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Common Programmer Health Problems (sheddingbikes.com)
394 points by GVRV on Aug 8, 2010 | hide | past | web | favorite | 184 comments



Another related problem is hygiene. I've met too many programmers that smell. Some people don't wash, don't wear deodorant or just don't realise that their clothes need washing even if they look clean.

It's especially annoying because it's so easy to fix!


That is a different class of problem. The health problems Zed mentions affect you, not others. Doesn't matter to your coworkers if you have wrist pain or diabetes.

On the other hard, you smelling doesn't affect you in any way (you get used to your own stench), it affects others. So this is not a health issue, it's a generic "getting along with others" issue.


It's not exactly the same, but it affects you in that people will start to avoid you as much as possible. Would you recommend someone with B.O. issues for a job?

One big distinction is that people often know they're unfit, but are normally oblivious to hygiene problems. I've never had the nerve to tell anyone myself.

Edit: It works both ways. If someone is unproductive due to their health problems, that definitely affects their coworkers. Diabetes, fair enough, but there's definitely an argument for putting many easily avoidable physical problems in the "getting along with others" category.

Edit Edit: If you're going to downvote, let's have your counter-arguments please.


I think hygiene is important, but Zed was not remiss in leaving it out of a health article. A separate article about programmer social issues would be great, though.


> Edit Edit: If you're going to downvote, let's have your counter-arguments please.

Off-topic: I also noticed that a lot of comments get some early attention from eager downvoters. I know it's frustrating. Just wait a bit for the score to settle.


Lack of friends and inability to get along with others leads to mental health problems though.


It can lead to other problems though.


Thanks for the downvote, define other problems:

- not brushing your teeth can lead to caries, which in turn can cause your teeth to degrade, gum trouble and can even cause you to literally lose your teeth

- not washing can have dermatological implications, including fungi and infections

Between the toothbrush, running water and penicillin we've probably increased the average lifespan of humans by a measurable amount.


Gum disease can also lead to heart disease and stroke.

http://www.perio.org/consumer/mbc.heart.htm


Honestly I never really understood this. If I don't take a shower in the morning, I'm simply not able to do anything.

The rest is just routine: new day -> new shirt; fresh cloth -> deodorant; sunday -> do laundry..


I prefer baby powder to deodorant. Deodorant clogs your pores while baby (talcum) powder soaks up moisture. Much cheaper too!


Protip: put on deodorant before shirt.

(Also, get an antiperspirant/deodorant (without aluminium/titanium if possible)).


Why is this a protip? What does putting it on before or after putting a shirt on do? Sounds like personal opinion, and not a clever technique to accomplish an old task.

invisible already stated that a dark shirt and white non-gel type deodorant will most likely result in a rather embarrassing slash down the side of your shirt. One that I have been a victim of more than once. Seems like a good enough reason to get in the habit of applying it after putting on your shirt.


I smell an A/B test.


Pun not intended?


Do not put on deodorant before shirt if deodorant is white or else you will regret it one day when you're marked with a "slash" of deodorant.


Don't forget new underwear ... you would think it wouldn't need to be said


You know, in all the time i've worked as a developer, I can honestly say I've never met a programmer who smelled or had obviously bad hygeine. Sure, I've met quite a few who dressed kind of funny, but never any that fit that particular bit of the stereotype.


When I used to work in an office we had this kid who worked with us who I don't think washed his clothes ever. He would have stains on his shirts and pants and was just generally disgusting. We finally had to tell him that he needed to clean up.

His clothes are now cleaner, but he's still pretty dirty. It's especially noticeable right after a new game comes out that he spends all night playing (WoW, and I'm told now SC2).


In the summer, it's not easy to fix. It's been quite hot here this summer, around 25-30℃ through June—August. Hot weather = sweating.

Taking a shower doesn't give you an edge over it for more than an hour: as soon as you've walked for a while or sitting in public transportation for more than five minutes, you're as soaked as before. And then you're smelling again.


It's been over 32c (90f) in NYC for most of this summer and with relatively high humidity and I don't stink after being outside and taking the trains. Nor do most of the people here. I would LOVE it to be 25-30C most of the summer! In fact it's hit 37C (99f) a number of times here too!


You must live in a rather humid climate because that isn't too hot, it is more of a comfortable temperature.


It's just what you are used to.


Put on some deodorant after you wash and keep a stick/roll-on in your bag or at work.

If it really is unbearably hot you could even pack a spare t-shirt. An American Apparel Summer T-Shirt will fold up to the size of a wallet if you're short on space.


Gold bond medicated powder is an absolute must for me in weather > 80F. And the older you get, the more important this is as certain parts of the male anatomy uh drop lower and lower. Sad but true.


I use one of the salt crystal rocks for deodorant, you wet it and rub it around on your pits, it works by far better than anything else I've tried for eliminating odor, especially in warm humid climates.


Rock Salt deodorant works great. For easier application, try the salt spray. It costs more, but a nice convenience. I imagine you can make your own spray by dissolving the rock in water.


Eating better makes your sweat stink less.


Some of us are aware of this. But it becomes less important if you are stuck in your apartment for a weekend coding and not seeing anybody. You have to take a bath in the morning when going to the office. You will smell otherwise.


A slightly related issue is that keyboards are usually incredibly dirty (especially those in public places). A habbit of touching your face after having typed on the keyboard can cause all sorts of problems.


I'm very OC about this. Anytime I eat or feel my fingers have become oily or dirty I have to wash my hands before working on the keyboard. Of course my keyboard still gets dirty over time, but not nearly as bad as some peoples I've looked at.


Go on, what sort of problems?


Acne


Spots?


Quit coffee. I ended up in the hospital after being in the heat and being hypercaffinated, so I decided to quit.

After the first few weeks of withdrawl, I've found that it is a net gain overall. No more feeling like crap until the first cup of the day. Better sleep. Clearer, less scattered thinking. I recently went on a trip with a friend who is still a heavy coffee drinker, and it was striking to see him suffer through the first several hours of the day before his second or third cup. Being able to wake up and feel great is well worth it.

The thing you lose is the muli-hour high speed coding marathon. But lets be honest, how often is it that the result of these marathons isn't something you end up needing to rewrite anyway because you jumped in too quickly or failed to think it through?

You could, of course, drink it "when you need it", but I've found that this is the slippery slope back into addiction. So, I just stay away.

Edit: I've also found that a tall decaf from Starbucks can serve as a mental substitute for those days when I really crave it. I even get a slight placebo energy boost. "It's so good when it hits the lips" :)


Seriously. Quitting caffeine was one of the best decisions I've ever made.

- I fall asleep within 5 minutes after hitting the pillow.

- I wake up when I want to, without problem, whether I've had 4 or 8 hours of sleep.

- The number of headaches I get has decreased dramatically.

- More importantly, the severity of the headaches I do get is dramatically different: before they were debilitating. Now, they're more like a hangover. Annoying, but easy to deal with.

- Caffeine radically improves the efficacy of medicines like acetaminophen. 350mg of Tylenol + 1/2 of a coke is more effective for me than 1g of Tylenol.

- When you get fuzzy headed because you've been staring at the screen too long, 10 minutes of fresh air works better than coffee used to.

- waking up is a lot more pleasant. It takes about an hour to fully wake up, but you're always partly functional, never grumpy. A little bit of exercise is the best way to shake it off.

Caffeine is a nasty drug to kick. DO NOT GO COLD TURKEY -- the headaches are evil. Slowly titrate off -- I used caffeine pills and a pill cutter.


That tall decaf from Starbucks is not just a placebo; it has 20mg of caffeine.

See: http://www.starbucks.com/menu/drinks/brewed-coffee/decaf-pik...


I'd rather die than quit coffee. The method I use with good success is:

a) Drink coffee without much sugar/milk. I prefer iced espresso drinks that end up being 50% ice or water. Drink it slow so the ice melts as you go.

b) Drink a 1:1 ratio of water to coffee. If I have a 20oz iced Americano I drink 20oz of water before having more coffee.

c) Pay attention to your pee. Easiest way to see if you're getting dehydrated.


But, it tastes so good! No! You can't have my coffee! :-)


I've heard several reports of the benefits of giving up coffee from people who were drinking several cups a day. What about moderate consumption? I usually start the day with one double-shot latte, and that's it.


In my experience, the whole caffeine thing works best with small amounts, divided throughout the day, rather than a spike and crash. Besides, for programming you want to be calm-but-alert, not wide-eyed, sweating profusely, and jibber-jabbering.

