Avoiding (Carpal) Tunnel Vision

"It's fine for you to explore other options, but if you're not better in six weeks, you should have the surgery or you'll permanently damage the median nerve."

That’s what the hand surgeon told me on after diagnosing me with carpal tunnel in January of 2016.

The words “permanent damage” might make most people agree to surgery for carpal tunnel right on the spot. There are at least a couple of reasons, however, why I was reluctant to jump on the surgery bandwagon.

When I fell off a ladder in September 2015 and sustained a buckle fracture to that same wrist (along with a broken metatarsal in the opposite foot—but that’s another story), I felt no hesitation in undergoing surgery. Not repairing the splinter of bone jutting off my left radius was unthinkable to me, and though I am no fan of surgery, we moved forward quickly to surgically insert a metal plate over the bone. I had really only just recovered from that surgery when I started experiencing numbness in my middle and index fingers and thumb. But after having experienced pretty severe postsurgical pain, weeks of occupational therapy, and six weeks away from work, I was none too eager to have another surgery.

In addition, from my training as a massage therapist, I remembered that a tight muscle in the chest or neck area could cause numbness in those same fingers. I wasn’t convinced, in other words, that I even had carpal tunnel issues.

But neither my internist nor the doctor of osteopathy who I consulted for additional opinions gave much credence to my theory that the numbness might be caused by something other than carpal tunnel syndrome, both of them suggesting that I should have the carpal tunnel surgery—this even after the Tinel’s and Phalen’s sign tests used to help diagnose carpal tunnel were negative. The doctor of osteopathy responded to my lack of pain upon her administration of these tests by saying, “Good—that means it’s not very bad yet.” (What, then, is the point of the tests, I wondered.) She also told me that the numbness I was experiencing couldn’t be due to the tight scalene muscles in my neck because, if that were the cause, I’d have numbness or pain all the way down my arm, which I didn’t.

She speculated that my carpal tunnel was caused by scar tissue in the wrist area from the surgery I’d had the previous autumn. “The surgeon can clean that all out,” she told me. It was only afterward that it occurred to me that if she was right that the scar tissue from surgery had caused my problem, wouldn’t having surgery to clean out the scar tissue only cause more scar tissue?

In short, rather than being more convinced to have the surgery after seeing the doctor of osteopathy, I felt even less inclined to do so. Instead, I kept reading about nerves and carpal tunnel syndrome, trying to learn more, and everything I read made me all the more skeptical that surgery was the right way to go for me.

For one thing, I only had some numbness in my fingers. I had zero pain, no loss of grip strength, no aching in my forearm or elbow, and no stiffness in my fingers—all symptoms of carpal tunnel. I only had the numbness—so why would I undergo surgery, with all of the usual risks that any surgery involves (anesthesia complications, infection, etc.), along with the particular risks of carpal tunnel surgery? The fact of the matter, of course, is that many people undergo carpal tunnel surgery with no complications or problems at all and experience tremendous relief from it.

However, small percentages of people, following surgery for carpal tunnel, do have problems, including damage to the median nerve, scar tissue, permanent weakness in the hand, persistence of the symptoms even after surgery, or a recurrence of the symptoms at some time in the future. Again, the percentages of people suffering such problems are small, but why would I want to take those risks when I had no pain and no loss of function?

Furthermore, the reading I’d done about nerve damage at various reputable medical sites made it clear that nerves regenerate. The caveat is that nerve regeneration doesn’t always mean return of function to the area the nerve serves, though I believe this tends to be a problem more common to instances where the nerve is severed (versus a nerve that is compressed—as is the case with carpal tunnel syndrome). At any rate, the Center for Nerve Injury and Paralysis at Washington University says, “Most often, symptoms that result from compression of a nerve can be reversed, even in long-standing cases.”

Still, I wasn’t entirely sure what I should do instead of surgery. Then a friend of friend suggested a chiropractic physician who practices active release technique, or ART. According to the ART website, this technique is “a patented, state of the art soft tissue system/movement-based massage technique that treats problems with muscles, tendons, ligaments, fascia, and nerves.”

