NetNews Usenet Archive 1992 #16/NN_1992_16.iso/spool/comp/sys/mac/digest/292

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From: [e-mail] (Adam C. Engst)
Newsgroups: comp.sys.mac.digest
Subject: TidBITS#134/20-Jul-92
Message-ID: <[e-mail]>
Date: 24 Jul 92 05:39:39 GMT
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TidBITS#134/20-Jul-92
=====================

 If you or anyone you know has ever felt hand or wrist pain while
   at the Mac, read on for more information on carpal tunnel
   syndrome and a number of easy ways of avoiding serious
   damage. We also have a look at a hot new product coming soon
   from SuperMac. Called SuperView, it will extend the PowerBooks'
   video output horizons significantly. Finally, we unveil our
   corporate sponsorship program, so check out the fileserver for
   some excellent files.


This issue of TidBITS sponsored in part by:

* Salient Software -- 415/321-5375 -- [e-mail]
    Makers of AutoDoubler and DiskDoubler
* Infogrip, Inc. -- 800/397-0921 -- BAT chord keyboards
    One hand on the BAT, one hand on the mouse, eyes on the screen.

 For detailed information on these companies and their products,
   please send email to <[e-mail]>.

 Copyright 1990-1992 Adam & Tonya Engst. Non-profit, non-commercial
   publications may reprint articles if full credit is given. Other
   publications please contact us. We do not guarantee the accuracy
   of articles. Publication, product, and company names may be
   registered trademarks of their companies. Disk subscriptions and
   back issues are available.

 For information send email to [e-mail] or [e-mail]
 CIS: 72511,306 -- AppleLink: [e-mail]@internet#
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 TidBITS -- 9301 Avondale Rd. NE Q1096 -- Redmond, WA 98052 USA
 -----------------------------------------------------------------

Topics:
    MailBITS/20-Jul-92
    TidBITS Sponsorship Program
    SuperView
    Carpal Tunnel Anonymous
    Carpal Tunnel Help
    Reviews/20-Jul-92

[Archived as /info-mac/digest/tb/tidbits-134.etx; 29K]


MailBITS/20-Jul-92
------------------
  Two minor mistakes last week, and one major problem this week,
  which accounts for the tardiness of this issue. First, we
  mentioned the existence of the Frequently Asked Questions file at
  sumex-aim.stanford.edu. Unfortunately, the source had transposed
  two letters in the filename, and so did we. Look for
  "csmf-faq.txt".

  Secondly, Andy Sheppard told us about an FTP and archie site in
  the UK, adding that it had mailserver capabilities though he
  didn't know the details. Unfortunately, it turns out this site is
  available only from the UK. I believe the address is
  <[e-mail]>.

  The previous paragraph is vague because our dearly-beloved 105 MB
  hard drive died a terrible death Tuesday when some moron got drunk
  and ran his car into an electric pole. The resulting power flutter
  (off-on-off in the space of a few seconds) turned the hard drive's
  controller card into the functional equivalent of a twisted heap
  of smoking metal. We had decent backups, but I lost all my mail
  and some recent work. By the time you read this, we'll be back up
  on another APS 105 MB drive ($270 cheaper than two years ago).


TidBITS Sponsorship Program
---------------------------
  People often ask me, "How can you possibly afford to put out
  TidBITS for free?" The answer is "Not that easily." However, we
  believe that the individual should not have to pay for quality
  information. This deranged view probably stems from being related
  to people who work in libraries (Hi Mom!) and from an academic
  background in which information is shared, not sold.

  As a result, TidBITS has always been and will always remain free
  to the individual end user, and non-profit, non-commercial
  publications can reprint articles freely. We encourage liberal
  redistribution to public online services, and we're kind to
  animals and small children. :-)

  Enough with the white hat speech - you all know what TidBITS is
  about. Having grown up in upstate New York, we subscribe, more or
  less, to the American capitalist imperialist dream of owning our
  own house and maybe annexing a small country or two someday. We're
  awfully good at living within our means, but those means don't
  extend far. Therein was hatched the idea of a corporate
  sponsorship program modeled after the one used by Public
  Broadcasting.

