The Holiday Cometh, My Waistline Goeth

Howdy, fellow Clubbies! How's December been for you this year? Cold? Wet? Windy? Too much food? Well, don't let any of those natural elements get in the way of having a nice close to the year. Here, sit down in this recliner, put yer feet up. Get you a cup of tea? Got introduced to Yorkshire Tea this year, by this great dame in the UK. Now, I don't have to sleep!! But, I also have many herbal teas, green teas, whatever you want. Ah, good choice. Need a pillow for your feet? No problem, here ye go. Say, how about some nice cookies, just made them. Enjoy!

So you don't feel awkward, being the first one here, not to worry, we expect a steady stream of visitors throughout the season, and we've recliners, and foot baths - you want one? No? OK, maybe later. We even have a foot massager coming a bit later - she's incredible, really knows clubby feet - has two of her own! Takes one to know one, doesn't it? That's what I always say. Hey, a little music? No, don't worry - I promise none of that chipmunk stuff. I can't stand it, either. Just a little easy jazz, for background, OK?

So, how's the year treated you so far? Tell me, did that thing work out, the doctor thing? Oh, good. And that shoemaker I sent you to - Oh, look at those!! Niiiiicceee! He really does a good job, doesn't he? Yeah, I know, a bit pricey. But it takes years to learn that craft, and he must put thirty, forty hours into each pair, all custom. Who else has that kind of patience these days, eh? But I bet you go back again - what? Three more pair on order? Well, I'm glad to have made the introduction, really. I probably ought to ask him for a finder's fee, I send so many his way. But I'm just glad to see another clubby get some improvement - I know what that's worth.

So, how's the family? Really? She's already in college? Oh, man, I'm getting old. Do you have a picture? Oh, my, she's a real beauty, you two did a great job. And the younger one? Wow, football! Good for him! Me? Well, some losses this year, but my sweety should be back in an hour, out getting her hair done. And you already met the dogs. No, girl, get down, down! Man, she just cannot get enough attention. No, down sit, that's a good girl. Hey, she loves everyone, what can I say? Oh, there's the door, I'll be right back.

Susan!! John!! Come on in! Wait till you see who's already here! Man, this is going to be one great clubby holiday party!! Oh, and there's Mark, and Jilli, and Shawn!

Howdy, Clubbies eile! Cén chaoi ar Nollaig curtha le haghaidh tú i mbliana? Fuar? Fliuch? Gaofar? Iomarca bia i bhfad? Bhuel, ná lig aon cheann de na heilimintí nádúrtha a fháil ar an mbealach ar a bhfuil gar deas na bliana. Anseo, suí síos sa recliner, a chur ar chosa yer suas. A gheobhaidh tú cupán tae? Got isteach chun Yorkshire Tae na bliana seo, leis an Dáma mór sa Ríocht Aontaithe. Anois, ní dóigh liom go bhfuil a chodladh!! Ach, tá mé chomh maith go leor taenna luibhe, tae glas, is cuma cad ba mhaith leat. Ah, rogha maith. Riachtanas is gá a pillow as do chosa? Fadhb ar bith, téigh anseo ye. Abair, conas mar gheall ar roinnt fianáin deas, ach iad a dhéanamh. Bain sult as!
Mar sin, nach mbraitheann tú awkward, is é sin an chéad cheann anseo, gan a bheith buartha, táimid ag súil le sruth seasta na gcuairteoirí ar fud an tséasúir, agus tá muid recliners, agus folcadáin coise - mian leat ceann? Uimh? OK, b'fhéidir níos déanaí. Againn fiú a bheith ag teacht le beagán massager chos níos déanaí - tá sí dochreidte, i ndáiríre a fhios ag cosa clubby - tá dhá cheann dá cuid féin! Glacann amháin a fhios ag duine, nach é? Sin an méid a rá liom i gcónaí. Hey, le ceol beag? Níl, ná bíodh imní ort - geallaim aon cheann de sin stuif chipmunk. Ní féidir liom seasamh leis, ach an oiread. Just snagcheol beag éasca, do chúlra, OK?
Mar sin, conas tá tú ag caitheamh na bliana go dtí seo? Inis dom, go raibh rud ag obair amach, an rud dochtúir? Ó, go maith. Agus go gréasaí Chuir mé tú - Ó, féach ar na!! Niiiiicceee! A dhéanann sé i ndáiríre post maith, nach bhfuil sé? Yeah, tá a fhios agam, le beagán daor. Ach a thógann sé bliana a fhoghlaim go ceardaíochta, agus ní mór dó a chur tríocha, daichead uair an chloig isteach i ngach péire, gach saincheaptha. Cé eile a bhfuil chineál sin de foighne na laethanta seo, eh? Ach mé geall leat dul ar ais arís - cad é? Péire Trí níos mó ar ordú? Bhuel, tá mé sásta go ndearna a thabhairt isteach, i ndáiríre. Is dócha gur chóir dom a iarraidh air ar feadh aimsitheoir táille, seol mé an oiread sin a bhealach. Ach tá mé díreach tar sásta a fheiceáil clubby eile a fháil ar roinnt feabhsúchán - Tá a fhios agam cad é go fiú.
Mar sin tá, conas an teaghlach? Really? Tá sí cheana féin sa choláiste? Ó, fear, tá mé ag dul d'aois. An bhfuil pictiúr? Ó, mo, tá sí fíor-áilleacht, chuaigh tú dhá post iontach. Agus an ceann níos óige? Wow, peile! Dea dó! Mise? Bhuel, ba cheart roinnt caillteanais na bliana seo, ach is mo sweety a bheith ar ais i uair an chloig, ag éirí as a cuid gruaige a dhéanamh. Agus bhuail tú cheana féin na madraí. No, cailín, a fháil amach, síos! Man, sí nach féidir a fháil ach aird go leor. No, suí síos, go bhfuil ina cailín maith. Hey, loves sí gach duine, cad is féidir liom a rá? Ó, níl an doras, beidh mé a bheith ceart ar ais.
Susan!! John!! Come on in! Fan go fheiceann tú atá an cheana féin anseo! Man, tá sé seo ag dul a bheith ar cheann pháirtí saoire iontach clubby!! Ó, agus níl Mark, agus Jilli, agus Shawn!

