The Good Doctor's Advice.
Aug. 27th, 2003 06:17 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
elfs"Stop writing."
That's what she said, the thin, thin-lipped physician sitting there in her office chair. The examination room was warm, almost too warm for someone dressed in the office drag I wore. And somehow, I tried to see it from her point of view. I'm sure she understood that writing was a hobby, that I could no more give it up than I could give up breathing or masturbation. Actually, I'm quite sure that if we were more comfortable with each other as patient and physician that she'd have asked me about that and recommended against it, too. She had dozens of patients. Many of them had the same problem I did. She knew that some of them could give it up, and some couldn't. She knew that I was one of the latter.
I was aghast. I'm sure the shock, the pain, the sheer impossibility of complying with her request was as visible on my face as the tattoo Poor impulse control might have been across my forehead.
"There's no noticeable weakness in your hands, which is good. You'll probably make a full recovery. You've done everything conservative you possibly can-- lowered your keyboard, optimized your mouse, gotten the footrest. But it sounds to me like you're in front of a computer far more than average. It's definitely typing-induced tendinitis-- you got that right the first time." I smiled, grateful to the gods of the Internet who brought me the initial diagnosis and the years of experience that let me separate wheat from chaff. "And I'm impressed with your keyboard layout. I've never heard of the Dvorak before. I'll definitely have to look into it for my other patients."
I made some comment about how it's hard to switch, especially after a lifetime of habit with QWERTY.
"Probably. But give up the freelance writing. That'll cause it to heal fastest. Other than giving up all typing-related duties, of course, which probably isn't an option right now." I shook my head. "I'll give you a wrist splint. Wear it in bed every night. That'll help. And use ibuprofen if it hurts."
I told her that I preferred aspirin. It's the best anti-inflammatory I know. "Try not to take too much, then. It's so hard on your stomach compared to the modern NSAIDs. Switch off with ibuprofen or naproxen if you can."
"If it doesn't get better in a month or two, come back. We'll have to talk to a surgeon. Not for surgery. But he can recommend courses of action that I can't."
I nodded, sheepishly, my equilibrium momentarily shocked at the word "surgeon," while she filled out the forms and had me sign for the wrist splint.
I don't know what I'm going to do. I really don't.
I can install xwrits. I can even give up mouse-heavy gaming.
But give up writing?
That's what she said, the thin, thin-lipped physician sitting there in her office chair. The examination room was warm, almost too warm for someone dressed in the office drag I wore. And somehow, I tried to see it from her point of view. I'm sure she understood that writing was a hobby, that I could no more give it up than I could give up breathing or masturbation. Actually, I'm quite sure that if we were more comfortable with each other as patient and physician that she'd have asked me about that and recommended against it, too. She had dozens of patients. Many of them had the same problem I did. She knew that some of them could give it up, and some couldn't. She knew that I was one of the latter.
I was aghast. I'm sure the shock, the pain, the sheer impossibility of complying with her request was as visible on my face as the tattoo Poor impulse control might have been across my forehead.
"There's no noticeable weakness in your hands, which is good. You'll probably make a full recovery. You've done everything conservative you possibly can-- lowered your keyboard, optimized your mouse, gotten the footrest. But it sounds to me like you're in front of a computer far more than average. It's definitely typing-induced tendinitis-- you got that right the first time." I smiled, grateful to the gods of the Internet who brought me the initial diagnosis and the years of experience that let me separate wheat from chaff. "And I'm impressed with your keyboard layout. I've never heard of the Dvorak before. I'll definitely have to look into it for my other patients."
I made some comment about how it's hard to switch, especially after a lifetime of habit with QWERTY.
"Probably. But give up the freelance writing. That'll cause it to heal fastest. Other than giving up all typing-related duties, of course, which probably isn't an option right now." I shook my head. "I'll give you a wrist splint. Wear it in bed every night. That'll help. And use ibuprofen if it hurts."
I told her that I preferred aspirin. It's the best anti-inflammatory I know. "Try not to take too much, then. It's so hard on your stomach compared to the modern NSAIDs. Switch off with ibuprofen or naproxen if you can."
"If it doesn't get better in a month or two, come back. We'll have to talk to a surgeon. Not for surgery. But he can recommend courses of action that I can't."
I nodded, sheepishly, my equilibrium momentarily shocked at the word "surgeon," while she filled out the forms and had me sign for the wrist splint.
I don't know what I'm going to do. I really don't.
I can install xwrits. I can even give up mouse-heavy gaming.
But give up writing?
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OK, that's a DOCTOR. Now try a CHIROPRACTOR.
Date: 2003-08-28 01:24 am (UTC)Re: OK, that's a DOCTOR. Now try a CHIROPRACTOR.