  But who to ask and how to set it all up? PBS has sponsors from
  every industry, although I've noticed that large oil companies
  fund a lot of the big name programs. (motto: "We sponsor good
  television. Ignore that oil slick.") The Federal Communications
  Commission restricts PBS sponsors to the dictum "Identify, not
  promote," and they must abide by numerous strict regulations.

  This sounded like a good idea, but we added our own twists. First,
  we are only interested in working with good companies. Fly-by-
  night outfits can hang with the bats. Second, we realized this
  could be an excellent way of providing more useful information to
  the nets, straight from the people who know the best. To that end
  we have added files to our fileserver at <[e-mail]>
  from our sponsors. The concept behind these files is that they are
  supposed to be useful (technical support information), interesting
  (company background or research on a particular topic), or
  otherwise worthwhile. We will not post any files that we believe
  to be false, fraudulent, defamatory, or illegal.

  We're sure that many of you will have comments and questions on
  this change, and please feel free to send them along. We'll
  respond as best we can, as we always do, but let us assure you up
  front that we believe this is the best move for TidBITS. Our
  editorial policies and biases (yes, we've all got them, no use
  denying it) will not change; our distribution and reprinting
  policies will not change; and the actual issues will only change
  by a few lines. The fileserver will have more files, and I
  certainly expect those files to be good reading, but if you don't
  want to see them, no one will force you to.

  That said, I strongly encourage you to send email to
  <[e-mail]> to get a listing of the new sponsorship
  files if you want to know more about AutoDoubler or DiskDoubler or
  if you want to find out more about chord keyboards and Infogrip's
  BAT. Feel free to send email to either of the companies directly,
  asking for more information, or if you approve of them sponsoring
  TidBITS, I'm sure they'd be happy to hear that too. I know we
  would. :-) Of course, if your company is interested in becoming a
  sponsor, drop us a line and we'll talk it over.

  By the way, we've ensured that all the files on the fileserver are
  small enough to pass through all the gateways, so those of you on
  CompuServe, America Online, and AppleLink can request files
  without fear of them bouncing or being truncated.

  Thanks for all the enthusiasm, suggestions, and the hundreds of
  compliments you have sent us over the past two and half years. We
  certainly hope that you will have reason to continue sending such
  letters in the future.

  Sincerely, Adam & Tonya Engst


SuperView
---------
  We've heard of an interesting product, called SuperView, in the
  works from SuperMac's wizards. They've come up with a video
  adapter for the PowerBooks that connects a PowerBook to almost
  anything that can display a picture short of a Nintendo GameBoy.
  The adapter is housed in an external case with a built-in,
  international AC-input power supply, and it connects to the
  PowerBook via the external SCSI port.

  SuperView will have three output jacks, a standard Mac DB-15 RGB
  connector for normal Macintosh monitors, a standard VGA connector
  for PC monitors, and most interestingly, an RCA connector with
  composite NTSC (we're talking basic TV here) or PAL (European
  basic TV) for the European version. The RCA jack will be suitable
  for use with a VCR, projection TV, hotel TV, etc., as long as the
  TV or VCR uses a Video-In RCA jack for input, but it won't work
  with those icky RF modulator boxes from Radio Shack that never
  provide a decent picture.

  Thinking back to our Pong days, we wondered if SuperView could
  provide acceptable picture quality on TV sets. Apparently SuperMac
  is working on some software that will attempt to compensate for
  the limited picture quality. This limitation goes back to the fact
  that TV sets draw interlaced pictures, so the electron gun draws
  every other line, then goes back and draws the missing lines.
  Since we all listened to our mothers as children and don't sit too
  close to the TV screen, we seldom notice the interlacing. In
  rigorous computer use, though, it would be eye-achingly obvious.
  Apparently some presentation graphics programs also know how to
  adjust images for the best appearance on NTSC or PAL, which will
  also help the quality a bit.

  Even with SuperMac's tweaking, we doubt that you'd want to use a
  TV as a monitor for long. That's not the point, though, because
  SuperView supports all standard Mac and VGA monitor resolutions up
  to 1024 x 768 at up to 75 Hz (fast and flicker-free) refresh
  rates. You can drive any monitor in 1-bit (monochrome) or 8-bit
  color mode, with the exception of the Apple 15" Portrait Display,
  which apparently has some technical quirks that limit it to 1-bit
  mode with SuperView.