Howdy, collega Clubbies! Hoe in december al voor u dit jaar? Koud? Wet? Windy? Te veel eten? Nou, laat niet een van deze natuurlijke elementen in de weg van het hebben van een leuke buurt van de jaren. Hier, zitten in deze ligstoel, zet yer voeten omhoog. Krijg je een kopje thee? Heb je kennis met Yorkshire Tea dit jaar, door deze grote dame in het Verenigd Koninkrijk. Nu hoef ik niet te slapen! Maar, ik heb ook veel kruidenthee, groene thee, wat je wilt. Ah, goede keuze. Noodzaak van een kussen voor je voeten? Geen probleem, hier zult gij gaan. Zeg, wat dacht je van een aantal leuke cookies, maar maakte hen. Genieten!
Zodat je niet ongemakkelijk voelen, als eerste een hier, geen zorgen te maken, verwachten we een gestage stroom van bezoekers gedurende het hele seizoen, en we hebben ligstoelen, en voetbaden - u wilt een? Nee? OK, misschien later. We hebben zelfs een voet massage komt een beetje later - ze is ongelooflijk, echt weet clubby voeten - heeft twee van haar eigen! Duurt een om te weten een, nietwaar? Dat is wat ik altijd zeg. Hey, een beetje muziek? Nee, maak je geen zorgen - Ik beloof niets van dat spul chipmunk. Ik kan er niet tegen, ook niet. Gewoon een beetje gemakkelijk jazz, voor de achtergrond, OK?
Dus, hoe is het jaar behandeld die u tot nu toe? Vertel me, deed dat ding uit te werken, de dokter ding? Oh, goed. En dat schoenmaker ik stuurde je - Oh, kijk naar die! Niiiiicceee! Hij doet echt een goede baan, of niet? Ja, ik weet het, een beetje prijzig. Maar het duurt jaren om te leren dat ambacht, en hij moet dertig, veertig uur zet in elk paar, alle aangepaste. Wie anders heeft dat soort geduld deze dag, hè? Maar ik wed dat je weer terug te gaan - wat? Drie paar op bestelling? Nou, ik ben blij te hebben gemaakt van de introductie, echt waar. Ik zou wellicht om hem te vragen om tegen betaling een finder's, stuur ik zo veel zijn weg. Maar ik ben gewoon blij om te zien een andere clubby nog wat verbetering - ik weet wat dat waard is.
Dus, hoe gaat het gezin? Echt waar? Ze is nu al op de universiteit? Oh, man, ik wordt oud. Hebt u een foto? Oh, mijn, ze is een echte schoonheid, jullie twee heeft een geweldige job. En de jongste? Wow, voetbal! Goed voor hem! Mij? Wel moet een aantal verliezen dit jaar, maar mijn sweety terug in een uur, uit het krijgen van haar haar gedaan. En je al aan de honden. Nee, meisje, get down, down! Man, ze kan het gewoon niet genoeg aandacht. Nee, ga zitten, dat is een goed meisje. Hey, iedereen houdt van ze, wat kan ik zeggen? Oh, er is de deur, ik ben zo terug.
Susan! John! Kom op in! Wacht maar tot je ziet wie hier al! Man, dit gaat een geweldige vakantie clubby feest! Oh, en er is Mark, en Jilli, en Shawn!