Whether that means one cup of coffee in the morning and another after lunch, a thermos of green tea over the day, or a couple slightly-caffeinated mints every few hours depends on how your body handles caffeine.


I was never even close to being addicted to coffee and I refuse to drink even one drink due to its effects on my body. Stimulants not only fry you a bit, they also fatigue your adrenal glands which is the major cause for midday fatigue, random allergies, and poor sleep at night.

I highly recommend anyone that drinks anything more than green tea to quit - it seriously f's up your adrenals...


Do you have any references to back this up? I'm curious specifically about your claim that caffeine negatively affects adrenal glands.


I don't have any specific scientific papers to cite (although I have seen them), I do have personal anecdotal experience and this article that I read a while ago about it: http://www.integrativepsychiatry.net/adrenal_fatigue.html

My personal experience was this: extreme fatigue during the day (it was difficult for me to stay awake and not nap when doing anything sedentary), daily allergies that fired up (very badly) for no allergic reason, and a general sense of sluggishness.

Once I cut out stimulants (it isn't just caffeine, but the amphetamines in decongestants, ADHD medications, etc...) and started taking pills with desiccated adrenal gland tissue and thyroid boosters I could stay sharp all day long without ANY caffeine or naps. I slept really well every night, and a general sense of well being came back.

This coupled with my improved diet in general (paleo diet, no grains at all, high in animal protein and vegetables) made my life so much better. My body feels good, finally.


I'm also very interested in more info about this.


See my reply to the previous commenter.


Why do you think than green tea is especially mild?


Well there is drinking coffee, and DRINKING coffee.

I sure enjoy a cup or two a day and I doubt that is excessive. Drinking lattes also has another nice side-effect: you get to drink some milk, for your daily calcium needs.


Well, it depends on what cup, what coffee, and your body weight. If you're a skinny dude downing a venti from starbucks every morning, you're in a world of difference than if you brewed a lighter blend and drank from a small coffee cup.

I found myself quite addicted drinking a grande from starbucks every morning. Before that cup I was pretty much useless.


Ligher roast coffees actually have more caffeine than the darker roast. The roasting process destroys caffeine.

Alton Brown mentions this on the Good Eats episode about coffee :)

Even then, from my additional readings on the topic the difference appears to be very small.


I just checked McGee's _On Food and Cooking_ (highly recommended, especially if you like Good Eats), and he's uncharacteristically vague about the effect lighter and darker roasts have on caffeine content. (The 2004 edition just mentions the weight loss during different roasts, pg. 443.)

I'm pretty sure you're right, though AB has been stubbornly wrong about enough things before that I prefer to fact-check him.

Also: If your love of kitchen science extends to mad science, you might also like _Wild Fermentation_ by Sandor Ellix Katz. Making sauerkraut, sourdough, mead, beer, tempeh, miso, etc. Best cookbook, ever!


I just found this and it makes sense.

http://coffeefaq.com/site/node/15

It seems the difference is very small regardless of which one has more.

I'll have to check out both books. Good Eats has inspired me more than a few times to spend a Sat. afternoon attempting to recreate what I just watched ;) It would probably help to have something a little more concrete in front of me.


A cup or two a day isn't excessive. But it's more than enough to be addictive.


A while ago this was posted: http://www.kk.org/quantifiedself/2009/10/the-false-god-of-co...

I found it interesting, if not very rigorous. It shows that one man's productivity did not suffer after quitting coffee.


The thing with caffeine depends entirely of the person and the flavor of coffee. A more accurate advice would be to suggest quitting anything you're even slightly addicted to.


But coffee makes you regular.


This article mentions several problems caused by stiff muscles and strategies for coping and preventing them. It may be useful to understand the mechanisms that cause and perpetuate this problem.

There's the muscle sheaths that have stiffened by the lack of use of the full range of motion and the constant deposition of collagen, which literally glues the sheath to itself. This tight sheath can impair blood flow to a muscle, especially when the muscle is contracted for a long time. The contracting muscle presses out against a tight sheath. Blood takes the path of least resistance.

That lack of healthy blood flow can cause the sarcomeres, the contractile unit of muscle, to get stuck in their contracted position. This is how a muscle gets tight and actually shorter.

When a muscle gets very stiff, a trigger point can develop. A trigger point is just an area where many sarcomeres are tight. We certainly notice trigger points, but the muscle gradually hardens for a while before a trigger point develops.

The hard muscles are shorter and thicker and this makes manipulating the sheath to break up the collagen much harder. But if the muscle is softened first, it can be done.

Massage is how you soften the muscle and get the sarcomeres in it functioning again. Massage pushes depleted blood out and then new blood is pulled in from the capillaries.

But there's still one other factor and that is the way muscles communicate with each other to accomplish work. When one muscle is engaged, other muscles receive nerve signals to help. And if there is a trigger point in one muscle, other muscles are engaged via the nerves.

So you may have a tense muscles but it may be another muscle that is the root cause. All of the muscles need to considered and massaged in a systematic way.


A little late to the party, but I went through a bout with wrist/arm pain for over a year. I did physical therapy for more than 6 months, saw a doctor that said I needed to have surgery on my arms, neither helped (did not have surgery BTW). I then finally saw a myofascial specialist. She identified the cause of my pain from trigger points in my upper back and shoulders. After just one visit and a follow up visit a year later, I've been relatively pian free. She basically taught me how to address the trigger points my self using a tennis ball and 'The Trigger Point Therapy Workbook' http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...

I'd definitely give this book a try since it clearly identifies which trigger points are causing the referred pain/numbness along with the ways to treat them.

Also if you are in the Chicago area, check out http://www.myopain.com/. Like I said, they were able to help me with only 2 visits.


All of the muscles need to considered and massaged in a systematic way.

I wish I had realized this years ago. I developed RSI symptoms, or at least they became severe enough that I took note of them, about two months ago. I did a lot of research after that and ended up booking my first ever massage.

When the therapist started working on my forearms, she explained that I was very tight, and she wasn't surprised it was causing me pain. Oddly, my left arm ended up being the worse off of the two. After the massage, I felt great and could type relatively normally again without pain.

She also told me that my neck muscles were essentially made of stone, and asked me if I regularly got headaches (I did).

I guess what I'm trying to say is that you shouldn't underestimate the value of regular massages. It would probably cost around $1k/year to go once a month, but I think it's worth it to keep yourself at the top of your game. Therapeutic massage is often used to manage chronic pain, so I see no reason why it couldn't also be used to prevent it (or cure it if you're in the early stages).


Massage addresses one piece of the puzzle and to me is primarily a coping mechanism. It does not necessarily addresses the underlying problem.

It depends on the therapist; some are really good and some approaches work much better than others. But this problem is clearly not addressed properly for most people. Many suffer for years with it and a quick trip to a nursing home will confirm that.


It depends very much on the massage therapist.

Or rather, it depends the therapist stepping out of the role of "fixing the body" and into the role of helping the person use their body well.

"just message therapy" but message therapists these days are learning a variety of modalities, from hypnotherapy to Qigong to Rosen Work. If you are in a major city and have money to spend on body work, I'm sure you can find really skilled people.

In many ways, what's really necessary is for a person to wish to learn how to effectively use their body. But this goes against the expectation people learn in a consumer society, the majority of people expect a "plugin" fix.

Of course, each person's response is somewhat different. Some people seem to do well being "fixed" once a month.


I didn't mean to imply that massage, and only massage, would rid you of pain permanently.

You need to take good care of yourself in general in order to stay healthy - eat right, sleep well, keep yourself hydrated, and sit/work comfortably.

It just seems to me that a lot of programmers already take care of some of these items - the fact that I've even heard of Herman Miller chairs is evidence that at least some programmers take these things seriously - but RSI is still a huge concern in the industry.

I think if you're already sitting right and taking care of yourself, you could still be slowly damaging yourself because you're still locked in a static position for large portions of the day. Your muscles get used to working together as a single muscle, and they start locking together and essentially becoming that single muscle. Massage helps relieve muscles in spasm, and deeper massages will help break the "supermuscles" apart so they act individually again.

RSI is an issue every programmer (or any other person sitting at a computer all day) needs to be aware of, and the more preventions and cures we can throw at it, the longer we'll be able to stay healthy and productive.


sorry, didn't mean to say you implied. just reiterating something.

Sitting all day is just an aggravating cause, not the underlying cause. A muscle gets stiff under a light load only when circulation is impaired. A muscle with good circulation will not get stiff.

