Playing "Puff the Magic Dragon" on the piano can be a fun and enchanting experience. The song, originally written by Peter Yarrow and Leonard Lipton, tells the story of a dragon named Puff and a young boy named Jackie Paper. The melody and lyrics evoke a sense of imagination and wonder. To play this iconic song on the piano, you'll need to familiarize yourself with the sheet music or chords. The song is typically played in the key of C major, which makes it relatively easy to pick up for beginner piano players. The main melody moves smoothly up and down the keyboard, creating a flowing and whimsical sound.
People who have cancer now or had cancer in the past have a higher risk of getting a blood clot in a vein, which is a serious health problem.
For her Jugling of the pay out of the Parliament souldiers heads, it is well known she can do no such matter, but the Captaines keep it back contrary to the minde of the Parliament and besides though I beleeve there are Monkeys in the Parliaments Army, yet they are often conicatcht themselves, and cannot deceive poor souldiers of their pay, and Prince Roberts Monkey dare not come thither left the Parliaments Bitch should tear her green coat off from her back. THe Parliaments Bitch is of such an ex cellent shape and proportion, that the most witty inventions cannot ima gine a thing of a more sweet and per fect feature, being beautifull in co lour and absolute in all the linea ments of her body; so that she seems to be a statue cut out in unspotted Alablaster by some cu rious workman, and doth in this exceed their exact imi tations, in that she doth live and breath, whereas the other are but dead Images.
The main melody moves smoothly up and down the keyboard, creating a flowing and whimsical sound. Remember to start off slowly when learning the song. Break it down into small sections and practice each part separately before attempting to play it altogether.
Reactive management
General recommendation: Severe HFSR can be painful and interfere with normal daily activities. It is essential to educate patients before treatment, to prioritise prevention, and to ensure early detection and prompt treatment of symptoms if these occur. 1
Treatment overview
Treatment for HFSR in patients receiving multikinase inhibitors is based largely on anecdotal evidence and expert opinion. 2
Supportive measures should be initiated promptly when symptoms are noted. This may include application of cold packs, wearing thick cotton gloves and/or socks at night, use of moisturising creams for relief and application of a keratolytic cream to aid exfoliation. 3, 4 In severe cases, temporary relief from the itching, burning, pain and swelling of HFSR may be obtained using topical preparations containing one or more of a vasoconstrictor (e.g. phenylephrine), astringent (e.g. witch hazel), anaesthetic (e.g. pramoxine) and protective agents. 5 Keratolytic options include a 20%–40% urea-based cream or salicylic acid 6%; 1,4 these should only be applied to hyperkeratosis-affected areas as they may cause ulcers on unaffected skin. 5 Alpha hydroxyl acids (5%–8%) may be applied liberally twice a day. 1 Hydrocolloid or alginate dressings can be used to protect pressure points and may aid healing. 5
A potent topical corticosteroid such as clobetasol propionate 0.05% may be initiated at the onset of grade 1 or grade 2 symptoms. 1, 6-9 A combination preparation with clobetasol propionate 0.05% and salicylic acid 3.5% may be considered. 5 Pain management is required for grade 2 or higher symptoms; lidocaine gel 4% may be tried. 5, 6 These measures should be continued for grade 3 symptoms, but treatment should be withheld for at least 7 days or until HFSR improves. 1, 4 Topical antibiotics may be needed to treat blisters and erosions. 8 Wet lesions should be swabbed and oral antibiotics initiated as appropriate. 5
For mild to moderate pain, apply topical anesthetics: use for instance lidocaine HCl gel 4%. For more severe pain, patients should be switched to oral analgesics if needed. 5,6
Following improvement of an acute episode of HFSR, tender hyperkeratotic lesions may develop. 1 Topical corticosteroids (e.g. fluocinonide 0.05%, clobetasol 0.05%) may be used to treat severe inflammation and painful erythematous areas. 10 Immersion of hands and feet in cold water may relieve pain. 10 Other options for treating these lesions include urea 40% cream, tazarotene 0.1% cream or fluorouracil 5% cream. 1
After treatment of a callus, an emollient cream should be applied to prevent the rapid recurrence of hyperkeratotic lesions. 1 Non-urea-based creams should also be liberally applied to unaffected areas of the hands and feet. 1
Patients should be evaluated weekly. With the second or third occurrence of hand-foot skin reaction intensifying supportive measures is advised. If symptoms worsen despite the intensified measures, drug interruption or discontinuation should be considered.
