Very interesting read. I've spent some time on that particular what-if now and then. I imagine a lot of people making a living at a keyboard do. Glad to hear that, much as I've imagined, it doesn't mean the end of the line. It will make things a lot harder but it doesn't have to be the end of life as someone doing programming.
Boy, did I misread that headline. I thought it was about hunt-and-peckers, and who cares? Why I know people quadriplegic/missing hands/nervous system problems, and they write code for a living. Turns out, that’s exactly what it’s about. Interesting read to broaden your thinking on who uses your stuff. An encouraging read as well: your life doesn’t end if you can no longer wiggle your fingers in pre-determined patterns.
I envy and truly admire people who suffer such adversity and who live good lives. I don't know if its because they usually never knew any different so can't compare, or if they just have an innate mental strength I do not. After losing my health and life I've had an extremely hard time accepting such a huge reduction in QOL that just seems to get worse and really wish I had their ability/outlook.
The interlude is very familiar.. I have several relatives who have gone through "the fibromyalgia experience". I can totally understand that one responds to what is effectively a refusal to acknowledge that you are actually experiencing pain with curses.
That story of how the doctors just dismissed her pain as delusion is terrifying. Doctors are supposed to be people of science, but one of the very fundamentals of science is to acknowledge that you don't know everything, that your current knowledge is just a theory that can be improved upon. I find there's a tendency among doctors to think they know every possible disease, and if someone comes along with one that doesn't fit in their system, they write it off as psychosomatic. They probably get their fair share of actual hypochondriacs, but I'll wager that more than half of the people who are dismissed this way, are actually suffering from a real, but rare or understudied illness.
My experience is that in particular cases where multiple disciplines need to work together in order to reach a diagnosis fail. It is up to the patient to relay information between specialists. In my experience, they don't even look at the records and images their colleagues produce.
Yes, this has happened to several family members in the US, though thankfully mine was diagnosed properly because I could point to family history. Initially they wanted to write it off to migraines (I can't blame them since it's more common and can have similar symptoms at first) and now nine years later it's painful to use my hands and I've mostly given up martial arts.
It would almost certainly be worse if I hadn't had the family history to point to and actually convince them to do the tests that would confirm the diagnosis. For chronic illnesses defined by random irreparable damage the sooner you start treatment the better your outcomes are likely to be.
I am surprised that four doctors in a row did this, that's shocking. Usually a second or third opinion is enough that at least one of the doctors is paying attention.
I wouldn't worry if it's little stuff, migraines really are weird. Don't anxiety yourself or anything, I just have a propensity for immunological stuff. In my case it was early symptoms of multiple sclerosis.
One of the doctors took them seriously, did a biopsy, and gave them a diagnosis.
They did not like their diagnosis because “idiopathic” means “we don’t know what causes this,” which the patient translated as “go the fuck away.” As if all human disease is deeply understood and an admission of ignorance is equivalent to laziness. They then continued going to additional doctors.
Indeed. Especially in neurology, where the tissue is non-regenerative. Hopefully we can find ways to slow tissue destruction - often we cannot - but that’s a far cry short from reversing it.
Hi, I wrote the post! I'm actually very grateful to my neurologist who gave me my idiopathic diagnosis, because he was the only doctor to figure out the mechanism of action. He's been enormously helpful.
It doesn't change the fact that, as a patient, an idiopathic diagnosis is not a satisfying outcome if it doesn't point to a course of treatment. And it's certainly not something I view as a "final diagnosis" -- I'm patient, and technology and medicine are still improving and I hope it'll be possible to identify the cause and treat it in the future.
As a fellow patient -- accepting that sometimes life is uncontrollable can bring a lot of peace. Even if there is no treatment, acceptance does a lot for happiness.
Nonetheless, know that your post is appreciated. For now it's mostly handling small fasteners that gets me, typing is usually mostly okay. But since I do hardware prototyping I had to learn to ask for help a lot more than I was used to.
I also find it's sometimes helpful to wear a cloth around the more painful hand to kind of remind people that the pain isn't obvious... well, plus if it's a little wet it helps the pain a lot so it's functional too. But invisible pain means my coworkers frequently assume I'm feeling about how they are. And I feel bad saying no to stuff since technically I can still do it... it's just painful to do.
I've had better experience with older doctors who no longer care about maximizing their billings. Extra points if they consider most other doctors to be idiots and like to prove them wrong. Unfortunately to find good ones like that takes time, determination and being ignored many many times.
>That story of how the doctors just dismissed her pain as delusion is terrifying.
The frightening thing to me is that from my reading there is little recourse for her since the UK has a centralized health system controlled by GP referrals.
Psychosomatic diseases are a real thing though. You can have real physical symptoms. Last year my muscles started to « shake », with lots of skipped heartbeats (extrasystoles). After all the checks the doctors said the classic « it’s stress ». Well then I took a real break and embarked on multi month road trip on another continent. The symptoms disappeared nearly overnight. I think I experienced a burnout but it manifested through physical symptoms.
Edit: needless to say the medical response was very frustrating and hard to believe. In the end they were right that it was not a physical cause, but apart from that it really felt like they had no idea. Also it could be a multi-level cause like gut flora causing anxiety causing be physical symptoms but it’s beyond what a doctor can diagnose I think.
They're real, but doctors often do a half-assed (if not downright negligent) job of ruling out other possibilities before settling on somatoform disorders (or any other psychiatric diagnosis, for that matter). Especially when it comes to women presenting with chronic or recurring pain or fatigue as their primary symptoms.
Regardless of whether you think the advice from the GP is sound or not, the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
Cursing at them out of frustration only makes your situation worse.
That has the possibility of working out disastrously if the doctors first recommendation is surgery, when physical therapy (rest + strengthening) ought to have been the first prescription.
The GP didn't give 'advice' so much as they said "your medical records? ha, right... you're crazy." And then proceeded to shut down all avenues to further care and pain management.
Honestly it sounds like the GP is so cynical about the hot garbage they perceive UK healthcare to be that they basically said "please go away so that our utter inability to help you doesn't weigh on my conscience any further... oh thank god you invoked the loophole that lets me kick you out now and pretend it's all really your fault"
> The GP didn't give 'advice' so much as they said "your medical records? ha, right... you're crazy." And then proceeded to shut down all avenues to further care and pain management.
That's a patient's perspective, but how about a doctor's perspective? You've got a patient refusing treatment for what could very well be a psychosomatic condition and instead demanding opiods that are very likely to result in addiction.
There is a large stigma around mental health, but there's no such thing as a person who's completely sane. Just because a doctor is saying you might have a psychosomatic condition is not the same as him saying you're deranged.
I support your point, but there's also one more thing to consider. Some MDs share the social stigma around mental health, and won't waste the opportunity to make the patient feel like it's their fault because they don't want to get better, and that they should make space for patients who have real conditions.
>Regardless of whether you think the advice from the GP is sound or not, the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
It's been shown that it's very hard to prove that you're not mentally ill if you're labeled as such. Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either but just claim you haven't gotten the right psychiatric treatment yet.
> It's been shown that it's very hard to prove that you're not mentally ill if you're labeled as such.
But what if you do have a condition that requires therapy? You're unlikely to recognize it yourself. Would you always refuse treatment and just go with painkillers instead?
> Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Instead he would be sent to a psychologist who can only recommend further therapy. Ofcourse if the symptoms become worse you should immediately see the GP and not wait for therapy.
> If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either
If your symptoms become worse the doctor will definitely recommend testing. Therapy is something to do as part of diagnosing your ailment.
>The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Severe pain due to psychosomatic causes sounds like mental illness to me.
>Instead he would be sent to a psychologist who can only recommend further therapy.
No, they can also strongly recommend that they see a psychiatrist for potential medications.
>The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Every health system I've dealt with funnels to medication pretty strongly. Therapy is a slow process and medication allows a patient to not be in distress during the years it can take.
>Therapy is something to do as part of diagnosing your ailment.
Therapy is a slow process that in the best of cases can take years to work and longer in other cases. It is a shitty approach to diagnosis.
>Because patients often insist on medication because they do not accept that the ailment can't immediately be diagnosed.
Not my experience both personally and with those I know regarding mental illness. Doctors are quick to diagnose mental illnesses (correctly or not) and prescribe medications for them (even if the patient is hesitant). Some health systems even make it nearly impossible to get a therapist (we can see you once a month starting in two months...) but not a psychiatrist.
> the best way to get a doctor to listen to you is to listen to (and follow) their advice first.
No. Because sometimes their advice is "nothing can be done, you'll need to manage." Or - "Wait for a few more weeks and if it doesn't go away, we'll rethink things".
Hmm? Lots of ailments do just get better if you leave them alone. That's probably the case for the majority of things that people go to the doctor for. If your knee hurts, you may as well wait a few weeks to see if it gets better before you start running a bunch of tests.
Thanks for caring so much that you would let me spend weeks in pain. I think I'll look for a doctor who actually wants to treat his/her patients' conditions.
I'm not a doctor. Of course one could prescribe medication for the pain. But many ailments are difficult to diagnose and fix themselves after a few weeks, so it makes no sense to rush into things.
More broadly, it's a mistake to measure how much your doctor "cares" by how eager they are to throw lots of tests and treatments at you. Modern medicine isn't magic, and there isn't always that much that a responsible doctor can do for you.
> Psychosomatic diseases are a real thing though. You can have real physical symptoms.
+1. Several people at work have reported that "The Mindbody Prescription: Healing the Body, Healing the Pain" helped their wrist pain go away.
YMMV. But just as doctors shouldn't dismiss the idea symptoms are due to a "real" (read: physical) condition, folks suffering shouldn't dismiss the idea they can be cured (or greatly improved) through non-physical means, even if there is some physical origin.
I haven't tried this book myself. I've had wrist/forearm/hand problems (weakness, tingling/numbness, pain, loss of flexibility, diagnosed as carpal tunnel and tendonitis), but they largely went away before I'd heard of the book. I think a bunch of things helped me, including wrist exercises suggested by a physical therapist, TENS (administered by the physical therapist), time, Qi Gong, meditation/relaxation techniques (I'd always had a lot of muscle tension, including tension headaches), and (later on) resuming rock climbing and weight lifting. So some combination of physical and mental changes.
Unfortunately for most people taking a break like that is impossible. I’m sure stress is a major factor in many of my health problems but the biggest break I can take is an hour or two to myself once a week.
You really don’t know how many hypochondriacs we get. And general anxiety disorder with a focus on healthcare. And totally reasonable people who start attaching every last twinge and twitch to their (real) core symptom, and want an answer that encompasses all of them.
And these people seek care. A lot. Literally orders of magnitude more than ordinary people do. You have your one story of (x). I can tell you about a score-plus of nuts I see in a regular week. Many of them are frequent fliers: I will get to see the same ones pretty soon with wildly different symptoms that in no way relate to their current symptoms. They certainly don’t relate to the crap they brought me a month ago.
I’ll take your wager for “more than half.” Dunning-Kruger is not your friend.
I do. I worked in healthcare and the overwhelming majority of patients are legit. Same with any category where people are cynical and project that cynicism onto the majority. When I became a patient I became a victim of this categorization. I've been labeled immediately as drug seeking or mental or whatever and things have gone ignored or dismissed until I pushed long enough and hard enough for testing etc. I've told the story over and over irl about working in inner city hospitals and seeing people consistently dismissed and joked about for hours until testing prove them legit and then watching people scramble mostly to CYA not out of any empathy. Was a major contributor to my burnout in the field.