So it isn't that we sit for long periods. Its that we haven't fully exercised our full range of motion on a regular basis. We haven't kept the normal deposition of collagen from essentially gluing our muscle sheaths into something stiff enough to impair blood flow to the muscles inside them.

That's my theory anyway. And part of my understanding is that this situation is totally reversible.


Reversibility is dependent on the type and extent of the damage. If the damage is isolated to the muscle, then it probably is reversible to a certain extent. First, the muscles in spasm (constant state of tension) need to be massaged back to pliability, then you need to focus on stretching the muscles so they can better manage repetitive stress, and once the muscle is relatively healthy again you can begin strengthening it to withstand added tension and pressure and to heal itself better. As programmers, we're constantly abusing our arm muscles, and they will wear down over time. The trick is to minimize the abuse, and maximize your ability to regenerate, and hopefully you can get to a state where you heal more at night than you damage in the day.

Now, prolonged stress and inflammation (and certain physical abnormalities) can cause damage to the nerves themselves and nerves suck at healing. If you start having problems with sensation (feeling cold or numb), that's the result of nerves under attack. Prolonged attack equals irreversible damage.

As far as your notation about collagen gluing muscles, that sounds about right to me, and is sort of part of what I was saying earlier. Also, collagen is largely made up of water, and this is why it is so critical to keep yourself hydrated.

Also, muscles locked in static positions (I assume as a result of spasm) can begin to act as a single unit rather than individual muscles. When this happens, your body can actually try to sort of "heal them together" and the muscles can literally begin to bind to each other. Massage, particularly deep tissue massage, can help to break these bands apart so your muscles become independent again.

That's my understanding, anyway. I'm definitely no expert in this, and my knowledge largely comes from online research, and the book "It's Not Carpal Tunnel."


Generally very interesting discussion. The point that multiple muscles need to be addressed is important. I've read The Trigger Point Handbook and had some training in a form of trigger point therapy but I hadn't heard that exact discussion of the origin of trigger points - some references would great. Trigger points themselves also can and should be massaged - ideally by someone who knows what they're doing it.

I suspect the narrative is simplifying a bit. In my experience, trigger points develop in a variety of situations following a variety of physical, genetic and psychological factors.

I stretch at least daily and I'm probably more limber than 90% of people but I can certain develop trigger points after some intense exercise - stretching isn't necessarily enough.


I'm a bit surprised Zed didn't mention getting a standing desk, or better yet building one (it's simple and cheap to do so).

I think standing desks are an obvious remedy for back pain and discomfort. Your "core muscles" are used more than if you were sitting down, and it reduces the pressure on your spine caused by sitting upright in a typical office chair.

A good, low-tech way to do this is to buy an unfinished door and paint or finish it yourself. If it has a doorknob cutout, just use it for cable management. Then get a pair of adjustable Stanley FatMax workhorses and you're in business:

http://www.amazon.com/Stanley-11031-Telescopic-Plastic-Sawho...


Do you do your best thinking when you are sitting down, staring at a monitor, or when you are pacing* around the room?

I prefer standing, as it is so easy to take a step away from the computer and really concentrate on the problem at hand. I find the computer can really distract me when I need to think.

* This is part of why I find whiteboards so helpful. They give me tons of space to think, both physically and mentally.


Walking or standing. I also find whiteboards helpful. What I want now is giant glass whiteboard: http://www.glasswhiteboard.com/


I just sit in a 120 degree angle and have never had problems with my back, wrists, neck or anything. Just make sure the screen is high up that you don't have to bend your neck...


Seriously, or just kidding? For years I have wanted to try a setup like this and would love to know how it actually feels to use one.


No, seriously. What sort of setup do you mean? I just lie back on my chair, so all you need is a chair with an adjustable back. I also lower it all the way down so the desk is at shoulder height. This forces you to rest your hands on your elbows instead of your wrists and to have them on a straight line.

Your desk just needs to be deep enough to allow your arms to be on it past the midway to the elbow, so you don't have to actively raise your hands. Lowering your chair also has the benefit of bringing the screen at eye-height, but you could just get a high desk...


This forces you to rest your hands on your elbows instead of your wrists and to have them on a straight line. ... deep enough to allow your arms to be on it past the midway to the elbow

Agreed. I don't put the chair back, but I have two of those rubberized "keyboard" wrist supports (the ones that are about 20x3 inches) across the edge of my desk (one for each arm), and I type with the point of my elbows just off the wrist pads, my forearms supported by the base of my forearm just near the elbow. I found that if I rest the point of my elbow on the wrist pad it's not as comfortable. Since they are side by side, they stretch the entire length of where I'm going to move my arms, for both using the keyboard and mouse. And since my arms are supported near the elbow, the natural most effective typing position for my wrists is straight, or what high school typing teachers would call "up", not resting on something. The pads put my forearms almost perfectly level when my hands are on the keyboards.

I don't use the gel or bead filled ones because they don't keep their shape as well, and I don't find their rounded edges to be as comfortable -- I know the exact position to be in based on being able to feel the edge of the pad with the base of my forearm. I need something to support the weight of my arm, not change its shape to the contour. Unfortunately the rubberized ones are getting hard to find.

In a pinch, I use rubberized mousepads, which every office seems to have lying around and no one uses. When using these, I just put one under each elbow and use the edge of the desk like I'd use the edge of the keyboard wrist rest, feeling out the edge with the base of my forearm. This isn't ideal though. I need to stock up on more of these "keyboard wrist rests".


My desk doesn't permit that and I like it higher anyhow, so I lean back in my chair and simply put the keyboard in my lap. Once you're used to it and relax, it meets all ergonomics criteria I've seen; flat, comfortable wrists, no stress or strain, etc. It's a Microsoft split keyboard, which helps, but my non-split laptop, which I use in the same position, is fine too.

(Also, I think switching to Dvorak may be helpful. My wrists move a lot less with this layout than they do with QWERTY. Touch typing is a good idea but where QWERTY discourages it, Dvorak makes it simply the best idea; you don't have to try, it just happens. YMMV; please note I said "I think", and I mean exactly that, not "It has been proved that".)


Anecdote: I typed ~95 WPM on Qwerty, hunt-and-peck* , and switched to Dvorak three or four years ago. Touch-typing Dvorak just feels natural to me, too. I haven't measured my speed in a while (over 60 WPM, who cares?), but Qwerty feels like a chaotic jumble by comparison. It's mostly a comfort/ergonomic issue for me.

It's a tricky thing to get hard data about, though, and the whole Qwerty vs. Dvorak thing somehow got caught in some religious argument about the free market, so there's probably too much noise to ever sort it out.

* Hey, I taught myself to type on a Commodore 64 as a kid.


I sit the same as the GP, if it helps. Large cheap IKEA chair, with my feet up the wall and leaning back as much as I can. Never ever had any position problems.


Unless you have specific support for that, as in a special chair/desk setup, that's horrible advice. I'd almost like to see what you're doing since I can't imagine it being comfortable. You got a picture maybe?


Unfortunately I don't, as the chair I have now is a stupid dorm chair. Any office chair with an adjustable back will do, just make it go back 120 degrees...


Didn't the BBC recently report about a study which concluded that obtuse sitting angles were actually better for your back than right angles? (As always, acute angles suck) If that's true, then his 120 degree sitting position might not be horrible after all.

That said, if he's in essentially a lying position all day, there could be other issues (like loss of muscle definition) at play.


I read that as well (can't recall where).

Here is one reference I did find: http://ergo.human.cornell.edu/DEA3250notes/sitting.html


All you need is a chair that you can lean back in. Preferably one with a high back.


This will probably be controversial, but I believe that RSI (and typing-related carpel tunnel) is psychosomatic. I experienced what I thought was chronic RSI that I wasn't able to solve through any other means but reading Dr. John E Sarno's "The Mindbody Prescription" which I highly recommend reading.

For 1.5 years I was not able to type without pain. I was able to rid myself of this pain in weeks through a psychological approach. It's been over 7 years since then and I haven't had problems.

I also play guitar, bass guitar, and drums. It can be painful sometimes to play a lot if I haven't been practicing, but that pain goes away immediately, and I don't believe it contributes to a permanent or long-standing problem.

Ergonomics is good for being comfortable and pain-free. And exercise is good for general health. But I don't think not doing so is going to give you chronic pain.

Of course you should see a doctor to rule out diseases like multiple sclerosis.

Here is a document that explains Sarno's ideas: http://www.rsi.deas.harvard.edu/handout.doc Google cache of it for HTML: http://www.google.com/url?sa=t&source=web&cd=2&v...