Dr.Ryan Verchota, who practices in Chicago, was the first medical professional I talked to who didn’t think I needed surgery, as well as the first to give credence to my suspicion that my chronically tight neck muscles might be involved in the numbness I was experiencing in my fingers. He proposed a treatment plan that would address what he diagnosed as a “double crush,” which is to say, pressure on the nerve at both the carpal tunnel and the neck muscles. Dr. Verchota informed me that the pressure at more than one site along a nerve’s pathway can be additive. Pressure at one site alone may not cause any symptoms yet compression at more than one site simultaneously can “add up” and cause the presenting symptoms of carpal tunnel syndrome. When I disclosed that I’d been told by one doctor that the neck muscles couldn’t be involved as I didn’t have symptoms of pain and/or numbness the entire length of my arm, he discounted that assessment, saying that it was indeed possible for an impingement on the nerve at the neck or shoulder to be experienced only in the fingers.

I also learned from Dr. Verchota that there is a difference between carpal tunnel syndrome and carpal tunnel–like symptoms, both of which may present with the exact same symptoms of pain and/or numbness. In the case of carpal tunnel syndrome, however, there is direct pressure and nerve entrapment in the wrist, whereas carpal tunnel–like symptoms can be due to pressure on the median nerve anywhere from the neck down to the fingers. Clearly, therefore, it is important that a practitioner be able to differentiate one from the other in order to offer the treatment options best suited for the individual. 

Dr. Verchota used a few hands-on techniques in his treatment, including ART on my neck, shoulders, forearm, and hand. Essentially, he would find a tight spot in one of those muscles, press on it with his thumb, and then either move or have me move the muscle away from the point of pressure he was applying. A technique called nerve flossing was used in conjunction with the ART. Nerve flossing is a procedure that promotes sliding and gliding of a nerve through all of the tissues in the body along its pathway. In this case, the median nerve was stretched and moved through the neck, shoulder, forearm, wrist, and fingers—all likely places for a double crush to occur.

He also used the Graston technique on my surgical scar, as well as on the area above the scar. Graston technique involves dragging specially designed stainless steel tools along areas where there is scar tissue or other types of muscle adhesions. I also began wearing, at night, a wrist brace that holds the wrist in a neutral position and so prevents the nerve from being further compressed—figuring that anything that might help was worth trying.

Now, breaking up scar tissue is one of the things that massage can do, and while I had massaged the area along and around the scar during occupational therapy, I had ceased doing so once that therapy was over, mistakenly assuming I was “cured.” While the end of my scar closest to my wrist seemed to be hard and dense, I thought I was just feeling the metal plate.

Dr. Verchota’s work made me realize I could and should be continuing to take an active role in my own healing process. I began doing myofascial work with my thumb along the scar—that is, pressing my thumb firmly against the skin and moving the thumb toward my wrist, creating a sensation of gently pulling on the skin and on the “sticky” spots (i.e., the adhered tissue) just below the surface.

Soon, though, it became apparent that I was also pulling the skin of my thumb away from the nail! Dr. Verchota suggested that I could probably do much the same work with a gua sha tool, available relatively inexpensively online. Gua sha, a traditional Chinese medical treatment, and Graston technique both involve scraping the skin with a tool. Their intentions and techniques are, however, different. For one thing, gua sha is ued to improve blood circulation, while Graston technique is used to break up adhesions in the muscle and promote mobilization of fascia (connective tissue). A 2014 review of research presented in the Journal of MultidisciplinaryHealthcare discusses evidence of a correlation between freely moving fascia and reduction in pain and symptomology, which opens up promising possibilities for treatment.

I am not trained as a practitioner in either gua sha or the Graston technique, however, and so am no expert. My suspicion, though, is that, once I had purchased my inexpensive jade gua sha tool, I was using it more like a Graston tool and as a substitute for the pressure of my thumb, rather than as a tool for improving blood circulation. For maybe a minute a day, I gently but firmly pressed and dragged the tool along the scar. More than that would likely have only increased the inflammation in that area. And my intent was only to make sure the scar tissue received a little attention every day, between my weekly appointments with Dr. Verchota.

For the first month or so, I noticed almost no difference in the numbness in my fingers—though my neck muscles were feeling better than they had in months. I questioned whether I had made the right decision: maybe I should have the surgery? But Dr. Verchota counseled patience. He firmly believed the work we were doing would eventually produce results.

