ginger ale

Aug. 23rd, 2013 02:36 pm
adrian_turtle: (Default)
A few years ago, Coca-cola started advertising that their new cans of regular coke contained only 100 calories. They had reduced the calorie count by making the cans slightly smaller--it seemed like a nice thing to do for their customers who liked the taste of classic coke and didn't want too many calories.

A couple of days ago, I was on an airplane, and I asked for ginger ale when the flight attendant offered me a drink. I hardly noticed the little green box on the green Seagrams can, announcing "25% fewer calories than regular ginger ales." When I saw it, I thought maybe they were using less sugar--a less sweet ginger ale would be nice. (There's a version of frosted flakes that just uses less of the frosting and brags that it's a lower cereal.) Then I thought maybe they were using a smaller can, but the can had a weird aspect ratio, and I picked it up trying to read the label to see how small.

It was a little tricky to read the label, because I didn't have my reading glasses. (I just had my e-reader, which lets me use big fonts and my distance glasses.) So there was a fair amount of dumb luck involved in seeing the sucralose on the ingredients list in the first place.* It wasn't diet pop; it had lots of corn syrup. It felt like they were just sneaking the migraine trigger into the can and hoping people wouldn't notice.

They really are being sneaky. It's not just that I was oblivious or that I've had so little ginger ale this year (while irrationally thinking of it as a familiar product I don't need to investigate before drinking.) I went back to the little airplane galley to discard the unused can and see if they could spare me a little water, and the flight attendant was shocked. "What seat are you in? I could have sworn I gave you regular soda!" No, really, it's not her fault. It looks exactly like non-diet soda. By the standards of people who want the diet stuff, it probably IS non-diet soda. Seagrams is just being sneaky. Or I suppose a person could use a less polite word than "sneaky."


*The flight attendant gave me the can in the first place, instead of just pouring me a cup.
I noticed the green-on-green box.
I read the ingredients list, when I didn't expect any need to.
adrian_turtle: (Default)
I went to see a new medical specialist this morning.

Office Manager: And what's your primary care doctor's name?
Adrian: Doctor [name]. It's spelled [...]
Office Manager: Do you know his first name?
Adrian: Of course. It's Deborah.

The office manager was seriously flustered by her mistake. I'm wondering how, in 2013, she might have made it. It's not like it's UNUSUAL for a family practitioner to be a woman. What surprised me even more was her thinking that I might not have known my doctor's first name.

A long time ago, when I lived in Michigan, my doctor was Dr. Bernstein. He shared an office with Dr. Blum, and I went on seeing Dr. Blum after Dr. Bernstein retired. I think I had some abstract awareness that they must have first names, but I had no idea what they might be.

Is this a difference between the 1970s and now? Or between how children and adults interact with their doctors? Or is it not perfectly routine to know the first name of one's primary doctor?
adrian_turtle: (Default)
The word "opiate" does not mean "something that makes a person behave badly." It does not even mean "something that makes a person behave badly, and is also hard to stop using." Most especially, it does not mean, "something that makes a person agitated and short-tempered, and is hard to avoid because it's so pervasive."

I wish there was not so much stigma around the medicine that lets me be as functional as I am.
adrian_turtle: (Default)
As many of you know, I live in Massachusetts, which has had a patchwork of nearly-universal health insurance coverage for several years now. We have religious exemptions to our health insurance requirements, but it's not nearly as infuriating as the type being discussed in national politics these days.

The Massachusetts plan tries to get as many people as possible into insurance plans, considering different reasons for doing without insurance:
1) health insurance plans won't sell to them
2) they have access, but can't afford the premiums
3) they have access and money, but want to save their money because they don't expect to need health care this year
4) they object to seeing doctors, on general principle

So there are rules for the health insurance plans to address problem 1, that they have to make their plans available to everybody, and can't raise the premiums too much. And rules for businesses, that they have to make group plans available to their employees. And subsidies to help low-income (and moderate-income) people with premiums. It's a reasonable attempt to address problem 2. In an attempt to get the 3rd group to pay premiums (whether they get insurance and health care or not), you're supposed to pay a tax penalty if you opt out of buying health insurance for reasons other than low income or religious conviction. The penalty money goes to support the subsidies.

The 4th group doesn't involve all that many people, but they're symbolically important. I don't know what religions have such strong objections to all medical care that the devout consider it wrong to have health insurance. (Maybe Christian Science?)

My Massachusetts tax form asks:
Are you claiming an exemption from the requirement to purchase health insurance based on your sincerely held religious beliefs?
If you are claiming a religious exemption in line 8a, did you receive medical health care during the 2011 tax year?