Keep in mind that this does not mean "it is all in your head"... The problem does cause a physical condition in your body, but the cause of it is psychological.


I agree, it is psychosomatic, although that's usually a term used by bad doctors to wave away real problems with people. I think a better way to explain it is that your body is controlled by your brain, and if you control it wrong you can cause damage. Same way if you punch or kick something wrong you can break your hand, if you spend 8+ hours a day typing with tension, poor technique, bad posture, and ignoring pain signals then you'll hurt your hands.

So yes, learning to control you body and how you use it is generally a good idea. In general I think that's all Sarno's method does. It just makes you focus on how the motions should be done in a more relaxed manner, rather than tense and harmful.

Combine that with the wrist exercises and you'll be even better off.


It's definitely controversial--so I feel obliged to mention that Sarno's methods also worked/work for me.

I also ran the gauntlet of standard medical treatments and therapies before trying Sarno's approach.

If you have seemingly untreatable RSI, it's worth giving Sarno's ideas a look.


Of course you should see a doctor to rule out diseases like multiple sclerosis.

Autoimmune (e.g. Lupus) diseases are another important set to rule out.

The good news is that, though not curable, many of the inflammatory ailments are easily and cheaply treatable.

My advice: have your doctor consider the old NSAIDs first.Ketoprofen is my favorite, though Wyeth pulled it off the OTC market[1], so the lowest single-pill dose is pretty high[2]. Among friends and relatives who've tried it, it consistently counters inflammation, even though its pain relief varies down to nothing. Being old, it's cheap, too.

[1] shortly after buying the company who marketed it under the brand "Orudis KT". The cynic in me says it's because Advil has a much higher profit margin.

[2] 50mg compared to 12.5mg. Sometimes, 12.5mg once a day is all I've needed. Especially with the recent concerns over the safety of NSAIDs, needlessly quadrupling the dose seems foolish, so I hack the dosages. I could probably get a compounding pharmacy to do this for me, but that would eliminate the "cheap" advantage.


I agree with you that it is sometimes (perhaps often) psychosomatic.

I myself experienced much improved condition when I stopped being fearful.

Would you agree that in at least 5% of serious cases, the physical not mental problem is the main thing?


A repost of my comment from the last time this came up (http://news.ycombinator.com/item?id=1270409):

--------------------

His experience matches mind as well. Horrible RSI persisting for years, with non of the conventional treatments effective beyond a short amount of time.

After doing a _lot_ of research into this, I experienced an almost complete short-term recovery. It wasn't just lack of pain... muscles that felt perpetually taut and ropey were suddenly softened, and I became extraordinarily thirsty for a couple of days as healing started again.

Unfortunately, I only have speculation about what's going on here medically. As a seasoned skeptic, Dr. Sarno's explanation of psychological causes is unsatisfying to me. My hypothesis is that RSI is caused by a problem in the autonomic nervous system (i.e. the part that regulates your body). Sympathetic nervous system activity is provoked when your body is in "danger" mode: muscles are tensed, ready to act, etc. Now, what happens in RSI is that your muscles are being stressed through use (typing). This isn't normally a problem: when you stop typing, your muscles heal the tiny amount of damage that was inflicted. But if you are stressed out, then your sympathetic nervous system activity is heightened and your muscles don't get a chance to heal.

Now this is the insidious bit: the pain and injury eventually becomes a danger signal to your body. The injury thus provokes further sympathetic nerve activity. This negative feedback loop can thus perpetuate without the person feeling actively stressed any more, but is obviously exacerbated by feelings of worry about the RSI. Every time you try to be careful, you make the problem worse.

For a more medical take, some pieces are conveyed in this article: http://www.aapb.org/tl_files/AAPB/files/biof_34_2_pain.pdf . Some people speculate that similar issues underlie more serious problems, like RSDS and fibromyalgia

So that's all well and good, but what about the "cure"? Well, it seems that many people have virtually instantly solved their problems by adopting positive beliefs about the nature of the problem, that it is a problem caused by problematic nervous system signals and NOT an insoluble muscular injury. How does that work, exactly? I have no idea. Obviously, some stress is reduced, but that can't explain the magnitude and suddenness of the change. If anyone has ideas, I'd be very interested in hearing them.

If you suffer from RSI, the advice I would have is to think about this explanation while researching the ideas thoroughly to see if you're convinced. In the meantime, the best thing to do is daily exercise that isn't too intense, but gets your blood flowing for 20-30 minutes. Biking, running, yoga all have good benefits. You can do things like lift weights as well, but it is easy to overdo it, so I don't recommend it if your symptoms are severe. It's worth reading Dr. Sarno's book, but keep in mind that he uses words like "freudian unconscious rage", which made it hard to take anything he said seriously. In my mind, he is inaccurately explaining something which isn't true but corresponds to _some_ true phenomenon.

I've wanted to write this up for a while, but while I'm relatively convinced that I have a better explanation for RSI than most doctors, I don't really understand how "the solution" works (nor for how many people it does). I also realize that it sounds exceptionally hokey, which fuels my reticence. We'll see how it goes over here... ask me anything.


Seriously? 65 comments and the top voted is about (off-topic) hygiene? With a community such as this, I expected a lot more advice and personal stories. To be fair, I guess this did get posted early on a Sunday.

Many thanks to Zed for bringing it up the topic. I think it is always good for the programming community to hear different views on it. As we rely more and more on computers, mobile devices, etc., we're going to see these sorts of injuries more and more and I'm not sure the medical community knows how to deal with them yet.

I read HN sometimes and there are so many people doing full time jobs, then coding at home, then playing guitar on top of that! It is depressing to read because I'm lucky if I can make it through lunch without my arms hurting some days. I don't think people in my camp speak up enough (partly because we are trying to type as little as possible). I haven't played my guitar in years while I try to cope. I've been to some physical therapy, but found that it didn't improve things much short or long term. If you do visit a doctor (which you probably should), just be aware that they may suggest surgery. Personally, I don't think that is the answer to RSI in most cases.

I weight lift occasionally but I can't tell whether it is helping or hurting. I've always been curious about yoga, I just need a kick in the pants to get started. So, there's my personal story.

As far as advice, I don't have much since I haven't actually found something that works well for me. I read "It's NOT Carpal Tunnel Syndrome" which was an short, interesting read, but ultimately didn't help me with my particular problem. It does have good general advice, a section with stretching exercises and nerve glides, etc.


Hey, just from what you're saying it sounds like your wrists have gone a little too far. If you have constant pain in your hands from typing, and you can't play guitar, and this fact is consuming your life, then you should do something about it. I don't know if that's surgery, but you should at least talk to a specialist about your pain (not a general practitioner), and see what they say. Also try to take a week or more off and not touch a keyboard or guitar. If that helps then it may just be you need to change how you do things with your hands.


It isn't my wrists; it is my forearms. From my reading and (ortho) doc visits, Radial Tunnel Syndrome is the closest diagnosis to what I experience. It could just be tendinitis, though. I agree I need a week off, but from my past experience I know a week isn't enough. I'm going to try and take several weeks off later this year.

Maybe my writeup sounded worse than it is. It isn't totally consuming my life, but it has been worsening again lately so the topic has been on my mind. I am not always in pain. I go through periods (days-weeks) of relative normalcy, but other periods where the pain is worse. I haven't played guitar because I try not to stress my arms while I'm home. I try to stay off the computer at home too, but you see how that is working out... I need some mental fortitude/willpower, too.

What do you mean by "change how you do things with your hands"? I've tried a few different chairs, chair/desk heights, keyboards, and mice. My latest is putting my MS Natural 4000 in my lap to type. I think that is an alright position for my hands, but I wish its keys had a little less resistance than they do.


Try this real quick:

1. Get a friend and ask them to help you. Take your index and thumb and touch them together tight as you can then have your friend try to slowly pry them open. Try to remember how weak or strong your hands were. Try a couple fingers to get an idea.

2. There's two bones in your forearm that join at your wrist. Take your other hand, and squeeze these two bones together at points along your forearm down to your wrist. Squeeze really hard for about 10-20 seconds then relax and shake your hand after each squeeze.

3. Now relax for a bit and do your other arm equally, then do those wrist exercises I gave you. Rotate them, warm them up, and do the stretches very carefully and slowly. Rotate your wrists after every one and shake them.

4. After you're done, have your friend come back and try the strength test. See if it improves. If it does, then do this every day, no matter what, before you do anything with your hands.

That squeezing of those two bones helps relieve pressure in there and takes it off of nerves in your wrist. Give it a try but as usual don't do it if it hurts too much.