Hola, Clubbies compañeros! ¿Cómo es diciembre sido para ti este año? Frío? Mojado? Viento? Demasiada comida? Bueno, no dejes que ninguno de los elementos naturales en el camino de tener un cierre agradable para todo el año. Aquí, siéntate en esta silla, poner los pies hasta yer. Conseguir que una taza de té? Se presentó a Yorkshire té este año, por esta gran dama en el Reino Unido. Ahora, no tengo que dormir! Sin embargo, también tengo muchos tés de hierbas, té verde, lo que quieras. Ah, buena opción. Necesidad de una almohada para sus pies? No hay problema, aquí entráis. Diga, ¿qué tal unas galletas agradable, sólo los ha hecho. Disfrute!
Así que no te sientes incómoda, siendo el primero aquí, no se preocupe, se espera un flujo constante de visitantes a lo largo de la temporada, y hemos sillones y baños para los pies - Quieres uno? ¿No? OK, tal vez más tarde. Incluso tenemos un masajeador de pies que viene un poco más tarde - ella es increíble, realmente sabe pies de club - tiene dos de su propio! Toma uno a saber uno, ¿no? Eso es lo que siempre digo. Hey, un poco de música? No, no te preocupes - le prometo nada de esas cosas ardilla. Yo no lo puedo soportar, ya sea. Sólo un poco de jazz fácil, para el fondo, ¿de acuerdo?
Entonces, ¿cómo es el año en que tratados hasta el momento? Dime, ¿que cosa funciona, la cosa doctor? Oh, bueno. Y que zapatero le envié a - ¡Oh, mira esas! Niiiiicceee! Él realmente hace un buen trabajo, ¿no? Sí, lo sé, un poco caro. Sin embargo, se necesitan años para aprender ese arte, y él debe poner treinta, cuarenta horas en cada par, todos ellos personalizados. ¿Quién más tiene ese tipo de paciencia en estos días, ¿eh? Pero apuesto a que volver de nuevo - ¿qué? Tres pares más en el orden? Bueno, me alegro de haber hecho la introducción, la verdad. Probablemente debería pedirle una comisión de intermediario, me envía para muchos su manera. Pero me alegro de ver a otro de club recibe algunas mejoras - Yo sé lo que vale la pena.
Entonces, ¿cómo está la familia? ¿En serio? Ya está en la universidad? Oh, hombre, me estoy poniendo viejo. ¿Tienes una foto? Oh, mi, ella es una verdadera belleza, que ustedes dos hicieron un gran trabajo. Y el más joven? Wow, el fútbol! Bien por él! Me? Bueno, algunas pérdidas de este año, pero mi chinita debe estar de vuelta en una hora, sin conseguir su pelo hecho. Y que ya se ha reunido a los perros. No, niña, abajo, abajo! El hombre, que no puede obtener suficiente atención. No, por sentado, que es una buena chica. Hey, que ama a todos, ¿qué puedo decir? Oh, ahí está la puerta, voy a estar de vuelta.
Susan! John! ¡Adelante! Espera a ver que ya está aquí! Hombre, esto va a ser una gran fiesta de club de vacaciones! Ah, y no hay marca, y Jilli, y Shawn!  

Salve, Clubbies compagni! Come nel dicembre stato per voi quest'anno? Freddo? Bagnato? Windy? Anche molto cibo? Beh, non lasciate che nessuno di questi elementi naturali ottenere nel senso di avere un vicino bello dell'anno. Qui, sedersi in questa poltrona, yer mettere i piedi in su. Farti una tazza di tè? Ha introdotto nello Yorkshire Tea quest'anno, da questa grande dama nel Regno Unito. Ora, non c'è bisogno di sonno! Ma, ho anche molte tisane, tè verde, quello che vuoi. Ah, buona scelta. Hai bisogno di un cuscino per i vostri piedi? Nessun problema, andate qui. Dire, che ne dici dei biscotti bello, appena li ha fatti. Buon divertimento!
Quindi non ci si sente scomodo, essendo la prima qui, non preoccuparti, ci aspettiamo un flusso costante di visitatori durante tutta la stagione, e abbiamo lettini, e pediluvi - vuoi uno? No? OK, forse più tardi. Abbiamo anche un piede massaggiatore a venire un po 'dopo - lei è incredibile, sa veramente piedi clubby - ha due dei suoi propri! Prende uno per conoscere uno, non è vero? Questo è quello che dico sempre. Ehi, un po 'di musica? No, non ti preoccupare - ti prometto niente di quella roba scoiattolo. Io non lo sopporto, neanche. Solo un po 'di jazz facile, per lo sfondo, OK?
Allora, come l'anno è trattato finora? Dimmi, che cosa ha funzionato, la cosa medico? Oh, bene. Calzolaio e che ti ho inviato - Oh, guarda questi! Niiiiicceee! Fa davvero un buon lavoro, no? Sì, lo so, un po 'caro. Ma ci vogliono anni per imparare che le imbarcazioni, e lui deve mettere trenta, quaranta ore in ogni coppia, tutti personalizzati. Chi altro ha quel tipo di pazienza in questi giorni, eh? Ma scommetto che si torna di nuovo - che cosa? Tre coppie più in ordine? Bene, sono contento di aver fatto l'introduzione, davvero. Probabilmente ho dovuto chiedergli tassa di un cercatore, mando tante la sua strada. Ma io sono solo contento di vedere un altro clubby ottenere qualche miglioramento - So cosa che vale la pena.
Allora, come sta la famiglia? Davvero? Lei è già al college? Oh, uomo, sto diventando vecchio. Hai una foto? Oh, mio, lei è una vera bellezza, voi due ha fatto un ottimo lavoro. E la più giovane? Wow, il calcio! Buon per lui! Me? Beh, alcune perdite di quest'anno, ma il mio Sweety dovrebbe tornare in un'ora, fuori ottenere i capelli fatto. E voi già incontrato i cani. No, ragazza, scendere, giù! L'uomo, lei non ne ha mai abbastanza attenzione. No, giù sedere, che è una brava ragazza. Ehi, che ama tutti, cosa posso dire? Oh, c'è la porta, io torno subito.
Susan! John! Avanti! Aspetta di vedere chi è già qui! L'uomo, questa sarà una parte grande festa clubby! Ah, e c'è Mark, e Jilli, e Shawn!