It was a religious exemption for individuals wanting to avoid buying health insurance. When did "religious exemption," in the context of health insurance, start to be about employers or insurers wanting to limit coverage? I feel like the jargon changed under my feet, and I didn't even notice it had changed until I sat down to do my taxes.
adrian_turtle: (Default)
Last month, I posted about a medical procedure I was planning to have on December 16th. It was scary and expensive, but I was hoping it would stop my migraines for a few months. I knew it wouldn't be an immediate fix. Patients who have good results report some pain after the injection, even headaches as a side effect. And the good results don't happen for at least a week. The doctor told me to expect optimal relief beginning 2 or 3 weeks after the injection.

I have mixed feelings about this "optimal relief."

The first week after the injection was very, very, bad. The shoulder pain flare was spectacular, and referred to hand and jaw. And my headache got worse. And a lot of my coping mechanisms stopped working, because I couldn't use my shoulder. (This made me overuse my bad hand on the other side, which wasn't any good for me either.) Fortunately, the worst of that effect was temporary. My shoulder pain is back down to the level it was in early December, with a reasonable range of motion. The problem is that I can't lift much at all.

You might have thought I couldn't lift much before. I certainly complained about not being able to do the hands-on part of my work in materials engineering. I was unhappy about not being able to carry a preschooler, or a whole turkey with a lot of vegetables. It's different when a 5-lb bag of oranges, all by itself, is too much to carry home in my backpack. It's different when it seems prudent to return paperbacks to the library one at a time.

For all that, it DID help my headaches. I had a continuous migraine from 10/29 to 12/29. Since then, my migraines have been frequent, but not continuous. I've even had a couple of half-day intervals with no headache at all, which were just lovely. That hasn't happened since the summer of 2000.

Thus, as I said, mixed feelings.
adrian_turtle: (Default)
Strobes don't bite most people, so he can get away with that. Usually. Last weekend, it went bad.

I was uncertain about going to Chicago for my cousin's bar mitzvah. I thought it would be worth the strain of air travel to see that set of relatives* and maintain my connection with the family. What really worried me was the possibility of strobe lights at the party after the service. Strobes are the worst triggers for my seizures, and pretty bad migraine triggers as well.

I dithered for WEEKS. It would be an evening party, which made strobes more likely. Yet it was a party in the synagogue social hall, which might make it quieter and less likely to have strobes than a party in a more party-specific space. Last time I saw the bar-mitzvah boy, he had been a very young 12 year old...would that make him less likely to be interested in the kind of dance party that relied on strobes? The next older cousin (who'd had strobes at her bat mitzvah party, that kept me hiding in the lobby most of the afternoon, and still needing a week of recovery time afterward) seemed a lot more sophisticated.

I finally phoned my cousin** and asked him if there would be strobes or flashing lights at the party. I grew up with the idea that it's an outrageous imposition for me to ask somebody to turn off a flickering light, or not to wear perfume. Now, mostly, I can recognize that people outside my family are ok with such requests (and if they aren't, I can walk away.) But when dealing with relatives, I can't bring myself to ask them to change what they're doing for my comfort. It feels daring and rude just to ask for information, so I can be be elsewhere if I think it's going to be too uncomfortable.***

In this case, my cousin was very gracious about it. He said they'd hired a DJ, and didn't know if he would have strobes. He's be happy to ask the DJ not to use any strobes, if they were a problem for me. I made travel plans thinking that maybe it was no longer appropriate for me to go on defining that side of my family based on my mother, my aunts and uncles, and my grandparents (of blessed memory.) The kids' table takes over gradually, and I didn't notice a lot of it, because it happened between my aunt and my cousins.

I shouldn't be surprised my cousin was so gracious about this issue. We haven't spoken much in the last few decades, and weren't particularly close as children, but I have no reason to think he's a mean guy. And I wasn't thinking about it when I made the call, but he has some reason to be sensitive about this sort of thing. The bar mitzvah boy also has absence seizures, and his parents have spent the last ten years trying hard to protect him from possible triggers. His seizures are very infrequent, and he's not photosensitive, and of course parents are more protective of children than adults are protective of themselves. Even so...when they're trying hard to make sure the kid doesn't have a seizure the week before he has to do something important, I wonder if my attempts to insist "I'm fine, it's nothing," for only one seizure in an evening might be inappropriate.