Table 30: Management of hand-foot skin reaction associated with multikinase by CTCAE grade 4, 6-9
Grade
Description
1
- Avoid hot water and alcohol-containing hand products
- Wear thick cotton gloves and/or socks at night
- Moisturising creams
- Urea 20% cream twice daily on the calluses and hyperkeratosic areas
- Clobetasol 0.05% cream once daily
2
- Continue treatment as for grade 1
- Pain management with lidocaine 4% gel or oral analgesics as needed (NSAIDs, COX-2 inhibitors, or paracetamol)
- Topical antibiotics to treat blisters and erosions
3
- Continue supportive treatment as for grades 1 and 2
- If pain is not controlled with classical analgesics, GABA agonists or narcotics may be considered
4
NSAIDs: nonsteroidal anti-inflammatory drugs; GABA: gamma-aminobutyric acid
Products
- Emollient cream
- Alpha hydroxyl acids 5%–8% (e.g. glycolic acid)
- Salicylic acid 6%
- Urea 20-40% cream
- Lidocaine 4% gel
- Oral analgesia (e.g. codeine, pregabalin)
- Clobetasol 0.05% ointment
- Fluocinonide 0.05% cream
- Tazarotene 0.1% cream
- Fluorouracil 5% cream
Multikinase inhibitor treatment
Continue with/withhold the selected multikinase inhibitor treatment regimen, as recommended in the current and relevant SPC and according to the patient’s condition.
References
- Wood LS et al. Commun Oncol. 2010; 7: 23-29.
- Anderson R et al. Oncologist. 2009; 14(3): 291-302.
- De Wit M et al. Support Care Cancer. 2014; 22 : 837-46.
- Lacouture ME et al. Oncologist. 2008; 13: 1001-1011.
- Boers-Doets CB. The TARGET SYSTEM. Approach to assessment, grading, and management of dermatological & mucosal side effects of targeted anticancer therapies. ISBN 978-94-92070-00-5. 2014.
- Balagula Y et al. J Support Oncol. 2010; 8(4): 149-161.
- Grothey A et al. Oncologist. 2014;19:669-80.
- Krishnamoorthy SK et al. Therap Adv Gastroenterol. 2015;8:285-97.
- McLellan B et al. Ann Oncol. 2015;26:2017-26.
- Gomez P & Lacouture ME. Oncologist. 2011; 16: 1508-1519.
For the Princes familiarity with him, it is but for his recreation, not for any affection he bears unto him, as he doth (I warrant you) to a Court Lady, nay, to any country Page [unnumbered] wench upon a case of necessity; but let him not brag of that, for if he have kift the Prince once, his head hath afterward been twice in the Porridge pot; and when he runs about to smell out Oxford Bitches that are full of concupisence, where is his nose then? The King and his children are thought to be very well beloved by Boy, but in regard he is a Malignant the Parliament Bitch dare affirme that he cannot love the King, and hate and grumble against the Par∣liament as he and other Popish dogs do.
This will help you build muscle memory and make the song easier to play over time. As you become more comfortable, gradually increase the speed and add dynamics to bring out the emotion in the music. Playing "Puff the Magic Dragon" on the piano allows you to channel your inner storyteller. The song's nostalgic lyrics and catchy melody make it a joy to play and share with others. Whether you are playing for yourself, friends, or an audience, let the magic of the music transport you to a world filled with friendly dragons and childhood dreams. So dive in, embrace the whimsy, and play the magic dragon on your piano!.
Reviews for "Join the Journey: Learn to Play "Puff the Magic Dragon" on the Piano"
1. Samantha - 1/5
I was really disappointed with "Play the Magic Dragon on the Piano." The arrangement of the song was all wrong and didn't capture the magic and beauty of the original. The piano playing was lackluster and lacked any true emotion or depth. I was expecting a captivating rendition of this beloved classic, but instead, I was left feeling bored and unimpressed. I wouldn't recommend wasting your time or money on this disappointing performance.
2. Mike - 2/5
I found "Play the Magic Dragon on the Piano" to be quite average. The piano playing was decent, but nothing exceptional or memorable. It felt like the performer was just going through the motions without adding any personal flair or interpretation to the song. Additionally, the recording quality wasn't the best, and the sound was a bit muffled. Overall, this rendition of "Puff the Magic Dragon" just didn't stand out and left me underwhelmed.
3. Sarah - 2/5
As a fan of the original song, I was really excited to hear "Play the Magic Dragon on the Piano." However, the arrangement of the melody didn't translate well to the piano and felt disjointed at times. The tempo was also a bit off, making it difficult to follow along and enjoy the performance. I think the pianist could have done a better job of capturing the whimsical essence of the song. Overall, I was disappointed with this rendition and would recommend seeking out a different version if you're looking to enjoy "Puff the Magic Dragon" on the piano.