What Does a Coder Do If They Can’t Type?

I developed an RSI a few years ago, and I had to leave my job. It was devastating to lose both my career and my passion to an injury.

Since then, I’ve been working with a friend on a new voice coding app called Serenade [1] that aims to enable anyone to program by voice. With Serenade, you can speak natural English voice commands like “delete second function” and “add class person”. Not only can this be faster than typing, but it also means you don’t have to memorize the syntax details of every language or a bunch of editor keyboard shortcuts.

We found that cloud speech APIs and programs like Dragon weren’t accurate enough for common programming words, so we built a custom speech engine (based on Kaldi [2]) that’s designed specifically for coding. The app is still early, but we think the future of programming is working with these higher-level inputs rather than typing out code entirely by hand.

We’re looking for people to give feedback, so if anyone is interested in giving it a try, you can download Serenade at [3] or email me at matt@serenade.ai.

[1] https://serenade.ai

[2] http://kaldi-asr.org

[3] https://serenade.ai/download

Definitely interested. I’ll check it out.

Same Boat, software engineer, my index and middle finger main knuckles on both hands inflame from the slightest use even after years of therapy, doctors visits, etc. Also tendinitis in both elbows/arms.

Note to those who are pushing off fixing your ergonomics, don’t. If you feel pain, numbing, tingling; do not ignore it. Listen to your body, don’t be like me.

I’m 23 and have been using computers very heavily for the last 10 or so years – probably an average of 6 hours a day. During a particularly intensive day of typing last week I started getting pain in my right hand. I had to resort to hunt-and-peck index finger typing to get the feature I was working on finished.

I’m horrified, it feels like I’m way too early in my career for something like this to happen, but I guess that’s what happens when you do something so repetitive for tens of thousands of hours.

What in particular have you found success with that helps? I’m kinda in denial right now, it’s already gotten better over Saturday but I know I shouldn’t be ignoring it.

Stop. Seriously stop. Don’t type thru the pain — you’ll do serious and permanent damage. I did that in lectures on an Apple Newton keyboard, and my hands never were the same since.

Install AntiRSI or workrave, and take breaks. But really pay attention and when your body gives out don’t take the chance. No feature or deadline is worth it. Probably even an hour break is enough to finish that feature.

I can’t be sure but it feels like a lot of people are discounting exercise here, I don’t mean stretches but something more serious.

I’ve been staring at a desktop screen 6h+ daily for 8y+ and started feeling serious rsi symptoms on my right wrist at the old age of 19.

I tried bandages and wraps in the beginning, but once I started lifting all pains literally disappeared.

Heavy deadlifts (and maybe a press), done with correct form, is something that I’m quite sure will resolve the issue for the majority of people — when your wrist starts being able to manage 200lbs+ loads then mouse-related issues feel like a joke.

I’d be interested in hearing stories where deadlifts didn’t help. Would there be any?

I can vouch for deadlifts. Had wrist tendonitis flare-ups first at age 29 while doing lots of coding for a newly launched product. I’m 43 now and haven’t had a flare-up in over 6 years (been doing heavy coding since 28yo). I do deadlifts once heavy a week, sometimes will add in an extra light set during the week. If you’re starting out with deadlifts, be sure to check out a program like Starting Strength and practice correct form before adding heavy weight.

Things like bench press and working with heavy dumbbells have probably helped too since the weight forces your hand, wrist, and arm muscles to strengthen. I have also used a hand-held grip squeeze device which has helped over the years when I had flare-ups.

I tried those squeeze devices too, but in my opinion they’re too weak unless you specifically shell out for the stronger / adjustable ones. Mine were from China and didn’t do jack for the rsi pain.

It’s deadlifts that whips forearms into shape, and then getting used to various presses seems to make the wrist more adaptable. I started with Phrak’s Greyskull LP which is a modification on SS with less volume.

Back, shoulder, and neck pain disappears too.

Not to mention the many other benefits to exercise, and weightlifting in particular.

Like everything else in life, if you neglect your body it will fail on you eventually.

that’s solid advice I think. I have pretty much the same story. I mean, I went all out with anabolics and such because I was also trying to get some hot babes, but I never had wrist issues after that.

I started to get pain in my right hand in my mid-20s (early 40s now) when I was spending a full working day programming and then spending most of my time playing fps games on my PC in the evening using KB+M. It progressed to the point that I would get stabbing pains on the top of my hand whenever I right-clicked my mouse.

After a few weeks of trying different layouts and avoiding my mouse as much as possible, I found the source of my issue was not my hand but a nerve in my elbow which was being crushed when using chair arm rests. I was also sleeping with my arms folded up on my chest which kept the nerve under tension when I was sleeping, preventing it from fully healing. I now avoid arm rests whenever possible and sleep with my arms to the side. The pain disappearred after about a week and I’ve been pain free ever since. I’ve also naturally reduced the amount of typing/mousing I do as I’ve got older and my career has progressed.

I came across something similar, I narrowed it down to Ulnar nerve entrapment which sounds particularly similar.

I had the same problem. I narrowed it down to moving my pinky to type things like (). Default keyboard layouts are awful for programming. You type a lot of symbols and they’re on weak fingers that require weird hand movements.

Using a keyboard with a programmable firmware lets you move those keys elsewhere, and then you can type them with strong fingers. I use my left thumb to activate a layer that turns jkl; into ({}), which has helped a lot. (I also moved the shifted numbers down to qweruipo -> !@#$&*`~, and brackets to m, -> [].)

I also have keys for macros like := and !=.

Finally, backspace and common symbols like – and _ are on my pointer finger (ErgoDox EZ, so I get a few extra keys in the middle), and meta, space, and enter are on thumb keys.

It takes a bit of time to get used to, but I type faster than on a traditional keyboard now AND with less pain.

Would still like to completely kill the mouse from my life, however.

This is exactly what’s motivated me to finally learn https://bepo.fr, a lot of special chars are on the left on the keyboard with the altgr key modifier. So you have to use left fingers and right thumb to get things like curlies, pipe etc. So far my pinkeys are much better. Though i must admit that learning to touchtype on bepo was one of the must frustrating thing i ever had to do ^^

Have you tried using an ergonomic keyboard?

I had always used non-ergonomic mice and kbs, until one day I started noticing some wrist pain when in certain positions. After a few months the pain increased and I figured this wasn’t right so I bought one of those Microsoft Natural Keyboards, and after a week or so, the pain went away.

