10.25.06

Tussling with RSI

Posted in General, Java at 12:13 pm

About a year ago, around September-October time 2005, I was doing a weekly drive, from Milton Keynes to Derbyshire. It was weekly because we lived in Derbyshire at the weekends, and around the London area during the week. Part of a weekly commute thing. Whilst rambling on to my partner, I began to notice a curious sensation in my right hand, a couple of the fingers to be more precise. It’s difficult to explain, but was kind of a tingling feeling, verging on a very dull throb. It’s important, I believe, to note that there was no sharp pain involved, and I as said, at the time I deemed it curious, nothing more. This was possibly my first mistake since having the condition.

This sensation came and went, but never went away totally. It began to appear in both hands, somewhat randomly afflicting various parts (fingers, bursa, knucles). Starting to worry about what it could be, I decided to consult a doctor. The doctor did an examination of the hands, and saw no physcial symptoms (swelling, discolouration etc). Also my hands were physically strong, in good shape. Suspecting something like a form of arthritis, the doctor gave a me blood test.

Ofcourse the blood test came back negative on the various things looked for. Going back to doctor (a different one) a month later, this particular doctor mentioned something could be up with my neck, in the way of impacting the nerves around this area sending pain down to my hands and fingers. Looking back now, I am in agreement to some extent with this tentative diagnosis. In this particular consultation, the doctor suggested that since Christmas was approaching, I should use my 2 1/2 week planned holiday to relax. When the new year was in, if the pain was still present, I should return to the doctor.

As it happens I had a stressful Christmas. In a typical Pithering About fashion, I overcommitted to my workload, and cooked various meals such as Turkey, Goose etc. I also invited various family round for the big day, and produced an abundance of food. By the end of the festive period I was exhausted. I’d probably exercised my hands through cooking and using the computer more so than I would at work. My partner was nervously anticipating a new job, which did not give a positive contribution to the kind relaxing holiday ambience I had in mind. My ‘aches and pains’, as I had come to call them, had not dissipated. Actually, the last 3-4 days of the break I did put my feet up and veg out on the sofa. By the fourth day of this relaxing climax, I noticed I had a pain free day. I guess, looking back, this was my first strong indicator that my condition was stress/work related.

Well, time moved on. Around february I had to admit to myself that the pain had spread to my wrists. It had progressed from the strange throbbing sensation to the occasional dull burning, and a occasional sharp pains. It’s important to note, that in no way had my pains reduced. I started to worry that my condition was on an upward curve. I decided on a three pronged attack. I bought wrist support pads, mouse support pads, booked in to see a chiropractor, and would demand some kind of anti-inflammatory medication from the doctor.

The doctor (another different one – jesh), gave me a prescription for Ibuprofen. This did not really help, although I can not hand on heart say I medicated myself as per instructed. After a couple of weeks I gave up on this. The supports for my mouse and keyboards did not help either – I’ll have more to say about this later. The chiropractor is an interesting one. Around this time in my life, a few things changed. Work had significantly adopted ‘pair-programming’, a software development technique where two developers sit at the same keyboard and work on the same problem. This resulted in me spending less time hammering away at the keys. Also I purchased a laptop stand which raised the monitor eye-level easing the pain on my neck. I believe that for six months or so, I kept this condition relatively contained.

Unfortunately, having a few things change at the same time does not allow me to conclusively say whether the chiropractor helped. She would spend 15 minutes every week mobilising my wrists and fingers, and doing some occasional dry needling (a form of acu-puncture). It was however a failure by her terms, that the pain would go away completely, or at least be diminshed. The therapy was also expensive, costing my 35 pounds for 15 mins. One part of me thought back then, and definitely thinks now ‘come on! how much can really be achieved in 15 mins!’.

Anyhow, the pain was relatively contained. I was working around 10 hours a day, and even with pair-programming, doing a significant amount of keyboard work. I was a technical team leader on the project, and through a dog-headed mentality would often not work in a pair, or hammer away through lunch and evenings to meet targets. I would still have occasional pain-free days, and sometimes, I would simply forget about the condition and not pay it much attention for a week or so at a time. I had not told anyone at work, and I do not believe the condition was noticeable.

So around March 2006 I had another positive (or maybe, we’ll get on to this) lifestyle change. I was driving an hour each way every day, and after chatting through this RSI problem with my partner, we decided to move closer to work, meaning now I was much closer. Actually, what sounds like a good change, may have not been at all. Now I did 4 drives per day, 2 of which were to take my partner to the station and back. Because we were closer to my work, and I had to wait to pick my partner up from the station, I actually worked longer each day, perhaps doing around 11 hours. This may have cancelled out any positive effect the lack of long driving sessions would have.