Howdy, Clubbies compatriotes! Comment va Décembre été pour vous cette année? Froide? Wet? Windy? Trop de nourriture? Eh bien, ne laissez pas l'un de ces éléments naturels obtenir de la manière d'avoir une belle fin d'année. Ici, s'asseoir dans ce fauteuil relax, mettre les pieds jusqu'à yer. Obtenez-vous une tasse de thé? Été présenté à Yorkshire Tea cette année, par cette grande dame au Royaume-Uni. Maintenant, je n'ai pas de dormir! Mais, j'ai aussi de nombreuses tisanes, thés verts, ce que vous voulez. Ah, bon choix. Besoin d'un oreiller pour vos pieds? Pas de problème, ici, vous irez. Dis, comment au sujet de certains biscuits agréable, juste les faits. Amusez-vous!
Donc vous n'avez pas mal à l'aise, étant le premier ici, ne vous inquiétez pas, nous nous attendons à un flux constant de visiteurs pendant toute la saison, et nous avons inclinables, et les bains de pieds - vous en voulez un? Non? OK, peut-être plus tard. Nous avons même un massage de pieds à venir un peu plus tard - elle est incroyable, sait vraiment clubby pieds - a deux de ses propres! Prend un pour connaître un, n'est-ce pas? C'est ce que je dis toujours. Hé, un peu de musique? Non, ne vous inquiétez pas - je promets qu'aucun de ces trucs tamia. Je ne peux pas le supporter, que ce soit. Juste un peu de jazz facile, pour le fond, OK?
Alors, comment vous avez traité l'année jusqu'à présent? Dites-moi, cette chose ne fonctionne pas, la chose médecin? Ah, bon. Et ce cordonnier, je vous envoyé à - Oh, regarde ces! Niiiiicceee! Il fait vraiment du bon boulot, n'est-ce pas? Ouais, je sais, un peu cher. Mais il faut des années pour apprendre que les embarcations, et il doit mettre trente, quarante heures dans chaque paire, toutes personnalisées. Qui d'autre a ce genre de patience ces jours-ci, hein? Mais je parie que vous allez revenir - ce? Trois paires plus sur commande? Eh bien, je suis heureux d'avoir fait l'introduction, vraiment. J'ai probablement devrais lui demander des honoraires d'intermédiation, j'envoie tellement son chemin. Mais je suis juste content de voir un autre clubby obtenir une certaine amélioration - Je sais ce que ça vaut.
Alors, comment la famille? Vraiment? Elle est déjà au collège? Oh, mec, je me fais vieux. Avez-vous une photo? Oh, mon, elle est une vraie beauté, vous deux fait un excellent travail. Et le plus jeune? Wow, le football! Tant mieux pour lui! Moi? Eh bien, certaines pertes de cette année, mais ma Sweety devrait être de retour dans une heure, à se faire coiffer. Et vous avez déjà rencontré les chiens. Non, ma fille, descendre, vers le bas! L'homme, elle ne peut pas obtenir assez d'attention. Non, en baisse de s'asseoir, c'est une bonne fille. Hé, elle aime tout le monde, ce que je peux dire? Oh, il ya la porte, je reviens tout de suite.
Susan! John! Entrez! Attendez de voir qui est déjà là! L'homme, cela va être une grande fête de vacances clubby! Oh, et il ya Mark, et Jilli, et Shawn!

Γεια σου, τους συναδέλφους Clubbies! Πώς του Δεκεμβρίου ήταν για σας αυτό το έτος; Κρύο; Wet; Windy; Πάρα πολλά τρόφιμα; Καλά, μην αφήνετε κανένα από αυτά τα φυσικά στοιχεία πάρει με τον τρόπο του με ένα ωραίο κοντά στο χρόνο. Εδώ, να καθίσει σε αυτό το recliner, βάλτε τα πόδια yer επάνω. Φέρω ένα φλιτζάνι τσάι; Πήρε εισήχθη στο Yorkshire Τσάι αυτό το έτος, με αυτή τη μεγάλη Dame στο Ηνωμένο Βασίλειο. Τώρα, δεν έχω να κοιμηθώ! Αλλά, έχω και πολλά αφεψήματα, πράσινο τσάι, ό, τι θέλεις. Αχ, καλή επιλογή. Χρειάζεστε ένα μαξιλάρι για τα πόδια σας; Κανένα πρόβλημα, εδώ εσείς πάτε. Ας πούμε, τι θα λέγατε για μερικά ωραία τα cookies, τους έκανε ακριβώς. Απολαύστε το!
Έτσι, δεν αισθάνεστε άβολα, όντας η πρώτη εδώ, για να μην ανησυχείτε, αναμένουμε μια σταθερή ροή των επισκεπτών σε όλη τη σεζόν, και έχουμε ξαπλώστρες, καθώς και χώρων πλυσίματος των ποδιών - θέλετε ένα; Όχι; Εντάξει, ίσως και αργότερα. Έχουμε ακόμη να έχει μασάζ ποδιών έρχεται λίγο αργότερα - Είναι απίστευτο, πραγματικά ξέρει Clubby πόδια - έχει δύο δικά της! Λαμβάνει να γνωρίζει κανείς ένα, έτσι δεν είναι; Αυτό είναι που λέω πάντα. Γεια σου, λίγη μουσική; Όχι, μην ανησυχείτε - Υπόσχομαι κανένα από αυτά chipmunk. Δεν μπορώ να σταθεί, ούτε. Λίγο εύκολο τζαζ, για το φόντο, εντάξει;
Έτσι, πώς είναι το έτος σας μέχρι τώρα; Πείτε μου, έκανε αυτό το πράγμα λειτουργήσει, πράγμα το γιατρό; Ω, καλά. Και αυτό τσαγκάρης που σας έστειλα να - Ω, κοίτα αυτά! Niiiiicceee! Κάνει πολύ καλή δουλειά, δεν είναι; Ναι, το ξέρω, είναι λίγο ακριβός. Αλλά παίρνει χρόνια για να μάθουν ότι τα σκάφη, και αυτός πρέπει να θέσει τριάντα, σαράντα ώρες σε κάθε ζεύγος, όλους τους τελωνειακούς. Ποιος άλλος έχει αυτού του είδους την υπομονή αυτές τις μέρες, ε; Αλλά εγώ το στοίχημα πάτε πίσω πάλι - τι; Τρεις ακόμη ζευγάρι στην τάξη; Λοιπόν, είμαι στην ευχάριστη θέση να έχουν κάνει την εισαγωγή, πραγματικά. Μάλλον θα έπρεπε να τον ρωτήσω για την αμοιβή ενός ανιχνευτή, στέλνω τόσα πολλά τον τρόπο του. Αλλά είμαι ακριβώς ευτυχής να δω μια άλλη Clubby πάρετε κάποια βελτίωση - Ξέρω τι αξίζει.
Έτσι, πώς είναι η οικογένεια; Αλήθεια; Είναι ήδη στο κολέγιο; Ω, ο άνθρωπος, θα σου βάλω παλιά. Έχετε μια φωτογραφία; Ω, μου, αυτή είναι μια πραγματική ομορφιά, εσείς οι δύο έκαναν σπουδαία δουλειά. Και η μικρότερη; Πω πω, το ποδόσφαιρο! Καλό για αυτόν! Εμένα; Λοιπόν, κάποιες απώλειες το τρέχον έτος, αλλά sweety μου θα πρέπει να είναι πίσω σε μια ώρα, να πάρει έξω την τρίχα της γίνει. Και εσείς ήδη συναντηθεί με τα σκυλιά. Όχι, κορίτσι, πέσε κάτω, κάτω! Ο άνθρωπος, που απλά δεν μπορεί να πάρει αρκετή προσοχή. Όχι, να καθίσει κάτω, αυτό είναι ένα καλό κορίτσι. Γεια σου, αγαπά ο καθένας, τι μπορώ να πω; Ω, υπάρχει η πόρτα, θα είμαι πίσω δεξιά.
Susan! John! Έλα μέσα! Περιμένετε μέχρι να δείτε ποιοι είναι ήδη εδώ! Ο άνθρωπος, αυτό θα είναι ένα μεγάλο κόμμα Clubby διακοπές! Ω, και δεν υπάρχει Mark, και Jilli, και Shawn!