Calling worried patients with scary symptoms "nuts" and their issues "crap" really sums up the sort of thing I am talking about and is what makes patients afraid their provider isn't going to do their best to help them. Empathy is required for good healthcare. I recently got another confirmed and terribly depressing diagnosis of an incurable issue, but the provider I was working with was so kind, caring, and informative it reduced the mental impact as much as is possible. A dismissive provider, who was ultimately wrong, a few weeks before had me in an even worse head space than normal until I got to someone good. When I reached out to the wrong one to notify them they didn't seem care at all and dug in harder despite the proof/labs etc.
"A few bad apples" isn't because of the few bad apples. It's because the farmer decides all the apples are rotten, and throws them all out with the few rotten ones, while telling others constantly about those rotten ones as if they are the norm.
I had a super serious reaction to an antibiotic. I have been to mayo clinic and somewhere around 60 physicians with different specializations by now.
At least 70% of physicians have left me angry, they were simply wrong. Some would not take all symptoms because it is too much to handle at one time. My experience with western medicine has been pathetic.
Also, when I was younger I had a sports hernia. It is almost like a inguinal hernia except there is no bulge. I struggled for 12 months. 4-5 months in I had a hunch it was a sports hernia from my research. I have seen total of about 6 surgeons and 4-5 doctors for the issue. All told me it is a strain, gave me NSAIDs, suggested I see a therapist. I found a great doctor in California. He performed the surgery and took images. I had completely ripped 3 different muscles in my inguinal area. By the way, the doctors I have seen were BIG name Chicago doctors from Northshore, RUSH.....it was one of the worst experiences of my life and I often feel hatred towards doctors. The shittiest thing is, that initially it was one side but they gave me a go ahead to go back and lift at work, so I ripped the other side. I was too young, broke and dumb to sue at that time, because now I would take them to the cleaners.
I would not be surprised if software engineers do more research than them.
You are required - ethically, perhaps even legally - to sort out the hypochondriacs/nuts from the bona-fide-condition cases using sound diagnostics. Now, for the person who complains about a couple of days or sore throat or a headache, you might dismiss them with something mild and symptomatic - but the person who tells you "I've had excruciating pain in my wrists for a year and I can't type", with the medical history to prove it, is definitely someone you should put through a battery of tests.
Let's try to remember that people with medically unexplained pain will be experiencing real, actual pain.
They're not inventing the pain. We can put them through fMRI and see the same bits of the brain light up.
The public have 3 incorrect beliefs about pain treatment.
1) Opioids work
2) The only acceptable outcome for pain treatment is elimination of all pain
3) Pain is either real (with a physical cause) or not real (psychologic, or made up).
It seems plenty of doctors believe (3) too.
Patients reject treatments that don't fit these beliefs.
As you know opioids are a good choice for some types of pain, but they're a poor choice for others. The patient will end up with an opioid addiction, and all the side effects from the opioid meds, and they'll still be in pain because they've got a tolerance to the meds.
So pain treatment now will try to eliminate pain if possible, but some people that's just not possible, and so HCPs will look at function. How well can the person live their life, even if they're in pain?
This leads to a multi-disciplinary approach to pain management, including physiotherapy but also importantly including a psychological treatment.
If this was a standard approach for all pain, obviously being tailored for different types of pain, patients would be less likely to reject it. Your "nuts" (a fucking horrible way to describe patients and incompatible with a professional registration in England) would be less likely to reject psychological treatments for pain if they knew that it was also being offered to cancer patients.
In this case yes because then the patient could seek further experts who might be able to identify a cause. By labeling it psychosomatic you are forcing a path of treatment even if it's not the right path.
Most(80%) issues doctors encounter are textbook cases with easily visible symptoms that match a known cause.
The remaining 20% consist of rare problems that might be really hard to spot and diagnose.
I'd guess doctors get a lot of unneeded spam visits from the mentally unwell, so it's really easy to get clumped into that same category as them if your problems aren't within that 80%
Getting a diagnosis when you don't have something easily understood can be an utterly soul destroying process.
I have fibromyalgia. Not as a label stuck to something that can't be understood, but firmly fitting to a disease that isn't yet fully understood. (Yay for me - I have every known symptom at one time or another.)
It took ten years, an enormous amount of pain, two neurologists, three GPs, a psychiatrist and a pain specialist before they were able to nail it down - and now they're able to help.
Unfortunately, there was a tendency to treat it as psychosomatic. Also unfortunately, treating it as psychosomatic promotes behaviours like "pushing through the pain" that are absolutely guaranteed to cause a flare up or major relapse in fibroymalgia.
This kind of story created fear for you. And it should, I'm sorry to say. For the most part, you will suffer alone and without understanding, and it's up to the sufferer to push their story along until they get an answer. I'd wish that process on nobody.
Diagnosis is a diagnosis of exclusion. Eventually with my set of symptoms it became clear that only two illnesses fit well enough. Fibromyalgia or multiple sclerosis. A clear MRI eliminated MS as an option.
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Treatment is a multi-pronged attack.
I have a drug cocktail aimed at desensitisation of the nervous system. It works well enough to take the edge off, but not during a flare up or relapse. It's the least important and least effective part of treatment.
I have a psychologist, aimed at pain management. The mental techniques around dealing with pain and stress on a daily basis. This becomes more important during a flare. It is also probably the most important part of treatment.
I have a physiotherapist. I need to maintain a certain level of physical activity or the illness can rapidly get worse, whilst at the same time, too much activity can also cause the same process.
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I should also point out that if I became completely resistant to treatment, a possibility for the future if things get worse, then my pain specialist is also involved in a series of trials using ketamine that usually results in desensitisation of the nervous system over the course of a couple weeks.
Point being, there is always hope for increasing quality of life, even if there is currently no hope of cure.
I know someone who also had suspected MS, and a clear MRI. Just to be sure, they also did a lumbar puncture. That actually confirmed the MS (presence of inflammation) despite the clear MRI.
Point being that a clear MRI does not totally eliminate MS.
I feel you. I have RSD, a related disease, and even today half the doctors I see either dismiss it or do not believe in it. I went through YEARS of blame and denial before a very kind specialist in Europe spent time with me and gave me answers. By then it was too late to put it in remission, but their treatments did reduce it some, for which I am grateful as I'd not have lasted beyond that time without it. But day to day its still life altering. It's taken so much from me, that I cannot even afford to deal with it well anymore, let alone the other inevitable medical things and aging.
Pain is too often ignored, dismissed, miscategorized. While psychosomatic issues and stress positively make things worse, it's not always the root of all issues and too often it's projected as such. It will ultimately be the end of me as there is no realistic way to get enough back to survive long term.
I suspect anti-american bigotry by the British doctor.
It is a cliché that Americans are hypochondriac* (especially women) so I can imagine some stuck-up British guy being so completely unprofessional and damaging.
* Why is it not HYPERchondriac? I wish medicine would replace hypo with another prefix: how many deaths and how much damage occurs by miscommunications due to mixups of opposites? Edit: hypochondrion means "below the cartilage" where the Greeks though the "seat of emotion" organ was - arrrgh.
I think this is something that happens more in the UK.
The NHS has a "policy" on these issues. If you have anything that is falls into the category of "poorly understood neuro", you are mad...according to NHS policy. What is even more disturbing though is that the research is fairly clear that these problems aren't psychological...but doctors within the NHS, usually non-researchers, are utterly convinced that it is which has massively hindered the amount of research on this within the UK.
And the massive irony of this is that most doctors in the UK, usually not in primary care, will happily accuse patients of being mad...but there is almost no investment in psychological services in the UK. The doctors are seeing an epidemic of mad people...but don't think they need treating...logical.
Btw, I look after a relative who has something like this and it is fucking terrifying (and upsetting watching someone get sicker every day with no professional help or even interest in help). These problems are usually genetic, if I get sick then I have no-one to look after me, and I know if I get sick there will be no professional help. Let's hope I am lucky.
I still use DragonDictate for Mac to do all of my dictation, whether that is writing Hacker News comments, writing emails, having meaningful discussions (okay arguing) on Twitter or writing code.
One of the most useful features of DragonDictate for Mac is the Auto-text feature where you can use single words to trigger larger blocks of text, this is great for filling in empty functions et cetera. There are also some really great Sublime Text plug-ins like auto complete all which makes writing code so much easier.
I mainly like to work in Python, but also have a huge library of Bash scripts to iron out lots of the little wrinkles that pop up when you cannot use your hands and you're trying to use a computer efficiently. Honestly there are so many of them that I have been using so long that I am not sure I could enumerate them off the top of my head!
I have played with Talon a little bit but never really got to grips with it, I don't know whether that's because I'm too used to using my method or that Talon was a little overcomplicated. I am however so pleased that there is work being done in this area, I am really happy that developers and industry are starting to understand that Accessibility does not just mean "works with a screen reader" as it has in the past.
One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
> One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
Sounds like LaTeX should be an option. When I write LaTeX I use vim and the KDE PDF viewer Okular. When I save the file I let a script compile it and Okular automatically updates when the new PDF file is ready.
While I do all that with a keyboard, I guess it shouldn't be that hard to set it up with voice commands (judging from the video in the blog post). I don't know how PDF viewers act on a Mac, but using sublime instead of vim should be no problem. To speed up the creation of formulas you might want to take a look at this post (it uses vim, but maybe there are some good ideas you can make use of):
Kudos to this guy’s bravery; he is living my worst nightmare. My biggest fear is losing eyesight or ability to use hands, and articles like this confirm my beliefs that our current technology is no way near mature enough where disability isn’t a concern anymore. And these doctors, what can I say about them. It looks like they are getting worse, or just lazy, with every passing day. If you are a doctor and you don’t want to do anything that requires more effort than prescribing painkillers, do this world a favor and get retired because you are actually damaging the medical industry.
One theory I've heard is that too many people were pushed into becoming doctors for the money, and now the profession is full of people who hate it, are deep in debt, and see no way out.
Close. The bigger issue is that reimbursement has fallen precipitously while documentation requirements have risen greatly. People who loved the job when they had 20 mins with a patient and two minutes of charting and had a comfy life with a hope of a retirement fund, are now seeing patients for 7 minutes, documenting for 10-15, and unable to pay off their debts before retirement (never mind sending their kids to school, or paying their own retirement.)
The job has changed, the pace has changed, and yes, going from “comfortable living” to “oh fuck” has an element to it.
I know very few who went into the field just for money though. It’s never been a good career for that, relative to all the school debt and the lost decade of life to education/training.
My career in Software would be over if it wasn't for voicecode.io and now Talon.
I go through periods where typing does not bother me at all and long periods of intense random pain in forearms, wrists, palms and top of my hands.
Certain aspects of controlling your computer by voice are way more efficient than using a keyboard, others not so much. Lucky for me using a mouse does not bother me that much so I continue to use that for scrolling and mousing and alternate clicking by voice or mouse. I probably work by voice about a 1/3 of the time right now, ideally it would be more like 2/3 of the time.
There is definitely a big learning curve to using voice control and like they said in the article you have to be careful about voice strain.