So. There I was, after the service, in the lobby of an enormous Chicago synagogue. The doors to the dining room were open, and the music was starting up, and I could tell there were strobe lights. Not a single device like a photographer's strobe, or even a disco ball, that I could point to and say "please turn that off." It was a whole dramatic light show, with flickering screens in several colors. I decided to stay in the lobby, eat the appetizers being carried around on trays, and play with my little nephews and their toy trains. (They didn't like the light show, either. Or possibly the music or the crowd.) It was unfortunate to miss the party after coming all that way, but the appetizers were yummy and there were lots of them, all pareve. And my nephews and I were enjoying one another's company. And maybe I could chat with various other relatives in passing. Everybody went in to dinner, and I settled down in the lobby.

Then my sister-in-law came for the boys. They had to go in and eat dinner. "Oh, you can't stay out here and miss the the whole party!" I tried to explain. A cousin came out to chat, and to invite me in. "But they turned off the strobes! You have to come in for this part!" I explained I preferred to stay in the lobby. Eventually, I was convinced to go into the party space--just for a little while, you'll see how safe it is now, it won't bother you, you really can't miss this. It was my own bad judgment that made me go into the room. But I stayed in the room for 2 hours because my judgment was so badly impaired by frequent seizures.

I made it home with great difficulty. I've felt purely awful all week. I am recovering, albeit slowly; I couldn't have written this on Wednesday.



*I would be seeing my brother and his wife and children, all my cousins and aunts and uncles on that side of the family, but not my mother.

**the one whose bar mitzvah was in 1980, not last week. Now that I think of it, that one also had strobes that made me uncomfortable, though it wasn't nearly so bad.

***as the bar mitzvah last week was Saturday evening, the young man was talking about Lech Lecha. He spoke of how admirable it is to just *go* when told, rather than trying to negotiate. (You want me to go WHERE? What's so great about this land that you will show me?) It echoed through what little thinking I was doing, later in the evening.
adrian_turtle: (Default)
Elise had a stroke a few days ago.* She managed to communicate enough of the problem that the person with her (sensitized by having one dear friend recovering from a stroke, and another working in emergency medicine) recognized the emergency and called 911. This was all despite Elise's initial desire to lie down and hope the symptoms went away. Thanks to prompt treatment, the stroke did not do permanent damage.

Elise, and the many people who care about her, bounced from profound terror to profound relief. In the first day or so after the stroke, I saw several people posting the news that she was in the hospital, and there was a tremendous outpouring of sympathy and offers to help. From over here, it looked like caring for Elise, caring for the community she helps build, and an attempt to fight back against disease and feeling helpless. Now that Elise is back from the hospital, and her stroke is no longer a medical problem, the community is redirecting the desire to help. I understand why so many people are talking about the importance of calling emergency medical services at the first sign of stroke symptoms. I even understand why the conversation has such emotional intensity--all that energy from fear and relief and the sudden transition has to go somewhere.

It's still making me uncomfortable. Read more... )
adrian_turtle: (Default)
I do not want to see this correlation, because it makes no sense and because implies I should limit my already limited lifestyle in fairly unpleasant ways, but here is the suspicion. It looks like audiobooks are bad for my shoulder. (Books or music. Any mp3 I listen to on purpose. But in practice, it turns out to be mostly books.) I got out of the habit of listening to anything after I got my ears pierced, but went back to it in January.
adrian_turtle: (Default)
I went to the eye doctor last year, and determined that my glasses prescription was a little too strong. I hadn't been sufficiently aware of this for it to send me to the eye doctor. I went because I was seeing bugs that should not have been in my apartment, that should not have been on my PLANET. When I asked the doctor who prescribes my anti-seizure meds if perhaps my brain might be playing an unpleasant new kind of trick on me, he asked if the bugs tended to turn up in the same place, and where I was when I saw them. When it turned out that I was seeing them in different rooms, but always to my left, he sent me to an eye doctor. My eye playing tricks on me is very much less scary than my brain playing tricks on me. The eye doctor assured me that I was seeing a moving dark spot and just interpreting it as "bug," and that it would gradually get smaller and disappear. That's how it went, from Lovecraftian horrors to palmeto bugs to ladybugs (a few of which I could see with both eyes and even step on) to ants. And no bugs at all since the middle of December.