And then, very slowly, I began to notice the numbness receding from my thumb and index finger. Eventually, the numbness was growing noticeably less in my middle finger as well, the first place I’d felt the numbness and where the numbness was most pronounced. And finally, after three or four months of Dr. Verchota’s treatments, the wrist brace, and my own work on my wrist, there was no numbness in my fingers.

I don’t know whether any of these three things alone would have done the trick or whether it was their combination that eliminated my numbness. And I can’t know for sure whether it was only scar tissue from my wrist surgery that had caused the problem or whether my tight neck muscles were also a contributing factor.

What I do know is that it was worth it to me to investigate other avenues for resolving the problem before pursuing something as invasive as surgery, with all of its inherent risks. The route I took to get out of my carpal tunnel problem cost less money, caused less harm, provided me an opportunity to learn more about the human body in general and my own body in particular, validated my belief in the efficacy of alternative and complementary medicines, and afforded me a personalized and rewarding relationship with a medicial professional whose raison d’être is not about finding the quickest fix or the one fix that fits all.

I have nothing against surgery per se—witness, for example, my readiness to go that route when my radius was splintered. But I do think it’s important to do your research first and not just accept that surgery is the only solution. Not everyone experiencing one or more symptoms of carpal tunnel syndrome would necessarily find relief following the route I did. But that doesn’t mean there isn’t another nonsurgical route that might be just right for them.

Sniffing Out the Truth(s) about Aromatherapy

Though the term “aromatherapy” wasn’t coined until 1928 (by French chemist Rene-Maurice Gattefosse), the use of aromatic plants likely dates back to prehistoric times. Various perfumed ointments were used in ancient Rome to reduce inflammation and might actually have provided some relief by functioning as a germicide. Such ointments were also highly prized, however, because they could offset the foul odors emanating from festering wounds!
Today, aromatherapy is an established medical field in, Japan, France, and various Western European nations. In those countries, aromatherapy is often used as an antiseptic, antiviral, antifungal, and antibacterial, with physicians in France and Japan using it to treat such conditions as diabetes and seizure disorders. Some essential oils are even regulated as prescription drugs in France and can only be prescribed by a doctor.

Dr. Andrew Weil, the Harvard-trained physician who founded and directs the Arizona Center for Integrative Medicine, feels that physicians and researchers here in the United States “have only a primitive understanding of [aromatherapy’s] potential to affect physiology and health.” In this country, aromatherapy is primarily associated with spas and, to a more limited extent, is embraced as an alternative medicine. But because of increased acceptance of alternative and complementary medicines—including massage!—more research is being done concerning the mechanism(s) of aromatherapy and its efficacy in a wide variety contexts.

The first question you or a researcher might have—assuming that aromatherapy does, in fact, have some impact on health—is, How does it work? But before I address that, it probably makes some sense to define our terms first. Aromatherapy uses essential oils, which are aromatic products extracted by steam distillation and other methods from plant parts, including flowers, leaves, fruits, barks, and roots. Because aromatherapy is not regulated in this country, the quality of these essential oils can vary greatly. In general, though, the best and purest essential oils are very concentrated—and very expensive.

To return to the question of the mechanism by which aromatherapy has an impact on you, it depends on how the essential oil is used. When used to target the sense of smell, the miniscule molecules of essential oils are absorbed into the bloodstream when inhaled and a signal is sent to the limbic system in the brain, which is the center of emotions and memory. When applied to the skin, they activate thermal receptors and destroy microbes and fungi.

The next question, though, is, What does aromatherapy actually do? One of the major complaints of physicians and scientists here and in the UK and Canada is that all too often authors of aromatherapy textbooks and aromatherapists more generally make a large number of extraordinary claims regarding its benefits with no systematic collection of data to support those claims. Studies are being done, though, that verify some benefits deriving from aromatherapy. There is, for instance, solid evidence that certain scents can help promote relaxation and enhance sleep.

Studies done in the past fifteen or twenty years have also shown such effects as reduced anxiety in patients undergoing MRI scans when presented with the vanilla-like smell of heliotropin; a reduction in agitation of dementia patients after lemon balm oil was applied to their faces and arms; and hair growth being induced among patients with alopecia areata (an autoimmune disorder that causes hair to fall out) after the application of a combination of cedarwood, rosemary, thyme, and lavender oils. A study done in April 2008 at Ohio state University, however, found that volunteers who had been exposed to lavender and lemon oil showed no effect, based on analysis of blood samples, on biochemical markers of immune and endocrine status, stress, pain control, and wound healing.

