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RSInetwork#6/June 92
====================
For People Concerned About Tendinitis, Carpal Tunnel Syndrome, and
Other Repetitive Strain Injuries
Produced by:
Caroline Rose, 970 Paradise Way, Palo Alto CA 94306
(crose@applelink.apple.com)
Apple Computer is in no way affiliated with this newsletter.
This document is in setext (structure-enhanced text) format.
To index, browse, and copy from collected setext documents,
use Easy View, written by M. Akif Eyler, Bilkent University,
06533 Ankara, Turkey
(eyler@trbilun.bitnet).
Setext formatting by:
Craig O'Donnell, Assistant Sysop, MacWEEK Forum on ZiffNet
(72511.240@compuserve.com).
Other issues of RSInetwork are available through ZiffNet/Mac
and Compuserve, in the "Reference" file library at location
ZMC:DOWNTECH. Easy View is in the "Applications" library at
the same location under filename EASYVW.SEA.
Thanks!
-------
These past two months I've gotten lots of materials from
subscribers, as well as a lot of new subscribers. (We're
especially gaining momentum on the East coast.) Many thanks to all
of you who have contributed! Please don't be surprised if your
letters or information didn't make it into this issue; I'm limited
by how much I can type. I hope to publish everything in time.
Requests From Readers
---------------------
Alternative Employment?
More than one member of the RSI Network has asked me what careers
people have changed to who have come down with RSI. Please send in
your stories.
Workers' Comp Complaints
A reader who is gathering complaints against California Workers'
Comp medical evaluators asks that if you have any such complaints,
please send them to Workers' Comp Complaints, 2130 Fillmore #222,
San Francisco CA 94115.
Statistics
----------
People often ask me about RSI-related statistics. I'm jotting down
what I learn, but often find discrepancies in figures from
different sources, even though they all claim to be based on data
from the U.S. Bureau of Labor Statistics. Here's what I've come up
with so far ("percentage" means the percentage of workplace
illnesses reported by private industry that are RSI). Please let
me know if you can verify or fill in any numbers.
Year Percentage Total RSI cases
1980? 18% ?
1985 ? 29,000 ?
1989 52% 73,000
1990 60% 87,000 ?
Regarding the cost: Aetna Insurance estimates a cost to U.S.
industry of $20 billion/year. The American Academy of Orthopedic
Surgeons estimates a cost of $27 billion in lost wages and medical
care for the year 1984 (obviously quite larger now).
Voice Recognition And Word Prediction
-------------------------------------
Madenta Communications has announced three Voice Recognition
Technology-based products for physically challenged users of
Macintosh computers: Pre-Dict-ate, VT (Virtual Telephone), and
Telepathic. These products, which use Articulate Systems' Voice
User Interface technology, allow people who are unable to use
their hands to control the computer and a telephone by voice.
Pre-Dict-ate is a word-prediction program that combines the
hardware and software of Voice Navigator II with Madenta's
Telepathic software. You enter letters by saying the military
alphabet and the computer predicts what word you're spelling.
Pre-Dict-ate retails for $1095. Voice Navigator II owners can
purchase Telepathic software, which comes complete with language
files, for $395.
Telepathic, the prediction module in Pre-Dict-ate, also ships
separately for $295. Words are predicted just as with Pre-Dict-
ate, but with the keyboard as the input device.
VT is a voice-controlled on-screen telephone that retails for
$1295.
Madenta is located in Edmonton, Alberta, Canada, and can be
reached at 1-800-661-8406, (403)450-8926, (403)428-5376 fax, or
AppleLink MADENTA.
Another word prediction program that's supposed to be very good is
Co:Writer from Don Johnston's Developmental Equipment, 1-800-999-
4660.
Other Resources For Macintosh Users
-----------------------------------
For Macintosh computer users who have HyperCard 2.0 or later,
Apple Computer offers the Macintosh Disability Resources (MDR)
stack for finding accessibility solutions for the Macintosh. It's
a collection of answers developed in response to the hundreds of
questions the Worldwide Disability Solutions Group at Apple
receives every week from individuals with disability and from
special education and rehabilitation professionals. Contact
Marianne Wydeven at (408)862-6488 or AppleLink WYDEVEN.M.
