SURVIVING YOUR COMPUTER: WHY SIT WHEN YOU CAN STAND ?

When it comes to the design of the human body, you can argue back and forth quite a bit about what the body is engineered to do optimally and what it is not ( that is the case in the area of human nutrition for example). One area where there is very little controversy is the area of sitting. The human body is clearly not engineered to sit for very long. Not just for the musculoskeletal system, but also for the cardiovascular system and the central nervous system. A while back I uploaded to the blog a longitudinal study on the mortality rate associated with the number of hours the average adult spent sitting during their day.  The results were not pretty. 4 hours of total sitting seemed to be the upper end of what the body could take before the health outcomes fell off a cliff. Back pain was the least of their problems in the end, while rates of strokes and dementia went up steeply.

Thankfully, furniture design has come to the rescue of the majority of the US adults who derive an income from working full time at a desk/phone/computer.  And the good news is that there is a big range of retrofit options at a variety of price points. Some are as simple as a desk stand to perch a laptop. Intermediate options include a sit-stand telescoping platform that sits on your desk but does not require any hardwired installation. The upper echelon of sit stand workstations can hold multiple monitors and electrically adjustable height. 

The HR policies about employees requesting and receiving adjustable workstations still vary a lot.  Some will do it simply upon employee request for accommodations, while other still request cumbersome medical notes and a lot of paperwork. Most employers do have a policy for that particular situation, and the HR department is the place to contact.

 For an idea of what may be available out there, this article is a good starting point. As you begin using a sit stand station, increase your standing time gradually, and aim for a total of no more than 4 hours of sitting per day. Also remember that you will need to bring with you shoes that are compatible with standing.

https://www.omnicoreagency.com/best-standing-desks/

T'IS GARDENING SEASON AGAIN

With the first nice weekend of the planting season, gardeners always seem to go overboard. And so it was no surprise to see the first wave of gardening strains flow through the office this week.

Enough people have asked me that same question since Monday that I might as well re-post that answer for a broader audience. The question : " what is that gardening-thingy-rocking-stool you recommended last year so that I don't have to bend over my flower garden for hours?"

https://www.amazon.com/Vertex-GB1200-Garden-Rocker-Gardening/dp/B0002P12FA

There are several variants of that same model you can purchase at your local garden store or online. For those of you who grew up in dairy country like I did, you will note one major flaw: it really needs a strap on belt system so that you can tie it to your rear like a milking stool and not have to pick it up every time you move down a row of plants. One of my patients talked her husband into doing just that, and the result was quite spectacular.  So if you are handy, or have a handy living mate, think about retrofitting that. The rest of us will have to wait until the manufacturers make that improvement

---

HEARING LOSS AND DEMENTIA

During my first year in practice, many moons ago, I encountered an unexpected issue with my patients that had nothing to do with my skills or their presenting problems: many of them could not hear me well. I blamed some of it on my remaining accent my tendency to speak fast and mumble, but I also noticed a pattern among those complaining that my voice was too soft: they were disproportionately older and males.

Out of puzzlement and frustration I consulted with an audiologist that I knew. She took some measurements of my voice and analyzed volume and pitch. It turns out that my voice was of normal volume for my gender and size, however my pitch was in a narrow range of auditory frequencies that are lost first in age related hearing loss ( especially in males, who tend to lose the higher pitches first). She told me that for the rest of my life, I would be the "singing canari" of early hearing loss: I would be one of the first person that someone would stop being able to hear.

Her prophetic words have, for better or for worse, turned out to be very true. 

Last year, I decided to turn my soprano monotone voice from a problem into an opportunity. I was doing some research on the long term environmental and modifiable risk factors for dementia when I stumbled upon a landmark, large scale meta-analysis from 2016. Along with the factors that were already suspected ( hypertension, depression, diabetese, smoking etc), was a surprising newcomer: mid to later life acquired hearing loss.

