## Progress

It’s April 1, and nobody seems to have noticed the little joke I put on my site, or at least didn’t react to it. Which is fine, it was mostly a last-minute commentary on web UX patterns and so on.

(If you’re seeing this in the future, I added a GDPR compliance popover that prompts you with, “This website uses cookies to remember if you’ve clicked this button,” and a button which reads “I clicked it.”)

Anyway! It’s been a few days since my last post and I’m feeling somewhat better right now, so I’d might as well share what’s changed.

## Backslide

So, whatever positive effect I’ve gotten from the nortriptyline isn’t enough to make up for my current baseline pain levels. At least I’m able to get out of bed again (unlike a week ago) but holy moly do I fall into agonizing pain after not doing a whole lot. This weekend I wasn’t even capable of doing my usual 3-to-5 miles of walking a day, and I’m thinking tomorrow I might end up having to take a bus or even a Lyft to work. Very frustrating.

Also, lately I’ve noticed that the extra weight of my iPad in my purse is taking its toll on me. I should probably switch back to using my backpack as my main conveyance; it’s heavier but at least it’s symmetrical and puts the stress on my back rather than my shoulder and neck.

On the plus side, I’ve finally gotten my CPAP working well enough for me. I ended up finding a decent video on how to adjust the nasal pillows and those have turned out to be much more comfortable, given a second chance. The face mask ends up being too disruptive for a bunch of reasons (the slightest movement makes it leak around the sides and I have no way of scratching my nose without hecking the fit up) and I somehow managed to lose the nasal mask (which was nearly as bad as the full mask anyway) so the fact that I’ve gotten the one I’m “supposed” to be using to work reliably and comfortably is nice.

I still feel like it disrupts my sleep somewhat, though. I hope that’s just a matter of something I Need to get used to. Hopefully I’ll eventually start getting reliable deep sleep on it once I’ve fully acclimated.

Anyway. Being up this late and typing a blog post isn’t exactly helping. But I figured an update was in order.

So, Seattle’s been basically shut down for most of the past, oh, week and change, thanks to the snow. People did overreact to the news of the snow (did they really need to stock up with a month’s worth of bread and milk?) but the various shutdowns do otherwise make sense; Seattle is very hilly and when it snows it gets icy and slippery. And some caution does make sense for having a nonperishable food supply, since power outages are a thing. The really remarkable thing is just how much snow we’ve gotten this year; most years we’ll get none or just a light dusting, or maybe we’ll get one or two snow days when it gets especially bad.

But anyway. Despite the shutdowns, my doctor’s office was still open today (thankfully, although unsurprisingly as they have an urgent care clinic so they make plans to stay open as much as possible). So I was able to do my appointment where I finally got to deal with my various medications for fibromyalgia (as well as finally getting a new prescription of estradiol).

## I have fibromyalgia.

So yeah. This explains a lot about my chronic pain issues – and a bunch of other things.

It explains my IBS and anxiety.

It explains my chemical sensitivity.

It explains my need to manage my “spoons.”

It explains why drinking alcohol makes me hurt all over.

And it also explains how I can move forward, and I’m actually already on the right track.

## Wrist diagnosis

Me: My wrists have been chronically sore for over 20 years and it’s basically everything except carpal tunnel syndrome.

Doctor: Maybe it’s arthritis?

Me: No, it doesn’t match the symptoms of arthritis, it’s some sort of chronic inflammation. Maybe there’s a structural issue that makes me extra prone to inflammation.

Doctor: Hmm. Well, let’s get a bunch of tests done, like x-rays and such.

Me: And soft-tissue scans?

Doctor: Sure.

Doctor: [orders a bunch of tests, including x-rays, but no soft-tissue scans]

Me: [does them, wonders what the point was]

Tests: [are for arthritis]

Doctor: You don’t have arthritis. But you do have signs of inflammation!

Me: You don’t say.

## Notes from the pain management workshop, week 6 ~THE FINAL~

I was kind of thinking about skipping this last week because the previous few sessions were feeling not very useful for me, but I ended up going anyway and I’m glad that I did.

Also, I’m not sure if I mentioned this before but if you’re in Seattle, these workshops are available to you whether you’re a Kaiser Permanente member or not! There’s more information about that on their living well classes, including online versions (and they also have additional online resources).

Main topics today:

• Working with healthcare providers
• Weight management (ugh, but don’t worry)
• Looking forward

## Notes from the pain management workshop, week 5

Oops, I forgot to post these earlier while the session was fresh in my mind. I’m going to have to work a lot harder to decipher my handwriting this time around.

This was the 5th week. Next week is the last one. I’m kind of glad to see it ending. Sigh.

Topics covered this week:

• Medications
• Depression management
• Physical activity
• Mind management

## Notes from the pain management workshop, week 4

This week’s topics were on healthy eating, communication, and problem solving.

## Notes from the pain management workshop, week 3

Week 3’s curriculum covered the Moving Easy Program (a simple but effective stretching and minor strength training regimen), pacing and planning, treatment evaluation, and decision making strategies (both for treatment seeking and for other aspects of life).

Last week’s action plan was to do 10 minutes of yoga in the morning, 4 times. I was mostly successful, but only did it 3 times, as today I slept in from having to work late last night (doing a final build of the iOS app for Borealis).