  There are two main ways to use a second monitor on a computer. The
  Mac generally uses the extended desktop mode, which seriously
  increases productivity by giving you both monitors to use at once
  (both screens are active and you simply drag the mouse between
  them). The second method, presentation mode, duplicates the
  picture on both screens, which is useless for normal work (unless
  you have two heads) but ideal for presentations, in which you want
  to see the projected image on both screens. Initially, SuperView
  will only support the extended desktop display mode, but
  presentation mode will come along a little later.

  It's too early to guess at prices or shipping dates, but if you
  travel frequently with your PowerBook, SuperView might be well
  worth looking into for expanding your display horizons.

  Information from:
    Pythaeus


Carpal Tunnel Anonymous
-----------------------
  Hi. My name is Adam and I have carpal tunnel syndrome. It's a bit
  hard to talk about at first, especially for us guys because carpal
  tunnel syndrome (CTS) is not a real guy injury. Guys break bones
  parachuting from hang gliders onto oil rigs and the like. Guys do
  not get pains in their hands, wrists, and arms from typing a
  little too much while sitting in a bad chair.

  Well, yes they do. So do women. Face it, if you are reading this
  on a computer then you may be at risk for CTS or some other
  repetitive strain injury. Perhaps the hardest part of dealing with
  these injuries is admitting that you have them. Tonya has a
  related problem, tendinitis, in her wrists, and after she admitted
  publicly at work that she couldn't do as much as she'd like, a
  number of colleagues came over individually and said that they too
  had occasional wrist pain. And this is from people who talk on the
  phone six hours a day (using headsets).

  The first thing to do is to immediately send this issue to anyone
  you know who might be suffering from CTS or a related injury. I
  mean it. The State of Washington Department of Labor estimates
  that symptoms of carpal tunnel syndrome will develop in 10% of all
  employed adults in Washington sometime during their employment
  careers. Surveys of doctors suggest that these sort of injuries
  are now the major occupational hazard of the Information Age.

  It's also expensive, for you or your insurance company, if you
  don't treat it immediately. A study by the American Physical
  Therapy Association claims that a mild case of CTS can cost
  between $5,000 and $10,000 in medical care and lost work time, and
  a serious case that requires surgery on both hands can cost
  $100,000. If you have bad furniture at work that hurts your
  wrists, statistics like the one above can help convince even the
  stingiest employer to replace it. After all, your employer will be
  paying the worker's compensation and a good bit of your health
  insurance premiums.

  I'm not going to explain CTS in detail because that's best
  explained by a book on the subject or an unusual doctor with time
  to talk. The basic idea is that several tendons and the median
  nerve pass through the carpal tunnel, formed by three bones and
  some tough cartilage, in the forearm and wrist. When you
  repeatedly bend the wrist at bad angles, you irritate those
  tendons and the nerve. Irritation leads to inflammation, which in
  turn leads to more irritation since the carpal tunnel doesn't have
  much extra room and the inflamed tendons rub on each other and on
  the nerve. We're talking about vicious cycles.

  CTS manifests itself in pain from the thumb and next three fingers
  (another nerve serves the little finger) all the way up to the
  elbow. We've found that overcompensation and stress can also cause
  pain in the shoulder, neck, and back, and it might even cause
  migraine headaches if you're unlucky. The pain can range from
  minor itching and stiffness (that's how bad I've got it) to
  flaming shots of white-hot pain searing up and down the fingers
  whenever you move them. Buttoning a shirt becomes impossible and
  sleep may as well. What can you do? Read on.


Carpal Tunnel Help
------------------
  I'm not a doctor, but I've seen one and have researched this
  subject, searching for more information on ways of avoiding CTS
  and curing it once it has happened. If you believe that you have
  CTS, please go see a doctor right away, or at least after reading
  what I've written below. I concentrate on the easy things you can
  do, in part because they're cheap and easy, and in part because I
  feel that they are in the long run more effective than the drastic
  invasive measures that a doctor may recommend as a last ditch
  effort. Do note that the measures listed below are not in any
  specific order because I think they're all important, and none
  conflict with each other, unless you go under the knife.