The upshot of all this is, for now, “If aromatherapy makes you feel better, by all means use it,” as Dr. Weil says. One just needs to be cautious not only about all of the claims made for treatment of ailments with essential oils but also about the credentials of your aromatherapist as improper use of essential oils can cause burns, allergic reactions, headaches, and nausea. And some oils may actually change the effectiveness of conventional medicine, making it a good idea to check with a qualified pharmacist or doctor if in doubt.

In my own practice, the only essential oil I currently use is eucalyptus oil placed near the face cradle to help open the sinuses of clients who tend to experience congestion during massage. But bear in mind what Associate Attending Research Methodologist Andrew Vickers (Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center) has concluded: “Aromatherapy probably reduces anxiety because it usually involves massage” [emphasis mine]. Now as to massage—that’s something I could do in my sleep. And actually have. But that’s another story.

Good Vibrations!

You may think that the music played during a massage is nothing more than a relaxing distraction from ambient noises such as sirens, loud conversations, and your therapist’s grumbling belly.

Music can definitely be relaxing. Music with tempos ranging from 60 to 70 beats have been found to be soothing, apparently because they reflect the similar pace of the heart. And a number of clinical studies have shown that music reduces cortisol levels (the stress hormone), and there is also evidence that it may reduce blood pressure and heart rate. Furthermore, scientific trials using EEGs, or electroencephalograms, have demonstrated that “the slow rhythms in classical music cause the brain from Beta to Alpha activity, and rhythmic music can produce the lowest frequency [Delta] waves,” according to Dr. Lars Heslet in his article “Our Musical Brain.” Beta waves, as you may know, are the fastest of the four brain waves and occur when the mind is actively engaged, while alpha waves are lower in frequency and tend to be associated with relaxation and daydreaming. (Theta waves are slower still and are present during deep meditation, for example, while the slowest brain waves—delta—are present during deep, dreamless sleep.) Music is, on that basis alone, a good adjunct to massage in that it can enhance the relaxing effects of massage.

In addition, as I alluded at the start, music is also helpful at blocking ambient noise from one’s consciousness. For example, a study reported on in Adolescence found not only that patients who were exposed to music during or after surgery had less pain and needed less morphine, but also that random noise on the hospital ward were subdued by the music because the mind focuses on the music, thereby becoming less conscious of other noise.

But music, whether in association with a massage or not, has the potential actually to help promote healing. It has been used since the time of the ancient Greeks to calm the mentally ill and, since the invention of the phonograph, at least, to help hospital patients sleep and become less anxious before surgery. Currently, researchers within the field of psychoacoustics—defined by Mosby’s Medical Dictionary as “the branch of science concerned with the physical features of sound as it relates to the psychologic and physiologic aspects of the sense of hearing in the unimpaired ear”—are investigating the ways in which sound, especially music, can promote healing.

Much of this work involves the use of beat frequencies to influence brainwaves, in particular, binaural beats. Normally, when the brain is confronted with binaural beats—two pure tones or sine waves of similar frequency—coming one to each ear, it uses the phase difference between the two beats to provide the listener with directional information. But when such beats are received through headphones or speakers, the brain perceives them as a fluctuating rhythm. Numerous researchers have shown such rhythms to be effective in producing beneficial brain-state changes, from changes in attentional focus and levels of awareness to pain management and treatment of alcoholic depression.

Dr. Andrew Weil suggests that, because “stress and deep-seated tension are primary or aggravating causes of most cases of illness and frequently obstruct the body’s effort to return to a state of health,” using binaural beats to alter brainwave frequencies can help to “keep the mind from interfering with the healing system.” Working with a team of brainwave experts and musicians, Dr. Weil has created “psychoacoustically designed music” to promote the body’s own tendency to restore health.

You may have noticed a piece of music I sometimes play during massages that incorporates symphonic music with Tibetan bowls and other Asian instruments. This is Dr. Weil’s Symphony of Brainwaves. You probably haven’t been aware of the binaural beats incorporated into the music. Nor have you likely been conscious of your state of awareness changing during the music. I can’t say that I’ve noticed those things myself. But I can tell you that I have frequently employed this piece of music to help get me through stressful and scary doctor and dentist procedures and it has helped keep me calm and relaxed.