I've been getting less nearsighted as I age*, rather than the more common pattern of becoming both nearsighted and farsighted and needing bifocals (or transition lenses. Or two pair of glasses.) I know some people have a lot of trouble adjusting to bifocals or transition lenses, or are unable to do so at all, and I'm afraid I might be one of them. I have been really, really, bad at visual processing since I was very young and throwing up every time I tried to use a Viewmaster. This past eye exam included something I've never done before--I don't know if it's a standard thing for being over 40, or something this doctor does, or a recent part of the standard of care. After I looked at the eye chart across the room, with and without my glasses, the doctor gave me a laminated card with an eye chart on it, and told me to read the smallest line I could see clearly. "Where should I hold it?" "Wherever you like. Any place that's comfortable for you to read it." So I held it about 18-20" away and read a line with my glasses, and she asked me to read the next line but it was too blurry. And I took my glasses off, and had to move it closer because I couldn't see the text...but she'd said that was ok. At about 8-10" from my face, it popped into focus. Even the small text I couldn't read with my glasses popped into focus. I wouldn't have believed it if I hadn't seen it with my own eyes, and I wouldn't have thought to do the experiment. 8-10" is a great distance for reading a paperback in bed, in case you were wondering. The eye doctor wrote me a prescription for new glasses, and advised me to take them off for reading fine print or doing close work. And she warned me that I am likely to need bifocals or transition lenses in a few years, but that they are likely to be problematic for my migraines and motion sickness so I should put them off as long as I can.

I remember when my glasses were -8.00 and -7.50, and I had to argue with the opthamologist who couldn't believe a 10% change was significant enough to cause eyestrain. (I suppose one might not notice a 10% change in a 1 or 2 diopter correction.) That transition was really brutal, partly because I was working a full-time job with a fair amount of physical danger, and my migraines were completely out of control. Now I'm going from -5.50 to -5.00 and -4.75, with more astigmatism correction. It should be a piece of cake. Furthermore, I'm home, and can handle the adjustment period in relative safety. I think it also helps that I have more faith in the ophthalmologist. Anxiously second-guessing whether the new glasses are really a good idea makes it harder to persist through the headaches and double vision and motion sickness. This is going to be easy. Right. Easy. I am still going to go lie down for a bit.



*Note to the opthamologist in Winter Hill: this is unusual. It is not unheard of.
Note to the optometrist in Porter Square: this is unusual. It is not freakish.
Note to the medical professionals of the world: if our bodies worked perfectly well, we would not be consulting you nearly so often. Please be respectful of the ways in which bodies work differently or fail to work. It is your job to know this stuff, for crying out loud.
adrian_turtle: (Default)
A few weeks ago, my doctor suggested trying a new kind of treatment for the chronic pain in my hand and shoulder. It's not the silliest thing I've ever heard of, but the competition there is pretty stiff. A low intensity laser tuned to exactly the right wavelength is supposed to stimulate the mitochondria to produce more ATP, which improves healing even in an old injury. What amazes me is that this therapeutic wavelength is VISIBLE light. I don't see how it can get past my skin to the damaged tendon, much less reduce the scar tissue on the other side of the tendon. I want it to help. I want so much for it to help. And I want a hypoallergenic pony unicorn.

I tried it once, for both hand and shoulder. It didn't seem to do anything for the hand at all. It might have helped the shoulder a little, briefly. It didn't do me any harm, which puts it way ahead of lots of other pain treatments (including massage, direct acupuncture, capscicum ointments, muscle relaxants, and almost all PT.) So I tried it again, just on the shoulder. Again, it might have helped a little, briefly...I can't tell if it's a real benefit, or if I'm fooling myself because I want it so much. The pain varies so much it's hard to be sure of changes when they aren't large, sudden, or consistent. Did it get better because of the treatment and worse when the treatment effects worse off? Or just a little better in the warm middle of the day and worse when it got cold at night?
adrian_turtle: (Default)
Dear Health Connector,

Thanks for running this contest, asking people to tell their stories about why they are happy to have health insurance. I think it's great to have a wide range of personal stories as well as financial statistics to show why health insurance is such a good idea. I won't be entering the contest myself, though. I wouldn't, even if I really wanted the Red Sox tickets you're offering as a prize.

If I didn't have good health care, I would be so disabled by chronic pain and depression that I couldn't work at all. Thanks to the Health Connector, I have been able to afford health care when I was looking for work, or working intermittent contract jobs with no benefits. That makes me healthy enough to work 40-45 hours/week, doing the kind of scientific work I was trained for. Unfortunately, chronic pain and depression are both heavily stigmatized. Many employers would rather not hire somebody with that kind of problem, even if it's controlled well enough to not affect job performance. I don't want you to publicize my story, because I rely on medical privacy to protect me from discrimination.