- light years ahead of where voicecode.io was with speed and accuracy
- free
- can be used without Dragon (although accuracy with Dragon is much better)
- currently only works on Mac OSX, but has plans for Linux and Windows support
I have pair programmed off and on, both in person and remote; yes it helps because you are typing less, but sometimes you end up being the driver for long sessions so it is not perfect.
A friend of mine has a different solution to this problem which I think is really great. Programmer salaries are more than enough to pay someone to type for you. But he doesn't just hire typists. He trains apprentices. https://blog.iangilman.com/2018/06/wrists-apprentices.html
Having a medical condition which causes bone density and arthritic issues, I’m certain my body will diminish far quicker than my brain will. Hiring a typist is the same conclusion I’ve come to as well, and ultimately it would inevitably become a pair programming session.
This story resonates. A few years back I was dealing with mild pain while coding. I stupidly ignored it for months as it got significantly worse, to the point where it became impossible to type for extended periods.
I tried lots of things. My doctor did a nerve conduction study, which apparently ruled out carpal tunnel syndrome, but he wasn't much help beyond that. He gave me some straps that I slept in and wore around to keep my wrists immobilized. I did some physical therapy. I got a split keyboard and ergonomic mouse. I even took a month off from typing, then returned, but the pain was worse than ever.
The double whammy of severe pain combined with the fear that you'll never code again is rough to say the least.
I resolved to just code with my voice. I never found Talon but found VoiceCode instead. It also relied on Dragon's NaturallySpeaking software, which I was dismayed to learn was still the best desktop software out there. My hopes and ambition for what VoiceCode could do always outpaced reality, but it was workable. I remember impressing some friends who witnessed me quickly and accurately writing code by speaking what seemed like gibberish.
As the author notes, the biggest problem quickly becomes that your voice tires out. You're not built to talk nonstop for hours on end every day. I was forced to become a much more efficient developer for a bit.
Eventually the pain began to subside. I remember when I first noticed it happening, because it was one of the happiest moments of my life. After a little experimentation and observation, it was clear that my recovery was positively correlated with consistency in going to the gym for heavy weightlifting sessions. Even today, pain in my hands and wrists is a reliable signal that I haven't been lifting in recent weeks, and when I start back, the pain goes away.
I had literally the exact same experience as your first two paragraphs. Where my experience diverged is when I met a doctor of some kind who explained that it's the same kind of pain that truckers often get for resting their arms on the armrests. Turns out it was because I was resting my arms on the keyboard or the desk between me and the keyboard. Stopped doing that, the pain went away completely within a few days, and hasn't come back since. That was like 4 years ago. Just don't rest your arms on anything, that's the trick.
That makes a lot of sense, the best cure for my wrist pain I found was deep massage on certain places in my forearms. Thinking back the area I hit most often was the point where my forearms lay on the armrests.
This helped me too. It was combination of desk edge and sleeping on the hand that was causing it. Started sleeping on back or the other side and resting full forearm on desk (so not on edge; at least pressure's distributed) or the actual proper posture (not resting forearm anywhere), and it went away fairly soon.
In my case too much bouldering caused forearm pain that lasted for two years. Didn't stop me from typing, but it did have a significant impact on my daily life :/
I also suffered from hand pain from typing and took up climbing both inside and a bit of outside for a good 8 years solid.
I found bouldering to be way more intense than just top rope (eventually getting into lead) climbing. Most of my hand/arm injuries were from bouldering.
I concur with the previous response though... climbing, done well and not over doing it... was the 100% solution to my pain problem.
Sitting and typing all day, you lose muscle and strength, not just in your hands, but your arms, shoulders and neck. Climbing builds it right back and really helped more than any special keyboards or posture changes I tried.
Not the same especially with grip style but you can go a long way by strengthening your back. I'm talking of horizontal and vertical pulls (heavy rows, pullups, lat pulldowns, deadlifts to an extent).
In my unscientific observation, a lot of people have very weak posterior chains. My wrist pain has always (so far) been the result of a knot in my upper back or a weakness there.
Don't forget to foam roll, stretch and perhaps add in some periodic deep tissue massage to keep things from getting too tight cos that also brings problems
I used this as well. Same issue as bouldering. It tends to stress the joints too much.
For whatever reason, regular climbing is better. Probably because there is more 'levels' and thus less immediate stress. You can't really climb to the top of an indoor route until you can learn and get the strength to do it.
With fingerboards you try to see how much you can tolerate and tend to over do it. It also is more of a static movement. Grab and hold. Where top rope climbing is more dynamic... you're constantly moving up the wall in various poses.
How much was too much? I can certainly imagine that bouldering could cause wrist injuries. But in my case, like above, it strengthened my wrists and improved the pain I was having from typing.
It just depends on how you are built. I tried to get into climbing for a while but the constant strain on the fingers caused more and more pain over time until I could barely use my hands. Took many years to get back to normal.
That’s why you should test a lot of advice if it works for you. Things that work for one person can be damaging for another.
"Make or Break" by David MacLeod has helped me fix a handful of climbing related strains - https://www.davemacleod.com/shop/makeorbreak - might not be relevant for you anymore, but I would recommend it for anybody who climbs
As someone whose had RSI for about 6 years and managed it well enough for work; bouldering would be literally impossible for me.
Microsoft split keyboard, footrest and proper chair with adjustable armrests allow me to work with minimal pain, and I work long/after hours frequently. Prior to sorting out that setup I took a month of work because I was in so much pain, which returned as soon as I returned to work (without the ergo setup).
Playing games, playing guitar (sadly) or using tools like screwdrivers for even a short period of time does not end well for me. I absolutely still do each of these in moderation, and I would love to go rock climbing! It's just highly unlikely to be enjoyable after the first few minutes.
I had mild pain in my wrists in the late 90's I switched to ergonomic keyboard, got a good office chair, and switched to Dvorak layout. I did this for my work and home environment.
One additional step I had to take. I removed they armrests from each chair and have continued to do so with all chairs. I found myself leaning into the armrests too much to the extent of causing abrasions on my elbows. With removal of the armrests I work and play at the computer with better posture. I mention this only because what works will vary between people and I think it's an important change.
Also, I have no idea what to credit with the pain of my wrists going away. I suspect Dvorak, but it was probably a combination of factors.
>I mention this only because what works will vary between people and I think it's an important change.
I really like this because I took an alternative option. I decided "home row" thinking was too confining when writing code (I probably write more scripts), and I can't think as fast as I can type with that sort of approach. My colleagues call me a "hunt and pecker," while I actually simply refuse the home row. Muscle memory is quite odd and can be cultivated to encourage less repetition.
An alternative grip exercise that can be done anywhere and avoids the injury risk of climbing, is to alternately make a fist and then open your hands as far as possible while spreading your fingers apart. Start slowly and gradually increase the speed and repetitions. Be sure to have at least one rest day between sessions (I actually think two rest days is better). After a couple of weeks, you should be able to do it extremely quickly for hundreds of reps until your forearms are completely fatigued. In each workout, try to open and close your hand more quickly than the previous workout. Make your fingers look like a blur of motion. It is surprising how completely fatiguing this can be after just a few minutes.
The closest thing I've found is called a "Fist Flex," so I just call this a "Rapid Fist Flex." I adapted it from a rehab exercise I was given after an injury, which instructed you to only do 10 to 20 slow repetitions. Once I was largely recovered from the injury, I found that doing 20 repetitions at a slow rate did little for me, so I experimented and determined that just increasing the rate and exercising to fatigue allowed me to continue to strengthen as effectively as any weight-bearing exercise I had done. I think of it as using acceleration/deceleration to generate force rather than using weights, which is similar to what sprinting does for the legs, core, and arms. Take a look at a 100m sprinter. Rapid movement is very effective at strengthening and it works your full range of motion. If you want some extra resistance, just put your hands underwater in the bathtub when doing it.
I did something similar quite often in my aikido classes. There was also a twist exercise - start with your fingers together palm parallel to the ground facing down, and rotate the forearm rapidly so the palm is facing up, and then back again. Repeat until you can't. Go back to the open close motion. Do those pairs 3x daily.
I stopped akido due to a knee injury, but yikes were my wrists strong for a while.
Learning to play the guitar is a surprisingly good way to increase your hand strength - mostly the left/off hand, but not exclusively. Learning to play the piano has similar hand strength benefits. Obviously overdoing it in both cases can lead to it's own RSI issues. But just getting past the beginner stage really adds a lot of strength & dexterity.
I've certainly read this before, however are there any studies that back this up?
I played guitar before I got RSI. Now, I can't play for more than a few minutes at a time without ending up in pain - despite my RSI being under control for work purposes.
Actually, there's nothing quite like playing guitar in terms of causing me pain well after finishing the activity. Certain things like lifting heavy furniture, or using a screwdriver cause pain quicker but it also goes away pretty fast. 5 minutes of guitar will result in pain and weakness until the next day. Granted, it's not an enormous amount of pain, but it's certainly enough to be annoying. It sucks, because despite not being very good, I've always enjoyed playing guitar.
I should add that I also certainly never overdid playing either; I've never played a live show in my life and have never taken it too seriously, was just a hobby.
I wasn't trying to say that playing guitar was a treatment or therapy for RSI symptoms. Obviously any type of hand exercise can make things worse while your hand/wrist/ligaments are inflamed or you're otherwise subject to flareups of RSI.
The general idea in this thread was that increasing finger/hand strength could be a preventative action for people worried about RSI, and I think that's a reasonable train of thought - and playing guitar certainly does improve hand strength.
I think it's fair to say that no preventative action is 100% effective for the kinds of things we're talking about. I'm pretty sure other activities and factors, including genetics and luck play a lot into whether that increased hand strength is enough to prevent RSI in any individual case.
I do think it's good to bring it up as a warning though - it's very possible for any activity that uses the hands a lot to contribute to RSI symptoms rather than help, and people should really pay attention to what their body is telling them :)
Sorry to hear you're not able to play as much as you'd like - it's been one of my favorite things to do when I need to get away from the computer, and I'm super grateful it hasn't caused my RSI to return.
Thanks for posting this. The article, and your post, also resonated with me.
I have small fiber neuropathy in my arms and legs, which causes constant pain and a feeling of weakness. I've had this for a few years now, and I'm very aware that it's only got worse over that period, and that I may later get damage to the larger nerves used for motor control.
Like you say, the pain and fear that coding (which is my livelihood and passion) may become impossible is quite terrifying, and a constant, nagging presence in the back of my mind.
I haven't tried any dictation software since the days of Dragan Dictate, possibly 1-2 decades ago, but I'd like to hope it's come in since then. It sounds like you really persisted with it, and I have a few questions about your experience if you don't mind:
1. Was the pace much slower, and did you get frustrated with it? A mouse and keyboard allows me to operate closer to the "speed of thought" than I would guess dictation software would
2. What do you say to move the cursor around, or switch between open files?
3. I'd guess there's a big difference between dictating a document and coding or working on the command line, as you're not always inputting "real" words. How well did dictation work in that regard?
1. It was slower and I was frustrated, yes. I don't know about the newer Talon software, but with VoiceCode I spent a lot of overhead just configuring my setup and tweaking it, to say nothing of the slower coding speeds while using it. But once you get going, it's faster than you might think, and it feels vaguely futuristic. In fact I'd say some things are faster. I used a lot more macros, for example. Scrolling is slow. I often cheated and would type or use my mouse.