    

Dealing With It

One of the more common refrains many clubbies report having thrown at them over the years is, "Deal with it." That is just ahead of "Work through it" in the ignorant insults rally. Both these, and others like them, are never heard coming from a fellow clubby, just from people who have no idea what they are talking about. Do they think we are just making this ridiculous amount of pain up, that we just "want attention?" Actually, yes. We DO want attention - of the medical community, for them to actually do their job and conduct real research into both club feet and its etiologies, and into the sequelae found in post-club feet syndrome. And until that happens, quit with the "suck it up" crap, OK? Because, as I already so rudely stated, you haven't got a clue, until you've spent even one day in our shoes. And orthotics. And real, not imagined, pain.

I often wonder how people who make such asinine comments would take it if we spoke of their obvious ignorance in a similar fashion? "Hey, Bozo, shut yer trap," or "Do you really mind everyone seeing you without a brain?" Obviously that would just be a sign of bitter reprisal, but, as you who would pass such baloney in our direction should know if you were to turn that mirror around, such responses only get bitterness in return, so I am not advocating you other clubbies out there doing this. Instead, simply look at the bozo, shake your head sympathetically, and give them no further attention. It merely fuels their own disability, you see.

Of course, the difference is, they CAN shut their mouths. We clubbies, on the other hand, can't just exchange our feet for a new pair, much as we may dream of such an option. So, if you just can't restrain yourself, and let go a big "back atcha!" on a bozo, don't worry. You are forgiven. I mean, how better, once in a while, to just deal with it, eh?

Post-Club Foot Clinic Project

I want to make an offer to all fellow clubbies. It's not free, except for the time I put into it, but it is fairly comprehensive. I am putting together a set of highly qualified professionals with the aim toward developing a once-a-year clinic here in San Francisco. It will be comprised of a top-notch therapeutic shoemaker that has worked with nearly every pathology on the planet, and knows how to make the shoes look wonderful; a biomechanically-focused podiatrist, with many years treating all foot problems, including many with PCF, who will cast for orthotics; a seasoned surgical consultant, a top-level orthotic lab to produce any devices needed; and myself as the coordinator. We will be aiming at fall of 2012 to launch the clinic. It will be held over a two-week period initially, and if the demand is sufficient, expand that in following years.

This clinic will focus EXCLUSIVELY on post-club feet syndrome. We are aiming at making this centered on a single cost for the clinic itself, though footwear and orthotics will be additional based on specific needs. We will be seeking grants to fund the initial phases, and depending on our success in that area, to offset other costs to people who attend the clinic. However, attendees will have to foot their own travel and lodging expenses. We will aid attendees in locating cost-effective lodging and transportation on the ground.

I cannot give a specific date as yet - there's a lot to be done to make this a reality. But the intent is to create a one-stop consultancy with both orthotics and footwear specifically built to the individuals feet and specific needs, a full gait analysis and biomechanical assessment, and a surgical consult with x-rays as part of the consultation. This project has already begun - initial discussions have been held with at least three of the positions desired, and more will follow.