Some time later I started with wrist pain again but now in positions related to the mouse use, so I bought an Evoluent mouse and again, after a couple of weeks the pain was noticeably lower, and so I was convinced that the position of my wrists was not ideal for thousands of hours of use.

So, my point is, you don’t have to wait until it’s too late to try to figure out a way to fix that. I don’t think age is the only factor here, so just try out something on the affordable side and see if you get better, regardless of how young you are, begore things get worse.

Ergonomic keyboard and mouse.

A split keyboard is a huge win. When you sit with your hands in front of you, they don’t naturally want to go in towards the center. They want to be offset a bit.

Below the desk keyboard tray — Look up an ergonomics diagram. You aren’t supposed to have your hands going up to get to your desk. It’s supposed to be a 90 degree angle.

Going mechanical. I run Kailh Silvers, which are incredibly light and have a 1.1 mm travel distance before the key registers. It’s like typing on air. I barely have to move my fingers. This, of course, takes some getting used to.

Going ortholinear. Staggered keys are just a remnant of old typewriters. Your fingers were built to go straight back and forth. Making them go sideways forces _a lot_ of extra wrist movement. Again, this takes some time to learn.

Curved keyboard well. Your fingers aren’t all the same length. Couldn’t we make something that puts all of the fingers closer to their keys in the resting position? Yes. See below.

After a little time with mechanical keyboards, I ended up just going all out and building myself a Dactyl. That’s a split ortholinear keyboard with a curved keywell, and is basically as ergonomic as it gets. If you want advise on how to build one, I can help point you in the right direction. It took probably 10 hours. Otherwise the closest thing is an Ergodox or Kinesis Advantage. It only took a Sunday to get mostly used to it, and my typing speed has actually gotten way faster. I detailed the learning curve here: https://www.reddit.com/r/MechanicalKeyboards/comments/azkkpz…

The only disadvantage is that if you bring one of these into work, get ready to catch some flack 😀

At this point I’ve got my own chair, standing desk converter, mouse and keyboard. I plan on coding for a long time, not just for the money but because I love it. So I look like a bit of a dumbass, but in 20 years I’ll still be coding.

I should mention my issues have mainly been with wrist and neck pain.

This has completely gotten rid of the wrist pain. The split keyboard opened up my posture and helped a bit with the neck pain.

Since I got a new job that didn’t have standing desks, the neck pain has started to come back a little bit. It’s mostly because your neck gets weak when you sit for so many hours a day. Getting a standing desk converter can help keep your muscles from atrophying. It’s also not great to stand all day. You want to alternate.

The other posters have brought up a lot of important points, but if you’re struggling to change, here’s a first, really easy step for the lazy: Go to your nearest electronics store and buy a MS Natural 4000. Do it now.

Yes, I know, it might not be as high-quality, sophisticated and thorough in its design as specialized ergo keyboards. But: It’s widely available, it’s cheap, and – an often overlooked pro – it adheres to a standard keyboard layout, which means that it only needs minimal adjustment, both initial and when changing computers (if you don’t want to lug it around everywhere or switch out every keyboard you are in contact with). All IMO deciding factors for doing that first step and sticking to it. 🙂
And: In my experience it still gets you there most of the way regarding ergonomics – split and curved keyboard, and especially negative tilt(!).

I only wish MS would rerelease a modern, higher-quality version the model (the current model is almost 15 years old now!). It is still servicable, but oh, what could be possible…

PS: The immediate next step should of course be checking and adjusting the geometry of your workplace. An ergonomic keyboard won’t help much if you’re hunching there like Quasimodo.

Yes! Me too!

I’ve noticed that wearing long sleeves when I’m typing helps.

I had RSI and panicked as well. But now that I wear long sleeves while programming (even a heavy sweater sometimes, even though it might be hot outside).

Basically I need to keep everything warm.

Of course, you still need to take regular breaks.

But that let’s me go longer with minimal pain.

I learned to use mouse with my other hand. I was literally forced to one day, out of pain.

Took me 2 days to feel normal with it.

Nowadays, I juggle back and forth, depending on comfort.

Been here, done that. This is not a solution:

It was 5 years ago and my right hand was too painful to use so I switched to my left hand. Eventually, last year my left hand started to hurt too, and I started jungling between both. 5 months later, I had to stop completely for 2 months because of the pain.

If you ignore the pains for too long, it will do irrepairable damage to your nerves.

My timeline was this. I’ve been programming since 15. I’ve been on the computer for hours a day, making money freelancing in highschool. I didn’t have a single issue. Then, at 22, I got a professional gig. My pain started immediately. Within months, the damage was done.

My right hand still isn’t 100%, but since I’ve switched to using my last remaining good hand, I treat it much better than I did my right hand. It’s all I got.

Carpal tunnel can absolutely be prevented. It isn’t genetic or anything. You just have to monitor the warning signs and address them immediately.

So, yes, switching hands isn’t a solution, but the damage is done, so it has to be done. But now I have the insight needed to prevent my left arm from ever falling into the same situation.

I was in the same situation. It is incredibly frustrating to learn but it just takes time.

I kept two mice on each side of the computer for years and alternated between them as required.

Is it really the mice? I don’t use a mice, I had the impression that most of the problem was due to typing?

> What in particular have you found success with that helps?

* I bought two bathroom mats from Krogers, wrapped them around the arms of my office chair, and duct-taped them in place. Looks like hell, feels soft and cushy.

* I bought a bunch of those practice Tennis balls (the wimpy kind that don’t bounce worth a damn) and have one at home, one at work for squeezing when I take a break or watch TV.

* I wear one of those Ace bandage thingies around my right forearm.

* I have one of those ergonomic keyboards from Microsoft.
Huge improvement.

* THE MOST HELPFUL: I do curls and range-of-motion exercises with 10-lb dumbbells when watching TV. Nothing dramatic, a few sets of 30-40 curls plus rotating my wrists, and then some leaning-over pushups against the couch. You wouldn’t believe how much better I started feeling.

You can count yourself as one of the lucky ones as I had many classmates in college who lost the ability to type before they graduated because of RSI.

While I’m no medical professional, I’ve thus far avoided serious RSI by
1. Not typing very much. I spend most of my time thinking and a minority of time typing.
2. Periodically change work area. I have the Luxury of having the option of typing in an office, a laboratory or outside under a tree and frequently move around. Even if you don’t have this much flexibility, try adjusting your chair up and down, move your monitor around, etc.