Throughout today’s session we also got some useful affirmations that I can put onto my affirmation board:

• Practice makes progress
• You choose
• Are you choosing pain?

## Notes from the pain management workshop, week 2

This week was a lot more comprehensive than the first week, and it feels like a lot more happened in about the same amount of time.

The major areas of focus were: problem-solving, dealing with difficult emotions (especially useful for me right now), physical activity, relaxation techniques, and dealing with fatigue.

## Notes from the pain management workshop, week 1

A few months ago I signed up for the “Living Well with Chronic Pain” workshop that’s put on a few times a year by my HMO. It’s a six-week course that meets once a week. I figure it would be helpful to share the key insights from each session here, since I know a lot of my followers have similar issues and would like to benefit as well.

The textbook for the workshop is Living a Healthy Life with Chronic Pain. It also comes with a pain-management exercise audiobook on CD.

Hi, you may have seen some of my pained ramblings about my chronic pain and have decided to offer some advice. Maybe I was venting on social media, or perhaps I wrote something on a forum a few days/months/years ago that you want to help with. While I do appreciate the sentiment, there are a few things you should consider before messaging me with your solutions to my problems!

First of all, I have been dealing with these problems since 1996. My wrist problems are old enough to drink. Statistically-speaking, I have probably been working on this since before you were programming, or using computers, or maybe even before you were born.

Second, I have written extensively about wrist problems and the treatments thereof. For example, I’ve written about my ergonomic setup, my self-care regimen, and about many of the problems with trying to get help. And that’s just what’s on my new site – I had quite a bit more on my old blog before I tore it down in a fit of pique a few months ago.

Perhaps you want to let me know about that Python programmer who used voice dictation, or that game programmer who used voice dictation and eye tracking, or that accessibility software that lets people type without their fingers. I am aware of them! They also aren’t solutions which help me with my problems; among what I do, writing code is actually not a very large component of it, and my approach to making things requires much more iteration and (so to speak) hands-on processes which aren’t easy to capture in voice dictation. Also, until there’s software that allows me to draw, or control a piano, guitar, or multitrack DAW software with my voice – and is also smart enough to rule out background noises and conversations with my cats – voice software at its best can only scratch the surface of the assistance I need. (Gaze tracking isn’t an answer either.)

And yes, I am also aware of software that can convert humming into notation! Logic actually comes with some built in. That stuff I actually do use somewhat, but its utility is still limited and, again, only scratches the surface of what’s necessary for music production. It won’t twiddle the knobs or set up my LFOs or even do basic effect routing for me. And I still have to clean all the notes up afterward anyway.

I also spend a significant amount of time helping other people with their code and performing code reviews and sharing best practices; when I am trying to help someone else who doesn’t know how to program very well, I can’t simply talk to them at a high level about how they should be doing it, since if they were on that level I probably wouldn’t be assisting them in the first place.

Perhaps you just want to share your story about what worked for you/your spouse/some random person you met on the bus. I’m very glad that it worked for you/your spouse/some random person you met on the bus! But it’s probably stuff I’ve heard before or tried already. And explaining that repeatedly doesn’t exactly help with my wrists either.

Also, I know this reponse may seem a bit grumpy; after all, you were only trying to help. It is difficult for me to remain civil, cheerful, and patient when I am constantly at a 7 or 8 on the Mankoski pain scale, which is when I am most likely to be venting about these problems in the first place.

So, again, thank you for wanting to share your advice, but please be aware of the greater context first.

## Wrist wrest

My current wrist care regimen, which is… well, slowly helping me to not be in quite so much pain (more slowly than I’d like):

• Using Time Out with the following breaks set up (in decreasing priority order):
• Get to bed: break for 4 minutes every 19 minutes, between 1 AM and 6 AM
• Normal: break for 3 minutes every 20 minutes, all day long; only allow 3 1-minute postponements per day, and show the postpone count
• Micro: break for 10 seconds every 4 minutes
• Exercise: 5 minutes every hour, all day long; only allow 3 5-minute postponements per day, and show the postpone count. Randomly selects one of a few different wrist- and core-strength exercises for me to do.
• During a normal or get to bed break, do one of the following:
• Clean something
• Do some dishes
• Spin a powerball
• Stretches
• Squish some putty
• Don’t worry about not getting stuff done
• Type exclusively using a keyboard.io while (sometimes) wearing padded wrist braces
• Every time I walk through my office door, do some chin-ups
• Actually drink plenty of water and do stretches
• Remember that it isn’t a race

(For Windows and Linux users, the closest equivalent to Time Out is Workrave although it has plenty of problems.)

## On chronic pain

Note: While reading this you may be tempted to give me advice on things to help with chronic pain or wrist problems. Believe me when I say I have almost certainly heard it before, and I am not interested in advice; I simply want to help spread understanding.

I have, since my late teenage years, had chronic pain in both wrists, a result of heavy computer use that started when I was very young. I was fascinated by computers and absolutely determined to become an expert at everything that could be done on them; this drive led me to many spans of overworking as I tried to do everything I could in as short a time as I could. This obsessiveness combined with poor ergonomic practices led to a slow buildup of nerve adhesions and chronic tendinitis.