So, stay tuned to this space for more details as they develop.

What Life is Like for a Clubby – A Typical Day

5 AM. Alarm goes off – slam it against the wall. 

5:30 AM. Other alarm goes off, positioned across the room. Put pillow over head. Wait ten minutes, or less if your partner yells at you to get up and get going and turn that damn thing off.

5:40 AM. Hobble to the alarm, turn it off. Sit on the edge of the bed because your feet, knees, hips, back, neck are screaming at you, despite a solid 4-5 hours of heavily interrupted sleep.

5:50 AM. Push up from the bed, stand still for several minutes while you work to convince yourself this is actually do-able. Hobble to the bathroom, do your morning ablutions. Hobble back to bedroom, pull on your compression socks/elastic ankle brace/AFO/whatever, then get dressed.

6:15 AM. Breakfast, interrupted occasionally by electrical-storm cramping in one or several extremities. Wonder if the general body ache is worse or better than the day before. Maybe take a pill.

6:30 AM. Get in car/bus/train, go to work/look for job, hope you can keep your walking/standing time within your constitutional limits, unlike yesterday.

8:30 AM. Take pill, maybe.

9:30 AM. Remind boss why you are the wrong person to send out to canvas the local businesses/do his shopping/carry those ten boxes to FedEx/etc., and remind him what happened last time he did that. Hope he doesn’t threaten to fire your sorry, crippled ass. Before heading out, put on second elastic ankle braces over the first set. Maybe take a pill.

12 noon. Lunch. Forgot to prepare one this morning due to pain-induced procrastination. Force yourself to go to the nearest restaurant/fast food/burrito palace despite getting serious food poisoning there the last time, but at least its close. Chalk up another successful trade-off. Take the zantac before and after, just in case.

1:00 PM. Return to work. Enter basement/top floor storage closet, close door, scream for two minutes. Upon coming out, encounter a manager, and just say, “therapy, doctor-recommended,” and return to your station/cubicle/cash register/lift truck/etc. Sit/stand until next break. Maybe take a pill.

3:00 PM. Leave early to make it to doctor appointment. Arrive ten minutes late, receive disapproving look from receptionist, then wait for two hours as the sword of retaliation cuts you down. Enter doctor’s exam room. Wait. Get blood pressure and temperature taken. Wait. Get a reassuring promise from the assistant that it “won’t be much longer.” Wait.

4:30 PM. Doctor enters exam room, looks at your chart, says, “hmm” several times, then aims a fake smile in your direction, clears his throat. Hear him say exactly what he said last visit. Ask for another Rx. Hear him say, “well….. I’m concerned about possible addiction issues with the amount of pain medications you’ve taken so far.” Remind him about your always-on, chronic, no let-up in sight screaming bad pain. Tell him you appear to be already addicted to pain, and can’t he help you fight that addiction. Realize he is incapable of appreciating sarcasm, or irony, or both. Hear doctor repeat, “well……. Let’s try some different approaches to pain management. How about meditation, hmmm?” Repress strong desire to stab doctor in eye with his own always-clicking pen. Tell him the pain keeps you from sleeping, from getting up, from having sex. That last one does the trick. He also writes an Rx for Viagra. If you are a female, remind him of the uselessness of such an Rx, or not. Maybe take it for your partner. Let HIM take a pill this time.

6:00 PM. Take car/bus/train/cab home. Alternately, take a long walk off a short pier, er, go shopping for groceries. Say “screw it” and purchase extra-large tub of chocolate ice cream. Vow to bite off the head of your partner if they so much as raise an eyebrow about it. Then go home.

7:30 PM. After partner complains about their day, and shares excuses about why they cannot make the dinner tonight, open a can/take from freezer/call for delivery. Shoot dirty looks at partner/kids/dogs/cat/hamster when they ask what time dinner will be ready. Take a pill, definitely.

9:00 PM. Remove shoes/braces/splints/compression socks. Scream for ten minutes, screw the storage closet approach – let everyone else in on the secret. Ask your partner for a foot massage. Or, give him that pill. Whatever. Resent the lackluster approach they show, either way.

10:00 PM. Watch Grey’s Anatomy. Cry. Demand partner go and fetch the ice cream. Threaten them with a spoon if they so much as ask for some – it’s all yours, dammit! Take a break to slather on some of that useless deep-heating ointment. Maybe take a pill.

11:00 PM. Go to bed. Spend half-an-hour arranging blankets/pillows/ice pack/heating pad to the right specifications. Ignore the complaints of your partner that you are doing this just to annoy them, but consider using that on another night. Spend another hour finding the “right position.” When your partner tries to initiate intimate relations, ignore his pleas and his reminder that you did, after all, give him that pill. Let him suffer. Your night time cramp-screams help with that proposition.

3:00 AM. Get up, hobble to bathroom, step on the cat’s tail in the dark, hit your toe on an object in the hall later identified as child’s dump truck, curse loudly. Hobble back to bed. Take another hour to find that comfortable position again. Cry occasionally.

6:00 AM. Vow to get another alarm clock, realize you’ve already gone through seven this year alone. Begin another day. Definitely take a pill.

Another Post About the Not-So-Fatted Calf

Went to see my massage therapist yesterday. He spent an entire hour and a quarter just working on my feet and legs. And he really went digging for gold, let me tell you. Deep tissue? Pshaw, 'tain't nothing to that. No siree! He went to the bottom of the Marianas Trench! But, being that he held my most painful calf, the left, in the palm of his hand, he was able to make several quite astute (though no less painful) observations about that particular item of my anatomy.