EDIT: I make no guarantees these things have any correlation with my avoidance of serious RSI symptoms.

I’ve noticed that wearing long sleeves when I’m typing helps.

I had RSI and panicked as well. But now that I wear long sleeves while programming (even a heavy sweater sometimes, even though it might be hot outside).

Basically I need to keep everything warm.

Of course, you still need to take regular breaks.

But that let’s me go longer with minimal pain.

I have an ergonomic support for my right arm. My elbow rests on a silk fabric “hammock”, which is supported by a linear bearing slide, mounted on a vertical shaft. I bought it too many years ago to remember a brand. And hopefully the description makes sense.

Basically, my right arm feels ~weightless.

Edit: Also, I use a touchpad, not a mouse. If I use a mouse, my hand cramps. And it also helps, I think, that I never learned to type. So I’ve developed my own style that doesn’t hurt me.

OK, found it.

It’s a BodyBilt chair, with their Linear Tracking Arm.[0]

The chair has a moderate tractor seat, which forces you to sit properly, and not slouch. But that also means that you can’t really relax in the chair, because it hurts in the crotch. There’s also an inflatable lumbar support.

I used an Aeron for many years. It’s much cooler looking, but the BodyBilt is more comfortable for long term use.

0) https://www.backbenimble.com/bodybilt/closeups/closeup_all_a…

– adapt a time management technique (i.e. pomodoro) to ensure frequent breaks from typing. Listen to it. Your code can wait. Grab some other objects during the breaks (lacrosse ball)

– get light dumbbells, ranging from 2 to 6 kg, and start doing wrist flexor exercises every day. Slow pace, good form, not too heavy weight, stop when it really hurts.

Don’t discount resting. I limit my typing to 35 WPM and I try to be as even as I possibly can in my typing. I think while I type. Even then, I type for 30 seconds and rest for 30 seconds. In my rest period I’ll read what I typed and think a bit more. I find that I am actually more productive this way because I don’t rush.

when i stopped studying and started working full time, i began to get pain in my wrists. so i got an ergonomic keyboard and a large trackball. i’m fairly sure it’s replacing the mouse with a trackball that makes the most difference to the acute pain, but they both do make a difference. but everyone is different. act fast and change everythin,

I’m 38, and have been programming since ~16. I spend > 50 hrs / week typing. I’ve had several bouts of RSI and here is something to consider:

– It’s very possible to go from your current situation to being completely pain free. Have some optimism. I haven’t experienced RSI pain in 5 years.

– RSI is usually not _caused_ by typing (there is lots of data supporting this). Lots of typing usually exacerbates some other underlying condition. Don’t fall into the attribution error trap or you might not find the underlying cause.

– In my various bouts of RSI I switched to various ergonomic keyboards. These mitigated some of the pain, but did not eliminate it. I went from a standard laptop keyboard to MS natural 4k, to a Kinesis advantage. Each time, pain improved but did not completely subside.

– I solved my RSI by finding the root cause.

Anecdotal stories:

I’ve had on and off weakness in my left pinky for years (decades). I’m an Emacs user and used to use that pinky heavily as a ctrl/meta activator; I just attributed the pain / weakness to that. I would also have pain in left wrist, which I attributed to having to baby that hand at times and use it in awkward positions. At times, the pain was so bad I could not type for days to weeks.

I’d seen a doctor about this a few times, and they usually advised me to take a week or two away from the keyboard to let it heal and then the usual ‘take breaks while typing etc.’ Sometimes that worked, sometimes not.

At one point, I started noticing that my grip strength was declining in that hand and I was getting muscle twitches when I had to grip things very tightly (e.g. a hario hand grinder). Twitching and weakness are clinical signs of a motor neuron problem. After researching various nerve compression scenarios… I happened upon a website similar to this: http://www.eatonhand.com/hw/hw007.htm. This described me exactly; habit of sleeping with my arms stretched out in a way that compresses the ulnar nerve.

I got a 15 dollar brace off Amazon and started being careful about what position I slept in. A month later, my hand was completely back to normal and I’ve been pain free since.

My brother (also a programmer) had a similar situation. RSI to the point he couldn’t work. The root cause; a shoulder injury from his teens that wasn’t properly addressed. Did PT to work on the shoulder and his RSI resolved within a few months.

The point is, don’t focus on typing as the cause; look elsewhere. If you are injury free, you can type all day long and it won’t likely cause a problem.

A full list:

* Wear warm clothes that cover your wrists.

* Start going to the gym, and focus especially on free weight exercises. They make your arms and hands stronger, and the growth hormones released after working out promotes healing of any wrist injuries.

* Mouse sensitivity. Which is better, low or high DPI varies on a person-to-person basis but for me what worked was low as it forced me to use my hand to do large movements rather than my wrist.

* Mouse hardware. Again varies on a person-to-person basis, a mouse that is too large or too small for your hand can cause wrist pain.

* Sleep position. Sleeping on your back is probably the safest way, be sure to keep your arms relaxed on the sides. Having a pillow to hug might help as this feels somehow a natural position

* Don’t play video games with a mouse. Yes this sucks as some of the best competitive multiplayer games are on the PC, but LoL, CSGO, Overwatch etc are known to cause RSI issues and lots of professional players have ruined their wrists permanently.
Switching to a console will stop any wrist problems from gaming

Can you elaborate on somethings you wish you had done.

I get a bit of pain after half a day of coding, mostly my right pinky after hitting enter multiple times. Also get pain after certain activities like rolling food into a ball for my toddlers.

I’ve joint pains here and there and the doctors have not yet found the cause and think it’s early onset of arthritis and have been told to take pain killers.

I’m 39 by the way!

Edit: added age

(35 now, this started at 33) I wish I quit my job when it started to get worse instead of continuing while I was doing PT. I was doing 8-10 hour days of coding in a startup, my hands and arms got worse and I started doing 4 hour days 3 times a week and doing physical therapy, dr appointments etc. It continued to get worse. I had a lot of faith in my doctors figuring it out. They kept telling me I’d get better, it’d heal. Well, we’re years from then and none of that came to fruition.

Not only that, the doctors misdiagnosed me multiple times, not able to come to an agreement on what it was. They still don’t. They call it RSI, arthritis, posterior interosseous nerve syndrome, and others that I cannot remember.