Ergonomics
  The first thing you should do to prevent or treat CTS is to make
  sure that your computer environment is well-set up, ergonomically
  speaking. The basic principle involves right angles. Your feet
  should rest flat on the floor, your calves should be perpendicular
  to the floor and to your thighs, which should be parallel to the
  floor, and the angle between your thighs and back should be at
  least 90 degrees. Your arms should hang relaxed at your sides, and
  your forearms should project out straight in front of you, forming
  another 90 degree angle. Your wrists should be straight, not
  arched upward. You might adjust your keyboard for this, or you
  might have to adjust your chair and desk height. Standard typing
  height is supposedly 27 inches, but that will vary with your
  height. I had to saw an inch or so off my desk and buy an
  adjustable chair, both of which helped a great deal.

  You should be between 18 and 28 inches from your screen, and it
  should be adjusted so that it is between 15 and 30 degrees below
  your straight-ahead line of sight. If the screen is much lower
  than that, you'll probably end up slouching.


Wrist Pads
  By now you've probably seen the neoprene wrist pads that many
  people put in front of their keyboards. I highly recommend you buy
  one (about $10) because they help in two important ways. First,
  when you type, you shouldn't rest your hand on the desk, but many
  people do. The wrist pad is designed to remind you to lift up
  slightly so your hands don't rest on any surface as you type,
  because that angle can compress the carpal tunnel. Secondly, when
  you stop typing to think, you probably put your hands down, and
  it's better to rest them on a soft pad than on the hard corner of
  a desk, which can cut off circulation and compress the carpal
  tunnel.

  I'm convinced that these pads, simple as they are, help a great
  deal. Microsoft gives a wrist pad to every employee. Microsoft's
  wrist pads are unimpressive compared with the one I've been using
  from Silicon Sports. Generic wrist pads consist of a piece of
  neoprene or similar rubber padding, whereas Silicon Sports has a
  better design with two layers of padding under the colorful top
  covering. The lower layer is the standard dense foam rubber, but
  the thinner layer on top is a softer foam than the generic pads
  use, and I found it noticeably more comfortable. Silicon Sports
  also has a pad for the PowerBooks coming out soon and a clever
  wrist pad/mouse pad combination that fits together like puzzle
  pieces and keeps everything compact. Get one of these wrist pads
  and use it. Depending on your office-mates, it might also be good
  for whacking them on occasion. (Kids! Don't try this at home!)

    Silicon Sports -- 800/243-2972 -- 415/327-7900


Chill Out I
  Take a break and relax. I suspect you work too hard and put in too
  many consecutive hours at the keyboard. You should take a break
  every 45 minutes or so, and by a break I mean that you should
  actually do something different, like go hang around the water
  cooler or hassle a coworker (Dan Quayle's Council on
  Competitiveness will have me shot for that statement.). You can do
  some simple exercises as well, the easiest of which are (a) gently
  squeezing a rubber or foam ball in your upward-facing palm and (b)
  extending your fingers completely until you feel a stretch, then
  relaxing your fingers and curling them in toward your palms.


LifeGuard
  Visionary Software has a useful little DA called LifeGuard that
  can nag you into actually taking these breaks. It monitors how
  long you're typing or mousing, and then tells you to take a break.
  You set the length of both the work time and the break time, and
  it will give you either an audible reminder or a dialog reminder
  that suggests something else (which you can set) to do. LifeGuard
  also has a useful section on exercises (including the ones
  mentioned above) and another one on ergonomics. Lifeguard has a
  number of limitations, and I'd far prefer it if you could pick a
  set of sounds for it to choose from randomly and if it had an
  option to literally lock the screen to kick you off, but it's cute
  and useful.

    Visionary Software -- 503/246-6200


Splints
  One of the easiest things you can do that a doctor will also
  recommend is to get wrist splints and wear them in bed, if not
  also during the day. Most drugstores should have them in different
  sizes and shapes, although all the ones I've seen are a vague tan
  color. I'd like to see them in black, bright blue, and even
  perhaps some fluorescent colors. There's no reason they have to be
  ugly, and it would be nice if their velcro wasn't quite so
  exposed. I hate sticking to everything!