I wouldn't get so fired up quite yet: the way HN rates comments is very bizarre.


Mental health should be on that list.


I may mention those, but I think people with mental health problems tend to take them more personally than with physical health issues. It's very difficult to talk to someone who is depressed, has schizophrenia, has manic episodes, or is a drug addict. Definitely difficult with a blog.


I posted a quick note to Zed about this. The mental side is underrated. One thing I've noticed is mental exhaustion occurs much easier than physical exhaustion. With a strong minds you can block the physical. Crack the mind and that's it.

Some discussion on "mental habits of mind" would be good.


Mental health is partially (largely?) a function of physical health.

Sitting up straight and relaxing your breathing isn't just good for your back it changes the way you think about what you're doing.


> Mental health is partially (largely?) a function of physical health.

If only that were true, then the answer for every mental problem would be 'exercise'.

Not saying that people with mental health issues wouldn't benefit from exercise in general, but that goes for everybody, not just for them.

And even if their mental state would improve I'd be surprised to see 'schizophrenia cured by exercise' as a headline. And the same would go for plenty of other mental health issues. Mental health is influenced by physical health to some extent but to claim it is a function of physical health is a step too far I think. You can have perfectly healthy people with a very bad mental make-up and vice versa.


He did say "partially (largely?)", which I interpret as contributing factor. I think you're in agreement.

Simply being physically active goes a long way to solving everyday psychopathologies, like mild anxiety or depression; and is a curative factor in extremely serious mental illness, like the schizophrenia you mention. Exercise is often part of the answer.

Going for a walk does wonders for my state of mind.


I didn't limit anything to exercise. There's more to being physically healthy than going to the gym. An acne breakout affects your mind, for example. Apart from the obvious issues like self-consciousness in social situations, pain and itching can interrupt your thoughts.

Although I suppose "physical condition" would have been more accurate than "physical health."


Fully agree, staying behind a computer for a whole week is not healthy (even if you exercise regularly)


Funny, but not nice and not necessary.

Downvoters: you are aware that Zed lists problems he has struggled with and that his generalization of this list to 'common problems programmers face' is perhaps not warranted for all problems mentioned? If it was a serious suggestion, jacquesm would have included an explanation of why programmers would commonly face mental health problems.


Everyone, and I do mean everyone, with a mental health issue understands the first problem with mental health: People try to laugh it off, or hide it out of fear that others will laugh it off. Since people literally end up dead at an early age because of this attitude, your flippant comment seems likely to be downvoted by folks who have encountered mental illness, and that is a lot of people. Such is the risk of being flippant. Fortunately there's a -4 limit and you'll live.

Do you really need an explanation of why programmers might be at risk of mental health problems? To first order, Zed's list speaks for itself: being in poor health tends to depress you, especially the part about bad sleep. The depression and the health effects feed back on each other in a nasty way.

But I'd add that loneliness is a big factor. These days we have amazing tech like IRC and Twitter and HN, and it's easy to imagine that we can have rich social lives without ever seeing another person except through the medium of text. Well, your brain, designed and conditioned as it is for the presence of actual physical humans, may think differently. I spent eighteen months working as a solo consultant in my office, meeting clients only via email and the occasional phone call, and it eventually drove me bananas. My wife still laughs about the day I took half an hour off to go to the barber and then raved about the awesome social experience.

Even if you work in an office the isolation can be frustrating, because as a programmer you routinely work on problems that nobody else understands or wants to understand - even your fellow programmers, who are trying to focus on problems of their own. To interact with others you need to really break your focus, but that causes you to slow down, so maybe you try not to do it, and before you know it everyone else has gone home and it is dark and you're wandering through an empty parking lot...

Remember, solitary confinement is one of the worst tortures you can inflict on a human.


> My wife still laughs about the day I took half an hour off to go to the barber and then raved about the awesome social experience.

I had the same experience working for a company where I was on my own and the people weren't friendly. I ended up loving the staff in the nearby Cafe Nero because they were friendly and asked me how I was and sometimes had a little chat. When I finally left that job, I left them a massive tip... I actually wanted to leave a gushing thank you card but at least I still retained some sense of perspective to know that that would have probably weirded them out.

All day I was on messenger and forums and had music playing but having no friendly contact with humans for hours has quite an effect.


It wouldn't have weirded them out--it probably would have made their day. Why not err on the side of maybe delighting someone? Worse case scenario, it weirds them out and you never see them again anyway!


  To interact with others you need to really break your
  focus, but that causes you to slow down, so maybe you try
  not to do it, and before you know it everyone else has
  gone home and it is dark and you're wandering through 
  an empty parking lot...
Supposing that programming is indeed more isolating than other professions, that programmers are personalities more prone to isolating themselves in the first place and that this leads to a significant amount of mental health problems. What could Zed write that, in similar vein to the remarks about various physical conditions, would prevent people from acquiring those problems? What could you have read and understood and believed enough to have stopped you from taking on a job during which you went 18 months without enough social contact?

(Not trying to bait you, just honestly wondering what you think would help, because I feel I only solve/understand such things by experiencing them)


  your flippant comment seems likely to be downvoted by
  folks who have encountered mental illness
This 'flippant' comment was made by someone with enough experience with mental illness to not warrant downvoting based on their own projection of me not having enough respect for the seriousness of mental illness.

  Do you really need an explanation of why programmers might
  be at risk of mental health problems?
Yes, I really need an explanation of why mental health problems would be especially common among programmers and why Zed would need to include it in a book aimed at aspiring programmers. I don't think the risk of mental problems is even remotely close to the the risk of some of the physical problems mentioned, because contrary to your anecdote, every programmer I've met so far did not work alone for extended periods and was not reclusive. You're making the same dubious generalization as Zed: turning your own experience into something that you suppose to be 'common'. I'm asking for evidence of that. Your personal experience with loneliness does not provide that.

The question is what additional risks to your mental health becoming a programmer introduces, beyond the fact that mental health problems are already reason number one for disfunctioning, unhappiness, and even death in certain age categories. Should every writer of every introduction on any professional subject include a section on mental health problems, because everyone is at risk of them? I'd rather advocate people being taught the risks of certain working conditions in highschool.


> contrary to your anecdote, every programmer I've met so far did not work alone for extended periods and was not reclusive

> I'm asking for evidence of that

I can't speak for 'mechanical_fish' but I've seen plenty of evidence of that, including two very sad cases (very smart but socially mal-adapted people that ended up living more or less like hermits).


But was that because they were programmers or because their mind was already wired that way? If they had become physicists, would they not have ended up living more or less like hermits?

Lets suppose that they are self-taught programmers: would a section on mental health in the introductory works they read, warning them against the dangers of loneliness and seclusion, have helped? Would they have heeded the warnings and would they have been able to socialize, or were they already the kind of people that didn't socialize anyway?

The problem may be the other way around: programming attracts people, because it's a profession where you can be working alone. If that is part of the attraction, no amount of offtopic warnings are going to help. Only someone physically near that cares can help and then we are still supposing that these people are unhappy. Mechanical_fish needs company and social interactions, which is pretty normal. However, that doesn't mean that everyone needs it. You run the risk of imposing your moral standard about 'socializing' on others, that can, and want to, get by with little social interaction.


> But was that because they were programmers or because their mind was already wired that way?

I think the dialogue with the computer gave them what they never could get from having a dialogue with people, someone that could keep up with them and that understood them in a way that few people ever would be able to.

> If they had become physicists, would they not have ended up living more or less like hermits?

Physicists don't as a rule work from their houses with curtains in front of the window to block out the daylight and nothing but food ordered by phone. As a software guy you can easily get away with that, and with the virtual office trend we're even formalizing that whole concept.

> Lets suppose that they are self-taught programmers: would a section on mental health in the introductory works they read, warning them against the dangers of loneliness and seclusion, have helped?

That's a really good question, and I haven't a clue about an answer for you. Would it have hurt?

> Would they have heeded the warnings and would they have been able to socialize, or were they already the kind of people that didn't socialize anyway?

Maybe the computer is the escape for people that fall in to that category, but maybe there is more to it than just isolation. Personally I think isolation makes a bad thing worse. I've seen programmers work for companies that were absolutely gifted but they were kept as far behind the scenes as possible due to their lack of social skills and I'm not just talking about taking a bath or changing clothes. And according to their family they were doing ok as people until they discovered the computer, and then they somehow shut out the world. So the tendency must have been there already, but the machine amplified that to some extent. Again, probably nothing you could have read about that would have warned you.