Legislation
-----------
California Legislative Alert Two bills that would limit vocational
rehabilitation to $25,000 are ready for a vote in both the
Assembly and the Senate: AB 2570 (Burt Margolin) and its
companion, SB 1539 (Bill Lockyer). These Workers' Comp reform
bills also cover fraud, stress claims, medical-legal evaluations,
arbitration, disability rates, etc., but the voc rehab cap will
have the most serious negative effect on RSI victims, especially
if injuries are permanent. Write to your representatives
immediately!
Pending National Legislation A "Comprehensive Occupational Safety
and Health Reform Act" has been introduced by Senators Kennedy and
Metzenbaum (S.1622). Look for details in the next issue, or write
to the Senate Labor & Human Resources Committee for a copy.
Publications
Basic Stuff: A Survival Guide to Workers' Compensation
by Dorsey Hamilton.
This book is available through a non-profit organization
named Compensation Alert in Novato CA. To get the book, send a
check for $12.67 ($9.95 for the book, plus shipping and handling)
to Compensation Alert, P.O. Box 1907, Novato CA, 94948. Their
phone number is (415)382-9321.
Workers' Compensation Claims
by Gwen Hampton.
I'm told this is the "bible" used by California WC caseworkers
themselves. To get this (big) book, send a check or money order
for $50.81 to Workers' Compensation Company, P.O. Box 11448,
Glendale CA 91226. For more info, call (818)247-8224.
Healthy Computing: Risks and Remedies Every Computer User Needs to
Know
by Dr. Ronald Harwin and Colin Haynes, 1992.
Published by Amacom (division of American Management Association),
135 West 50th Street, New York NY 10020.
Sitting on the Job (How to Survive the Stresses of Sitting Down to
Work - A Practical Handbook)
by Scott Donkin, 1986, 1989. (Houghton Mifflin)
Computers and Visual Stress - How to Enhance Visual Comfort While
Using Computers
by Edward Godnig, OD, and John Hacunda, 1990.
Seacoast Information Services, 4446 South County Trail,
Charlestown RI 02813.
VDT NEWS (The VDT Health and Safety Report)
published bimonthly
Carries articles, stories, and news about health issues related to
VDTs, including repetitive strain injury, ergonomics, and
electromagnetic fields. It's a good source for manufacturers'
information through the advertisements for various products, and
it lists meetings and other publications related to VDT use. Cost
is $87 a year. Write VDT NEWS, P.O. Box 1799, Grand Central
Station, New York NY 10163; phone (212)517-2802 or fax (212)734-
0316.
Recording for the Blind recorded books
People with physical disabilities, including repetitive strain
injuries, can apply to Recording for the Blind for recorded books
and electronic (computer) versions of textbooks and computer
manuals. Verification by a doctor or physical therapist is
required. Contact Recording for the Blind, 20 Roszel Road,
Princeton NJ 08540, 1-800-221-4792, (609)452-0606, (609)987-8116
fax.
Organizations
-------------
The American Carpal Tunnel Syndrome Association is a nonprofit
organization, based in Michigan, that has a technical Advisory
Board consisting of six physicians. The basic annual membership
fee of $30 gets you a Carpal Tunnel Syndrome Information Kit and a
quarterly newsletter. Send your name, address, phone number, and a
check or money order made out to ACTSA, or just a request for
more information, to P.O. Box 6730, Saginaw MI 48608.
Compensation Alert, whose founder wrote the first book listed
above under "Publications," is a nonprofit organization dedicated
to teaching injured workers and employers about workers'
compensation in California. Call (415)382-9321 to request an
information packet. They offer a workers' compensation lawyer
referral service; the number for using that service is 1-800-800-
0391.
Jennifer's Story
----------------
(Jennifer Ovink, who lives in Corvallis OR, took a lot of time to
write down her story so the rest of us can learn from it. Please
consider doing the same with your own story. - Caroline)
I'd like to provide some information that I've learned the hard
way. If anyone thinks this is a trivial problem, let them read on
and take a few words from one who is wiser.