2. Honestly I can't remember the specifics of my setup. It was too long ago.
3. Above, I'm only really talking about dictating for code. You need a bunch of custom commands for that. Dictating for writing prose was pretty straightforward. If memory serves, VoiceCode had a different mode you could switch into for that.
4. Not sure. I believe I was using Atom at the time. I now use VS Code.
I once had a similar experience, except it was the muscles in my back, between my shoulder blades, that were causing great pain. I eventually realized that 1) the issue was due to long hours of keyboard work, and 2) when I added seated cable rows to my lifting routine, the pain went away completely.
Surely a bespoke and custom solution is do-able with ML anymore?
At least for me, I’m down to Python, and Go as my daily driver languages. I lean heavily into reusable code and can solve a lot of problems with imports from git sources (everyone all on about DRY and write less code, right?)
Feels like a reasonably constrained problem set to organize a few sequences of voice commands around.
I don't have pain in my hands, but I get severe back pain from time to time. It's difficult to sit or stand (or be in any position, really) for a few days at a time.
I can do some things just fine, like type, but I certainly can't concentrate long enough to do any programming tasks because the pain is so distracting.
same here, and I will repeat csallen's solution: going to the gym and lifting heavy things (squat/deadlifts/etc with good form and comfortable pace) has turned my decades long back pain around completely.
It took about 6 months to really be sure it had improved, but it's been amazing, plus there have been significant cognitive benefits. Couple the gym with less sitting, and more standing -- couldnt be happier, wish I had done it earlier.
> It also relied on Dragon's NaturallySpeaking software, which I was dismayed to learn was still the best desktop software out there.
Sounds like a business opportunity especially with the barrier to AI being lowered. But I guess there is some real value in having been doing it as long as the Dragon team has.
To other readers: Be very careful about weight lifting. It has a lot of risks, both of immediate trauma and longer-term excessive strain. So seek the guidance of relevant professionals, including a physical therapist and/or an orthopedics specialist physician, either before or during weight lift training. This is doubly true if you have been in serious pain.
I'm not suggesting that you _not_ lift weights - just take care.
All exercise has risks. Walking has risks. The question is not what the risks are, but do the benefits of the exercise outweigh potential risks?
For lifting weights, the answer is absolutely yes. Strengthening bones, improving mental health, better sleep, lower blood pressure, less injury prone as you get older, etc. etc. These are the benefits of regular strength training.
For otherwise healthy people, you do not have to consult a professional before starting a weight lifting routine.
I'm sure that your caution is well meaning, and people should definitely ease into a new exercise routine slowly, but recommending that people talk to a doctor or PT before they go to the gym is an overabundance of caution that will lead people to skip out on it altogether out of a misplaced fear of injury.
>After a little experimentation and observation, it was clear that my recovery was positively correlated with consistency in going to the gym for heavy weightlifting sessions
This was my experience as well.
Started getting inflammation and pain on the top of both forearms that made typing for longer than 15 minutes very painful. I was convinced for a while that I had some sort of nerve entrapment that would need surgery to fix.
Ibuprofen helped a little, as did wrapping my forearms in braces, but the only thing that alleviated the pain long term was lifting heavy weights.
If you have carpal tunnel, lifting weights can make things worse. It puts more stress in the narrow canal that your tendons go through, which cause the pain.
At the worst, I had continuous wrist pain and woke up in the morning unable to feel my arms. I couldn’t physically hold a mouse for more than about 15 minutes. When this happened I was also lifting weights.
I spent thousands of dollars on ergonomic chairs, keyboards, mice. It helped but didn’t solve the symptoms completely. I was unable to do things like use a laptop without pain.
Several years later I started doing basic body strength exercises. I thought I had permanent nerve damage by that point, but within about 4 weeks all symptoms were gone. That was 10 years ago.
I think a lot of these problems are related to shoulder, neck, and arm muscles. Stress, cold, seem to exacerbate the symptoms. Nothing I read in years of research had the right answer.
Can you describe what body weight exercises you found helpful? Why do you think those were different than what you were accomplishing with traditional gym weightlifting?
I think it was something related to the tight grip used in lifting weights.
I started with the beginning workouts from the book You Are Your Own Gym. In retrospect, 90% of the benefit was from the pushups, which I had completely avoided doing once I started getting severe wrist pain.
I started to have knee pain in my early 20s and my dad had both knees replaces sometime in his 60s. I was afraid I'd end up that way and went to a sports clinic (I do a lot of dancing). I had patilla bilat; basically the knee cap was off to the side instead of sitting squarely.
They said everything else on my knee looked good. Out of all the physically therapy exercises, the most significant was cycling. I started to do a lot of cycling after that, which builds the muscles on both sides of the knee and helps keep the kneecap centered.
I had a similar experience, where the knee pain would start to return if I slacked off on cycling. These days I cycle ~100km per week (12km per day to work and back and a bunch on the weekends) during the summer and still dance and haven't had the knee pain return in years.
I've been here with an L&I claim for RSI. Extreme pain.
Doctors are _very_ reluctant to tell you to take a break for work. Even for a while. What if they are wrong? Massive lawsuit. The best advocate and the one with the final say is yourself. You must become an expert on the subject and be prepared to make big changes in life for your happiness and health.
Dunning-Kruger applies to medicine as fully as it does to any other technical field. When people say things like “all (highly technically trained specialists) are idiots these days, they have no idea how to (do their jobs, which I am untrained to evaluate)”, that statement says a lot more about the intellectual humility of the speaker than it does about the people they’re criticizing.
I have been lucky to not be impacted by hand or wrist pain. I did experience chronic back pain for years due to a pinched sciatic nerve, it can be debilitating and depressing. Chronic pain is a large precursor to suicide, if you have it, you need to get it fixed.
My interest in this is from a FutureOfProgramming perspective, how can we interact with computers in different, higher order ways. What does the Mother of All Demos [0] look like in 2020?
Travis Rudd, "Coding by Voice" (2013) [1] this uses Dragon in a Windows VM to handle the speech to text. This was the original, "termie slash slap", a kind of Pootie Tang crossed structural editing.
Coding by Voice with Open Source Speech Recognition, from HOPE XI (2016) [2]
Another writeup [3] that outlines Dragon and a project I hadn't heard of called Silvius [4]
It looks like most of these systems rely on Dragon, and Dragon on Windows at that due to not having the extension APIs on Mac/Linux. Are there any efforts to use the Mac's built in STT or the Cloud APIs [5,6]?
Talon actually uses Mac's built in STT if you don't have Dragon.
James from http://handsfreecoding.org/ was working on a fork of Dragonfly[0] to add support for Google's speech recognition, but I'm not sure if he still is. There are several barriers to that working well though: additional latency really hurts, API usage costs and (as far as I know) an inability to specify a command grammar (Dragonfly/Vocola/Talon all let you use EBNF-like notation to define commands, which are preferentially recognized over free-form dictation).
Fibromyalgia And idiopathic disease are not terms for "go away".
They mean "I've tried what I can think of and theres no further testing we can recommend"
Notably, a positive punch biopsy for small fiber neuropathy IS diagnosis with treatment that works fairly well. Ideopathic simply means that the base cause is unknown.
The author need to educate themselves further about what doctors can do and what words mean. He has a good scientific diagnosis, and he's outright dismissing it based on some misdirected anger.
At the beginning of the story I empathized with the author, myself having had to deal with pain in my hands that required injections to resolve.
But their attempt to make their article more “funny” and dramatic at the expense of their doctors rubbed me the wrong way. It’s not cool to use other people like that to get more clicks.
The tipping point for me was the author making their doctor ask them to leave their office. It’s just as bad as people being rude to retail workers who can’t accept a refund.
I don't think the author is trying to exploit doctors to get clicks. I think they're expressing genuine anger and frustration with the healthcare systems they've encountered and the dismissal they've experienced from doctors in those systems.
A doctor telling you they don’t know what the root cause of your problem is is not dismissal, unless all of the author’s doctors are acting in bad faith.
I was sad to hear that because of my bone structure in my wrists I will have to be very careful when typing for the rest of my life in order to avoid the pain coming back. I didn’t swear at my doctor when he told me that.
> I went away to the UK. I brought my medical records from America, but my British neurologist did not read my records or perform examinations. [...] My GP read the note and informed me: He would not prescribe me painkillers. He would not send me for a second opinion from a neurologist, or treatment from any other specialist.
"Bad faith" is a vague term. Is not reading medical records evidence of bad faith? I don't know. But I'd sure feel dismissed if a doctor who hadn't read my records concluded without examination that the root cause of my problem was psychological and my GP refused to allow me to seek a second opinion.
I think you may be confusing the American diagnoses (which were of the "we don't know the underlying cause" variety - fibromyalgia, idiopathic neuropathy) with the UK diagnoses (which I'd paraphrase as "you don't have a non-psychological problem and we won't allow a second opinion").
It wasn't just that, but the doctor was also closing down all of her options, eliminating pain management, and ignoring all her medical records and telling her she's delusional.
I'd say it's bad faith to so boldly screw someone over like that when you know they physically can't punch your face in for it.
> Notably, a positive punch biopsy for small fiber neuropathy IS diagnosis with treatment that works fairly well. Ideopathic simply means that the base cause is unknown.
What is the treatment you claim?
Wikipedia claims that "Treatment [for small fiber neuropathy] is based on the underlying cause, if any." Given that idiopathic means having an unknown cause, that seems to contradict your statement.
SFN sufferer here, can confirm that there is no treatment. There are some promising research chemicals, but we are a long, long way from seeing anything available.
There must be some miscommunication here. Gabapentin and Pregabalin are both used successfully for SFN and are first line treatment options.
For severe cases, things like mexiletine can be used if you're willing to tolerate the side effects. Sodium-channel blockers like lidocaine + epinephrine can be used for localized treatment during sever pain.
It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown), and symptomatic treatment IS medical treatment.
Apologies, I meant "treatment" to mean "treat the condition", as in "make it better".
Gabapentin, Pregabalin etc can help with the pain, but not the underlying cause.
I haven't come across mexiletine before, but after a quick glance if looks like it's unlikely to be prescribed in the UK (I'm in the UK :).
I must have tried dozens of medications over the past 4 years or so, but it seems I have some dodgy genetics, as I can't tolerate most, or I have an atypical response (gabapentoids make me feel drunk, SNRIs nauseous, and tricyclics do absolutely nothing). I also tried topical gabapentin and capsaicin, but neither did anything.
> It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown)
For me it started when taking immunosuppressants for another condition - within a couple of weeks, the pain started and has been there every minute of every day for years since. I have 3 other immune-related conditions, one of which is rare, and I do believe all of these is related - but I'm resigned to the fact that I'll never find the underlying cause.
I'm not sure if it will help, but I also felt rather poorly on Gabapentin (and Pregabalin).
I did two rounds of it and decided it was a terrible medication. I could barely even walk (I distinctly remember my poor father helping me down some stairs at ikea the first day I took it, unknowing what was to come).
Eventually I found a rheumatologist that understood. She started me on 100mg Gabapentin in the evenings. I did that for 2 weeks. I slept better, which was nice.
Then I added 100mg in the morning with a dose of magnesium citrate. Gabapentin is absorbed in the lower GI tract and magnesium citrate increases intestinal motility. This effectively makes the 100mg dose therapeutically equivalent to 20-50mg.
After a week, I'd have my morning dose normally.
Then 200mg in the evening after a week. Then 200mg in the morning. Then 400mg in the evening... Etc...