My advice, look up an ergonomics diagram, compare your setup to a proper setup. Then make adjustments to areas you’re having trouble with.

I use an ergodox ez keyboard w/ a 3m sort of joystick mouse (it doesn’t tilt though, you move it like a normal mouse).

I can get away with 1 hour working, then icing, stretching then repeat. For about 4 hours total for a day, but I wonder; does doing this cause more damage? I guess I’ll find out when I am older, as I have to pay my bills.

Lots of good advice here. Ergo keyboards (I like the kinesis advantage, and they last decades) and breaks worked for me. Dvorak is mostly useful because you have to relearn it, and might learn it without whatever broken ideas your body has about QWERTY.

Chair adjustments are huge. Get a steelcase chair—I like the leap. Have it adjusted by a pro, whose biggest advantages are being able to see what you really do as you type and knowing all the dials in advance.

And get stronger. A stronger back, shoulders, arms, grip will help you stay working in safe positions longer. Anything from Tennis to deadlifts will work here.

Just adding another data point, my Kinesis Advantage only lasted 6 months before it started experiencing phantom key strokes.

Sending it in to get repaired would have costed almost as much as getting a new keyboard since I don’t live in the US.

I replaced it with a Microsoft Sculpt that has lasted for years now.

When I was trying to learn 10 finger my wrists started to have pain. I immediately stopped and to this day still do my made up three finger touch typing on each hand. I’m still paranoid, my right elbow and lower arm still feel sensitive. I switched to an ergo mouse that’s vertical there. It’s crazy to think I could go from XK/year to 0K/year over something so “simple”.

Staying strong is a good idea – I will start more core / physical fitness.

I (25yo), also had pain in my right pinky and wrist, starting about 2 years ago.

I spoke with a friend who had surgery for Carpel Tunnel Syndrome, and knew a lot more about this than me. What he told me:

* Carpel Tunnel Syndrome affects the thumb/index-finger; pain in the pinky side of your hand could be caused by uthe ulnar tunnel or the cubital tunnel.

* He does sets of 10 of these stretches every hour
http://2.bp.blogspot.com/-cl-rpkmgPqI/UeUWdH4oMUI/AAAAAAAAAJ… https://s-media-cache-ak0.pinimg.com/originals/8a/a4/2c/8aa4…

* “One of the biggest things you can do is splint your wrist at night. This is one of the best wrist braces I’ve found: https://www.amazon.com/Mueller-Fitted-Wrist-Brace-Number/dp/…

My experience:

– I got a foot pedal, and put Alt, Ctrl, Shift, and Enter on it (and for a while pulled those keycaps off the right side of my keyboard, to force myself to learn to use the foot pedal). This allowed me to keep using a computer while I recovered, and allowed me to avoid stressing my pinky after I recovered. I wrote a bit about that on Reddit https://old.reddit.com/r/emacs/comments/7remed/has_anybody_u… .

– The tendon gliding exercises were very helpful. The other stretches didn’t seem to make much difference. While I was recovering, I tried to do them hourly. I now only do them if it’s acting up.

– I second his endorsement of those wrist braces. When using them, I wear them at night, and when typing if I can (I can use a desk keyboard with them, but can’t use my laptop with them). While I was recovering, I used them all the time, now I only use them if it’s acting up.

– More recently, I got a Keyboardio Model 01, which puts the modifiers on the thumbs, not the pinkies. The foot pedal is entirely unnecessary with it; it puts much less strain on my hands.

Nowadays, my wrist acts up maybe once a month or two.

you might want to look at the kinesis advantage keyboard, moves the backspace and enter to your thumbs cluster, and greatly improves ergonomics for your pinkie fingers.

For those in this thread, try mechanical keyboards without much actuation force, like Cherry MX clear.

Also try programmable keyboards or custom keymap layouts, which will allow you to map Return to the caps lock key to balance RSI a bit. I have issues with my right index which I almost completely blame on Diablo 1/2, swapping left + right click helps a lot.

I’ve also tried and wouldn’t recommend:
Dvorak (no noticeable difference)
Egrodox (extremely hard to learn)

Maaaaybeee tiled window managers, dunno where I stand on that one but it probably doesn’t help a lot ergonomics wise.

My experience is different here… changing to Dvorak + changing mouse to a trackball in the left hand (along with a MS ergonomic keyboard) made a world of difference for me.

I can currently code a whole day without feeling anything… coming from not having enough strenght to hold a glass sometimes due to RSI — 10 years since I did the switch already… having to type much slower when doing the switch to Dvorak also forces you to be slower and helps in the initial recovery.

As a note for people with issues, don’t go to pain killers when you’re still typing, you’ll only make the problem worse… if you go to pain killers make sure you also stop typing/injuring yourself.

I have the same experience with Dvorak. Haven’t got any pain issue anymore since i switched from qwerty to dvorak. My typing speed really suffer for the first week though. Also, now i can’t type on qwerty anymore except on a phone on-screen keyboard.

I didn’t have too much trouble learning the Dactyl. Detailed my experience here: https://www.reddit.com/r/MechanicalKeyboards/comments/azkkpz…

It took 4 hours or so of constant typing tests to get up to 60 wpm. It took another week or so of working with the keyboard programming 8+ hours a day to stop having stupid mistakes.

It seems like it’s going to be extremely hard to learn at first. Especially when you’re hitting 5 WPM every time, but trust me, your brain will adapt. I was helped out by the fact that after spending a few days _building_ the keyboard, I wasn’t about to back down. I was pleasantly surprised when it only took 4 hours.

Since then, my productivity is through the roof. Tons of thumb keys that are entirely programmable = heaven for an Ergoemacs user like me.

I really like my ergodox. I can’t go back to a normal keyboard. The only upgrade I can think of is going to a kinesis advantage or dactyl. It took about a week to get comfortable with mine, longer until I was better with it than a normal keyboard.

I’ll also mention that cherry mx blue are much to heavy for me, and brown hurt after a week of furious typing. My problem with clears is that if I rest my hands too much I press keys because they’re so light

Grantparent poster here. Hrm, you’re right, I remember purchasing keys ‘lighter’ than browns, possibly silvers. They’re very light, but I’d probably prefer ‘too light’ over ‘too heavy’.