Date: 2003-08-28 01:54 am (UTC)To the best of my knowledge
Date: 2003-08-28 02:12 am (UTC)Mine does. And does a good job of it, too.
Date: 2003-08-28 02:18 am (UTC)Actually...
Date: 2003-08-28 03:22 am (UTC)Eeeek...
Date: 2003-08-28 01:38 am (UTC)It's expensive, but I blew the dough on one of these (http://www.kinesis-ergo.com/evol_chair.htm) (I think
Also, have you considered an accupuncturist? I know a good one on the Eastside, if that'd be convenient for you...
no subject
Date: 2003-08-28 01:41 am (UTC)I also take a naproxen a day during flare-ups (and usually for a couple of weeks afterwards, to help finish healing the inflammation). Aspirin would probably work just as well. And sleeping in the wrist splints, definitely. Acupuncture also did wonders for getting me back to work.
*hugs* I'm sorry to hear you're going through this. It royally sucks, I know. And yes, I got the same advice. But really, what can we do without our hands?
Second the glucosamine!
Date: 2003-08-28 02:14 am (UTC)I third the suggestion!
Date: 2003-08-28 02:53 pm (UTC)You could also try taking turmeric instead of ibuprofen or aspirin. It's a highly effective anti-inflammatory; in European tests it's been shown to be as effective as cortisone, without the nasty side effects. It's also a liver tonic (so it's good for you in other ways) and it's hemostatic, so it doesn't thin your blood the way ibuprofen and aspirin will. It works well with glucosamine. */herblady soapbox*
Re: I third the suggestion!
Date: 2003-08-28 05:54 pm (UTC)You might also...
Date: 2003-08-28 01:53 am (UTC)Re: You might also...
Date: 2003-08-28 05:09 am (UTC)He ignored me.
Ah, the life of a martar...
Re: You might also...
Date: 2003-08-28 03:55 pm (UTC)Re: You might also...
Date: 2003-08-28 04:04 pm (UTC)Re: You might also...
Date: 2003-08-28 04:12 pm (UTC)Re: You might also...
Date: 2003-08-28 04:19 pm (UTC)LOL - You say that, but I just got two spams trying to sell it version 6 to me.
(And yet, the links are dead...)
Re: You might also...
Date: 2003-08-28 05:39 pm (UTC)Re: You might also...
Date: 2003-08-28 08:58 pm (UTC)Hon, I didn't say that it wasn't available in places, just that it was no longer being published. If you type in "Dragon Naturally Speaking" into google, you will find this link: http://www.dragonnaturallyspeaking.com/header.php which will show you that the domain name is for sale. Another link I looked at mentioned that the product had been discontinued.
no subject
Date: 2003-08-28 01:57 am (UTC)One thing your doctor probably won't tell you is to stay away from vibrators, especially powerful ones.
no subject
Date: 2003-08-28 04:53 am (UTC)no subject
Date: 2003-08-28 02:15 am (UTC)You'll probably find it valuable to cut back to an absolute minimum level of wrist-stressing stuff while you let them heal. Once they're better you can add back in some of the activities that you'd cut out, and find some maintenance level of activity plus cure (e.g. writing but wearing wrist splints at night) that works for you.
So maybe you *do* want to give up writing, but not forever. Can you lay off for a few weeks, or maybe switch to a tape recorder (or the digital equivalent) rather than a keyboard?
Oh, OK. Two other things. Is your mouse hand worse than your non-mouse one? I found that if I use good piano-teacher-approved style keyboard technique I can type forever with no problems, but mousing gives me no end of fits. A long time ago I switched from a mouse to a touchpad for all of my computing, and that too has made a great deal of difference.
Okay, okay, I get the hint!
Date: 2003-08-28 03:09 am (UTC)All right, all right! I get the hint folks! I'll give Elf more sex so he can cut out the masturbation! Jeez!
;)
Re: Okay, okay, I get the hint!
Date: 2003-08-28 08:41 am (UTC)Re: Okay, okay, I get the hint!
Date: 2003-08-28 05:41 pm (UTC)no subject
Date: 2003-08-28 02:28 pm (UTC)Maybe I've been doing it wrong...
Re: Okay, okay, I get the hint!
Date: 2003-08-28 04:14 pm (UTC)Just a thought...
no subject
Date: 2003-08-28 03:52 am (UTC)1. Chair chair chair chair chair. Still using a $50 Ikea office chair? Throw it out with extreme prejudice. Then go shopping. Shop for a chair like you'd shop for a car: you'll probably spend more time in the chair, after all. Try Aerons, try the Steelcase Sensor, try the Grahl Synchron, try a lot of different chairs. Buy from some place that'll let you return it if 2 weeks of home use turns out to be a lot different than 15 minutes of in-store use.
