ADHD medication – can you take it long term? What are the risks and do benefits continue?

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Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

boy looks frustrated, sitting at table with adult
Medication is usually prescribed by a specialist but rules differ around Australia.
Ground Picture/Shutterstock

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.The Conversation

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • No, beetroot isn’t vegetable Viagra. But here’s what else it can do

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    Beetroot has been in the news for all the wrong reasons. Supply issues in recent months have seen a shortage of tinned beetroot on Australian supermarket shelves. At one point, a tin was reportedly selling on eBay for more than A$65.

    But as supplies increase, we turn our attention to beetroot’s apparent health benefits.

    Is beetroot really vegetable Viagra, as UK TV doctor Michael Mosley suggests? What about beetroot’s other apparent health benefits – from reducing your blood pressure to improving your daily workout? Here’s what the science says.

    What’s so special about beetroot?

    Beetroot – alongside foods such as berries, nuts and leafy greens – is a “superfood”. It contains above-average levels per gram of certain vitamins and minerals.

    Beetroot is particularly rich in vitamin B and C, minerals, fibre and antioxidants.

    Most cooking methods don’t significantly alter its antioxidant levels. Pressure cooking does, however, lower levels of carotenoid (a type of antioxidant) compared to raw beetroot.

    Processing into capsules, powders, chips or juice may affect beetroot’s ability to act as an antioxidant. However, this can vary between products, including between different brands of beetroot juice.

    Is beetroot really vegetable Viagra?

    The Romans are said to have used beetroot and its juice as an aphrodisiac.

    But there’s limited scientific evidence to say beetroot improves your sex life. This does not mean it doesn’t. Rather, the vast number of scientific studies looking at the effect of beetroot have not measured libido or other aspects of sexual health.

    How could it work?

    When we eat beetroot, chemical reactions involving bacteria and enzymes transform the nitrate in beetroot into nitrite, then to nitric oxide. Nitric oxide helps dilate (widen) blood vessels, potentially improving circulation.

    The richest sources of dietary nitric oxide that have been tested in clinical studies are beetroot, rocket and spinach.

    Nitric oxide is also thought to support testosterone in its role in controlling blood flow before and during sex in men.

    Beetroot’s ability to improve blood flow can benefit the circulatory system of the heart and blood vessels. This may positively impact sexual function, theoretically in men and women.

    Therefore, it is reasonable to suggest there could be a modest link between beetroot and preparedness for sex, but don’t expect it to transform your sex life.

    What else could it do?

    Beetroot has received increasing attention over recent years due to its antioxidant and anti-tumour effect in humans.

    Clinical trials have not verified all beetroot’s active ingredients and their effects. However, beetroot may be a potentially helpful treatment for various health issues related to oxidative stress and inflammation, such as cancer and diabetes. The idea is that you can take beetroot supplements or eat extra beetroot alongside your regular medicines (rather than replace them).

    There is evidence beetroot juice can help lower systolic blood pressure (the first number in your blood pressure reading) by 2.73-4.81 mmHg (millimetres of mercury, the standard unit of measuring blood pressure) in people with high blood pressure. Some researchers say this reduction is comparable to the effects seen with certain medications and dietary interventions.

    Other research finds even people without high blood pressure (but at risk of it) could benefit.

    Beetroot may also improve athletic performance. Some studies show small benefits for endurance athletes (who run, swim or cycle long distances). These studies looked at various forms of the food, such as beetroot juice as well as beetroot-based supplements.

    How to get more beetroot in your diet

    There is scientific evidence to support positive impacts of consuming beetroot in whole, juice and supplement forms. So even if you can’t get hold of tinned beetroot, there are plenty of other ways you can get more beetroot into your diet. You can try:

    • raw beetroot – grate raw beetroot and add it to salads or coleslaw, or slice beetroot to use as a crunchy topping for sandwiches or wraps
    • cooked beetroot – roast beetroot with olive oil, salt and pepper for a flavour packed side dish. Alternatively, steam beetroot and serve it as a standalone dish or mixed into other dishes
    • beetroot juice – make fresh beetroot juice using a juicer. You can combine it with other fruits and vegetables for added flavour. You can also blend raw or cooked beetroot with water and strain to make a juice
    • smoothies – add beetroot to your favourite smoothie. It pairs well with fruits such as berries, apples and oranges
    • soups – use beetroot in soups for both flavour and colour. Borscht is a classic beetroot soup, but you can also experiment with other recipes
    • pickled beetroot – make pickled beetroot at home, or buy it from the supermarket. This can be a tasty addition to salads or sandwiches
    • beetroot hummus – blend cooked beetroot into your homemade hummus for a vibrant and nutritious dip. You can also buy beetroot hummus from the supermarket
    • grilled beetroot – slice beetroot and grill it for a smoky flavour
    • beetroot chips – slice raw beetroot thinly, toss the slices with olive oil and your favourite seasonings, then bake or dehydrate them to make crispy beetroot chips
    • cakes and baked goods – add grated beetroot to muffins, cakes, or brownies for a moist and colourful twist.
    Three squares of beetroot/chocolate cake with white icing and nuts sprinkled on top
    You can add beetroot to baked goods. Ekaterina Khoroshilova/Shutterstock

    Are there any downsides?

    Compared to the large number of studies on the beneficial effects of beetroot, there is very little evidence of negative side effects.

    If you eat large amounts of beetroot, your urine may turn red or purple (called beeturia). But this is generally harmless.

    There have been reports in some countries of beetroot-based dietary supplements contaminated with harmful substances, yet we have not seen this reported in Australia.

    What’s the take-home message?

    Beetroot may give some modest boost to sex for men and women, likely by helping your circulation. But it’s unlikely to transform your sex life or act as vegetable Viagra. We know there are many contributing factors to sexual wellbeing. Diet is only one.

    For individually tailored support talk to your GP or an accredited practising dietitian.

    Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Lecturer, Southern Cross University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Healing Trauma – by Dr. Peter Levine

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Levine’s better-selling book about trauma, Waking The Tiger, laid the foundations for this one, but the reason we’re skipping straight into Healing Trauma, is that while the former book is more about the ideas that led him to what he currently believes is the best approach to healing trauma, this book is the one that explains how to actually do it.

    The core thesis is that trauma is a natural, transient response, and is not inherently pathological, but that it can become so if not allowed to do its thing.

    This book outlines exercises, trademarked as “somatic experiencing”, which allow the body to go through the physiological processes it needs to, to facilitate healing. If you buy the physical book, there is also an audio CD, which this reviewer has not listened to and cannot comment on, but the exercises are clearly described in the book in any case.

    The physical aspects of the exercises are similar to the principles of progressive relaxation, while the mental aspects of the exercises are about re-experiencing trauma in a safer fashion, in small doses.

    Any kind of dealing with trauma is not going to be comfortable, so this book is not an enjoyable read.

    As for how useful the exercises are, your mileage may vary. Like many books about trauma, the expectation is that once upon a time you were in a situation that was unsafe, and now you are safe. If that describes your trauma, you will get the most out of this. However, if your trauma is unrelated to your personal safety, or if it is about your personal safety but the threat still remains extant, then a lot of this may not help and may even make things worse.

    In terms of discussing sexual trauma specifically, it was probably not a good choice to favorably quote Woody Allen, and little things like that may be quite jarring for a lot of readers.

    Bottom line: if your trauma is PTSD of the kind “you faced an existential threat and now it is gone”, then chances are that this book can help you a lot. If your trauma is different, then your mileage may vary widely on this one.

    Click here to check out Healing Trauma, if it seems right for you!

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  • The Brain As A Work-In-Progress

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    And The Brain Goes Marching On!

    In Tuesday’s newsletter, we asked you “when does the human brain stop developing?” and got the above-depicted, below-described, set of responses:

    • About 64% of people said “Never”
    • About 16% of people said “25 years”
    • About 9% of people said “65 years”
    • About 5% of people said “13 years”
    • About 3% of people said “18 years”
    • About 3% of people said “45 years”

    Some thoughts, before we get into the science:

    An alternative wording for the original question was “when does the human brain finish developing”; the meaning is the same but the feeling is slightly different:

    • “When does the human brain stop developing?” focuses attention on the idea of cessation, and will skew responses to later ages
    • When does the human brain finish developing?” focuses on attention on a kind of “is it done yet?” and will skew responses to earlier ages

    Ultimately, since we had to chose one word or another, we picked the shortest one, but it would have been interesting if we could have done an A/B test, and asked half one way, and half the other way!