You may have Gateron Clears, which are lighter than Gateron Browns. Gateron Browns are basically equivalent to Cherry MX Browns, but Gateron Clears are entirely different from Cherry MX Clears. This has tripped me up more than once.

If what you have is actually tendinitis in your elbows then that’s fixable through physical therapy (progressively heavier slow loading of the joint in the form of concentric-only single-joint movements).

Also same Boat.

I’ve found that a mix of proper ergonomics, regular breaks, CBD oil (for inflammation), wrist braces and physical therapy exercises can do a lot of good.

I worked with a guy in 1999 who had severe RSI. He had spent a ton of time training whatever the highest pro version of Dragon Dictate was at the time, and then even more time setting up a bunch of macros to do complicated/repetitive tasks. It was impressive how fast he could ‘type’ (that is to say, it was really, really fast – faster than a keyboard) for the things he had trained it for. But, 20 years ago, none of the non-RSI people were tempted to follow his lead having seen how much work it took to get it set up.

But, fast forwarding 20 years, I can totally imagine that a product such as yours that is designed from the ground up for programmer types could be significantly faster for text input, but hopefully without all of that burdensome training and setup before you can be productive.

Reading the docs it struck me that your not far off from a vim or emacs like abstraction around text processing. Hopefully you are building this so it’s easy to add commands in other languages and not a ton of specialized code. thinking something like command + regex matcher… Or really if you can integrating with the language server spec you’d have a quite powerful system if you just have users learn the ast parts of that spec as commands.

Didn’t get to play with it as my computer died again right after I installed it. Not your fault, main ssd desoldered and cracked connector a week back while I’m in a month long road trip. I’ve been hobbling along on live USB distros (surprisingly fast) until last night when the boot USB torched.

I have rsi flare-ups that cause my fingertips and blades of hands to go somewhat numb or hurt. Usually goes away when I use my good ergo setup (appeared when I played about 40 hours of pubg over a weekend) and get some exercise around my hands / forearms.

Is this open source? I’d love to play with it and see what it would take to support C# in Visual Studio.

I gave it a shot. Here is my feedback:

1- It doesn’t recgonize my voice very well. I know that my accent is not that good, but Google has around 9~% accuracy. This had maybe 10%!

2- Why a VSCode plugin? Why not make it at the OS level. So I can type with my voice anywhere I want.

3- Being able to customize the commands myself.

Thanks for the feedback! We’re actively working on improving the speech engine, apologies it didn’t work well for you. We’re starting with editor plugins, but eventually want to expand to other apps as well. Definitely want to support customization down the line too.

The snippets feature looks quite powerful and particularly like the enumeration conversion example. Are there any plans of making these kinda of transformations extensible?

I’ve recently gone into speech assisted video editing and came across Kald about a month ago, was interested specifically in its diarization feature … it’s quite daunting. How did you get up to speed on it … I’ve talked to a few people who’ve worked with it but it took them months to feel comfortable with it.

Just today I heard about this guy with motor issues who can play competitive fighting games using only his tongue (not directly, using it to push his cheeks/skin) I would imagine combining something like that with voice recognition would be the best approach, something like press X before saying (on your mic) a variable name, or press Y before saying a control structure, such approach would remove a lot of ambiguity because the number of possible interpretations by the speech recognition software would be greatly reduced.

I was thinking along these lines. Wish i had time but good that you have made considerable progress.

My motivation was different though. I wanted to break barrier to code, make cleaner/efficient/consistent code, automated tests ingestion and for the ability to port code to other languages from metadata. If you could focus also on those lines too – it would be useful for the general community too.

Doing the good work. It keeps me up at night thinking that I might be in this position. So little has to go wrong.

I was actually VERY close to being in this same Boat, one of my nerves in my shoulder was pinched so badly that it started to take damage. Took me a few months to regain full use of my left (dominant) hand with lots of physical therapy.

Seeing this gives me real hope that there is hope for everyone regardless of a sudden life altering possibility.

What’s the licensing for this? I feel very strongly that accessibility technologies must be free/open source software, so that the already disadvantaged community which relies on them can work together on improving them to give each other a leg up, or to adapt it to their specific circumstances.

There is no license listed in the github repos for the VSCode and Atom plugins[0]. As such they are not currently open source.

Open source seems like a major advantage with assistive technologies and something that the community should insist on in the products it uses.

However, insisting that only free (as in beer) software is acceptable seems to unnecessarily restrict the potential new software that is needed.

[0] https://github.com/serenadeai

Right now it works best for python. We’ve got early versions of JavaScript and Java out too. We’re also releasing HTML and CSS soon.

little constructive criticism… no where on the site or in the document does it mention what the supported languages are. After a little bit I saw that this was only for python, but I think it would be better for you cause if you not only said what languages are supported, but maybe also how you can add other languages.

It’s directly on home page:

    Multiple languages.
    Use the same commands across multiple languages: Python, JavaScript, Java, and more on the way.

This won’t help anyone who has lost the use of their hands, but I have some advice for touch typists who use a standard keyboard like a laptop or typical desktop keyboard: don’t bend your wrists.

Of course most people know about the ergonomic advice to have your keyboard at the right height so your wrists don’t have to bend up or down. But I often see people typing with a horizontal bend in their wrists so that their hands are pointing straight forward as they type, like this crude sketch:

      | | |   | | |
      | | |   | | |
      +---+   +---+
      /  /       
     /  /         
    /  /           

If you do that, try this instead: don’t bend your wrists to make your hands straight. Relax your wrists and let your hands be at the same angle as your arms:

      / / /     
     / / /       
    +---+       +---+
    /  /           
   /  /             
  /  /               

Your fingers will still be able to find the keys, but it may take some getting used to if you’ve been using the “bent wrist” position. Once you get the hang of it, this may reduce the stress on your wrists.

I’ve been typing on standard keyboards nearly every day for about 50 years without any significant problems. I tried using the “bent wrist” position as a quick experiment and it was really uncomfortable. So while I can’t say for sure that it will help everyone, I’m pretty sure the “straight wrist” position has helped me.

Better solution is to ditch the single-block-style keyboard and get a proper ergonomic one that’s split into two parts. That allows you to keep your wrists at a natural angle but you also need to change the layout to use columnar staggering so the fingers are only moving vertically.