But I know of at least one person whose story I would love to read, if only he were around to write it, there might be a warning in there for some of us that really would make a difference.

> Perhaps the problem is the other way around: programming attracts such people, because it's a profession where you can be working alone.

Yes, I believe that is true.

> If that is part of the attraction, no amount of offtopic warnings are going to help.

Not sure about that. As I wrote above, I have no evidence or idea of whether it would help, but since programming seems to attract such people the place to warn them would be in a place where those interested in their health would read about it, say a book about programmers and their health.

BTW, I'm upset at the way you're being downvoted in this thread, I'd prefer those that downvote to articulate their point of view instead of this silly piling on mob voting. The point you made was articulate, maybe unpopular but it definitely added to the discussion because it brought some interesting stuff to light.


  Physicists don't as a rule work from their houses with
  curtains in front of the window to block out the daylight
  and nothing but food ordered by phone.
But neither do most programmers. What you're describing is the stereotypical hacker, but that's a far cry from programmers in general, programmers here (it seems to me an interest in entrepreneurship doesn't correlate with seclusion: you should be enthusiastic about a product and intent on talking to actual people to sell it to), all those people working together on open source projects (and being encouraged to meet each other) or even actual hackers.

Rather than warning prospective programmers of the mental health risks that stereotypical hackers run, I think it would be better to stop glorifying that lifestyle in the first place. If you describe the health risks of that lifestyle, you are still suggesting that it is the proper lifestyle for a programmer. Instead, it would be better to, for instance, stress the importance of communicating with colleagues, because no matter how brilliant you (think you) are, you will overlook things and not come up with all alternative solutions for a problem. It would be better to stress the importance of other hobbies, because of the cross pollination that would never happen if the only thing one has mastered is computer related. It would be better to stress how every computer program ends up being used by people and those people are quirky and different from you, which is why you need to know stuff about people to be able to make programs for them. Even if those people are other programmers.

I don't think it's a good thing if introductory texts in our field start include a section on the mental health risks of such a tiny group, while that risk should already be mitigated by other advice that is nicely relevant, because it makes them better programmers. I think it might make matters worse by once again making it seem as if 48-hour-Dr.Pepper-and-pizza-fueled-codathons are a normal thing, a good thing, a cool thing, something people should aspire to. It should be crystal clear to everyone that you won't be productive, that what you do produce will be sub-your-standard and that the seclusion was a bad idea in the first place, for all the reasons listed above.

  BTW, I'm upset at the way you're being downvoted [..]
Don't be; so far, HN runs fine even when someone is being downvoted in threads like these.


I've been working from home for a year. I'm an introvert, but I think loneliness would've set in by now except for some fortunate balance in my setup. My wife and baby are in the house most of the time (not so much that they interrupt, but enough that I can hear noises when they're around), I meet friends for lunch at least once a week, and in the evenings and weekends I do other things besides code constantly. I thought I'd need to get out to cafes more for a change of pace, but so far I haven't needed to.

Everyone's social needs are different as relates to mental health, but my recommendation is if you don't have family or roommates around making some noise and conversation, keep an eye on your how you're feeling and set limits on how much of the week you toil in isolation.

It can also be bad for your health if remote work relationships are difficult, so you have to have a certain amount of company support for what you're doing as well.


If you though that was in jest then I'm really sorry I didn't make it clear that I was 100% serious.

I don't think an explanation of why programmers commonly face mental health problems is required beyond asking you to read through the last years postings on HN, which include some very sad entries indeed.


Such stories are extremely varied. You're now arguing that people in general, not programmers specifically, commonly face mental health problems. The question here is what additional risks you run when you become a programmer. If there are only few or none, then including a section on mental health in a book about learning to program is really straying from the subject of the book.


> Such stories are extremely varied

That's true.

> You're now arguing that people in general, not programmers specifically, commonly face mental health problems.

No, I mean to imply that programmers, contrary to people in general may be at a higher risk to develop mental issues, mostly related to work pressure, personality related issues that tend to surface earlier or more serious with people that are regularly under stress and people that deal with abstractions that they can not easily talk about with others leading to isolation, and isolation is the exact wrong thing to do for people dealing with pressure and stress on a daily basis.

But if you're not talking about your work anymore (or even about why it matters to you) then alarm bells won't ring until it is much too late.

Now I could go and dig up the HN references I was alluding to earlier but I think the memories of some of those would tear open wounds that are best left to heal. Anecdotally, for the size of the community the number of people that have come forward here out of their own accord and that have testified to having 'issues', and very serious ones at that is something of a surprise to me.

It would be good to prove/disprove this by pointing to some study or other that has listed mental health issues and their occurrence by profession but either my google fu is failing me or such a study does not exist.


This is decidedly unscientific and at least in the small part I read clearly uniformed. Eyesight problems from LCDs have nothing to do with fonts. It's staring at something that's bright and at a close range for hours at a time. Even if you were just watching YouTube for 8 hours a day you'd suffer.


Still, everyone should use f.lux at night: http://www.stereopsis.com/flux/ :)


Yeah, a lot of eye health seems to be voodoo bullshit. But, you got any links to references on this? It might help people who have the problem.


This is an New Scientist article on an epidemiological study on the causes of myopia. The link is to a blog which copied the content. The original is behind a paywall. The fact that this paper is behind a paywall makes me freaking mad because it could literally save the eyesight of a huge number of people.

Original Article: http://www.newscientist.com/article/mg20427331.100-generatio...

Actual Content: http://www.sunilreddy.com/?p=1429

An excerpt: On average the children in Sydney spent nearly 14 hours per week outside, and only 3 per cent developed myopia. In contrast, the children in Singapore spent just 3 hours outside, and 30 per cent developed myopia. Once again, close work had a minimal influence; the Australian children actually spent more time reading and in front of their computers than the Singaporeans


From what I've read it's not proximity that matters. It's brightness at close range.

http://www.poynton.com/notes/brightness_and_contrast/ gives us a good setup procedure.


Something that worked really well for me is having several hobbies outside of work. It prevents me from just coding for 12 hours a day, and makes my life so much more enjoyable.

A really big one for me is mountain biking. I always found it to be a great escape from whatever I had going on - school, work, relationships - you can really forget about all of that stuff on trails. Mountain biking at times feels more like an addiction, to be honest. Indeed, I own a shirt that reads "Mountain biking is as addictive as crack, but twice as expensive". I start feeling bad about myself and getting a bit anxious if I don't go out on trails for several days in a row. It sure feels great afterwards though - really push yourself, have fun, get that dose of adrenalin and be physically exhausted in the end. I always solve my toughest problems after "hardcore" biking sessions :-)

Having talked to some hospital staff during my several biking-related emergency room visits, I can tell you that some forms of it (downhill-type stuff) are very hard on your joints, so don't over do it. If you're really into downhill racing and freeride, mix in several good XC sessions for cross-training. You'll be stronger and healthier.

P.S.: another thing that really helps is having an active S.O., someone who'll drag you out of your work-mode and take you hiking several times a week, and who will want social interactions outside of "reading HN".


I'm addicted to Swing Dancing.


When you sit all day with your hands on a keyboard, your shoulders are constantly in internal rotation. Try this quick test:

Hold a couple pens loosely in your hands with the points facing out, and stand naturally with your arms at your sides. Where are pens pointed? If they are pointed forward, then you've got excellent posture. If they are pointed diagonally inwards, you have slight internal rotation. If they are pointed almost straight inwards, then that internal rotation is severe.

The point of this is that pushups, and everyone's favourite lift, the bench press, promote more internal rotation. Most office people would be far better served performing more pulling exercises than push. So deadlifts, rows, pull downs, pull ups, etc.


As a medical doctor, i think its a good article

the hacker community is not thought about in the medical community overall


My eyes used to be my weakest link. Then I got a pair of Gunnar Optics computer glasses. They soften the contrast of bright screens with their yellow tint, cut glare, have a slight corrective factor, and reduce airflow around my eyes keeping them more moist.

They work wonders.


While we're on the topic of computer use issues, thought I'd share something I discovered for mouse use. I realize lots of us like to go solo keyboard, but for when you have to use a mouse, try this:

Put the mouse (m] sideways pointed left at the bottom left side of your keyboard:

  [Keyboard]
  (m]
Rest your elbow on the desk, so your arm is parallel to the keyboard.

I've been doing this for a few months now, and it's been a huge improvement. It might take a while to get used to the mouse being perpendicular to the pointer orientation on screen, but maybe not (didn't for me). The position is somewhat adapted from the tai chi standing practice posture.