"You have some funny calves." There, now its no longer my secret, I thought. I didn't say it out loud, of course. But what I did say was, "Uh, funny, ha ha? Or, funny, you may want to take out a life insurance policy?" He thought this was superb massage table humor. Yes - he laughed. But then he said this: "the top of your calf narrows from it's widest point very abruptly. Most people's calves taper from the widest point to the insertion of the tendon more gradually." I suggested that perhaps it's because I'm just special, but he wasn't biting (thank goodness.) He knows about my "special" problem - yep - post-club feet, so I wasn't going to get away with anything on this go-round. So, we just bantered back and forth for a while, doing that speculative boogie occasioned by people with a fetish for biomechanics like to do.

It occurred to me that this may be another aspect of the overall issue of atrophy peculiar to Post-Club Feet, where the actual muscle fibers are substantially different compared to the general population. They are in fact shorter fibers, when viewed under a microscope. So perhaps this shortening of the fibers also manifests with this more abrupt tapering of the gastrocnemius and soleus muscles as they approach the posterior knee. And that brings us to this week's question for the clubbie hoards out there: Do you have this particular shape to your calf muscles, where they taper toward the knee very abruptly? You can test this a number of ways to arrive at your answer:    

Compare your calf to another family member's or friend's calf muscles. Palpate (that just means feel) your own calf's shape, then palpate the shape of your "control group." Then, try it with a few more people, to rule out ( somewhat) the random factor. Focus on the upper third of the calf, from the widest part to the back of the knee. Yes, I am asking you all to participate in a very simple bit of research. And if you want to take it a step further, then get out your camera! Have someone photograph the backs of your calves, while you are standing. Then, photograph each of your "control group's" calves in the same posture. If there is something to this bit of speculation, and if we can entice a sufficient number of you clubbies into taking part in it, we may actually be able to add something to the rather limited knowledge base regarding post-club feet!

Now, wouldn't that be fun?!

The Weakness at the Edge of Town

I recently had a doctor say to me: "look, you really need to get focused on how you felt when everything was working right, instead of focusing on your pain. That's what it takes to recover after a surgery." Yeah, I know - should have just slapped his face. Would have been less wear and tear on my vocal cords. But, you know me - why punch when you can just harangue, right? I mean, what is it about, "I have severely atrophied musculature in my lower legs from a congenital condition" that these guys just can't get? "Work harder and you'll be able to re-build them." Oh, criminy sakes, would you guys just listen to yourselves? Where exactly did you do your medical educations?

But that's really just a part of the over-all slide into opinion as the primary operating procedure for expertise we are seeing in this country (yes, yes, its my opinion. Sheesh - it's also my blog, and I don't do this very often, so be patient, OK? The meds ought to kick in soon.) From pretty much every profession, yes, even those supposedly held firmly in the grip of the scientific process, the tendency is toward cookie-cutter thinking, framed through the lenses of ideologies.

So, to review the (actual) science. re: muscle atrophy:

This is an abstract from:

Journal of Bone and Joint Surgery - British Volume, Vol 59-B, Issue 4, 465-472
Copyright © 1977 by British Editorial Society of Bone and Joint Surgery

The muscles in club foot--a histological histochemical and electron microscopic study

H Isaacs, JE Handelsman, M Badenhorst, and A Pickering
In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of neurogenic disease was seen in most instances and was more obvious in the older patients. The pattern of abnormality was similar in both muscle groups. It is thought that shortening of the postero-medial muscles may result from a small increase of fibrosis due to minor innervation changes occurring in intra-uterine life. There is evidence that immobilisation, stretching or relaxation of muscles does not account for the anomalies observed. This study of the extrinsic muscles in talipes equino-varus indicates a dominant neurogenic factor in its causation. 

And this one:

Talipes equinovarus

Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?

Related Articles

Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?
J Child Orthop. 2009 Jun;3(3):171-8
Authors: Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A
PURPOSE: To investigate whether atrophy of the leg muscles present in congenital clubfoot (CCF) is primitive or secondary to treatment of the deformity. METHODS: Magnetic resonance imaging (MRI) of both legs was taken in three cohorts of patients with unilateral congenital clubfoot (UCCF): eight untreated newborns (age range 10 days to 2 weeks); eight children who had been treated with the Ponseti method (age range 2-4 years); eight adults whose deformity had been corrected by manipulation and casting according to Ponseti, followed by a limited posterior release performed at age 2-3 months (age range 19-23 years). All of the treated patients wore a brace until 3 years of age. Muscles were measured on transverse MRI scans of both legs taken midway between the articular surface of the knee and the articular surface of the ankle, using a computer program (AutoCAD 2002 LT). The same program was used to measure leg muscles in the histologic cross sections of the legs of two fetuses with UCCF, spontaneously aborted at 13 and 19 weeks of gestation, respectively. Measurements of the whole cross section of the leg (total leg volume: TLV), of the muscular tissue (muscular tissue volume: MTV), and of the adipose tissue (adipose tissue volume: ATV) of the tibia, fibula, and of the other soft tissues (tendons, nerves, and vessels) were taken by using an interactive image analyzer (IAS 2000, Delta System, Milan, Italy). RESULTS: Marked atrophy of the leg muscles on the clubfoot side was found in both fetuses and untreated newborns, with a percentage ratio of MTV between the normal and the affected leg of 1.3 and 1.5, respectively. Leg muscle atrophy increased with growth, and the percentage ratio of MTV between the normal and the affected leg was, respectively, 1.8 and 2 in treated children and adults. On the other hand, fatty tissue tended to increase relatively from birth to adulthood, but it could not compensate for the progressive muscular atrophy. As a result, the difference in TLV tended to increase from childhood to adulthood. CONCLUSIONS: Our study shows that leg muscular atrophy is a primitive pathological component of CCF which is already present in the early stages of fetal CCF development and in newborns before starting treatment. Muscular atrophy increases with the patient's age, suggesting a mechanism of muscle growth impairment as a possible pathogenic factor of CCF.