There’s many things wrong with traditional keyboards and many solutions that I could write for years about. This one’s mine and is focused at programmers/Vim/Linux users [1]. The main takaway is move the fingers less and leverage a programmable layout to overload fingers. Look at how the thumbs are used and the relation to common programming symbols. [2] and I mean it’s programmable so if you don’t like it, flash it.

[1] https://www.gboards.ca/

[2] https://qmk.fm/keyboards/gergo/keymap.png

That’s a really interesting keyboard! I think I’ve seen one or two like it at the office – I will have to take a closer look.

It wouldn’t work for me, because as I mentioned in another comment I am a TrackPoint fanatic. I’ve used ThinkPads for 20 years and even have a USB ThinkPad keyboard on my desktop at work.

But thank you for mentioning this option – everyone has different needs and I’m sure this will be very helpful for someone.

It does, but it’s also not very programmable or backed by a open source firmware. Give JWZs review on it a read 🙂

The UHK firmware is open source. I should also mention that the configurator of the UHK is more advanced and polished than any alternatives.

JWZs review is completely unjust as he hates 60% keyboards. Read my comment in his post.

I did, My main Issue with the UHK is it doesn’t go hard enough. I looks like a half-baked attempt the make a ergonomic board similar to Alice and the Mistel Barraco just with some extra doodads.

Cool that it’s open-source. Why not leverage QMK and Via for a graphical configurator?

Edit: Not trying to shit on the UHK, but it seems like a _decent_ keyboard. My fault with it is that it’s much too conventional and thus ends up falling into the trap that many boards already to (pinky overuse, wrist angling, gimmicks over form). It’s great that you managed to create a product and bring it to market. But it doesn’t really bring anything new to the table or deserve the name ‘Ultimate Hacking Keyboard’.

The modules are a game changer of actual usability value which haven’t been implemented by any keyboards yet. Ignoring their value and calling them doodads is unfair.

None of the open source firmwares support the modular architecture of the UHK or allow for the easy update of the configuration without using full-blown compilers so they are not suitable for us.

We’ll release further UHKs of additional layouts, columnar included.

Seems easy enough to check if a device at a given I2C address is there and enable functionality. There few a few devices doing this already.

Via has been doing non-flashing keymap updates for years and is cross platform. Reach out and help contribute.

Here’s hoping you can make a keyboard worth the name. Exposing interfaces to users can bodge on their own hardware would be a good start. Maybe getting a ergonomics nuts on the team as well.

For off-the-shelf solutions, consider the Mistel Barocco, Matias Ergo Pro, Ergodox EZ, Mitosis, and of course keyboardio.

I own the Mistel Barocco and keep the two halves of the keyboard like two feet apart; cannot recommend it enough.

Yeah Split Ortho with columnar stagger. Those are important features. Another one is the overall height of a board, the lower and lighter the switch the better. One of the current issues I’m having is simple MX switch height + a given profile. Tack on a case and suddenly your wrists are all bent!

On my personal boards I go caseless with Low-Profile Kailh Chocs and very low caps for them. It’s not pretty but with 12g switches I haven’t had rsi flaring issues in months. This is something I went a bit extreme with Georgi and chording, very comfy but very radical. [1] [2]

Wrist rests can help alleviate this issue, but a badly designed rest will do more harm then good.

[1] https://www.gboards.ca/product/georgi

[2] http://docs.gboards.ca/Unboxing-Georgi

I’ve found that most office desk & chair combinations I’ve had don’t have enough flexibility for me to get in a completely ideal position for my wrists. In particular even with the chair maxed out, it’s still an inch or two shorter of what I would need for my forearms and wrists to be parallel to the ground and at the keyboard height, so my wrists are always bent a little bit up. I’ve had occasional wrist and hand pain creep up, but luckily have always been able to manage it by typing a little slower and making an effort to sit up a little straighter and hit the keys a little softer, and it has always gone away in a week or two.

Desk and chair heights seem to be pretty standardized so even if there is a hodge-podge of chairs around they’re all the same height. I’m definitely taller than average, but a quick search says only by about one standard deviation, so I can’t be that unusual.

In general, it does seem like there’s a stigma against office comfort, at least in small to medium startups that I’ve worked at. Usually everyone is using the same shitty, half-broken desks and chairs that came free with the office lease, and the already independently wealthy founders will brag about how scrappy the company is and how proud they are of not wasting any effort or money on something as banal as office comfort. In that environment if you ask for special equipment you’re really made to feel like you’re being difficult.

Yeah, I wish I had more options at work. At home I use an adjustable height sit/stand desk from Ikea, and I’ve a Lifespan walking treadmill (just the base) which really helps with body posture (it’s impossible to rest in the wrong position when you have to keep stepping forward a bit at a time…)

I’ve suggested getting a treaddesk (treadmill desk) at work more than once, with co-workers, direct managers and company execs, but presumably as no one else has tried one, everyone looks at me funny when I ask. So I tend to split my work programming time between workplace and home as a compromise…

Then there’s the Vivo Barefoot shoes I’ve been recently trying for increased awareness when walking, and better walking ergonomics… at this point it seems like a safe assumption that most things humans habitually do aren’t ergonomically optimal. 😉

I hear you. I’m fortunate enough to have sit-stand desks at home and at work, and I notice if the height is even a fraction of an inch off. I also have them in standing position nearly all the time. I get sleepy if I sit too long.

There must be a way for you to solve this. For example, could you convert your desk to a standing desk by putting a sturdy box on top of it? I did this for a while using a wine box that happened to add just the right amount of height.

I was only using my ThinkPad at the time, no external monitors, so I didn’t need to raise the whole desk. You could even accommodate a desktop keyboard and mouse using a bigger box.

If this works, your team will be impressed by your scrappy inventiveness! 🙂

The biggest change that helped when I developed temporary RSI when playing video games in my mid-teens was learning and switching to Colemak.

Natural keyboards (Microsoft-style) helped a bit, but the curved Kinesis Advantage really taught me that you should try to never raise your keyboard angle, and instead keep the keyboard flat at a height where your fingers rest on the home row, wrists straight and naturally held at a comfortable position in line with your lower arms. When done well, it’s like your fingers are hovering over the keys on the keyboard, pushing down, but it can cause strain in your arms as you don’t have any palm rests in this position without buying a Kinesis (and re-learning how to type on a straight column key layout). But by far the biggest difference was learning Colemak, it means my fingers rarely leave the home row and typing is less of a chore on my fingers, but still affects my wrists.