2. Keyboards. Consider one of these (http://www.datahand.com/). Or one of these (http://www.infogrip.com/product_view.asp?RecordNumber=12) maybe. Or one of these (http://www.kinesis.com/)? There's lots of options.
3. I have at least one friend who, confronted with the same situation as you (only basically worse), converted entirely to using Dragon NaturallySpeaking. It's not an ideal solution for any number of obvious reasons, but she's been able to make it work for her.
4. If possible, make work pay for some or all of the above: your fingers are an asset they want to protect. Suggest to them that spending $2-3000 on a new chair and keyboard now is a much better idea than spending $20-200,000 on physical therapy and workmans comp claims later. If they can't, claim a home office deduction on your next tax return and you should be able to deduct a large chunk of the cost. (ISTR it was about 50% for me in NY.)
And good luck. I know the feeling: I'd sooner give up oxygen.
no subject
Date: 2003-08-28 06:55 am (UTC)He also writes a bit about chairs... specifically, the Aeron (http://www.hermanmiller.com/CDA/product/0,1469,c225-pss7-p8,00.html), which one of my cow orkers has, and swears by...
I also second the "see what work will cover" idea. One of my former employers paid for me to get a second kinesis evolution, rather than making me lug the one I bought (with chair attached) into the office.
no subject
Date: 2003-08-28 05:58 pm (UTC)As for the Aeron, I had one at F5. Hated it with a passion. Was so glad to get rid of it for a "normal" office chair. I felt like I was being swallowed by the damn thing and it caused unnatural tensions in my arms because the reach was so damned far.
no subject
Date: 2003-08-28 06:24 pm (UTC)Chairs are a very idiosyncratic thing. You couldn't pry me away from my Aeron with a team of pack mules, but I've met plenty of people who feel the way you do about them. Like I said: shop shop shop, then shop some more. :)
The 'Dvorak' option is actually a moot point if you get the fully reprogramable version anyways...
Date: 2003-08-29 05:39 am (UTC)It's an option I'd almost say they should remove, as it's non-intuitive and something I still disagree on the need for, pricing-wise.
Then again, I'm surprised they don't just let you remap the keys to begin with, it seems a rather basic tool, and one that's hardly costly in terms of their hardware or software resources.
Relax, there's all kinds of hope.
Date: 2003-08-28 05:01 am (UTC)However, as whipartist says "You'll probably find it valuable to cut back to an absolute minimum level of wrist-stressing stuff while you let them heal." This is in accordance with the doc's frightening recommendation, and unfortunately necessary with tendon stress injuries. Another reason music-types fear them so.
BUT one thing that nobody seems to have mentioned yet is that an important part of decreasing stress on the injury is keeping WEIGHT off your wrists. This is arguably more important and more beneficial than moving less, which makes you stiff -- and I don't need to say anything about the dangers of stiff injured parts.
So give some thought to all the heavy things (say, more than just a couple pounds) you lift and shift on a daily basis, and consider doing less of that. If you carry briefcases etc by the handle, break out the shoulder strap for a month or so. Also, think about your kitchen chores (as a ready example): what do you stir, knead, chop, toss? Think about anything that involves combining firm grasp with rotational motions -- ones that involve extension/flexion, pronation/supponation, and rapid, forceful radial/ulnar deviation (like tossing a saute in the pan.)
You can look for a lot of ways to rest your injury that don't involve giving up writing. Though, if longhand is relatively comfortable, consider doing some of that as well while you recuperate. And you MUST be highly disciplined about typing -- be warm and gently stretched, have the keyboard low and close, rest as needed, use ice and drugs to control inflammation.
And, just in case: Absolutely no fencing!
(Addenda: 1:Osteopaths and physiatrists over chiropractors for stuff like this, IMO. 2:The fact that your doc hasn't heard of the Dvorak keyboard says to me she doesn't treat a large number of office-ergonomics cases. Which is nothing against her general competence, but could be a factor in your treatment. 3: If you end up talking to a surgeon, I highly recommend one with a SPECIALTY in performance/sports medicine. These can be found by asking who the local professional musicians will entrust with their careers if faced with debilitating injury. 4: In the orthopedics community, there are many good doctors and many good occupational therapists, not all of whom know about each other. Should you end up at an orthopedics practice, make sure they know their OT shop very well, and make sure there is accord between the doc and the OT managing your program. Bad OT can derail a recovery like nothing else i've ever experienced.)
To your health.
Re: Relax, there's all kinds of hope.