I expect you'll get stories from lots of people whose lives were saved by health insurance. Or their children's lives. Stories of life and death are certainly dramatic, and a program that saves lives is impressive. But I wonder how many people are using health insurance to stay on the employable side of marginal disabilities? (Is the state as a whole supposed to turn a profit? Or is it just health insurance that is supposed to take in more money than it spends?) Those people are tremendously happy to have health insurance, but they aren't going to tell you about it, if they are trying to keep stigmatized disorders hidden.

Best wishes,
[name withheld]

ETA: Hours later, I noticed that I wrote "those people" to refer to a group that includes me. At the end of a letter *about* being a member of that stigmatized group. Speaking of stigma.
adrian_turtle: (Default)
The full study and set of recommendations aren't available yet. I'm going by the New York Times article. Apparently, somebody did a statistical study on the children of women who took Depakote while they were pregnant, comparing them to the children of women who took other anti-seizure meds.
http://www.nytimes.com/2009/04/16/health/research/16child.html?hpw
Comparing IQ scores at 2 and 3 found a small but statistically significant difference. 6-8 points, difference. They looked at 303 children, which is a small group but not completely ridiculous (as opposed to studies that try to draw sweeping conclusions from 15-patient samples.) So they concluded:
Physicians involved in the study warned that valproate should never be the first choice for use in women of childbearing age, though exceptions may be made if a woman’s epileptic seizures cannot be controlled with other available medications.

The first problem is the idea that discovering something might cause problems in pregnancy is a reason for restrictions on "women of childbearing age," rather than some subset of that group. (Women of childbearing intentions, perhaps? Sexually active heterosexuals of childbearing age?) I realize that plans change, accidents happen, and a teenager isn't going to call her neurologist either after a rape or after starting to experiment with her boyfriend. Nevertheless. I'd like to hope the Atlanta neurologists who did the study took a more nuanced view, that was only simplified for the newspaper summary. It doesn't really matter. Most doctors will only read the abstract, and are likely to remember a sentence at most.

This isn't like making sure everybody gets enough folic acid. Imposing more limits than necessary on the range of possible anti-seizure meds can be a serious problem. As a woman of childbearing age who is never going to have a child, it scares me even though I can't imagine a situation where I would be willing to take Depakote. I got horrible side effects when I tried it. That brings us to the second problem: only breakthrough seizures are recognized as justifying use of Depakote in women of childbearing age. It is reasonably common to change anti-seizure meds when a person has troubling side effects with one med and hopes to get the same seizure control (or migraine prevention, or whatever) with fewer side effects. Because the study found a relatively small danger in utero, the authors recommend prescribing Depakote if nothing else can control seizures. Generous of them.

Once upon a time, I met a woman from Atlanta with partial seizures and out-of-control side effects. Her doctor just couldn't *believe* that a married woman her age (I think it was early 30s) could avoid having a second child, could seriously want to avoid it. The doctor thought the possible risk to a hypothetical fetus was more important than the woman in front of him, coming back again and again to tell him about disabling side effects and beg him to prescribe something else. She left Atlanta. She found a better doctor, and meds that aren't so hard on her body. But I feel like I'm racing to get to menopause before standard medical practice (and insurance formulary guidelines) make the universal substitution "not for women of childbearing age" for "not during pregnancy."
adrian_turtle: (Default)
The headline in Anesthesiology News is "Fraud Case Rocks Anesthesiology Community."
http://www.anesthesiologynews.com/index.asp?section_id=3&show=dept&ses=ogst&issue_id=486&article_id=12634
A pain management researcher is being accused of multiple forgeries. Read more... )

It's no excuse for Dr. Reuben's fraud to think about why he might have done it. I'm just thinking about how other researchers can be tempted to do the same sorts of things, and many of them make better choices. Part of the problem may be researchers and reviewers starting from True Belief or pet theories, relying on data to confirm them, rather than starting from the data and following where it leads.
"Dr. Shafer said that although he still believes “philosophically” in multimodal analgesia, he can no longer be absolutely certain of its benefits without confirmation from future studies."
adrian_turtle: (Default)
I am really angry at the implication that I am somehow being unreasonable in expecting that my health insurance would continue without interruption when they stopped sending the bills to my former employer and started sending them to me. (Especially considering they told me explicitly that I would go on sending the same premiums to the same address as before, and would keep the same policy with the same policy number.) I have mostly managed to avoid expressing anger *at* the clerks on the phone, because I believe the problem is not their fault, but that belief starts to slip when people from both the HMO and Commonwealth Choice tell me to calm down, I should not expect an immediate response. They sent the information Feb 2, and I should be patient and trust that the database will be updated within 24-48 hours. You know, I don't trust them anymore.

needles

Oct. 28th, 2008 04:43 pm
adrian_turtle: (Default)
Sometime in the next 2 weeks, I'm going to get a flu shot. If I were thinking of it as a civic responsibility to help stop disease from spreading through the community, I'd probably do it November 4, after voting. (If any of my neighbors are thinking in that direction, the CVS at Fresh Pond is selling vaccinations from 10am-4pm.) The Walgreens in East Arlington has flu shots tomorrow, so there's a certain temptation to just go there and be done with it. Once I've done it, I won't have to worry about scheduling it.