It took me a little over 3 months to get to the appropriate therapeutic dose, but I managed without experiencing any unpleasant side effects. I then switched to Pregabalin without any titration, and it's more effective for me.
I spent at least 5 years rolling back and forth between pregab/gaba before a sensible doctor walked me through a tolerable process. Hopefully this might help you communicate a similar system with your healthcare professional so you can try it again.
I really persisted with both Gabapentin and Pregbalin, as everything I've read points to them resulting in the best outcomes for patients that tolerate them.
I actually do take magnesium citrate daily anyway (200mg twice a day), but it didn't seem to help me here.
I even tried taking 2 weeks off work and took the minimum dose for the entire period - it was a horrible couple of weeks, where I felt drunk, dizzy, disoriented and anxious for the whole time. I just really can't tolerate them :( I had a similar experience with SNRIs, and also experienced horrendous withdrawals with them - I've tried about half a dozen of them, but after my last experience I accept they are not for me, and will never try another! I guess it all comes down to genetics.
Anyway, all that said, your advice seems good, and I'd encourage others to try to persist and slowly titrate up.
Just curious, have you tried any kind of autoimmune diet? It seems a bit strange to me that RSI never seemed to be a thing before the past few decades.
I don't have RSI, I have SFN (Small Fiber Neuropathy), as very different condition.
At some point after this happened to me, I switched to a low-carb diet (but not because of the SFN, because of a rare auto-immune condition; didn't make any different to the SFN pain, not that I expected it to).
I'm sorry, but at least in the UK and on the NHS, fibromyalgia is very much a diagnosis of "go away".
I had to battle with my neurologist to get a skin biopsy, despite very clear symptoms of neuropathy, and a very clear trigger.
He eventually ordered it, very reluctantly. It came back normal, which for him for conclusive proof that I had fibromyalgia.
When I asked him about fibromyalgia, it was immediately clear that he literally had no idea about it - when I said that it disproportionately affected women, he actually laughed at the idea. When I said I didn't have pain in the tender points associated with fibromyalgia, and I didn't have flare-ups that are typical of fibromyalgia, he just filibustered. It really was his way of saying "I dunno, you're probably a wacko, go away".
I did a lot of reading of papers, and was convinced I did have small fiber neuropathy. I requested a copy of my medical notes and discovered 2 very interesting things - firstly, the neurologist was indeed convinced it was all in my head, that no physical cause would ever be found, and he'd influenced and biased other medical professionals I was involved with by telling them this at every opportunity. Secondly, the biopsy sample had been taken from the wrong place, and had later gone missing - there were no results!
I insisted on another biopsy, and sure enough it found small fiber neuropathy in my arms and legs. He didn't even apologise for what I see as clear negligence.
In the author's case, he had a biopsy diagnosis from the US, but said the UK docs didn't accept that, and he doesn't even have any pain meds - he absolutely should outright dismiss that in anger!
My advice for the author: you're in a profession where you can afford to self-fund private healthcare - put aside principles and just pay to see a private neurologist. If needed, they can repeat a skin biopsy, and you will absolutely not be left without any pain meds.
For neuropathic pain, the best pain meds for most people are Gabapentin, Pregbalin and tricyclics. If those don't work, SNRIs such as duloxetine, might. Opioid medications don't work well on neuropathic pain for the majority of people, but can help some, especially if nothing else works. Sativex (basically a cannabis tincture) also helps some people, and is very easy to get privately now if you have proven SFN (let me know if you want to try this and I'll tell you where to get it).
> and you will absolutely not be left without any pain meds
Based on what I've learned, over-the-counter pain medication, such as Tylenol and Advil, is most effective for pain. It's also cheaper, doesn't require a prescription, and isn't addictive. You should consult with a doctor for high doses and long-term usage.
When I had opioids after surgery, I could not concentrate. Specifically, I could not concentrate to read for pleasure, or do the kind of reading needed for our profession. Everything came back as soon the last dose wore off. Since then, even with minor dental surgery, a few high doses of Advil work much better than Valium. (The Valium just leaves me hung over the next day.
It's unsurprising that Advil (Ibuprofen), an anti-inflammatory painkiller, would work better for pain than Valium (Diazepam), an anti-anxiety medication with no pain relieving properties of any kind, and certainly not an opiate. Perhaps you meant Vicodin? In either case you undercut your position to give advice about choice of painkiller.
Not in the UK. Almost all doctors don't like to prescribe benzos at all nowadays, and if they do it will be literally a few as a one-off for something like anxiety.
I had an identical experience to you, however Fibro is diagnosis of exclusion. When the doctor doesn't know what else to do, and you match the symptoms... Boom, Fibro.
I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
In my case, after seeing dozens of specialists, the doctors simply had no clue what to do. Thus what was left was fibro (which few understand) or psychosomatic causes.
I much rather frame a response of "I don't know" as just that, they don't know. It allows me to proceed further with a more knowledgable source.
Early in my experience I took it as "Go Away" or "You're faking", which made me combative. Combative against a source that lacked the knowledge to help me further. It was a COMPLETE waste of time.
If I took "We don't know" as just that, I would have much more quickly moved towards finding a proper specialist with the knowledge to do proper testing and followup care.
It's really easy to think that Doctors are being malicious because, hey! They're doctors, they're not dumb, right? Except they are. Even the most educated of generalists lacks significantly more medical knowledge than they possess. Doctors know a lot less than they know, and almost always best to recognize those limitations in an individual as soon as possible so you can find the right person for your care.
In part, yes, but there are actually well-defined criteria for fibromyalgia[0]
> I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
sigh, I agree. In my (unfortunately vast) experience with NHS doctors, it seems the majority have never had any training or even read a paper since they became doctors, and that they are trained to diagnose the obvious and write everyone else as a nutjob.
For example NHS endocrinologists mainly know about diabetes (even if somewhat outdated) and thyroid cancer - anything else, forget about it, you need to go private and see a specialist that doesn't have tunnel vision.
I got RSI like 15 years ago. The only thing that's worked for me long term when I'm actually doing coding all day long, is a combination of:
a) a keyboard holder below the desk - something similar to https://kw.pricenacdn.com/files/images/products/original/14/... - I got mine from IKEA a long time ago - unfortunately they discontinued that product - the key thing here is the get the keyboard as close to your legs as possible, i.e. enabling your arms to be purely horizontally oriented while typing - or ideally even sort of downwards-pointing.
I love the MS Natural Keyboards and agree about the durability. I had one of them so long the little nubs on the J and F keys actually wore away and I couldn't place my hands by touch any more. (I scored the two keys with an old soldering iron.)
I've tried the Sculpt keyboard, and just not as good for me. I do use the silver media and other keys along the top quite extensively, plus being a Vim user, the escape key seems to be a bit too dodgy.
As they've been harder to buy, when my last one finally died (which is when I found I don't like the Sculpt that much) I ended up trading fixing someone's printer configuration for their barely used Natural keyboard that had been sitting in a corner for ages as they didn't like it. Going to be very sad when I can't find one any more.
That's awesome that you were able to solve your issues with changes to your equipment. I wish I could do the same. Unfortunately, some of us have tried all types of ergonomic devices, and none of them work, thus the emergence of "alt" input like Talon. That being said, I personally fall back to an ergo keyboard like the one you posted for short bursts as needed, or use a stylus to peck at keys.
I have a very similar issue. I tried to use Vocola and it worked for a while but then i kept straining my voice. I recently had to quit school because I've strained my voice and hands too many times to count. But its not just my hands anymore. Anything that involves any amount of real effort for more than a few minutes usually ends up injuring a muscle group.
Has anyone successfully come back from something like this? Life is getting pretty bleak.
I try walking 5 minutes a couple times a day which is ok. I tried doing DDP yoga, the routine you do in your bed, and i got hurt the first time. it took months for my abdomen to stop hurting.
I was in a similar boat a few years ago. I had to leave my job a because of an RSI—it was devastating to lose both my career and my passion to this injury. My solution was to switch to coding by voice, and I've been doing that full-time for the past year. I did notice some voice strain at the start, but it went away after I started speaking more naturally (i.e., pretending I'm talking to a person and not a computer).
I'm working on a new voice coding app—developing it entirely by voice—that I hope can help people in this situation: https://serenade.ai. I'd be happy to chat more with you; my email is matt@serenade.ai.
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[ 4.6 ms ] story [ 294 ms ] threadIt could have been worse. I read it as a bad lead to an article about dynamically typed languages.
It would almost certainly be worse if I hadn't had the family history to point to and actually convince them to do the tests that would confirm the diagnosis. For chronic illnesses defined by random irreparable damage the sooner you start treatment the better your outcomes are likely to be.
I am surprised that four doctors in a row did this, that's shocking. Usually a second or third opinion is enough that at least one of the doctors is paying attention.
They did not like their diagnosis because “idiopathic” means “we don’t know what causes this,” which the patient translated as “go the fuck away.” As if all human disease is deeply understood and an admission of ignorance is equivalent to laziness. They then continued going to additional doctors.
People think that there is a pill or operation for whatever ails you, which is simply not true even with modern medicine.
It doesn't change the fact that, as a patient, an idiopathic diagnosis is not a satisfying outcome if it doesn't point to a course of treatment. And it's certainly not something I view as a "final diagnosis" -- I'm patient, and technology and medicine are still improving and I hope it'll be possible to identify the cause and treat it in the future.
Nonetheless, know that your post is appreciated. For now it's mostly handling small fasteners that gets me, typing is usually mostly okay. But since I do hardware prototyping I had to learn to ask for help a lot more than I was used to.
I also find it's sometimes helpful to wear a cloth around the more painful hand to kind of remind people that the pain isn't obvious... well, plus if it's a little wet it helps the pain a lot so it's functional too. But invisible pain means my coworkers frequently assume I'm feeling about how they are. And I feel bad saying no to stuff since technically I can still do it... it's just painful to do.
>That story of how the doctors just dismissed her pain as delusion is terrifying.
The frightening thing to me is that from my reading there is little recourse for her since the UK has a centralized health system controlled by GP referrals.
Edit: needless to say the medical response was very frustrating and hard to believe. In the end they were right that it was not a physical cause, but apart from that it really felt like they had no idea. Also it could be a multi-level cause like gut flora causing anxiety causing be physical symptoms but it’s beyond what a doctor can diagnose I think.
Cursing at them out of frustration only makes your situation worse.
Honestly it sounds like the GP is so cynical about the hot garbage they perceive UK healthcare to be that they basically said "please go away so that our utter inability to help you doesn't weigh on my conscience any further... oh thank god you invoked the loophole that lets me kick you out now and pretend it's all really your fault"
That's a patient's perspective, but how about a doctor's perspective? You've got a patient refusing treatment for what could very well be a psychosomatic condition and instead demanding opiods that are very likely to result in addiction.
There is a large stigma around mental health, but there's no such thing as a person who's completely sane. Just because a doctor is saying you might have a psychosomatic condition is not the same as him saying you're deranged.
It's been shown that it's very hard to prove that you're not mentally ill if you're labeled as such. Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either but just claim you haven't gotten the right psychiatric treatment yet.
But what if you do have a condition that requires therapy? You're unlikely to recognize it yourself. Would you always refuse treatment and just go with painkillers instead?
> Getting treatment just means you'll be put on essentially random psychiatric medications (which have their own side-effects) or have to spend years in useless therapy (while your actual disease may progress).