For your mouse hand, the Evoluent mouse may look (and feel) funny, but it certainly is less stress on your mousing wrist. You can fake this with a normal mouse (when you remember to) by rotating your hand, wrist and lower arm 90 degrees, placing your hand pinky side down next to the mouse, palm facing the mouse. Then keeping your wrist in that same vertical orientation, slowly move your thumb and first two fingers to cover the mouse. It’s a loose hold, not as easy to use as the normal grip, but it’s much easier on the mousing wrist. Don’t move the wrist in this position, when moving the mouse, try to remember to move your whole arm if possible. I’ll admit, I only use this mousing technique on days when I’m extra sensitive to RSI, normally my mouse movement is halfway between this extreme and a normal mouse grip—generally I modify the mouse grip to not cup it so tightly with a more horizontal wrist and that works okay…

Also watch out for wrist/finger/positional strain from non-computer activities you do regularly, including how you grip or put extra strain on your body when commuting or when using exercise equipment. There’s always a balance — you want stress to build tolerance, but you don’t want to take it too far and build injury instead. Listen to your body! 🙂

Kinesis Advantage was a game changer for me too. But when I type on my laptop for a day or two the pain is back. The pain also depends on the stress level, because it seems that I type with more tightened fingers (as is the whole body as well).

Have you tried just a straight trackball? I switched to a trackball for rsi, and it helped. But I’m curious if a thumb trackball would be better.

I didn’t try the trackballs that you use your fingers with. The thumb-controlled ones are pretty natural to use, as the left and right click actions and the scroll-wheel are identical to a regular mouse. I suspect the act of using the same finger for moving the ball and clicking the button would be more difficult (at least for me 🙂 )

I haven’t used a mouse in years, just Kensington trackballs and laptop trackpads. The trackballs are great; clicking is predominately with the thumb whereas pointing is with the fingers. Even when using fingers for both, it’s not something I notice since I’ve never clicked and moved at the same time – maybe for a gamer it would be different

I also have a kensington, and it’s easy to hold down the left click and move around the cursor.

Ah yes, trackballs are good too due to the reduced wrist movement/strain, and much cheaper than the Evoluent. Trackpads can work, but hand and wrist placement matters similar to keyboarding…

I want to pick up a couple of those mice. Which do you prefer – the VerticalMouse 4 or VerticalMouse C? Is the only difference the # of buttons?

I haven’t used the C yet, I’ve only used the 4 – I’ve a “For Mac” Bluetooth one which I returned because the 2.4GHz wireless version was performing much better. I suspect they made the Bluetooth one to sell in the Apple Store. As far as I know, they haven’t changed the basic mouse design in 5-6 years now. It still works and feels high quality, I’ve no complaints. (Except that it is definitely not “travel size” – and isn’t rechargeable, it takes an AA battery – but for all that, it has a nice high quality plastic feel and the design of the mouse means you’re not rubbing your palm all over the table as when trying to hold a regular mouse with a vertical wrist.)

The extra buttons require their driver but it works fine without and I don’t notice the buttons most of the time anyway.

I had every VerticalMouse so far (they don’t seem to last for me for whatever reason). I prefer the C, it sits nicer in my hand, they changed the shape; I can’t comment on the buttons as I under-utilize those.
Either way though, going to any VerticalMouse from a regular mouse is a huge improvement. The changes between 4 and C are probably hard to pick out for someone who hasn’t exclusively used those mice for a decade.

Anecdata alert: For what it’s worth, I am relatively sure that the key factor in developing (and then avoiding) RSI for me at least is sitting posture. This may in turn be impacting the wrist posture when typing, but I’ve systematically realised that when starting to feel RSI that it’s coincident with having started slouching or hunching at my desk (or using a different physical layout). Fixing that (and taking it easy for a bit) managed to stave off disaster.

The other revelation has been that general stress levels massively impact one’s posture; if I’m stressing about something the entire upper half of my body tenses up, causing me to hunch over the keyboard (and, almost without noticing it, type about 5x harder than normal). And this probably ends up being the root cause for me.

Just mentioning it in case anyone else had failed to spot a stress -> tensing up -> bad posture -> RSI -> stress feedback loop…

Yes, posture and stress tension are huge! I don’t work sitting down any more, and I think that has helped me a lot. But one thing I’ve made a point to avoid is standing still in one spot like John Carmack giving a talk.

Instead, I’m always moving when I stand at my desk. At home I have a FluidStance Level:


They are expensive, but mine has already paid for itself in terms of feeling better and more alert and hopefully longer life. 🙂 I don’t have one at the office yet, but in the meantime when I stand at my desk I’m always moving around – swaying from side to side, climbing an invisible ladder (raising each foot back and forth), etc.

As others mentioned, ergonomic keyboard helps with this. I’m using Microsoft Sculpt Ergonomic wireless keyboard (haven’t tried Kinesis) which is IMO a good compromise between price, quality and size. One thing to be aware of though is that for security, the USB dongle is paired with the keyboard at the factory via a unique encryption key, so if the dongle breaks, you can basically throw the keyboard to the bin (contrary to other vendors which offer universal dongles that can be paired with existing keyboards).

Another RSI tip concerning mouse usage: try to learn using the mouse with your secondary hand. Initially it’s very hard, but after few weeks you can do all but the most precise things with the secondary hand. Changing hands can significantly reduce the pain. I have two mice (that may look weird but I find it useful): an ergonomic one for the right hand, and a symmetric trackball for the left hand.

Great tips, thanks! I recommend your “secondary mouse hand” trick in particular for right-handers who use desktop keyboards with the typical cursor keys on the right. I did this before I switched to ThinkPads, and it was great being able to seamlessly work the mouse with my left hand and the cursor keys with my right. Putting the mouse on the left also made a much shorter reach to get to it.

For Windows users with desktop keyboards that have numeric pads, I also suggest turning on the Mouse Keys feature. One thing I always found most stressful with a mouse was dragging with the button down and trying to make precise movements. I felt like I was cramping my hand every time I did that. Mouse Keys makes precise mouse movements easy:


Or on a laptop keyboard – particularly on a ThinkPad – use my JKLmouse program (an AutoHotkey script) that does much the same thing without a number pad. Whenever you hold any mouse (TrackPoint) button or the Caps Lock key down, various keyboard keys turn into mouse movement keys. It works on any keyboard but is especially nice on a ThinkPad where you can press a TrackPoint button, use the TrackPoint to get the cursor about where you want it, and then – with your hand still on the home row! – move pixel by pixel with the keyboard.