Anyhow, around May-June my pains increased. The dull burning would occupy the hands more and wrists. I decided to see my doctor (yet again a new one). This time I asked to be put forward to a rhuematoid specialist. I was thinking more and more I had something like Rhuematoid Athritis and wanted to rule it out. Before seeing the specialist, I had another blood test which came back negative.

Seeing the specialist through private health care was initially a wonderful experience. After seeing doctors for around 6 or so months and getting nothing but blood tests, I found I could have things like x-rays, ultrasounds and possibly an MRI. So I got stuck in, I had an x-ray of the hands and wrists, which showed nothing, and an ultrasound of the hands and wrists which also showed nothing. I had a couple more blood tests which showed nothing. The doctor prescribed my Dicloflenax, an anti-inflammatory which also did close to… nothing. It did do something though, I had very small pains in my right shoulder and in both elbows. I believe the Dicloflexan (which I took in a more disciplined fashion than the ibuprofen), reduced the generalized pain and made it much more focussed in the hands only. I was back to having just ‘hand pain’.

The disappointing thing about the specialist was that after three minutes of examination diagnosed me with joint-hypermobility. She became convinced, and at the time convinced me, that this was my problem. In fact she was sure that just by me knowing I had this problem, it would automatically go away. It did not. And I’ve seen people with joint hypermobility. Their joints are a lot more mobile than mine. Maybe I do have this condition, but in my mind it’s similar to physcological stress: it’s a contributing factor to a vicious cycle, not a root cause.

So I became a little downbeat. I had cancelled further appointments with my chiropractor on the specialist’s advice, and so at this time I was receiving no treatment, and was consulting with no one that I believed actually understood what my problem was. On the positive side, my aches and pains were not that bad, certainly not to the point it was career threatening. On the negative side, the condition could still ramp up, and I was a million miles away from understanding how to make it go away.

Around this time I was unexpectedly made redundant. My company has ceased to exist due to the government changing laws. Well, hey, it’s not all bad because I got a fantastic job with a fantastic company. I think it’s fair to say that around this time my ‘aches and pains’ took more of a back seat. We were moving house also. So, I really had about two months off work. During this time though, my RSI did not go away. In fact because only a small portion of our new house was usuable, the ergonomics of my make-do workstation probably made my RSI worse.

Since I had time on my side, seeing as I’d moved house and arranged a new job, I decided to have another three-pronged attack on my condition. I bought wrists-braces (which did no good), had a massage with a so-called RSI specialist in London (did no good), and I attended a RSI support group in London for the first time.

The support group was an interesting experience. Meeting in the upstairs of a typical London pub, they are an upbeat and extremely pleasant bunch of people, striving to share information on what might help, whilst also offering support to each other. Some of the people there had the condition in a form far more progressed than my own, and it was particularly sad for me to see professionals in the same trade as I out of work. It served as a warning to myself about what could happen if my condition continued to deteriorate. Armed with more knowledge, and a connection to other sufferers, I was perhaps given more of a kick to find ways of helping myself. The next day I bought two books:

• It’s not Carpal Tunnel Syndrome
• Dr Pascarelli Complete guide to RSI

I would recommend to anyone interested in RSI to pick them up. I certainly read them and thought ‘This is what I have!’.

Around this time, after visitng the support group, luck (or perhaps a divine intervention), intervened. My new company ThoughtWorks sent me to India for a 2 week induction process. The course was to be held in Bangalore. Bangalore rang a bell, and the reason it did was because through my RSI research, and contact with the London support group, I had heard of an RSI specialist centre in that very city: Recoup. As soon as I could I arranged a consultation with Dr Deepak Sharan to coincide with my visit to India. When I got out to India, I visited him, and the rest of this rather long blog entry will focus on my treatment out there.

So the first thing I must write about was finding the place. It took about an hour to get to the centre, through some of the most… different… traffic conditions I had ever seen. Driving through Bangalore on a rickshaw at first terrified the life out of me, but I got used to it. The one thing that challenged my supposed cool composure was that the driver would frequently haul the vehicle on the sidewalk/pavement/edge of road and ask people where my destination was. Sometimes the driver would get plain lost, and sometimes, if the meter was running, the driver would purposely take me on an unsolicited tour of his city, which at times when I was very late, was most unwelcome. I don’t mean to sound negative. When not travelling to and from this clinic I had a great time with my colleagues on the rickshaws, and found them priced extremely cheaply (to foreign visitors) and of a huge convenience. After a couple of trips to the clinic, and after some long draining days, I decided to pay a driver to take me to and from the clinic in a car and to wait outside. A slight expense yes, but it made all the difference.