  The splints are generally called "cock-up splints" or something
  similar because the metal splint cocks your wrist at a 20 to 30
  degree angle. This position is neutral, so in theory you aren't
  compressing the carpal tunnel while wearing them. I also find that
  certain life activities, like driving a car without power steering
  or pushing a shopping cart, are extremely hard on damaged wrists.
  The wrists splints provide welcome support in those cases, but I
  do wish they didn't look so stupid.


Vitamins
  My doctor recommended that I take vitamin B6. Apparently the
  omniscient "they" have done studies showing that vitamin B6, in
  doses of 100 mg daily, can help cure CTS. Apparently B6 plays a
  role in producing neurochemical transmitters, and that can help.
  You can find B6 naturally in brewer's yeast, wheat germ, and
  blackstrap molasses, but if you're like me, your diet doesn't
  include those three items regularly. Supplements are probably in
  order.

  Another vitamin that _may_ help is vitamin E, in 400 IU doses
  before bed. My doctor mentioned it as well, and my father had
  excellent luck with it clearing up his arthritis in his mid-
  thirties. I've taken it on and off when I'm running competitively
  because I find that I tend to get shin splints otherwise. Medical
  science is still undecided about vitamin E, and the only things
  they've proven, I believe, are that it reduces free radicals (a
  laudable goal) and it prevents impotence in rats (an equally
  laudable goal).


Chill Out II
  This time I mean it literally. Current medical thought believes
  cold is much better than heat for aiding healing. The basic idea
  is that cold reduces inflammation, whereas heat may reinforce it.
  Also, since nerves are extremely sensitive to heat, heating aching
  hands may feel good, but it's deceptive because all that's
  happening is that the nerves that were transmitting pain impulses
  are now sending heat signals.

  Probably the best way of applying cold to your arms is via ice
  massage. If you freeze water in paper cups, you can then rub your
  arms with the frozen cup, gradually tearing the cup away as the
  ice melts. It's messy and not terribly ecologically-conscious, but
  it works and lots of athletes use it to reduce pain and swelling
  after exercise.

  A tidier method is to go to a sports store and pick up four or
  five of those ice bags that have some sort of blue gel in them.
  They're cheap and they work well. Don't overdo the cold. Frostbite
  isn't fun.


Massage
  Gentle massage on the hands, wrists, arms, and shoulders (which
  may often be tight and sore too), may feel good, especially if
  someone else does it, and you can also use a hand lotion that has
  vitamin E in it, just in case some vitamin E is absorbed through
  the skin. No clue if that's true, but I've had good luck with
  using it in massage.


Exercise
  When I first admitted that I had CTS, I thought a bit about what I
  could do that doesn't involve my hands. Other than being a couch
  potato, which I don't approve of, all I could think of is running.
  It was an excellent excuse to get out on the trails regularly. My
  doctor agreed that exercise was excellent, in part because it
  doesn't use the hands, and in part because it helps relax both the
  body and the mind. I'm not going to recommend that you all
  immediately become distance runners, but exercise-induced
  endorphins are good stuff (now I'll have a drug czar on my case).

  Standard warnings about overdoing it apply here too. You may not
  think about it normally, but if you're having trouble with your
  hands and wrists, be careful not to clench your fists when you
  run, and avoid shaking your hands at the wrist. Of course, walking
  is good, and swimming may be, although I find that it tends to put
  a bit too much pressure on my wrists, depending on which stroke I
  use. Bowling is right out.


Alternative input devices
  Definitely look into alternative input methods that will reduce
  strain on your hands and wrists. The most common of these devices
  is the trackball, and next week we'll look at two well-designed
  trackballs, the CoStar Stingray and the Curtis MVP Mouse and
  Footswitch. Trackballs are often more comfortable because the
  mouse click & drag action requires a significant downward
  pressure, and that pressure requires additional force to move the
  mouse horizontally. Also, moving the mouse with your wrist and arm
  is more likely to compress the carpal tunnel than similar
  movements with a trackball, which requires only the use of the
  fingers.

  More esoteric input devices include chord keyboards and voice
  controllers. Chord keyboards may help reduce CTS problems because
  you don't have to move your hand at the wrist to reach all the
  keys. A chord keyboard arrays its small number of keys so your
  fingers are always on the correct keys, and all you have to do is
  press the proper combinations. It may sound awkward, but I'll bet
  it took you more than an hour to learn to touch type on a standard
  QWERTY keyboard. We'll have more on Infogrip's BAT chord keyboard
  in a future issue, and you can get more information from the files
  stored on our fileserver.