The GP, PT, and OT
I started having symptoms in my right wrist in October 1990. I
went to my GP in November and received advice to take 4 Advil 4X a
day and wear a wrist brace that he provided. He also told me to
start using the Macintosh mouse and my Sun workstation mouse with
my left hand. Within two months I had symptoms in my left arm and
the pain in my right had not subsided. I went back to the GP and
received a brace for my left wrist. I bought a foot rest and moved
the keyboard around so my arms were better supported. However, in
January, 1991, a short deadline caused me to work two late nights,
past my usual 6 hours at the mouse/keyboard.
With the problems continuing to worsen, in late June I was sent to
physical/occupational therapy locally by my GP and I filed a
workers' compensation claim in Oregon. My injury was accepted as
non-disabling. Hindsight has shown me that PT and OT were shooting
in the dark and I knew more than they did about the problem due to
my own research. PT did two sessions of ultrasound and showed me
how to ice and wrap my forearm above the wrist brace. OT explored
the usual advice about workstation ergonomics that's generally
available to the public. After 5 weeks of this nonsense, I quit
the physical therapy and went back to my GP. I had heard of people
receiving relief by taking a break from the job for a month; he
agreed. At that time I refiled my workers' compensation claim as a
disabling injury.
The Rheumatologist
On August 1, I left work and was told by my GP that I had tested
positive for the rheumatoid arthritis factor. This meant that I
had to see a rheumatologist and that workers' compensation might
rebill me for past expenses if it turned out that I had an illness
and not an injury. After waiting 7 weeks (off work) I saw a
rheumatologist; three weeks later all tests turned up negative.
However, the rheumatologist said he could help me. I got a
cortisone shot in each forearm (extensor muscles) and he
prescribed 8 weeks of physical therapy 3X a week at a sports
injury clinic, plus 4-6 weeks of massage 2X a week. Two days after
the shot, I received my first PT at the sports injury clinic. My
therapist was a certified athletic trainer as well as a physical
therapist. I felt amazing relief from the cortisone within two
days. My pain went from a 10 to a 4.
The Consultants from Workers' Comp
The workers' compensation insurance carrier hired two consultants
to work on my case. The first, a vocational rehabilitation
company, assigned a case worker to oversee my medical care and all
PT and learn in-depth about my job history and possible employment
options. The second consultant was a medical consultation group
that scheduled an appointment for an exam with an insurance-
approved physician to determine whether or not I was medically
stable. Once a worker is declared medically stable (no chance of
improvement), the Oregon insurance carrier is not required to pay
time loss from employment. Of course the insurance doctor found
that I was medically stable.
The Orthopedist
After two months of this nonsense, on my own I sought the advice
of an orthopedist who specializes in hands and upper extremities.
Dr. Walter Hales, who had already seen a great number of RSI
cases, diagnosed me as having tennis elbow (lateral epicondylitis)
from a long-term overuse. As he described it, this condition is a
degenerative one, not a true inflammation; the tendon may actually
be full of holes or tears, or have dying tissue on it. Dr. Hales
administered another cortisone shot, this time in the right
lateral epicondyle. OUCH. After a month, my recheck found no
improvement. Dr. Hales recommended surgery in my case but he
admitted that it has, at best, only a 40% success rate. Mentally,
I'm not prepared for a 12-week recovery period with only 20%
chance of improvement, 20% chance of "complete" recovery; I
declined the surgery. Dr. Hales did prescribe an anti-inflammatory
medication, Lodine, which I've found to be far superior to
Naprosyn. I continue with stretching and ice, and massage when I
can afford it (insurance won't pay for this any longer).
Where I Am Today
I am now back to work part-time. I am somewhat resigned to the
fact that my elbows/forearms will never be the same. I have cut
back on all activities that use the extensor muscles: sports,
housework, any writing with a pen or pencil. I got an electric can
opener (yecch) and a food processor (no more hand cutting) for
cooking. I keyboard only 2 hours a day for work.
Mistakes and Regrets
1. I did not take this problem seriously sooner.
2. I believed that the insurance company and their agents were
working in my best interests, for the first two months I was off
work.
3. I let my GP treat me for over a year even though he admitted
that he did not know much about the cause of my problem. He felt I
had "routine" tendinitis that he could treat with conservative
care.