I do this when I'm forced to work at a desk. Though presently I'm sitting- well, reclining across two chairs, my keyboard in my lap. My mouse is sitting on a table to my right, so I actually raise my arm so it's at a 90 degree angle from my body to use the mouse. That works pretty well (incidentally, I'm reclining to spare my knees - keeping them bent for hours at a time is not a good thing, better to leave them straight. )


I can confirm that this setup has legs, long-term. I've been using my mice that way for over a decade now, after accidentally stumbling onto it.

A good cordless mouse makes this configuration much more convenient (I'm still using an aging Logitech G7, for example).

Curious, do you write left handed? I do, and so does the only other person I know of that uses this setup.


Actually no, I'm right-handed. I don't even remember how I ended up with the setup... maybe my mouse just gradually moved leftwards across the desk in search of better comfort!


I cannot stress how important it is to stay healthy. I used to be a competitive natural bodybuilder (which isn't the healthiest thing, overall) and a personal trainer, so being healthy was always a part of my life. After I graduated college, I didn't have enough time for them and let myself go. As a result, I get sick more often, and have back pain.

I'm currently in the process of getting back into shape (not as a competitive bodybuilder, but just general fitness). So please, if you can avoid becoming unhealthy, do, and stay fit. There's literally no downside to it (that I can think of).


It's effortful, time consuming, boring, and involves changes of behaviour, self image and thought processes, and involves potentially standing out against peers, family, friends, colleagues and industry culture.

If there were literally no down sides, everyone would do it by default.


It's hard to take health advice from a guy who considers martial arts to be a qualification in dispensing them. Especially when he trots out bullshit old wifes tales like caffeine leading to dehydration.


It's not the coffee, it's the fact that many people drink everything _but_ water. Coffee's got a lot but you can't drink that much of it, so if that's all you drink, then you get dehydrated. People also drink too much soda which doesn't help, and people also just don't drink for long periods of time.

If you get headaches then try drinking some water. Pretty simple.

Also, man you're a giant douche. Did someone piss in your fucking coco puffs today little boy? Shit.


Indeed. Studies have shown that those that are used to caffeine don't get dehydrated from drinking caffeinated beverages.

The NYT examine this here: http://www.nytimes.com/2008/03/04/health/nutrition/04real.ht...


Really, though, you shouldn't need Zed, the NYT or anyone else to tell you whether coffee is dehydrating. You should be able to tell, for yourself, one way or the other.

For myself, it's headaches and feeling "parched" (for lack of a better term), preceded by the usual coffee-smelling piss. I usually don't let it get that far, but once my head starts to ache I quickly switch over to green tea and/or water.

Whether the latest journal reports caffeine is or isn't dehydrating may be interesting, but should mean fuck-all to your daily routine. Don't look for authorization in science. Look for it in careful examination of your own experience.


>bullshit old wifes tales like caffeine leading to dehydration.

[citation please] - I am genuinely curious about the current scientific consensus on that one, as IIRC I have heard the reverse claim in this talk: http://www.youtube.com/watch?v=dBnniua6-oM regarding Cola being stuffed with caffeine for both its normal effects and the diuretic side-effect (my memory could be failing me, of course).

Cheers,


Coffee etc. is still mostly water. One unit of coffee/cola/tea, compared to the same unit of water will A) give you slightly less water up front and B) cause some loss of fluid due to diuretic effect but overall you still gain fluids.

It is by far not the best source of hydration, of course. You are much better off drinking water or (preferrably unsweetened) fruit/vegetable juices - or even just eating said fruit or vegetables. Hypotonic sports drinks have their place too, but not when your exercise consists of walking up to the fridge.


Unsweetened fruit juice is still high in sugar comparable to soda levels, and high in fructose which is particularly bad sugar to be high in.

Sugar levels in juice compared to Coca-Cola: http://www.hookedonjuice.com/

Dr Davis' Goodbye Fructose: http://heartscanblog.blogspot.com/2009/07/goodbye-fructose.h...

Dr Robert Lustig's what happens when we eat fructose and why it's bad video: http://www.youtube.com/watch?v=dBnniua6-oM

Aside from the hydration, you're probably better off with even sweetened coffee than unsweetened fruit juice.


Well, the advice is all based on experience. You could skip the 'background and qualifications' bit and it still makes sense.

He might want to check with a GP to find out whether these are really problems that are common among programmers. When you've dealt with something yourself, it's easy to confirmation bias your way into thinking the ailments are common in your profession.


I've been working professionally for a long time and have seen way too many programmers with these issues. I haven't met someone with all of them at once, but I have met plenty of people who have had one or more during their life. I've just been lucky to have had all of them, but not severe at all.


That part was him saying, "I used to be in really excellent shape, here is what has worked for me, and I can really notice when I get less exercise," not "don't take health advice from someone unless they're at least third dan.".

And maybe caffeine doesn't dehydrate everyone, but coffee sure as hell makes me sweat more. (Coffee dehydrates me, but tea doesn't anywhere near as much.)


You do know that coffee causes you to pee more often? Lookup it up in wikipedia. If you drink a lot of coffee those liquids are going to be sent straight to your blader. That is what causes dehydration. Same for caffeinated soda.


I'm curious: if someone other than Zed Shaw had written this, would you still have responded so contemptuously?


It sounds like a lot of these are symptoms of the real problem: People are so hell-bent on hyper-focusing for long hacking marathons that they ignore warning signs and neglect their bodies.

Also: I did Aikido for a couple years, too, and know exactly which wrist stretches he means. They're great pre-typing stretches.


I disagree with his advice on vitamin D, especially for those over 40 who have lost most of their ability to synthesize it from sunlight. See:

http://heartscanblog.blogspot.com/2010/01/getting-vitamin-d-...


Something that really upped my motivation for running is using my cellphone's gps to log data. I coded a small web-app to show a little bit of stats (http://fitness.marc-seeger.de/category/joggen / http://github.com/rb2k/run-a-log) as my first little project with ruby/sinatra. My inner nerd loves to collect data and do stuff with it and my body is probably thankful for it (just finished my 800th recorded kilometer)

p.s. I currently use "cardio trainer" on android which would also offer a webinterface to data. Before that I used MyTracks (android), Nokia Sportstracker (Symbian), jogstats (webos)


I've suffered from the low back problems he mentions, but mine was not primarily caused by sitting for long periods of time. It was from playing sports when I was younger--I really messed it up.

However, I recently got an ergonomic chair after minor back surgery and it is awesome! It has made a big difference in how I sit and I am much more comfortable with it.

I would also add: don't sit at your desk and eat your lunch and surf to HN. :) Go outside for a 20-30 minute walk. Walk somewhere different every day and look at things you haven't seen before. Not only do you get good exercise, you will spur your creativity and curiosity.


I can definitely see how bleeding out of your rectum might interfere with your programming flow.


I believe a tight bubble (intestine + vein) of blood hanging out of your rectum (i.e. an actual hemorrhoid) would actually be more distracting than the bleeding, which would be a relief.


If you don't read the rest of this, get a styrofoam foam noodle around 12" in diameter and 3 feet in length. Lie on it to relax and stretch your back. Back stores have them. They're expensive but I use mine twice a day.

For those of you who type like madmen with no regard for ergonomics and work breaks, I did that since I was 9. I have systems in place to avoid that now. Through grade school, high school, college. I was a blazing fast slouch typer. After I graduated from grad school, I started getting pains. So I would rest up and be as good as new overnight. There reaches a point where if you ignore the problem long enough it becomes persistent. Finally, it became such that even after a weekend of rest it would (pain, soreness) still remain. Maybe at a level three out of ten. I went to see a physical therapist and he tested my grip strength - my left hand was stronger. And I'm right handed. Leaving out thousands of ergonomics purchases, the best thing you can do is to start a swimming program. Swimming is zero-impact; you're not pounding the pavement. It is excellent for working your full body. Swimming is hard if you don't know how to swim because you're basically putting all your energy into fighting water resistance. Elite swimmers are three times more efficient than average swimmers (91% of energy fighting water vs 97% for average swimmers - meaning they can put 9% towards forward propulsion). Total Immersion has an awesome swim-like-a-fish program (http://totalimmersion.net). For eyestrain, rest your eyes by looking at least twenty feet away every twenty minutes for at least twenty seconds (the 20-20-20 rule). If you wear corrective lenses, ask your optometrist for a computer Rx (that you can use while screen working). WorkPace software from Wellnomics is awesome because it forces me to micro-pause every 4 minutes for 20 seconds and stop working for 4 minutes every 14 minutes. Believe me, I am a very efficient programmer. Also, use the mouse with your non-dominant hand.

