taking place, I can take action to mitigate its possibly negative effects.

As I wrote in my blog post about coping with COVID-19, “Thinking about all the things I can’t control can become overwhelming, but focusing on what I can control makes me feel better. It reminds me I’m doing the best I can do, which is all anyone can do. What are the things you can control these days?”


2- Do what helps you feel a sense of safety.

The first time I wrote about finding a sense of safety in the midst of a stressful time, the US was just emerging from its strictest lockdowns due to the COVID-19 pandemic. I wrote about observing people not complying with recommendations to avoid being around others, and I recounted my own efforts to do the opposite. I wrote about shopping online instead of in-person and masking whenever entering a public building.

Now I find myself in the midst of continuing concerns about the risks of COVID-19, especially Long COVID. I know someone whose stepmother recently died of COVID-19, and I also know someone who is dealing with Long COVID’s brain fog and fatigue. It’s certainly an impactful condition. When I feel fear about contracting Long COVID, a disease I can’t control, I remind myself of actions I can take to try to avoid it, such as these suggested by the Cleveland Clinic:

• getting vaccinated against COVID-19,
• washing my hands (or using hand sanitizer) frequently,
• masking in places that carry higher risks,
• limiting unnecessary exposure to other people who might be sick, and
• taking appropriate antiviral medication should I contract COVID-19.

Thankfully, according to the Cleveland Clinic, Long COVID is fairly uncommon, affecting only up to 10% of people who come down with COVID-19. I take some comfort in that knowledge. I also gain a sense of safety in the awareness that I’m taking the recommended actions to avoid Long COVID, even though others may be letting such actions fall by the wayside.

The point I want to make in this regard is the same point I made in my first post on this topic: “If the crowd is doing something that makes you feel unsafe, do something different.” And I’ll ask you the same question I asked before: “What is helping you feel safe these days?”

2- Get outside in nature.

Both times I wrote about this coping strategy previously, I mentioned taking walks in my neighborhood and watching nature through the window thanks to my birding hobby. Since then, more research has emerged attesting to the benefits of spending time communing with nature. Caroline Gable, writing for NU Sci Magazine, reported on the health benefits of what’s called “forest bathing.” Similarly, a group of authors writing in the International Journal of Environmental Research and Public Health noted a rise in interest in what they called “nature prescription programs,” in which spending time in nature is given as a prescription for ailments instead of or in addition to medication.

As for my current efforts to spend time with nature, I’ve continued with my bird watching hobby, even finding out I share the hobby with the famous author Amy Tan. I frequently grab a pair of binoculars to look through the window to see what bird it is that’s singing so beautifully out in the yard. Another way I spend time with nature is that when I read a book or a magazine, I often do so in a room with lots of windows where I can sneak a peek outside when I reach the end of a chapter or an article. Even when I’m not looking outside, just being surrounded by natural light as I read feels refreshing. With pollen season finally winding down, I hope to spend more time outside soon. Taking my book or magazine out to the patio and feeling the outdoor air while I read is certainly rejuvenating. How do you connect with nature on a regular basis?

3- Challenge yourself to stay in the present.

The first time I wrote about this coping strategy, I admitted it was challenging for me. It can be hard to stay in the present—acting on things you can control, doing what makes you feel safe, and appreciating nature—when you’re surrounded by situations with unknown outcomes. As I noted then, “not having answers creates uncertainty, which in many people, myself included, can cause stress.”

In that previous post, I listed several fun activities that can help with staying focused on the present:

• Reading books
• Listening to music
• Dancing
• Doing crossword puzzles
• Playing Sudoku
• Completing word searches
• Putting together jigsaw puzzles
• Playing board games
• Playing card games
• Knitting
• Crocheting
• Sewing
• Woodworking
• Coloring
• Painting

In my second post on coping strategies, I mentioned I was reading, doing crossword and jigsaw puzzles, and watching TV. I still do several of those activities regularly. I play a variety of games on my cell phone: solitaire, mahjong, dominoes, and crosswords. I do hard copy crossword puzzles and other word games as well. I also love reading books, as my blog has frequently attested, and I subscribe to and read several magazines regularly.

Other activities on my current list of ways to stay in the present include deep breathing (which I addressed in my second post on coping strategies as being helpful because it was something I could control), getting up to move several times a day, and streaming documentaries or other movies. One documentary I enjoyed was called Journey of the Bonesetter’s Daughter. It focused on Amy Tan’s semi-autobiographical novel The Bonesetter’s Daughter and the process of producing an adaptation of it as an opera. As I noted when reflecting on getting out in nature in #2 in this post, I recently discovered Amy Tan and I share a love of birding, so that’s one element that drew me to the documentary. And I’ve read all of her novels, making the documentary even more enticing.

I have a long enough list of movies queued up to keep me living in the present for a while! What activities do you enjoy that help you stay in the present, escaping for a little while from stressful situations with uncertain outcomes?

5- Stay connected and reach out if you need more support.

The first time I wrote about this strategy, I mentioned staying connected with people through social media. These days, I’m actually trying to reduce my use of social media. I may have taken this way of staying connected too far, as I found myself turning to social media, particularly Facebook, more and more often to find a sense of connectedness. As explained in an article in the BBC’s Science Focus magazine, social media can be addicting, and I wanted to avoid falling into that trap, so I’ve reduced my time spent there.

Instead, I’m using another technique for connectedness that I mentioned both previous times I wrote about this strategy, which is texting. And I’m using the Facebook and LinkedIn messaging features to communicate with friends and family members that way, although I prefer texting whenever possible. As I mentioned in my second post on coping strategies, I’ve also done video calls with a few friends, and my friend Algernon and I still exchange letters via snail mail. Groups I volunteer with meet via video on a frequent basis as well, and I’ve had a few phone calls with friends, also. As I mentioned in my second post on coping, I’m still writing this blog, too, as a way of staying connected with you, my readers.

As for reaching out for support, I’ve added that to my actions. Lately I’ve been having appointments with a licensed clinical mental health counselor (LCMHC) for some help in dealing with stress. Where I live, the LCMHC credential is common. As listed by Verywell Mind, others you may notice where you live include PsyD, LPC, or LCSW, to name a few.

If you feel you could benefit from a professional perspective, I encourage you to reach out to a counselor or therapist. As with physical health, self-help techniques only go so far when it comes to mental health. If your efforts to maintain a healthy mental state don’t seem to be enough, reach out for assistance. Just as you would see your doctor if you had a sore throat that wouldn’t go away, I encourage you to seek professional assistance if you feel you’d like help managing high levels of stress.

Some places where you can find assistance include the AFSP and PsychHub, which I mentioned the first time I wrote about this coping strategy. Resources are also available through the National Alliance on Mental Illness, also known as NAMI, or, if you’re in a mental health crisis, you can call or text 988, which I’ve written about before. If you’re interested in what experts in leadership and mental health have to say about coping with stress, you might check out this webinar on mental health during difficult times.

I hope you find this update on stress and coping strategies helpful. Let me know if you think of other coping strategies I haven’t mentioned!