The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Instead he would be sent to a psychologist who can only recommend further therapy. Ofcourse if the symptoms become worse you should immediately see the GP and not wait for therapy.
> If a doctor isn't willing to do the proper testing or evaluation the first time then they won't do it a second time either
If your symptoms become worse the doctor will definitely recommend testing. Therapy is something to do as part of diagnosing your ailment.
Severe pain due to psychosomatic causes sounds like mental illness to me.
>Instead he would be sent to a psychologist who can only recommend further therapy.
No, they can also strongly recommend that they see a psychiatrist for potential medications.
>The patient in this case would not see a psychiatrist since he's not depressed or mentally ill.
Every health system I've dealt with funnels to medication pretty strongly. Therapy is a slow process and medication allows a patient to not be in distress during the years it can take.
>Therapy is something to do as part of diagnosing your ailment.
Therapy is a slow process that in the best of cases can take years to work and longer in other cases. It is a shitty approach to diagnosis.
In that case you're assuming both the psychiatrist and the GP overreact.
> Every health system I've dealt with funnels to medication pretty strongly.
Because patients often insist on medication because they do not accept that the ailment can't immediately be diagnosed.
Not my experience both personally and with those I know regarding mental illness. Doctors are quick to diagnose mental illnesses (correctly or not) and prescribe medications for them (even if the patient is hesitant). Some health systems even make it nearly impossible to get a therapist (we can see you once a month starting in two months...) but not a psychiatrist.
No. Because sometimes their advice is "nothing can be done, you'll need to manage." Or - "Wait for a few more weeks and if it doesn't go away, we'll rethink things".
To be fair, this is often excellent advice.
More broadly, it's a mistake to measure how much your doctor "cares" by how eager they are to throw lots of tests and treatments at you. Modern medicine isn't magic, and there isn't always that much that a responsible doctor can do for you.
+1. Several people at work have reported that "The Mindbody Prescription: Healing the Body, Healing the Pain" helped their wrist pain go away.
YMMV. But just as doctors shouldn't dismiss the idea symptoms are due to a "real" (read: physical) condition, folks suffering shouldn't dismiss the idea they can be cured (or greatly improved) through non-physical means, even if there is some physical origin.
I haven't tried this book myself. I've had wrist/forearm/hand problems (weakness, tingling/numbness, pain, loss of flexibility, diagnosed as carpal tunnel and tendonitis), but they largely went away before I'd heard of the book. I think a bunch of things helped me, including wrist exercises suggested by a physical therapist, TENS (administered by the physical therapist), time, Qi Gong, meditation/relaxation techniques (I'd always had a lot of muscle tension, including tension headaches), and (later on) resuming rock climbing and weight lifting. So some combination of physical and mental changes.
And these people seek care. A lot. Literally orders of magnitude more than ordinary people do. You have your one story of (x). I can tell you about a score-plus of nuts I see in a regular week. Many of them are frequent fliers: I will get to see the same ones pretty soon with wildly different symptoms that in no way relate to their current symptoms. They certainly don’t relate to the crap they brought me a month ago.
I’ll take your wager for “more than half.” Dunning-Kruger is not your friend.
Calling worried patients with scary symptoms "nuts" and their issues "crap" really sums up the sort of thing I am talking about and is what makes patients afraid their provider isn't going to do their best to help them. Empathy is required for good healthcare. I recently got another confirmed and terribly depressing diagnosis of an incurable issue, but the provider I was working with was so kind, caring, and informative it reduced the mental impact as much as is possible. A dismissive provider, who was ultimately wrong, a few weeks before had me in an even worse head space than normal until I got to someone good. When I reached out to the wrong one to notify them they didn't seem care at all and dug in harder despite the proof/labs etc.
"A few bad apples" isn't because of the few bad apples. It's because the farmer decides all the apples are rotten, and throws them all out with the few rotten ones, while telling others constantly about those rotten ones as if they are the norm.
At least 70% of physicians have left me angry, they were simply wrong. Some would not take all symptoms because it is too much to handle at one time. My experience with western medicine has been pathetic.
Also, when I was younger I had a sports hernia. It is almost like a inguinal hernia except there is no bulge. I struggled for 12 months. 4-5 months in I had a hunch it was a sports hernia from my research. I have seen total of about 6 surgeons and 4-5 doctors for the issue. All told me it is a strain, gave me NSAIDs, suggested I see a therapist. I found a great doctor in California. He performed the surgery and took images. I had completely ripped 3 different muscles in my inguinal area. By the way, the doctors I have seen were BIG name Chicago doctors from Northshore, RUSH.....it was one of the worst experiences of my life and I often feel hatred towards doctors. The shittiest thing is, that initially it was one side but they gave me a go ahead to go back and lift at work, so I ripped the other side. I was too young, broke and dumb to sue at that time, because now I would take them to the cleaners.
I would not be surprised if software engineers do more research than them.
They're not inventing the pain. We can put them through fMRI and see the same bits of the brain light up.
The public have 3 incorrect beliefs about pain treatment.
1) Opioids work
2) The only acceptable outcome for pain treatment is elimination of all pain
3) Pain is either real (with a physical cause) or not real (psychologic, or made up).
It seems plenty of doctors believe (3) too.
Patients reject treatments that don't fit these beliefs.
As you know opioids are a good choice for some types of pain, but they're a poor choice for others. The patient will end up with an opioid addiction, and all the side effects from the opioid meds, and they'll still be in pain because they've got a tolerance to the meds.
So pain treatment now will try to eliminate pain if possible, but some people that's just not possible, and so HCPs will look at function. How well can the person live their life, even if they're in pain?
This leads to a multi-disciplinary approach to pain management, including physiotherapy but also importantly including a psychological treatment.
If this was a standard approach for all pain, obviously being tailored for different types of pain, patients would be less likely to reject it. Your "nuts" (a fucking horrible way to describe patients and incompatible with a professional registration in England) would be less likely to reject psychological treatments for pain if they knew that it was also being offered to cancer patients.
Most(80%) issues doctors encounter are textbook cases with easily visible symptoms that match a known cause.
The remaining 20% consist of rare problems that might be really hard to spot and diagnose.
I'd guess doctors get a lot of unneeded spam visits from the mentally unwell, so it's really easy to get clumped into that same category as them if your problems aren't within that 80%
I have fibromyalgia. Not as a label stuck to something that can't be understood, but firmly fitting to a disease that isn't yet fully understood. (Yay for me - I have every known symptom at one time or another.)
It took ten years, an enormous amount of pain, two neurologists, three GPs, a psychiatrist and a pain specialist before they were able to nail it down - and now they're able to help.
Unfortunately, there was a tendency to treat it as psychosomatic. Also unfortunately, treating it as psychosomatic promotes behaviours like "pushing through the pain" that are absolutely guaranteed to cause a flare up or major relapse in fibroymalgia.
This kind of story created fear for you. And it should, I'm sorry to say. For the most part, you will suffer alone and without understanding, and it's up to the sufferer to push their story along until they get an answer. I'd wish that process on nobody.
what was the nail-down / how are they able to help now?
---
Treatment is a multi-pronged attack.
I have a drug cocktail aimed at desensitisation of the nervous system. It works well enough to take the edge off, but not during a flare up or relapse. It's the least important and least effective part of treatment.
I have a psychologist, aimed at pain management. The mental techniques around dealing with pain and stress on a daily basis. This becomes more important during a flare. It is also probably the most important part of treatment.
I have a physiotherapist. I need to maintain a certain level of physical activity or the illness can rapidly get worse, whilst at the same time, too much activity can also cause the same process.
---
I should also point out that if I became completely resistant to treatment, a possibility for the future if things get worse, then my pain specialist is also involved in a series of trials using ketamine that usually results in desensitisation of the nervous system over the course of a couple weeks.
Point being, there is always hope for increasing quality of life, even if there is currently no hope of cure.
Point being that a clear MRI does not totally eliminate MS.
Pain is too often ignored, dismissed, miscategorized. While psychosomatic issues and stress positively make things worse, it's not always the root of all issues and too often it's projected as such. It will ultimately be the end of me as there is no realistic way to get enough back to survive long term.
It is a cliché that Americans are hypochondriac* (especially women) so I can imagine some stuck-up British guy being so completely unprofessional and damaging.
* Why is it not HYPERchondriac? I wish medicine would replace hypo with another prefix: how many deaths and how much damage occurs by miscommunications due to mixups of opposites? Edit: hypochondrion means "below the cartilage" where the Greeks though the "seat of emotion" organ was - arrrgh.
The NHS has a "policy" on these issues. If you have anything that is falls into the category of "poorly understood neuro", you are mad...according to NHS policy. What is even more disturbing though is that the research is fairly clear that these problems aren't psychological...but doctors within the NHS, usually non-researchers, are utterly convinced that it is which has massively hindered the amount of research on this within the UK.
And the massive irony of this is that most doctors in the UK, usually not in primary care, will happily accuse patients of being mad...but there is almost no investment in psychological services in the UK. The doctors are seeing an epidemic of mad people...but don't think they need treating...logical.
Btw, I look after a relative who has something like this and it is fucking terrifying (and upsetting watching someone get sicker every day with no professional help or even interest in help). These problems are usually genetic, if I get sick then I have no-one to look after me, and I know if I get sick there will be no professional help. Let's hope I am lucky.
https://news.ycombinator.com/item?id=20359884
- https://robotsandcake.org/about/humans/stuart-turner.html
- https://www.youtube.com/channel/UCjnBpiirfr7LL-mUk9uSpZw
I still use DragonDictate for Mac to do all of my dictation, whether that is writing Hacker News comments, writing emails, having meaningful discussions (okay arguing) on Twitter or writing code.
One of the most useful features of DragonDictate for Mac is the Auto-text feature where you can use single words to trigger larger blocks of text, this is great for filling in empty functions et cetera. There are also some really great Sublime Text plug-ins like auto complete all which makes writing code so much easier.
I mainly like to work in Python, but also have a huge library of Bash scripts to iron out lots of the little wrinkles that pop up when you cannot use your hands and you're trying to use a computer efficiently. Honestly there are so many of them that I have been using so long that I am not sure I could enumerate them off the top of my head!
I have played with Talon a little bit but never really got to grips with it, I don't know whether that's because I'm too used to using my method or that Talon was a little overcomplicated. I am however so pleased that there is work being done in this area, I am really happy that developers and industry are starting to understand that Accessibility does not just mean "works with a screen reader" as it has in the past.
One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
Anyway, I am a coder who cannot type, AMA!
> One of the main problems and trying to solve at the moment is how to write mathematical notation using the tools I have at hand, which is a Mac, Sublime Text and DragonDictate for Mac.
Sounds like LaTeX should be an option. When I write LaTeX I use vim and the KDE PDF viewer Okular. When I save the file I let a script compile it and Okular automatically updates when the new PDF file is ready.
While I do all that with a keyboard, I guess it shouldn't be that hard to set it up with voice commands (judging from the video in the blog post). I don't know how PDF viewers act on a Mac, but using sublime instead of vim should be no problem. To speed up the creation of formulas you might want to take a look at this post (it uses vim, but maybe there are some good ideas you can make use of):
https://castel.dev/post/lecture-notes-1/
The job has changed, the pace has changed, and yes, going from “comfortable living” to “oh fuck” has an element to it.