  Voice controllers are definitely neat, but they must be trained,
  are sensitive to changes in your voice, and can only do the sort
  of things you can do with QuicKeys. The Voice Navigator demos are
  impressive, with the slick salesman quickly drawing their logo by
  voice. He sounds like he swallowed an auctioneer. However, the
  problem is accuracy, not speed. Apple's Casper technology promises
  to be pretty snazzy when it ships with the next generation of
  high-end Macs, but I'm not holding my breath. Finally, none of
  these systems will do dictation - for that you need a costly
  speech recognition system.


Simple Drugs
  Doctors will recommend aspirin or ibuprofen early on. They may
  also provide a prescription for more potent stuff like Feldene,
  which is much stronger and has more side effects. Remember, drugs
  merely treat the symptoms, and unless you're in a situation where
  the symptoms prevent the body from healing itself, drugs may
  provide only temporary relief. You can't take this stuff for the
  rest of your life.


Relaxation
  OK, you've read all of my suggestions, but I will venture into
  left field here and claim that none of it will help unless you
  reduce your stress level. Since I've had CTS, I've talked to a
  number of people who have successfully defeated it in interesting
  ways. One swears by Tai Chi, a martial art that involves slow,
  deliberate movements and heightened consciousness of your body.
  Another had CTS so badly that they hospitalized him and gave him
  morphine for the pain. Surgery cured the CTS, but didn't reduce
  the pain. It wasn't until another doctor put him on a stress
  reduction program that he started to recover.

  Another name for CTS-type injuries is cumulative stress injuries
  because you are essentially stressing a certain part of your body
  thousands of times an hour, and the body can't handle the stress.
  Mental stress will cause physical reactions as well, and the guy I
  spoke of above who had surgery didn't experience reduced pain
  until he was able to relax and break the stressful mental pathways
  he'd built up.

  Support for this theory also comes from a study showing that early
  symptoms of CTS were twice as a common among communications
  workers who were electronically monitored than those who weren't,
  possibly because of lower stress levels in unmonitored workers.

  I suggest that you can and must reduce your stress level to allow
  your body to heal. From what I've read and heard, you have a
  variety of choices on how to go about this, be it yoga, Tai Chi,
  meditation, a non-violent martial art, or even acupuncture. I
  suspect it will be hard for many of you, being rational computer-
  types like me, to try one of these methods wholeheartedly,
  although I gather people become much more accepting when the
  alternative is the knife. I also highly recommend that you look
  for a book called "Freedom From Stress: A Holistic Approach" by
  Phil Nuernberger (ISBN 0-89389-071-5). It combines well-explained
  scientific evidence along with advice on ways to reduce stress
  using the theories of yoga as a base. Do with that advice what you
  will - I'm trying it.


Icky things
  I don't want to talk about this much, but if you let wrist pain
  progress too far, Western medicine will almost certainly want to
  give you drugs or cut you open The first move is a cortisone
  injection into the wrist. This is painful and doesn't always work.
  Doctors generally try injecting you up to three times at intervals
  of three weeks. If you're lucky, the pain will recede by three
  days after the injection. Some people have great luck with this
  treatment. Others don't.

  If you're not lucky, you progress to surgery. The basic principle
  is that the doctor can release the pressure in the carpal tunnel
  by slitting it so that it can expand slightly. Some people do well
  after this process and return to normal work several months later.
  However, if you don't treat the causes of CTS, you can just get it
  all over again. So do yourself a favor and try the stuff I suggest
  above wholeheartedly before you submit to the needle and the
  knife. It can't hurt, and I sincerely hope it helps a great deal.


Reviews/20-Jul-92
-----------------

* MacWEEK -- 13-Jul-92, Vol. 6, #26
    Excel 4.0 -- pg. 75
    SnapBack -- pg. 78
    Freedom 120 -- pg. 78
    A/UX 3.0 -- pg. 84
    DupLocator -- pg. 84
    EasyServer Viper -- pg. 86
    InForum -- pg. 88


..

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