The last few years, a flu shot gives me a couples of days of pain in the arm where I get the shot, a couple of days of low fever, and 3 or 4 days of feeling achy and exhausted. This is so much better than how my body deals with the flu that it's not hard to decide *whether* to get a flu shot, but it's unpleasant enough to make it hard for me to decide *when* to get a flu shot. If I put it off too long, the end of vaccination season can sneak up on me and I need to scramble to find one of the few places still doing flu shots.

My shoulder hurts from a steroid injection this morning. I hope that's going to be better soon. It also hurts from trying to do OT with ELIZA. I'm afraid that's going to get worse. Unfortunately, the one thing she says that I really believe is "the way you've been doing it may seem comfortable, but your body mechanics are out of balance and that contributes to your shoulder problems." (So I can't just ignore her.) Furthermore, PT is about to get scary again, probably starting next week.

I could get the flu shot tomorrow, in the left shoulder (the one that hurts most), in the hope of getting it all over with as soon as possible, while keeping one shoulder as fit for use as possible. Or I could get the flu shot tomorrow, in the right shoulder, in the hope of avoiding swelling and muscle spasm on top of swelling and muscle spasm. If I have the flu shot tomorrow (in either arm), driving before my next OT appointment is going to be problematic, and part of my OT is supposed to be working on driving.* I can go back for the next appointment and say, "thanks for lending me the prop, I'll get one of my own," or "thanks for lending me the prop, now I know that doesn't work for me," but it seems wrong to come back and say, "I have no idea if it helps or not because I was in too much pain for a valid test." Dither. Dither.


*I was really hoping occupational therapy could make driving hurt less. The OT seems determined to adjust my driving posture for the benefit of my lower back, in the hope that it will help my shoulder, once I got past the "I don't like it because it feels weird" reaction.
adrian_turtle: (Default)
The first time I saw the occupational therapist about my shoulder, she went through an amazingly long list with me. The list can't really be called "What Do People Do All Day?" Do I do this and that? Do I need help with it? Does it hurt? How much of a problem is it? Some things (child care, gardening), aren't problems because I'm not trying to do them. Others (walking, putting on shoes), aren't problems because they're easy for me. I knew I was doing better since the summer, but I still sort of surprised myself when I said laundry and grocery shopping were only a little challenging...this spring and summer, they were much more difficult. I asked for help with driving. The fact that driving makes my pain so much worse makes everything more difficult. This is supposed to be the sort of thing OT can help with, and I've brought the car to several appointments in the hope we would be able to work with it. (There hasn't been time. Recent visits to the clinic have been deeply fraught.)

The OT asked if I used a computer a lot. (Not compared to most of my friends, but I suppose some people would consider it a lot.) According to all the best practices of occupational therapy, this is a Problem that should be addressed with Proper Ergonomic Body Mechanics. It doesn't feel like a problem. When I just use my laptop on a table, with improper body mechanics, it doesn't aggravate any of my pain problems. Not even when I use the computer all day. That's why I bought the laptop in the first place. Using a mouse is just terrible for my hand pain, and most auxiliary monitors are migraine triggers. I'm aware of those problems on a fairly short time scale (5-10 minutes for the mouse, usually less for the migraine triggers).

According to the OT, good body mechanics require having the computer monitor at eye level and the keyboard low enough to type with forearms parallel to thighs. Obviously, this isn't possible while looking at a laptop screen and typing on the same laptop.* According to the OT, any other position is bad for a person's neck and back. Even though I am not aware of any short-term correlations between shoulder pain and computer use, unnecessary strain on my neck and back are unlikely to do my shoulder any good in the long run. So I am trying hard to follow her suggestions:

1) I elevated the laptop so the screen is approximately at eye level. I try to increase text size instead of leaning forwards to see things.