 (bold highlite added for emphasis)

So, the next time a doctor, PT, orthotist, etc., makes some remark that you just aren't working hard enough, or that if only you'd get focused on healing (like that would be the last thing you really would want, right?) send them these two abstracts.

Then, tell them to shut up and refer you to someone who's already done their homework.

Oh, just to do full disclosure? The second abstract above? I found it at http://www.checkorphan.org/

This is from their "About" page:

CheckOrphan is a non-profit organization located in Basel, Switzerland and Santa Cruz, California that is dedicated to rare, orphan and neglected diseases. CheckOrphan offers users an interactive and dynamic platform for all these diseases. This strategy allows visitors to be updated daily on all the latest news and interact with people internationally. This is essential, because due to the nature of these diseases, there is not a large concentration of individuals within any given proximity. 

Visit them today, learn about their mission. They are doing the real work, for people like us - people whose issues fall between the cracks.

Calculations and Considerations

Perhaps one of the most frustrating things about post club feet is their variability, their unpredictability (though it's not so hard to predict they will only get worse over time.) What I mean by this is how one day the pain is tolerable, and the next? Who knows? It always seems to make anything I want to do, say, go to the park with my dogs, an adventure in calculations. "Let's see - if I go and walk just for ten minutes, then I will only need to prop up my feet with an ice pack for a half an hour tonight. But if I go over, tomorrow's gonna be a real bear. Hmm. What to do?" This is not unlike the dilemma faced by folks with arthritis. The very thought of getting to their feet is fraught with complexity. "I'll leave the door unlocked, so that when Martha drops by for a visit, I can just yell for her to come on in. But with all the crime in the world today, perhaps I shouldn't. OK, I'll just flip a coin..."

The same holds true for the level and the quality of the chronic and not-so-occasional sharp pain. That famous 1-10 scale? For us clubbies, it should start at 5, and go all the way to 25. Five is pretty much background noise. Seven is an uncomfortable day. Ten and up? Do not allow me to own a gun. No, I am not suicidal. Why would I want to use a gun on myself? But the next bozo that cuts in front of me and makes me stop short? or the joker of a bus driver who likes to hit the brakes or the gas when people are not even in a seat yet? or the next complete idiot who tries to dismiss my pain and disses me for having handicapped plates on my van? Yeah. It would be for them. That's why I don't want to own one. I simply do not wish to make the six-o'clock news, that's all.

Having one club foot stinks, but having two? Well, that's pretty special. Every time one gets a bit worse than the other, I can start limping to put more weight on the temporarily "good" foot to give the really bad doggie a rest. Then, several hours later, I can switch! What fun! It's like serial self-flagellation - well, that set of raw bleeding welts is starting to sting, so I better get to work on the other side. Oh, yes, that's the ticket!

And what about those shoes and orthotics, eh? Aren't they special? When they are new, I have to deal with the "break-in" period. Then, after several truly fun weeks getting "broken-in - not the orthotics, mind, but the feet,) I get maybe a month before there's enough wear on my shoes that the balance is once again off by, oh, I don't know - 1/2 a degree, maybe? And then, it all goes to pot again. So, to maintain anything remotely related to general comfort, I have to re-balance the soles of my shoes at least once a month. More money, more time - it's what I live for.

And what about those doctor's, hey? "Well, your x-rays look fine, they can't really hurt that bad. So, I can't give you a refill for your meds - don't want you getting addicted, you understand?" No. No I don't "understand." You see, Doc, it's like this - these feet? I am unfortunately addicted to THEM. So, pain meds help me break my addiction, at least temporarily. He ain't buying it! OK, I say, try to see it this way, Doc. I GET TO LIVE IN PAIN THE REST OF MY LIFE, REGARDLESS OF WHAT THOSE DAMN X-RAYS SUGGEST TO YOU, SO GIVE ME JUST ONE THING TO HELP ME GET SOME RELIEF!! Oh, I see - - you have no idea what to do? Well, why didn't you say that in the first place? I feel better already.

Well, sarcasm aside, I can't think there's a single clubby out there who does not hold the fervent desire to get just one day in their lives where they didn't have to even think one time about their feet. To do what they want to do, go where they like, and not once think, "well, I've already walked about a mile today, all told, so I think I might have a quarter mile left. What the hell, I'll take the chance." Sheesh, nice deal, eh? Who needs pain meds when you're having this much fun!?

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Once the Recordings screen is up, look at the Calendar in the upper right hand corner. Select September 30. Then scroll to the date of the 30^th, and click on International Clubfoot Week – it is at this point you will be prompted to Install Java – click on those words! – follow the prompts, including any other pop-up windows – always select Yes. It takes a few moments for the Eluminate Session screen to fully load, so be patient.

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Willy Kiyotte