I know very few who went into the field just for money though. It’s never been a good career for that, relative to all the school debt and the lost decade of life to education/training.
I go through periods where typing does not bother me at all and long periods of intense random pain in forearms, wrists, palms and top of my hands.
Certain aspects of controlling your computer by voice are way more efficient than using a keyboard, others not so much. Lucky for me using a mouse does not bother me that much so I continue to use that for scrolling and mousing and alternate clicking by voice or mouse. I probably work by voice about a 1/3 of the time right now, ideally it would be more like 2/3 of the time.
There is definitely a big learning curve to using voice control and like they said in the article you have to be careful about voice strain.
- http://voicecode.io/ (now defunct)
- https://talonvoice.com/
I tried lots of things. My doctor did a nerve conduction study, which apparently ruled out carpal tunnel syndrome, but he wasn't much help beyond that. He gave me some straps that I slept in and wore around to keep my wrists immobilized. I did some physical therapy. I got a split keyboard and ergonomic mouse. I even took a month off from typing, then returned, but the pain was worse than ever.
The double whammy of severe pain combined with the fear that you'll never code again is rough to say the least.
I resolved to just code with my voice. I never found Talon but found VoiceCode instead. It also relied on Dragon's NaturallySpeaking software, which I was dismayed to learn was still the best desktop software out there. My hopes and ambition for what VoiceCode could do always outpaced reality, but it was workable. I remember impressing some friends who witnessed me quickly and accurately writing code by speaking what seemed like gibberish.
As the author notes, the biggest problem quickly becomes that your voice tires out. You're not built to talk nonstop for hours on end every day. I was forced to become a much more efficient developer for a bit.
Eventually the pain began to subside. I remember when I first noticed it happening, because it was one of the happiest moments of my life. After a little experimentation and observation, it was clear that my recovery was positively correlated with consistency in going to the gym for heavy weightlifting sessions. Even today, pain in my hands and wrists is a reliable signal that I haven't been lifting in recent weeks, and when I start back, the pain goes away.
I found bouldering to be way more intense than just top rope (eventually getting into lead) climbing. Most of my hand/arm injuries were from bouldering.
I concur with the previous response though... climbing, done well and not over doing it... was the 100% solution to my pain problem.
Sitting and typing all day, you lose muscle and strength, not just in your hands, but your arms, shoulders and neck. Climbing builds it right back and really helped more than any special keyboards or posture changes I tried.
In my unscientific observation, a lot of people have very weak posterior chains. My wrist pain has always (so far) been the result of a knot in my upper back or a weakness there.
Don't forget to foam roll, stretch and perhaps add in some periodic deep tissue massage to keep things from getting too tight cos that also brings problems
Good for fixing or hang above a door way.
You don't need to actively climb on these, hanging from the holds will do the trick and reduce the possibility of dynamic loads.
For whatever reason, regular climbing is better. Probably because there is more 'levels' and thus less immediate stress. You can't really climb to the top of an indoor route until you can learn and get the strength to do it.
With fingerboards you try to see how much you can tolerate and tend to over do it. It also is more of a static movement. Grab and hold. Where top rope climbing is more dynamic... you're constantly moving up the wall in various poses.
That’s why you should test a lot of advice if it works for you. Things that work for one person can be damaging for another.
https://github.com/melling/ErgonomicNotes/blob/master/README...
I’ve also saved a bunch of Programming by Voice links:
https://github.com/melling/ErgonomicNotes/blob/master/progra...
The current theory of my doctor is that it’s a brachial plexus injury - just waiting on some MRI results to confirm.
On a bad day I could barely hold a cup of tea with the affected arm. Now I just have a tense muscle now and again.
Microsoft split keyboard, footrest and proper chair with adjustable armrests allow me to work with minimal pain, and I work long/after hours frequently. Prior to sorting out that setup I took a month of work because I was in so much pain, which returned as soon as I returned to work (without the ergo setup).
Playing games, playing guitar (sadly) or using tools like screwdrivers for even a short period of time does not end well for me. I absolutely still do each of these in moderation, and I would love to go rock climbing! It's just highly unlikely to be enjoyable after the first few minutes.
One additional step I had to take. I removed they armrests from each chair and have continued to do so with all chairs. I found myself leaning into the armrests too much to the extent of causing abrasions on my elbows. With removal of the armrests I work and play at the computer with better posture. I mention this only because what works will vary between people and I think it's an important change.
Also, I have no idea what to credit with the pain of my wrists going away. I suspect Dvorak, but it was probably a combination of factors.
I really like this because I took an alternative option. I decided "home row" thinking was too confining when writing code (I probably write more scripts), and I can't think as fast as I can type with that sort of approach. My colleagues call me a "hunt and pecker," while I actually simply refuse the home row. Muscle memory is quite odd and can be cultivated to encourage less repetition.
I stopped akido due to a knee injury, but yikes were my wrists strong for a while.
I played guitar before I got RSI. Now, I can't play for more than a few minutes at a time without ending up in pain - despite my RSI being under control for work purposes.
Actually, there's nothing quite like playing guitar in terms of causing me pain well after finishing the activity. Certain things like lifting heavy furniture, or using a screwdriver cause pain quicker but it also goes away pretty fast. 5 minutes of guitar will result in pain and weakness until the next day. Granted, it's not an enormous amount of pain, but it's certainly enough to be annoying. It sucks, because despite not being very good, I've always enjoyed playing guitar.
I should add that I also certainly never overdid playing either; I've never played a live show in my life and have never taken it too seriously, was just a hobby.
The general idea in this thread was that increasing finger/hand strength could be a preventative action for people worried about RSI, and I think that's a reasonable train of thought - and playing guitar certainly does improve hand strength.
I think it's fair to say that no preventative action is 100% effective for the kinds of things we're talking about. I'm pretty sure other activities and factors, including genetics and luck play a lot into whether that increased hand strength is enough to prevent RSI in any individual case.
I do think it's good to bring it up as a warning though - it's very possible for any activity that uses the hands a lot to contribute to RSI symptoms rather than help, and people should really pay attention to what their body is telling them :)
Sorry to hear you're not able to play as much as you'd like - it's been one of my favorite things to do when I need to get away from the computer, and I'm super grateful it hasn't caused my RSI to return.
I have small fiber neuropathy in my arms and legs, which causes constant pain and a feeling of weakness. I've had this for a few years now, and I'm very aware that it's only got worse over that period, and that I may later get damage to the larger nerves used for motor control.
Like you say, the pain and fear that coding (which is my livelihood and passion) may become impossible is quite terrifying, and a constant, nagging presence in the back of my mind.
I haven't tried any dictation software since the days of Dragan Dictate, possibly 1-2 decades ago, but I'd like to hope it's come in since then. It sounds like you really persisted with it, and I have a few questions about your experience if you don't mind:
1. Was the pace much slower, and did you get frustrated with it? A mouse and keyboard allows me to operate closer to the "speed of thought" than I would guess dictation software would
2. What do you say to move the cursor around, or switch between open files?
3. I'd guess there's a big difference between dictating a document and coding or working on the command line, as you're not always inputting "real" words. How well did dictation work in that regard?
4. Are any IDEs particular dictation-friendly?
2. Honestly I can't remember the specifics of my setup. It was too long ago.
3. Above, I'm only really talking about dictating for code. You need a bunch of custom commands for that. Dictating for writing prose was pretty straightforward. If memory serves, VoiceCode had a different mode you could switch into for that.
4. Not sure. I believe I was using Atom at the time. I now use VS Code.
Surely a bespoke and custom solution is do-able with ML anymore?
At least for me, I’m down to Python, and Go as my daily driver languages. I lean heavily into reusable code and can solve a lot of problems with imports from git sources (everyone all on about DRY and write less code, right?)
Feels like a reasonably constrained problem set to organize a few sequences of voice commands around.
I can do some things just fine, like type, but I certainly can't concentrate long enough to do any programming tasks because the pain is so distracting.
It took about 6 months to really be sure it had improved, but it's been amazing, plus there have been significant cognitive benefits. Couple the gym with less sitting, and more standing -- couldnt be happier, wish I had done it earlier.
When not going for some weeks (like when traveling) I can tell it becomes worse.
Plus you get in shape which is neat. I started out for health benefits but would be lying if I said I did not enjoy the visual benefits. :P
Sounds like a business opportunity especially with the barrier to AI being lowered. But I guess there is some real value in having been doing it as long as the Dragon team has.
I'm not suggesting that you _not_ lift weights - just take care.
For lifting weights, the answer is absolutely yes. Strengthening bones, improving mental health, better sleep, lower blood pressure, less injury prone as you get older, etc. etc. These are the benefits of regular strength training.
For otherwise healthy people, you do not have to consult a professional before starting a weight lifting routine.
I'm sure that your caution is well meaning, and people should definitely ease into a new exercise routine slowly, but recommending that people talk to a doctor or PT before they go to the gym is an overabundance of caution that will lead people to skip out on it altogether out of a misplaced fear of injury.
This was my experience as well. Started getting inflammation and pain on the top of both forearms that made typing for longer than 15 minutes very painful. I was convinced for a while that I had some sort of nerve entrapment that would need surgery to fix.
Ibuprofen helped a little, as did wrapping my forearms in braces, but the only thing that alleviated the pain long term was lifting heavy weights.
I spent thousands of dollars on ergonomic chairs, keyboards, mice. It helped but didn’t solve the symptoms completely. I was unable to do things like use a laptop without pain.
Several years later I started doing basic body strength exercises. I thought I had permanent nerve damage by that point, but within about 4 weeks all symptoms were gone. That was 10 years ago.
I think a lot of these problems are related to shoulder, neck, and arm muscles. Stress, cold, seem to exacerbate the symptoms. Nothing I read in years of research had the right answer.
I started with the beginning workouts from the book You Are Your Own Gym. In retrospect, 90% of the benefit was from the pushups, which I had completely avoided doing once I started getting severe wrist pain.
They said everything else on my knee looked good. Out of all the physically therapy exercises, the most significant was cycling. I started to do a lot of cycling after that, which builds the muscles on both sides of the knee and helps keep the kneecap centered.
I had a similar experience, where the knee pain would start to return if I slacked off on cycling. These days I cycle ~100km per week (12km per day to work and back and a bunch on the weekends) during the summer and still dance and haven't had the knee pain return in years.
Doctors are _very_ reluctant to tell you to take a break for work. Even for a while. What if they are wrong? Massive lawsuit. The best advocate and the one with the final say is yourself. You must become an expert on the subject and be prepared to make big changes in life for your happiness and health.
"It is that hard. You can do it."
My interest in this is from a FutureOfProgramming perspective, how can we interact with computers in different, higher order ways. What does the Mother of All Demos [0] look like in 2020?
Travis Rudd, "Coding by Voice" (2013) [1] this uses Dragon in a Windows VM to handle the speech to text. This was the original, "termie slash slap", a kind of Pootie Tang crossed structural editing.
Coding by Voice with Open Source Speech Recognition, from HOPE XI (2016) [2]
Another writeup [3] that outlines Dragon and a project I hadn't heard of called Silvius [4]
It looks like most of these systems rely on Dragon, and Dragon on Windows at that due to not having the extension APIs on Mac/Linux. Are there any efforts to use the Mac's built in STT or the Cloud APIs [5,6]?