The study of the effects on the body of sound, including music, is a relatively new field so those looking for scientific proof of cause and effect may be disappointed. Part of the problem is that, as Dr. Weil says, “we know less about this potential of the body [to heal itself] than we should because conventional medicine is focuses so much on disease. Doctors do not collect and study cases of healing.” But the body of evidence, if you’ll excuse the pun, is growing that supports the positive effects of sound on healing. And even if music only helps you relax psychologically, it is clearly a copacetic accompaniment to the physical relaxation you experience during massage.

Does Your Weight-Loss Plan Include Massage? It Should!

It may seem too good to be true that massage can help you with a weight-loss program. There are many ways, however, in which massage therapy will indeed support your exercise and weight-loss goals. Massage is unlikely to have a direct impact on weight loss, such as physically bursting fat capsules as some have claimed. This doesn’t mean, however, that the benefits are not real.

To begin with, massage will improve your flexibility by loosening tight muscles. Muscles that are therapeutically manipulated will experience an increase in blood flow, which helps lubricate muscle fibers that are sticking together. And an added benefit of loosening tight muscles is that you will be less stiff and sore, making it easier for you to stay on track as you work toward achieving your objectives. In short, because massage increases oxygenation of muscle tissue, it can shorten recovery times and prolong endurance.

Massage can also help reduce your risk of injury, especially as you increase your level of activity, putting greater stress on muscles that have been less active. By stretching and manipulating the connective tissue that enwraps all muscle tissue, massage can help reduce adhesions, or scar tissues, which are common with muscle injury.

Further, research has shown that massage will increase metabolic rate, thereby allowing your muscles to burn more calories. This improved metabolic rate is a result of the endorphins released during massage. Endorphins, as you probably know, make you feel better, too, and will help you remain motivated and active.

Another frequent factor in weight gain is the production of cortisol, a hormone that is released in response to stress and has been shown to increase appetite and cause fat to be deposited in the abdominal area. Exercise is the best way to reduce cortisol levels, but massage can reduce it as well by lessening your stress level.

Digestive health is another critical factor if you are going to achieve your target weight, since the digestive tract supplies your body with the fuel it needs for energy and eliminates waste products. Abdominal massage not only promotes digestion, it also reduces constipation, bloating, and flatulence, all of which are facets in belly size. Abdominal massage should therefore be given serious consideration if you are intent on decreasing your body size.

Finally, although losing weight and regular exercise are rewards in themselves—improving your health, your self-esteem, and so on—the results are not instant and it can be easy to feel discouraged. Therefore, if you are working hard, it’s important to find healthy ways to reward yourself regularly to maintain your motivation. Massage is an excellent way to do that because not only does it feel great but it can also be an important adjunct to any exercise and diet plan.

Low-Back Pain Can Be a Pain in the Butt--Literally

Not only will 80–90 percent of the population have issues with low-back pain sometime during their adulthood but, in addition, back pain is one of the most common symptoms inducing people to visit a physician and is involved in almost a fourth of all occupational injuries and illnesses. In 2001, back injuries resulted in the highest percentage of short-term disability of all nonfatal illness and injury cases. In sum, back pain, especially low-back pain, is a big problem—for workers, employers, and insurance companies alike.

Part of the problem is that back pain can be difficult to diagnose, and physicians often overlook or misdiagnose trigger point pain (that is, localized areas of muscle soreness that refer pain to elsewhere in the body). This diagnostic difficulty can lead to treatments that don’t accurately address the problem, such as painkillers, which don’t necessarily rectify the problem but simply dull the pain. It is also worth mentioning that surgical rates for low-back pain are twice as high in the United States as in most other developed countries.

Often, to give a commonly occurring example, clients who are experiencing low-back pain actually have an issue with trigger points in the gluteal muscles, the piriformis muscle (which lies deep to the glutes), or even muscles as far away as the calf (the soleus muscle, to be exact). The piriformis, in particular, seems to be a major culprit when it comes to low-back pain. In my own practice, when I release knots in the piriformis muscle, I have had clients say they can feel the tension in their lower backs dissolve immediately. I even had one client say he felt his whole back realign when the tight spot in his piriformis let go.