The first consultation with Dr Deepak Sharan uplifted me. He listened to my story, and what I found emphatically pleasing was that instead of diving in with a diagnosis after a couple of seconds, and pronouncing with a broad grin that after a quick wonder-treatment all would be well with myself and the world, he instead sat back, rubbed his chin and appeared to think. Then he gave me a hands on examination. He analysed ‘trigger points’ on my neck, shoulders, chest, wrists, and hands. He said he thought I had Thoratic Outlet Syndrome and cubital tunnel syndrome (both together is double crush syndrome), and possibly I have RSD. In my undeveloped, simplistic understanding, I thought this to mean that my nerves, running somewhat of a jauntlet throught all the muscle, bones and tendons from my neck to my hands had become pressed upon at certain places called ‘trigger points’. These nerves may have become compressed around my neck, which kick started a cycle of damage, leading to the nerves becoming compressed at the elbow, which in turn increased the problems. The therapy he said I needed would be Myotherapy of the trigger points, soft tissue and articular mobilisation and lessons on stretches etc. I would need as many sessions as I could possibly cram into my stay in Bangalore. Also, I told the doctor I wanted an MRI, which the doctor said was unnecessary, but if I was willing it may be helpful in ruling out other conditions.

Above, in order, you can see where Ergonomic training happens, Asif and Ranjith who are both therapists, and a treatment room where I spent many hours.

So, I had lots of therapy on my various trigger points, releasing them. I had lots of mobilisation treatment, of the hands, wrists, elbows and neck. I have also had my nerves mobilised and gently massaged. I still felt pain in my hands after a week, so we proceeded with ultrasound treatment to treat the inflammation, and apply hot wax to heat up the tissue, to reach the same aim. Amongst this, I learnt about applying ‘contrast baths’, where you submerge your hands in hot water (hot as you can bear), before transferring them to cold water, and then repeating this process a few times. While you hands are submerged, if you can exercise them, for instance by wringing a towel, this helps the therapy. I also picked up some anti-inflammatory cream to put on my hands if they ache. Towards the end of the course, I practised stretches, nerve glides, and had a work-station ergonomic lesson.

What was it like? Well treatment of the trigger points was measurable. At the start of the course, light pressure on these points gave me pain, towards the end, the pain was much reduced. The pressure applied to these points increased as the course progressed. Two hours or more of therapy each night was draining, and I give much credit to the practicioners. They were very professional, and extremely pleasant guys. They gave me practical advice such as not using wrist rests for the keyboard and mouse. Now I’ve got my keyboard on my lap and am trying to maintain a decent posture. I’m currently trialling some software – RSI Warrior to help with this.

I had the MRI done of the cervical spine (my neck). It did not show anything of interest, though the experience was fascinating and the quality of the scan results was brilliant. I’m glad I had the MRI done, as it’s something to tick off the list, and now I won’t spend huge amounts of time in the UK trying to get one. Cost wise, the treatment was about 100 UK pounds a week. The MRI was 80. I guess you can say all in all I spent about 300-350 on everything, including travel costs. Now (belatedly) I’ll chat about where I am now, and whether all this time and effort was worth it.

Yes I think it was. When I got home, I had a pain free day for the first time in months, and now generally I have much reduced pain in the hands, wrists, elbows. I’m close to being ‘pain free’. In the short term, my trip to Recoup and Bangalore made a big difference. Time will tell if I can convert the short term to the long term. I would like to thank Dr Deepak Sharan, Asif and Ranjith for the excellent care I received.

Now I’m stretching often and using contrast baths. I’m taking each day as it comes, but I feel more in touch with my body. I know when to take breaks and when to stretch. I feel my posture and know how to control it. I’m drinking more water to keep the insides of my arms moisturised. I believe and I hope very much, that I’ve levelled off the upward curve of my RSI progression. I will continue to do my research, look at other’s experiences and carrying on attending the London RSI support group. I’ll blog any findings I think I ought to share. I want to concentrate now on looking after myself, and bringing the curve down. I’ll still be 100% effective at work as always, as it’s in my personality. I will though give more thought to, and have a slightly different perspective on the saying ‘hard work never hurt anybody’. Lazy workers do not get RSI, it’s an spiralling epidemic hitting those who have pushed themselves too far.

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