[0] Mother of All Demos https://www.youtube.com/watch?v=yJDv-zdhzMY
[1a] https://www.youtube.com/watch?v=8SkdfdXWYaI
[1b] https://youtu.be/8SkdfdXWYaI?t=510
[2] https://www.youtube.com/watch?v=YRyYIIFKsdU
[3] https://blog.logrocket.com/programming-by-voice-in-2019-3e18...
[4] http://www.voxhub.io/silvius
[5] https://cloud.google.com/speech-to-text/
[6] https://aws.amazon.com/transcribe/
James from http://handsfreecoding.org/ was working on a fork of Dragonfly[0] to add support for Google's speech recognition, but I'm not sure if he still is. There are several barriers to that working well though: additional latency really hurts, API usage costs and (as far as I know) an inability to specify a command grammar (Dragonfly/Vocola/Talon all let you use EBNF-like notation to define commands, which are preferentially recognized over free-form dictation).
[0]: https://github.com/dictation-toolbox/dragonfly
They mean "I've tried what I can think of and theres no further testing we can recommend"
Notably, a positive punch biopsy for small fiber neuropathy IS diagnosis with treatment that works fairly well. Ideopathic simply means that the base cause is unknown.
The author need to educate themselves further about what doctors can do and what words mean. He has a good scientific diagnosis, and he's outright dismissing it based on some misdirected anger.
But their attempt to make their article more “funny” and dramatic at the expense of their doctors rubbed me the wrong way. It’s not cool to use other people like that to get more clicks.
The tipping point for me was the author making their doctor ask them to leave their office. It’s just as bad as people being rude to retail workers who can’t accept a refund.
I was sad to hear that because of my bone structure in my wrists I will have to be very careful when typing for the rest of my life in order to avoid the pain coming back. I didn’t swear at my doctor when he told me that.
> I went away to the UK. I brought my medical records from America, but my British neurologist did not read my records or perform examinations. [...] My GP read the note and informed me: He would not prescribe me painkillers. He would not send me for a second opinion from a neurologist, or treatment from any other specialist.
"Bad faith" is a vague term. Is not reading medical records evidence of bad faith? I don't know. But I'd sure feel dismissed if a doctor who hadn't read my records concluded without examination that the root cause of my problem was psychological and my GP refused to allow me to seek a second opinion.
I think you may be confusing the American diagnoses (which were of the "we don't know the underlying cause" variety - fibromyalgia, idiopathic neuropathy) with the UK diagnoses (which I'd paraphrase as "you don't have a non-psychological problem and we won't allow a second opinion").
I'd say it's bad faith to so boldly screw someone over like that when you know they physically can't punch your face in for it.
What is the treatment you claim?
Wikipedia claims that "Treatment [for small fiber neuropathy] is based on the underlying cause, if any." Given that idiopathic means having an unknown cause, that seems to contradict your statement.
For severe cases, things like mexiletine can be used if you're willing to tolerate the side effects. Sodium-channel blockers like lidocaine + epinephrine can be used for localized treatment during sever pain.
It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown), and symptomatic treatment IS medical treatment.
(fwiw: I have SFN as well, not that it matters)
Gabapentin, Pregabalin etc can help with the pain, but not the underlying cause.
I haven't come across mexiletine before, but after a quick glance if looks like it's unlikely to be prescribed in the UK (I'm in the UK :).
I must have tried dozens of medications over the past 4 years or so, but it seems I have some dodgy genetics, as I can't tolerate most, or I have an atypical response (gabapentoids make me feel drunk, SNRIs nauseous, and tricyclics do absolutely nothing). I also tried topical gabapentin and capsaicin, but neither did anything.
> It's a fuzzy distinction because SFN is almost always a sign of an underlying cause (even if unknown)
For me it started when taking immunosuppressants for another condition - within a couple of weeks, the pain started and has been there every minute of every day for years since. I have 3 other immune-related conditions, one of which is rare, and I do believe all of these is related - but I'm resigned to the fact that I'll never find the underlying cause.
I did two rounds of it and decided it was a terrible medication. I could barely even walk (I distinctly remember my poor father helping me down some stairs at ikea the first day I took it, unknowing what was to come).
Eventually I found a rheumatologist that understood. She started me on 100mg Gabapentin in the evenings. I did that for 2 weeks. I slept better, which was nice.
Then I added 100mg in the morning with a dose of magnesium citrate. Gabapentin is absorbed in the lower GI tract and magnesium citrate increases intestinal motility. This effectively makes the 100mg dose therapeutically equivalent to 20-50mg.
After a week, I'd have my morning dose normally.
Then 200mg in the evening after a week. Then 200mg in the morning. Then 400mg in the evening... Etc...
It took me a little over 3 months to get to the appropriate therapeutic dose, but I managed without experiencing any unpleasant side effects. I then switched to Pregabalin without any titration, and it's more effective for me.
I spent at least 5 years rolling back and forth between pregab/gaba before a sensible doctor walked me through a tolerable process. Hopefully this might help you communicate a similar system with your healthcare professional so you can try it again.
It's been totally worth the effort.
I actually do take magnesium citrate daily anyway (200mg twice a day), but it didn't seem to help me here.
I even tried taking 2 weeks off work and took the minimum dose for the entire period - it was a horrible couple of weeks, where I felt drunk, dizzy, disoriented and anxious for the whole time. I just really can't tolerate them :( I had a similar experience with SNRIs, and also experienced horrendous withdrawals with them - I've tried about half a dozen of them, but after my last experience I accept they are not for me, and will never try another! I guess it all comes down to genetics.
Anyway, all that said, your advice seems good, and I'd encourage others to try to persist and slowly titrate up.
At some point after this happened to me, I switched to a low-carb diet (but not because of the SFN, because of a rare auto-immune condition; didn't make any different to the SFN pain, not that I expected it to).
I had to battle with my neurologist to get a skin biopsy, despite very clear symptoms of neuropathy, and a very clear trigger.
He eventually ordered it, very reluctantly. It came back normal, which for him for conclusive proof that I had fibromyalgia.
When I asked him about fibromyalgia, it was immediately clear that he literally had no idea about it - when I said that it disproportionately affected women, he actually laughed at the idea. When I said I didn't have pain in the tender points associated with fibromyalgia, and I didn't have flare-ups that are typical of fibromyalgia, he just filibustered. It really was his way of saying "I dunno, you're probably a wacko, go away".
I did a lot of reading of papers, and was convinced I did have small fiber neuropathy. I requested a copy of my medical notes and discovered 2 very interesting things - firstly, the neurologist was indeed convinced it was all in my head, that no physical cause would ever be found, and he'd influenced and biased other medical professionals I was involved with by telling them this at every opportunity. Secondly, the biopsy sample had been taken from the wrong place, and had later gone missing - there were no results!
I insisted on another biopsy, and sure enough it found small fiber neuropathy in my arms and legs. He didn't even apologise for what I see as clear negligence.
In the author's case, he had a biopsy diagnosis from the US, but said the UK docs didn't accept that, and he doesn't even have any pain meds - he absolutely should outright dismiss that in anger!
My advice for the author: you're in a profession where you can afford to self-fund private healthcare - put aside principles and just pay to see a private neurologist. If needed, they can repeat a skin biopsy, and you will absolutely not be left without any pain meds.
For neuropathic pain, the best pain meds for most people are Gabapentin, Pregbalin and tricyclics. If those don't work, SNRIs such as duloxetine, might. Opioid medications don't work well on neuropathic pain for the majority of people, but can help some, especially if nothing else works. Sativex (basically a cannabis tincture) also helps some people, and is very easy to get privately now if you have proven SFN (let me know if you want to try this and I'll tell you where to get it).
Based on what I've learned, over-the-counter pain medication, such as Tylenol and Advil, is most effective for pain. It's also cheaper, doesn't require a prescription, and isn't addictive. You should consult with a doctor for high doses and long-term usage.
When I had opioids after surgery, I could not concentrate. Specifically, I could not concentrate to read for pleasure, or do the kind of reading needed for our profession. Everything came back as soon the last dose wore off. Since then, even with minor dental surgery, a few high doses of Advil work much better than Valium. (The Valium just leaves me hung over the next day.
For inflammatory pain, yes, NSAIDs can be very effective.
Neuropathic pain however, is a very different beast - NSAIDs will not help at all.
I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
In my case, after seeing dozens of specialists, the doctors simply had no clue what to do. Thus what was left was fibro (which few understand) or psychosomatic causes.
I much rather frame a response of "I don't know" as just that, they don't know. It allows me to proceed further with a more knowledgable source.
Early in my experience I took it as "Go Away" or "You're faking", which made me combative. Combative against a source that lacked the knowledge to help me further. It was a COMPLETE waste of time.
If I took "We don't know" as just that, I would have much more quickly moved towards finding a proper specialist with the knowledge to do proper testing and followup care.
It's really easy to think that Doctors are being malicious because, hey! They're doctors, they're not dumb, right? Except they are. Even the most educated of generalists lacks significantly more medical knowledge than they possess. Doctors know a lot less than they know, and almost always best to recognize those limitations in an individual as soon as possible so you can find the right person for your care.
In part, yes, but there are actually well-defined criteria for fibromyalgia[0]
> I think that hanlon's razor applies: "Never attribute to malice that which is adequately explained by stupidity."
sigh, I agree. In my (unfortunately vast) experience with NHS doctors, it seems the majority have never had any training or even read a paper since they became doctors, and that they are trained to diagnose the obvious and write everyone else as a nutjob.
For example NHS endocrinologists mainly know about diabetes (even if somewhat outdated) and thyroid cancer - anything else, forget about it, you need to go private and see a specialist that doesn't have tunnel vision.
[0] https://www.ncbi.nlm.nih.gov/pubmed/20461783
a) a keyboard holder below the desk - something similar to https://kw.pricenacdn.com/files/images/products/original/14/... - I got mine from IKEA a long time ago - unfortunately they discontinued that product - the key thing here is the get the keyboard as close to your legs as possible, i.e. enabling your arms to be purely horizontally oriented while typing - or ideally even sort of downwards-pointing.
b) Microsoft Natural Keyboard Pro - manufactured 1999-2001 (e.g. https://mechanicalkeyboardtryout.blogspot.com/2016/03/micros... or http://www.dansdata.com/nkpro.htm) I have two of these; they're very durable. You'll need to wash the key caps in your dishwasher once a year.
Switched to a mouse for a while, 2 months in RSI came back. Trackball it is.
I've tried the Sculpt keyboard, and just not as good for me. I do use the silver media and other keys along the top quite extensively, plus being a Vim user, the escape key seems to be a bit too dodgy.
As they've been harder to buy, when my last one finally died (which is when I found I don't like the Sculpt that much) I ended up trading fixing someone's printer configuration for their barely used Natural keyboard that had been sitting in a corner for ages as they didn't like it. Going to be very sad when I can't find one any more.
Has anyone successfully come back from something like this? Life is getting pretty bleak.
I'm working on a new voice coding app—developing it entirely by voice—that I hope can help people in this situation: https://serenade.ai. I'd be happy to chat more with you; my email is matt@serenade.ai.
I'm not anywhere near 100%. But I'm finally on my way there, after many years of negative or zero progress.
Above all else, fight to maintain hope that your situation can improve.
- take breaks
- stay hydrated
- tea with licorice root (Yogi brand: Throat Comfort is one example)
- speech/singing coach (I have not tried this yet, but apparently it can help a lot)