2) I bought an extra keyboard to plug into the laptop. It's this thing
http://www.amazon.com/Microsoft-Digital-Media-Pro-Keyboard/dp/B0002CPBUK
which has an extra row of keys for keyboard shortcuts. I know there are users who find it not only tolerable but actively useful (because more than 100 of them posted to Amazon), but it's driving me crazy. The keyboard driver slows down the whole computer like it's telegraphing Redmond for permission to display each letter I type on the screen. The added function keys are for things I haven't used in the last 2 weeks, or for things like "open web browser," which hadn't been a navigational problem before. The trade-off is that the labels "F1", "F2", etc are small and almost illegible, under the keys instead of on them. And that the keyboard shortcut I used to rely on (F5=screen refresh) does not work anymore.

3) I plugged in the auxiliary touchpad I bought in order to use with desktop computers at work. It claimed to work as a simple touchpad if you just plugged it into a USB port, but more elaborate functionality was available if you installed the driver from the CD. No such luck.
http://www.cirque.com/cpages/?page=23
Just plugging it into the USB port makes it work like an inert piece of plastic. I've disabled most of the elaborate touchpad functions, but the driver still slows the laptop down even worse than the keyboard alone.

I hadn't appreciated how much of the reason I valued my touchpad before was that I could use it in a central position, with both hands. I don't mean with either hand--most pointing devices advertise that users can set them up for right or left hand use. I mean BOTH hands. When I was mostly using my right hand, I'd sometimes bring in the left for a moment to push a button. Or when I was mostly using the left hand, I'd bring in the right to manipulate the cursor through something fiddly. It happened so easily, without pause or profanity, I hardly noticed I was doing it. But now I have a touchpad I can put to the left or right of my keyboard, and it matters. (Because both sides are wrong.)

4) Most of the time I'm online (ie, most of the time I use the computer) involves websites set up to require frequent touchpad or mouse use. I don't know how to avoid this.** Sometimes I use the auxiliary touchpad, which twists on its cord so often I need to look down and orient myself to it. Sometimes I reach up to use the touchpad in the laptop, which is at an inconvenient level, but is at least central so there's no lateral strain in reaching for it. And it keeps itself stable. Either way, I need to look down at the keyboard to find my place again, even after just using the touchpad very briefly.***

5) This setup is a lot less comfortable than what I was doing before. It's so bad for both my shoulders**** that I've been avoiding the computer, which is terrible for my job search as well as my social life. I know this is really trivial, as adaptive technology goes, even as OT goes. But it's enough of a change from what I'm familiar with that I'm having real trouble with it.



* Is it possible to connect two laptops, using the input devices from one and screen from the other? With the processor and memory from the one providing input devices, or from whichever is more powerful?

** I use Hotmail, which is profoundly cursor-driven. One can't even delete a message, or read the next one, without clicking a box. I started using Hotmail because of the ease of reading mail from different computers, and that's still valuable to me. Now it's important to me to maintain that email address because it's on my business cards and resumes, and I want to be reachable through it. Still, the GUI is becoming problematic...is there a way to read Hotmail through another mailreading program?
Is it possible to program keyboard shortcuts to navigate websites like CareerBuilder? The hundreds of variations of BrassRing? (Every large corporation seems to have their own, these days.) What about those popup windows that ask if you want to [Continue] or [Cancel]? (where no part of either word is emphasized in any way.)

*** Having the keyboard in that little drawer under the desk makes it hard to see at night, because the desktop shades it from the lamp on top of the desk. (I don't want to put a floor lamp right behind my chair, because I'd knock it over when I stood up.) Is this a solved problem, or is the Proper Ergonomic Solution to only type in full daylight? Or in rooms with overhead lights (presumably not in New England apartments. This problem has almost certainly been addressed before.)

**** When I say it's bad for my shoulders, I'm talking about a time scale of hours and days. The OT says it will be good for my shoulder on a time scale of months and years. That's why I haven't given up on the whole thing already.
adrian_turtle: (Default)
The shoulder specialist in Wellesley sent me to Medford for PT, rather than having me schlep out to Wellesley all the time. It's a big clinic, and I didn't ask to see anybody in particular. Even their "first available therapist" was pretty well booked. So I got there for the initial appointment, and a vaguely-familiar-looking therapist asked, "Haven't I seen you before?" Now that I think about it, yes. I was there in 2001, for what was supposed to be comprehensive pain management, but turned out to be a fairly comprehensive disaster. The evaluation was unpleasant, but not nearly as bad as it might have been. She asked a lot of questions about what kinds of PT had helped and what had been problematic. She also said I didn't need to do strengthening work--my arms are a lot less strong than they used to be, but they're within the normal range of useful arm strength, even after 10 years of having the mildest strength training imaginable set off catastrophic pain flares.