Because low-back pain relief can be so close at hand—literally—it only makes sense to visit a knowledgeable massage therapist before trying something more invasive or simply palliative but not curative (such as pharmacologic “solutions”). And research is mounting to support this course of action. In one study, massage recipients reported less pain, depression, and anxiety, as well as improved sleep, and they showed improved trunk flexion. Stress hormones associated with chronic low-back pain were also reduced. A more recent study found similar results, with benefits lasting up to six months. And numerous other studies have shown massage to be helpful in relieving back pain.

Although reduction of stress hormones may come into play, in terms of how massage works to relieve low-back pain, as found in the one study, other researchers aren’t sure why massage seems to work. It may be that massage stimulates the muscle tissue locally or that it causes a response from the central nervous system. They also hypothesize that the reasons for improvement could be as simple as being in a relaxing environment or being cared for by a sympathetic therapist.

In any case, I agree with the chief author of the most recent study, who was quoted as saying, “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.” I would go one step further, though, and suggest that perhaps massage should be one of the first things you try.

Sources

Bagduk, Nikolai. 2004. “Management of Chronic Low Back Pain.” Medical Journal of Australia, vol. 180.

Bakalar, Nicholas. 2011. “Stubborn Back Pain? Try Massage.” New York Times, July 4 (http://well.blogs.nytimes.com/2011/07/04/embargo-july-4-5pm-for-back-pain-try-massage/?scp=1&sq=%22low%20back%20pain%22&st=cse).

Cherkin, Daniel C., et al. 2011. “A Comparison of the Effects of Two Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial.” Annals of Internal Medicine 155:1–9.

Deyo, Richard A. 1983. “Conservative therapy for low back pain: Distinguishing Useful from Useless Therapy.” Journal of the American Medical Association 250:1057–62.

Deyo, Richard A., et al. 1996. “Low Back Pain: A Primary Care Challenge.” Spine 21:2826–32.

Hernandez-Reif, Maria, et al. 2001. “Lower Back Pain Is Reduced and Range of Motion Increased after Massage Therapy.” International Journal of Neuroscience 106:131–45.

Papadopoulos, E. C., and S. N. Kahn. 2004. “Piriformis Syndrome and Low Back Pain: A New Classification and Review of the Literature” Orthopedic Clinics of North America 2004 35:65–71.

Simons, D. G., and J. G. Travell. 1983. “Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles. Postgraduate Medicine 73:99–105, 108.

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. 2004. Worker Health Chartbook 2004. Publication no. 2004-146. Cincinnati, OH: U.S. DHHS, PHS, CDCP, National Institute for Occupational Safety and Health. Fig. 1-38.

Cruisin', on a Sunday Afternoon

Not since I was a kid have I had the leisure to ride a bike simply for the fun of it. I bike to work. I bike to run errands. I bike to dinner parties. I enjoy all of those excursions, but there are almost always time constraints or, at least, substantial distances to cover. Consequently, I've been riding bikes that can go, baby, go! Skinny tires, multiple gears.

But in Michigan, on vacation, time is a little more free form and we're not in much of a rush for anything. So I decided to try my gal's cruiser. I love the look of cruisers, but they've never been especially practical for my purposes. On vacation, though, with lots of leisure, there was nothing to hold me back, so I hopped on Kathy's cruiser. And unlike when I'm riding in the city, with cars and people and other bikers everywhere, I didn't even worry that I didn't have on a helmet or that I was riding with flipflops. What a freeing experience!

A Jury of My Gears?

Jury duty is not only a civic responsibility: it's an honor and a privilege. Sometimes, though--much like having a job--it gets in the way of things. Like exercise.

Recently, I received notification that I was supposed to report to jury duty in Maywood, IL. Jury duty doesn't start that early in the morning, but counting in travel time and all, I was pretty sure I'd end up forgoing my exercise that day because I can no longer get up before dawn.

But then I had the bright idea to see whether it was bikable. And it was! So I biked from my house in Chicago, through Oak Park and River Forest and on into Maywood. I'm pretty sure I've never even been through the latter communities by car, so it was a lot of fun seeing completely new things.

And I'm fairly certain I was the only one who biked to jury duty that day.