For those of you who don't have health issues, realize that you will not take endless, pain-free typing for granted once you have soreness that becomes persistent. The only true rehabilitation would be to stop typing all together for a long time (2 years). Until then, I'm appreciating my job for what it is - something in the short term. Diversify your portfolio of skills - don't be over-weighted in tech. Start creating things that you own.


micro-pause every 4 minutes for 20 seconds and stop working for 4 minutes every 14 minutes

I doubt that's feasible for anyone working in an office, rather than for themselves.

I ran the numbers a bit, and I assumed: a) that you work 4 minutes, break 20s, then work for - i.e. the clock resets after the break, b) the 14m breaks are wall clock, not non-break time, and c) when you return from a 14m break, the 4m clock resets.

According to this, you're taking 19m of breaks per hour. I'd be fired if I only worked 2/3 of every hour.

Edit: For anyone interested, I did this in Excel and it breaks down like this:

work 4m, break 20s, work 4m, break 20s, work 4m, break 20s, work 1m, break 4m, work 4m, break 20s, work 4m, break 20s, work 2m, break 4m, work 4m, break 20s, work 4m, break 20s, work 1m20s, break 4m, work 4m, break 20s, work 4m, break 20s, work 1m, break 4m


Don't let them know. You aren't a factory worker. You can sit there with your eyes closed for a few minutes once in a while.


It only counts active time (keyboard activity, mouse movement). For instance, I naturally pause for some time while thinking. If you take a break, the counter will reset automatically. Yes, it has driven my co-workers nuts when they try working on some code but I tell them to relax.

As for being fired, I've proven that I can get more done than others in this setup. It's not quantity of code, per se, but fixing three to four times more bugs than other devs. That's my niche - I love fixing bugs. I don't understand why other developers claim to not like fixing bugs. For me, quality balanced with efficiency is utmost.

Getting laid off would be a nice clean break.


That makes sense, I suppose. I guess I was thinking about it more in terms of my own habits - since I got "carpal tunnel" (or whatever it really was that was killing my wrist last month), I've taken regular breaks where I stretch my wrists. I wasn't thinking about your setup as being strictly about "keyboard time."

Thanks for the clarification.


Presumably most of us are adding value by a mix of activities and not just merely by typing. You can work during the forced downtime.

That said, such software would drive me insane.


You can read my reply to wallflower above, but the problem with my assumption was that these were "hard" breaks, not just "time I'm not actively typing something."

Other than that, I've found that even non-coding tasks tend to be typing tasks for me. I almost can't stand writing by hand anymore since it just feels so slow by comparison.

That said, with my wrist issues I think of writing as being a task in the same abuse category as typing. My wrist only flared up after I had written a lot by hand for the first time in months.


Take care of yourself. I use the grip described here for handwriting.

http://www.tifaq.org/articles/healing-from-a-repetitive-stra...


Laptop ergonomics deserves a special mention. Because it forces your line of sight and wrist level to converge, there really is no ergonomic option -- either you hunch or you scrunch. Elevating the screen and either using an external keyboard or external monitor really helps.


Actually my Macbook Pro has improved my ergonomic situation. I use the built-in zoom tool, (it's the reason I bought a mac, as I have low vision) and because of the zoom feature, I can put the laptop wherever I find it comfortable but still see things. The zoom keeps me from hunching over or leaning in.

Also, I use my middle finger on the trackpad, as I need to use the middle AND index fingers to "right click", and this slight turn of my wrist completely removed the wrist pain I get from using a mouse or a normal trackpad.


But don't you end up angling your head downward to see the screen? Or angling your forearms upward to reach the keyboard? All the ergonomics material I've read suggests keeping these on the level, or possibly even angling your forearms down a bit into your lap. Almost impossible to do with just a laptop.


I've wondered about this ever since reading Peter Cochrane's comments on it. When people want to concentrate on things, we hunch over them. Nobody reads a book at arms length, head up. Nobody knits or threads a needls at arms length, or does any kind of paperwork that way. Why do we compute that way?


Yeah but my physician says it's better to look slightly downward at the screen. Which is kinda what you see with some of the standing desks too. Totally not an ergonomics guy... I just know what I was told. :/


Here's an easy way to release some muscular stiffness if you're having lower back pain while sitting.

Stand up and feel your lower back and whether you can massage it easily.

With your arms back at your sides, bend both legs just 1/4 of the way down. Do this 3 to 5 times.

Now stretch the front of each thigh by holding the foot to your butt. Don't use a lot of effort to do this. Just hold in place for 5 seconds or until it completely stretches.

Now feel your lower back again and see if you can massage it. If its much easier to massage now, the source of your pain is your tight thighs. But now you have a way to cope with and reduce the consequences of this tightness.


Another useful thing is http://en.wikipedia.org/wiki/Myofascial_release.

Go pick up the hardest foam roller you can handle and start rolling:

http://www.amazon.com/Foam-Roller-6-x-36/dp/B000Y4W9VA/

It has done wonders for my body.


1. RSI: Take a week off, then, switch to Dvorak (maybe get a Kinesis keyboard if that helps you as well).

2. Back: Standing desk w/ nice architects chair.

3. Eyes: Get a Kindle and read PDF's/etc on it instead of computer.

My quick $0.02 on the problems I've helped resolve from your list Zed.

The other problems, I have yet to tackle, but, I probably should sooner than later! Great detailed post.


On Vitamin D, you need to be careful because it can also mess up your calcium levels. If you calcium levels change, then it can affect your magnesium levels. If your magnesium levels drop, then your muscles will hurt hard core. If you ignore the pain (and deal with it like a real man), then you will die.


Most of the problems mentioned won't even happen in the first place if one takes regular breaks.

I recommend WorkRave for this: http://www.workrave.org/


Or follow my twitter bot: http://twitter.com/officeworkout (strictly non-scientific)


Or xwrits (http://www.lcdf.org/xwrits/), on Unix.


This is an interesting thing for Zed to share.

Sleeping on your back is something that can exacerbate sleep apnea, so I would modify his otherwise quite pleasant sleep suggestions with that in mind.


If you have sleep apnea, go get yourself a damn CPAP machine and wear it when you sleep. Sleep apnea is almost, but not quite, as bad as never even sleeping. That means dozing off during every quiet moment of the day, having waking hallucinations, waking up just as tired as you felt when you went to bed, even sleeping all weekend. Your concentration and mental abilities end up just plain shot. I've known two people with sleep apnea and they both turned their lives around considerably when they had it treated.


There is essentially a continuous normal distribution of "apneic" sleep features. There is no bright line between apnea and not apnea, though we create lines for simplicity's sake. Of course if you need CPAP, use CPAP. But there are plenty of people who have soft tissue that closes off the upper airway to a significant degree only when supine. These are the people who don't need to deal with the modest but non-zero risks associated with respiratory assistance — all by just sleeping in a different position.


CS departments should make all students attend a short course covering all of Zed's topics and the personal hygiene and mental health issues mentioned in this thread.


Or better yet companies that expect people to sit at computers for 40-60-80 hours should. One good thing about meetings: sitting in them is easier on your hands, if it doesn't drive you crazy...


Semi-fast once a week. Much easier than trying to calculate your calorie count each and every meal.

I skip dinner and breakfast the next morning, so I'm without food for 24 hours.


Very well written and practical. Thanks for sharing this.


What's a door jam?


http://en.wikipedia.org/w/index.php?title=Door_jamb&oldi...

Depending on the context that inspired you to ask, the literal explanation may not help.


Zed, you forgot kidney stones. One of the consequences of too much caffeine is it's easy to be dehydrated, which puts you at risk of kidney stones. Which essentially means you get the dubious pleasure of pissing razor sharp calcium rocks out your urethra. It hasn't happened to me, but it has happened to friends; based on their experiences, I wouldn't recommend it.


Happened to my father & it was the most agonizing experience I have seen him go through. Kidney stones cripple you with pain, you can't sit, you can't lie down. It rips basic comfort out of your life for weeks on end.


EXERCISE REGULARLY.

Nobody forces you to drink coffee.

Really I don't think it's so hard to do programming w/o becoming a complete nerd.


Run, Forrest! Run!


But trust me on the sunscreen…


Give up guitar. Write less. Think. Solve problems in ways that use least typing.


Well that'd be no fun.


Why give up guitar ? Playing an instrument can be a very creative process and it's also an excellent way of relaxing.

You can do whatever you want to do, just do it with moderation.




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