I don’t know of macOS or Linux equivalents for these, but would be interested in hearing about them if anyone is familiar.

i learned touch typing in school, but i never really picked up on it. it just felt uncomfortable. i could not get enough strength into my fingers to push down the typewriter keys we used and the wrist felt uncomfortable. i did get ergonomic keyboards when available, they definitely make a difference, but they were not always available. (i never even considered that, but i wouldn’t have been able to carry them to school where i had to work on a random terminal instead of my own workspace using unix workstations which weren’t even compatible)

so eventually i just started typing with the index fingers and thumbs only.

i don’t actually see the point in touch-typing for programmers.
programming requires more thinking than typing. it also uses more special keys that touch-typing is not really adjusted to, so i don’t feel like i am loosing any productivity by not being able to type as fast as a trained touch-typist.

and in light of the stories here, i consider my early uncomfort as a warning sign that stopped me from making things worse.

as others said: if you feel uncomfortable, fix the uncomfort, no matter how small

I was supposed to learn touch-typing in school, but all I learned was how to game the system. To this day I still type with pretty much only index and middle fingers, even the space bar.

I don’t feel particularly restricted by my _maybe_ slower typing with more frequent mistakes due to looking at the keyboard. Like you said, my job is engineering, not typing.

right, i forgot about the looking at the keyboard part. that is a distraction, but in fact, i have been doing this for so long that i can type with just index fingers without looking at the keyboard. seriously, i am am trying this right now, and i am astonished how few mistakes i am making. it does feel awkward because i am not used to typing this way but apparently my muscle memory is good enough…

I have my wrists straight when I type, but I used to have a problem with left hand’s control key; every time I needed to press ctrl+ my writs bend and it started to cause pain. Then, one day I decided to map my capslock key to act as ctrl (found online that this was a thing) and once I learned to use it, all the pain was basically gone. It maybe took a week or so of learning to get used to it.

+1 on keyboard remapping, though I’ve never gotten used to it permanently myself. In Colemak, Caps Lock was originally changed to backspace, so for users who don’t need to hit Ctrl as often, that’s also an option. I suspect the only way I’ll remember the remapping permanently is to disable the original/bad mapping, such that every time I do the old way, I remind myself it doesn’t work that way and hit the new key instead.

I’ve heard some to map esc to capslock too, or even ctrl _and_ esc (tap for one, hold for the other). I don’t think I would have learned the new mapping if it weren’t for the pain.

This is great advice. I really enjoy ergonomic keyboards, and having as little strain on your wrist as possible is key. On “regular” non-split keyboards I ignore the touch-typist tenets and keep my wrists relaxed, so my index fingers are on an arc roughly around `qwefjiop`. Much more relaxed than forcing your fingers to an unnatural “home” row.

Indeed, that is one of the purposes of those keyboards.

For myself, I love the TrackPoint so much that I can’t bear the thought of using any other kind of keyboard with only a touchpad or a mouse. So standard ThinkPad keyboards it is for me. I even use a USB ThinkPad keyboard on my desktop at work!

I’m a big fan of the MS Natural Ergonomic models. The keys are a little squishy but that’s OK

Split keyboards allow you to have both hands and arms perpendicular to the table.

I can type quite fast (easily 100 words / minute), but never had any official training. My hands are always positioned like your second drawing. Could it perhaps be that the standard way people are taught to type (i.e. fingers resting by default on the middle row with index fingers on the F and J key) makes people more inclined to bend their wrists which can lead to complaints?

This is how I was taught to position my hands on the keyboard in 6th or 7th grade (I can’t remember) and to this day I thankfully don’t suffer from any wrist pain or fatigue.

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.

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.

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.

Anywhere from my pinky to my elbow, depending on the day and hour. Sometimes connecting them in a straight line.

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?

4. Are any IDEs particular dictation-friendly?

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.

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.

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.

Try doing some rock climbing either outdoors or at the rock gym. Fixed my hand pain real quick.

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.

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.

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.

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

Search for climbing fingerboard or hangboard.

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.

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.

Same position here – going on 2 years now. Did you ever get a diagnosis?

The current theory of my doctor is that it’s a brachial plexus injury – just waiting on some MRI results to confirm.

No diagnosis, but I did receive some exercises from a physical-therapist which helped significantly.

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.

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.

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.

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.

Re: dragonfly

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 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.

>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.

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.

I can regularly workout and deadlift 500lbs – it has certainly helped but hasn’t eliminated the pain.

Going to add more anecdata to the thread. Going to the gym and swimming both helped with my neck and back pain.

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. 😛

> 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.

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.

Oh that’s Ian Gilman from Openseadragon! That’s an awesome piece of software and in the issues Ian is always positive and ready to help

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.

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.

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.

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.

> and now they’re able to help.

what was the nail-down / how are they able to help now?

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.

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.

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 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.

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.

> 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.

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.

>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.

> Severe pain due to psychosomatic causes sounds like mental illness to me.

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.

>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 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.

> 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”.

>”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.

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.

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.

There are exceptions of course, don’t go for a treatment you aren’t comfortable with. But the recommendation here was therapy.

I’ve had weird symptoms for over a year. If it’s not something plainly obvious, most doctors want you the fuck out of their office. No joke.

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.

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.

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.

> As if all human disease is deeply understood and an admission of ignorance is equivalent to laziness.

People think that there is a pill or operation for whatever ails you, which is simply not true even with modern medicine.

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.

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.

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.

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.

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.

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.

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.

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).

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.

> however Fibro is diagnosis of exclusion

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

> 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.

Parent may have mistyped, but benzodiazepines are very frequently utilized for treating Firbomyalgia pain. (at least in the US)

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 was thinking the same thing when I first read the above comment, I just assumed that he meant Vicodin.

> over-the-counter pain medication, such as Tylenol and Advil, is most effective for pain

For inflammatory pain, yes, NSAIDs can be very effective.

Neuropathic pain however, is a very different beast – NSAIDs will not help at all.

> 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.

(fwiw: I have SFN as well, not that it matters)

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.

It’s been totally worth the effort.

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).

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.

From the post:

> 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.

The author swore at the doctor who said “it’s all in your head”. Which, frankly, seems like a pretty reasonable response.