4. I did not seek the advice of a specialist sooner.
Changes to My Workstation
1. ErgoArms by ErgoFlex, 1-800-788-2810. These are marvelous! They
take the strain off shoulders and neck. Neck and shoulder problems
and pain are common after the original injury has caused stress
and tension in the forearms. Hands floating over the keyboard
helps since in my condition, using the extensor muscles to hold up
my hands continues the injury.
2. Trackball and foot pedal.
I have the Curtis trackball and foot pedal on my Macintosh and an
Evergreen trackball for my Sun. To the Evergreen trackball, my
employer wired four foot pedals (cassette recorder foot pedals
purchased at Radio Shack) to the four buttons on the trackball. I
use only two of the foot pedals.
3. Footrest.
I angle the foot pedals so that I rest my foot on the foot rest
and use my heel to push the foot pedal down. This relieves stress
on the muscles attached to the shin area of the leg.
Insurance and Workers' Compensation in Oregon
This is a whole 'nother story. Even though my two doctors have
said I'm not medically stable, the insurance company's doctor says
I am. The state of Oregon just issued a Determination order of
Closure in my case and the insurance company was ordered to pay me
permanent disability, MINUS all the time- loss payments from
October 1991. To make a long story short, even though I was not
conditionally released for work by my doctor until January 24,
1992 and my employer had not made any work site modifications
until March 1992 (the conditions for my release), since I
continued to receive time-loss benefits all during this time, the
insurance company may subtract all the time-loss benefits from the
final disability payment. Result: they owe me nil. Under Oregon
law I have 180 days to consult a lawyer and contest the findings.
It has been an education in incompetence and mental stress.
Quote Of The Month
------------------
"Our evaluation of more than 1,100 workers...indicates that
individual characteristics, such as body mass (a measure of
obesity), age, wrist dimensions, and lack of exercise, are major
determinants of median nerve entrapment neuropathy, which causes
carpal tunnel syndrome. Poor health habits, such as cigarette
smoking, alcohol abuse, and excessive caffeinated beverages, also
appear to affect condition of the median nerve. . . . Job-related
factors, such as specific occupation, duration of employment, and
occupational hand use, have contributed very little to abnormal
median nerve conduction." - Peter A. Nathan, MD, Portland OR,
letter to the editor of the NY Times, in response to their article
on RSI. Joan Lichterman of the CA East Bay support group sent an
excellent letter refuting Dr. Nathan's, but it wasn't printed.
RSI Support Groups (California)
-------------------------------
San Francisco:
Judy Doane, (415)931-8780, or Yari Leski, (415)759-0140.
Alternate Mondays, 7:30 PM, at the California Pacific Medical
Center (3773 Sacramento St., at Maple, SF), rooms G and H.
1/18: Ilana Parker, physical therapist specializing in the
Feldenkrais method
1/4/93 and 2/1/93: no speaker, general support meeting.
East Bay:
Joan Lichterman, (510)653-1802.
Meets monthly, 7 to 9 PM, usually on the second Wednesday, at
CalARM 400 29th Street, #105 (at summit), Oakland.
1/8/93: Glen Kohler, Using Tai Chi to Prevent RSIs
North Bay:
Stephanie Barnes, (707)571-0397.
Tuesday evenings in Santa Rosa, 7 to 9 PM, Round Table Pizza 550
Montecito Blvd., between Middle Rincon and Mission Blvd.
South Bay:
Pat Roggy, (408)297-8725, or Petzoldt Hand Center, (408)261-
7660.
Los Angeles area:
Samantha Greenberg, (213)207-1653.
A "computer injury network".
Contributions & Subscriptions
-----------------------------
This newsletter relies on contributions from its readers: please
contribute your questions, stories, and any information that may
be of interest to people with RSI.
Where possible please submit contributions on diskette or via
Email. Xeroxes of interesting articles from anywhere are always
welcome. Mail disks or xeroxes to:
Caroline Rose, 970 Paradise Way, Palo Alto CA 94306
Electronic subscriptions are free.
Formatted setexts are found on ZiffNet/Mac via Compuserve.
Other issues of RSInetwork are available through ZiffNet/Mac
and Compuserve, in the "Reference" file library at location
ZMC:DOWNTECH.
For Internet mailing list distribution, send your Internet
address to:
crose@applelink.apple.com
and you'll receive the newsletter (plain ASCII).
..