Date: 2003-08-29 11:26 pm (UTC)When my tendonitis was at its worst I didn't cook, lift, or much else. I learned out to carry things with my forearms instead of my hands to remove stress from my wrists. I bought a car with power steering and wore leather gloves while driving.
To this day I often ask hubby to knead bread dough for me.
I'm trying to re-learn an instrument. I was doing fine until I tried to play with a group; that resulted in Yet More Pain. A key thing I've found in the literature is to *relax* while I play.
Re: Relax, there's all kinds of hope.
Date: 2003-08-30 01:41 am (UTC)I'm not complaining -- this is really all good. If i hadn't worked hard enough in rehab to develop tendonitis, I would not have full range of motion and I wouldn't be able to play piano, let alone vibes and marimba. As it is I'm very lucky, and I am still a musician.
"When my tendonitis was at its worst I didn't cook, lift, or much else. I learned [how?] to carry things with my forearms instead of my hands to remove stress from my wrists."
For about 3 months after surgery I was pretty much completely incapable of cooking, lifting, and just about everything else. When you're that bad off, and that dependent upon others to do basic things, depression becomes a real danger -- fortunately Elf's injury doesn't sound like it's anywhere close to that bad at this time.
I am curious about how lifing with your forearms takes stress off the wrists. . .The muscles in the lower arm are the very ones that control the wrist and fingers, so whether there's anything in your hand or not, even hanging a bag from your forearm -- a bracing action -- does involve the wrist (though the hand is fairly relaxed, I have just tested and confirmed.) Was your tendonitis perhaps limited to the extensors only (the tendons on the back of the arm and hand?)
"I'm trying to re-learn an instrument. I was doing fine until I tried to play with a group; that resulted in Yet More Pain. A key thing I've found in the literature is to *relax* while I play."
The key to relaxing in ensemble is not being afraid to sound really bad. And that's so very hard to do. Even when you're practicing alone. Mistakes lead to frustration which leads to tension -- and stiff practice is a fabulous way to get hurt. Mistakes are part of the price of improvement, and after 15 years doing this I'm finally learning not to mind them so much. (I mean, you never want mistakes, but if your practice is perfect. . .then it's time to start practicing something else.)
Which instrument are you 're-learning'?
and get a new mouse
Date: 2003-08-28 05:22 am (UTC)no subject
Date: 2003-08-28 07:20 am (UTC)no subject
Date: 2003-08-28 11:35 am (UTC)I believe I mentioned them before, they're called quilter's gloves (sometimes called crafter's gloves). They're lightweight, fingerless gloves made out of medi-lycra that actually massage your hands as you use them and give some wrist support.
I've used them while typing, sewing, and crocheting. I've even used playing wallyball and they took the punishing impact of setting, serving, and bumping just fine. Remind me to show you one next time I see you. You can find them at places like Jo-Ann Fabrics and Michael's for about $10-$13 each (sold singly).
They've been a great help for me and I rarely have problems with wrists or hands anymore.
Ah ha!
Date: 2003-08-28 11:45 am (UTC)Craft Glove
And they do make them large enough for a man's hand.
no subject
Date: 2003-08-28 05:28 pm (UTC)Got acupunctured once. Got three needles in each arm. It didn't hurt. The tendonitis went away for six months. It started to flare up again, just the slightest amount, so I went back for more, and I haven't been bothered with it since, and that was about 9 years ago.
Take breaks
Date: 2003-08-28 08:51 pm (UTC)Besides getting an ergonomic keyboard (vide supra; I've nothing to add to what's already been discussed), the biggest thing she did to keep her wrists healthy was to take breaks. Type for 30 minutes, rest for 5-10, lather-rinse-repeat. She managed it by listening to cassette tapes while working - when the side ended, it was time for a rest. You can try that, or a kitchen timer, or whatever you can think of to reliably provide an interruption after 25-35 minutes.
I agree that you'll probably need to take a near-total hiatus *while it heals*, not permanently. But changes in habit are what you'll need to keep it from coming back once you resume normal activity. Good luck!
(I do know a few people who've worked through tendinitis and other orthopedic problems like this using voice-recognition software; unfortunately, they both are Mac users, so I can't recommend the products they used. The concept is worth a try, however, if you can find anyone to sell you something that works under Linux. From subsequent comments you've made, it doesn't sound easy. I can only reiterate: Good luck!)
If nothing else, there's another alternative even beyond Dvorak...
Date: 2003-08-29 03:36 am (UTC)Though they do look like something out of Ghost in the Shell to me, I don't think that's really a downside. :-) The only real downside is their price, over a thousand dollars by themselves, but as an upside apparently some insurance companies will cover it with work.
Silly question...
Date: 2003-08-29 11:28 pm (UTC)Re: Silly question...
Date: 2003-09-01 07:41 am (UTC)