When I came back a week later, she asked me how I was feeling. Some places, that's a greeting, but in a doctor's office, it's a question, so I answered, "okay." She looked at me more intently and said, "You're lying to me, aren't you?" I hadn't been. Not really. Doesn't everyone think of "no worse than usual" as "okay?" Apparently not. It feels oddly encouraging.
adrian_turtle: (Default)
I thought I had found an acupuncturist, or a way of doing acupuncture, that worked for me. Sometimes it didn't help, or only helped for a few minutes, but other times it gave me more than a day of diminished pain. The time and money I'm spending on it is not trivial. It's not so much the half-hour I actually spend with the acupuncturist that makes me wonder if the benefits are really quite worth it...it's the time and energy of getting to Central Square, and the constraint on my schedule. It's challenging.

Read more... )

When I plan for treatment of chronic health problems, and consider "Can I afford this treatment now?" I think about how much it will cost in money, and how much it costs up front in time. Sometimes I remember to think about travel time and energy, or how difficult it will be to schedule around work or other obligations. The thing that's hard to plan for is the risk of introducing new problems or of making the original problem worse. At least people are accustomed to talking about side effects for drugs (even if they presume they all go away when you stop taking the drug), but stuff like acupuncture or physical therapy or vitamins or chiropracty are all spoken of as having positive effects when they do anything at all.
adrian_turtle: (Default)
After 5 days, I have recovered most of the feeling in my left hand. This is not an unmitigated good thing, because my left hand hurts rather a lot. The last time I saw my GP, I summed up the problems I've been having with my left shoulder and arm. I'm not sure if there is anything useful to be done about them. Still, if the doctor wants to see me every couple of months to keep an eye on my right hand and general health, it doesn't seem right to conceal the fact that my left arm has become quite a bit less useful over the past year, hurts about as much as the right hand, and PT, etc, has only made it a little better.

My doctor thought it was time to consult an orthopedic specialist who was good with both shoulders and hands. It's not clear if the left shoulder problem is causing left hand pain, or vice versa, or if they are two unrelated problems. She only knows one local orthopedist who specializes in both joints. Unfortunately, it's the surgeon who operated on my right hand, 9 years ago. I am too frightened of him to think clearly about this.

I had an MRI on the shoulder Friday. An MRI is not supposed to do any damage, it's just imaging. But part of the problem with my shoulder is that part of the range of motion is very painful. (It seems trivial. Lying on my back, shoulder on a foam block, arm rotated to keep the palm up. It was almost impossible.) My hand was too numb to use effectively until this morning. I still have surface numbness on the back of the hand, like wearing a thin glove. I can live with that...I still have a patch of it on the right hand, since the surgery. At least now I can use my left hand for buttons, shoelaces, screw top containers, teakettles, and so on. It's been difficult.

lost

Mar. 25th, 2008 06:57 pm
adrian_turtle: (Default)
A recruiter called me this morning to say the company was hiring somebody else for the temporary technician job (that would be a long commute for me.) It wasn't clear if my commitment to stay for a 6-month contract was not convincing, or of they wanted somebody who wasn't so overqualified, that might be willing to stay with that level of job, indefinitely. Another factor was that they could get the other candidate for less money. That doesn't seem quite right, as my only discussion of salary was with the recruiter (who works for an independent contract agency, not the hiring company.)
Recruiter: What hourly rate do you want?
Adrian: I can be pretty flexible. Do you know how much they're offering?
Recruiter: [number]
Adrian: Wow. Are you sure?
Recruiter: Lemme check. Just a minute. [pause] Yeah. [same number] Is that ok?
Adrian: Yeah, I can work with that.

So, I could work with it, but it turns out they couldn't. Something about the process makes me feel cheated, but the end result with me not having to do the long commute for 6 months may be some kind of win.

health insurance difficulties )

I thought I'd grab my tax return, my driving license, and my passport*, and catch the next bus. I finished my taxes a few days ago, and all the documents were right where I remembered putting them. The problem was that I couldn't find my passport. Or my social security card, for that matter. They're probably together. I brought them both to work, to show HR in the middle of December. I don't remember where I put them after that. I've been turning the apartment upside down in search of them. This is really scary. I thought I only needed to find somebody to offer me a job, and to find the money to pay for health insurance. What could I do with either one without proof of citizenship**?

*My passport expired in November, but I haven't renewed it. I didn't want to send the old one off to the State Department and be without it for 2 months when I might need the proof of citizenship to start a new job.

**Proof of legal residency would probably be ok, if I were a citizen of someplace else. But as I AM a US citizen, not just a US taxpayer, I need to prove it.

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