The latter finding was significant in many regards. Hearing loss, it turns out, is not just an annoyance. We already knew it carried a safety risk for the person affected as well as those around them since emergency signals cannot not be heard. Most profoundly and more commonly however, hearing loss is associated with some definite decline in cognitive function over time. It makes sense if you understand how various lobes of the brain interact and provide stimulus for each other. If one of the five senses goes down, that is an enormous amount of normal daily stimulus that is lost as a domino effect to parts of the brains responsible for normal processing and storing of information.

The good news about hearing loss is that it is in many cases correctable with a well fitted hearing aid, thus making hearing loss a dementia risk factor that can be averted ( unlike other risk factors that are more difficult to control). Hearing aid technology has a way to go yet, and the price tag is not very friendly, but if you understand the consequences of not addressing hearing loss, it is still worth the effort and resources.

So back to my little soprano voice and the gents who grumble about it in my treatment room. I now take time to let people know that they are probably experiencing early hearing loss and this is a wonderful opportunity to intervene early.  Some of those folks are ill disposed toward the messenger of unpleasant news, but I am finding out that good science and the specter of everyone's worst aging nightmare is still a powerful motivator to maybe do something about it. 

https://www.alz.org/aaic/releases_2017/AAIC17-Mon-briefing-risk-factor.asp

SURVIVING YOUR COMPUTER : SLEEP AND THE CIRCADIAN CYCLE

SURVIVING YOUR COMPUTER : FOLLOWING THE CIRCADIAN CYCLE

With days getting longer until June 21st, it is getting harder to remember the long dark days of winter. And I cannot think of anyone complaining about that right now...

Our brains are equipped with light sensors that are able to recognize light patterns associated with different times of the day. The brain's interpretation of the time of the day, in turn, allows it to trigger the right hormones that regulate the sleep-wake cycle

A big issue that can arise from the use of computers is that the main light stimulation emanating from our screens does not mirror those normal diurnal variations, but instead give off a steady "early to mid-day" blue light signal that continuously tells our brains that it is not evening, and delays the release of major sleep hormones including melatonin. Thus, computer use, especially in the afternoon and evening, can set you up for disrupted sleep cycles.

Ultimately it is best to get your computer work done as early as possible during the day, and keep non-screen based reading such as books and other print materials for later hours. This is especially true for children since their developing brains are so much more sensitive to any kind of stimulus, but there are a few technologies available to mitigate the problem. The link below is to a free software that will adjust the light/color emitting pattern of your screen based on the sunset/sunrise times of your particular geographic location.

https://justgetflux.com/

Surviving your computer part 4: the mouse

This week I want to deviate a bit from the neck and shoulder impact of computer work to move a few inches laterally to the shoulder and the rest of the upper extremity. The incidence of upper extremity repetitive use disorders is quite high among computer users. There are some user "technique" issues to account for that: most people need to actively be reminded of how to position their shoulders in a posterior relaxed position and keep their arm close to their trunk to avoid constantly using their arm while reaching forward or to the side. This can be tough especially when you get a bit stressed out about your work and you tend to assume a "defensive" posture hunched over.  Other considerations are more ergonomic in nature and once again come back to having the right equipment for the task. A standard mouse requires a lot of horizontal moving on a flat surface and thus tends to keep your arm in flexion and abduction most of the time.

There are a variety of mouse options ( can we say "mice" in this context ???). There is some user preference is chosing the right one for you. I don't use my computer mouse a lot, but if I had to upgrade I would personally lean toward a vertical mouse, which virtually eliminates side movement of the arm. The downfall is that is takes a longer learning curve than hybrid sloped mouse ( #1 in this article). If you have kids at home learning to use a computer, get them started on a vertical mouse right away. The other slight downfall is that of all the computer retrofits I have mentioned so far, ergo mouse options are the pricier, but still cheaper than seeking care for an injury after the fact.

Another often forgotten strategy to minimize mouse use is to use the Windows keys on the top of your keyboard. One key will replace several clicks and drags for a lot of common functions like undo, copy and past etc... In the next few years, I anticipate that voice recognition will even further decrease mouse use by replacing them with voice commands. It will turn doing your work in a coffee shop into a new and interesting, and very chatty experience

http://ergonomictrends.com/best-ergonomic-mouse-reviews/