    Why we picked those ages

    We picked those ages as poll options for reasons people might be drawn to them:

    • 13 years: in English-speaking cultures, an important milestone of entering adolescence (note that the concept of a “teenager” is not precisely universal as most languages do not have “-teen” numbers in the same way; the concept of “adolescent” may thus be tied to other milestones)
    • 18 years: age of legal majority in N. America and many other places
    • 25 years: age popularly believed to be when the brain is finished developing, due to a study that we’ll talk about shortly (we guess that’s why there’s a spike in our results for this, too!)
    • 45 years: age where many midlife hormonal changes occur, and many professionals are considered to have peaked in competence and start looking towards retirement
    • 65 years: age considered “senior” in much of N. America and many other places, as well as the cut-off and/or starting point for a lot of medical research

    Notice, therefore, how a lot of things are coming from places they really shouldn’t. For example, because there are many studies saying “n% of people over 65 get Alzheimer’s” or “n% of people over 65 get age-related cognitive decline”, etc, 65 becomes the age where we start expecting this—because of an arbitrary human choice of where to draw the cut-off for the study enrollment!

    Similarly, we may look at common ages of legal majority, or retirement pensions, and assume “well it must be for a good reason”, and dear reader, those reasons are more often economically motivated than they are biologically reasoned.

    So, what does the science say?

    Our brains are never finished developing: True or False?

    True! If we define “finished developing” as “we cease doing neurogenesis and neuroplasticity is no longer in effect”.

    Glossary:

    • Neurogenesis: the process of creating new brain cells
    • Neuroplasticity: the process of the brain adapting to changes by essentially rebuilding itself to suit our perceived current needs

    We say “perceived” because sometimes neuroplasticity can do very unhelpful things to us (e.g: psychological trauma, or even just bad habits), but on a biological level, it is always doing its best to serve our overall success as an organism.

    For a long time it was thought that we don’t do neurogenesis at all as adults, but this was found to be untrue:

    How To Grow New Brain Cells (At Any Age)

    Summary of conclusions of the above: we’re all growing new brain cells at every age, even if we be in our 80s and with Alzheimer’s disease, but there are things we can do to enhance our neurogenic potential along the way.

    Neuroplasticity will always be somewhat enhanced by neurogenesis (after all, new neurons get given jobs to do), and we reviewed a great book about the marvels of neuroplasticity including in older age:

    The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity – by Dr. Norman Doidge

    Our brains are still developing up to the age of 25: True or False?

    True! And then it keeps on developing after that, too. Now this is abundantly obvious considering what we just talked about, but see what a difference the phrasing makes? Now it makes it sound like it stops at 25, which this statement doesn’t claim at all—it only speaks for the time up to that age.

    A lot of the popular press about “the brain isn’t fully mature until the age of 25” stems from a 2006 study that found:

    ❝For instance, frontal gray matter volume peaks at about age 11.0 years in girls and 12.1 years in boys, whereas temporal gray matter volume peaks at about age at 16.7 years in girls and 16.2 years in boys. The dorsal lateral prefrontal cortex, important for controlling impulses, is among the latest brain regions to mature without reaching adult dimensions until the early 20s.❞

    ~ Dr. Jay Giedd

    Source: Structural Magnetic Resonance Imaging of the Adolescent Brain

    There are several things to note here:

    • The above statement is talking about the physical size of the brain growing
    • Nowhere does he say “and stops developing at 25”

    However… The study only looked at brains up to the age of 25. After that, they stopped looking, because the study was about “the adolescent brain” so there has to be a cut-off somewhere, and that was the cut-off they chose.

    This is the equivalent of saying “it didn’t stop raining until four o’clock” when the reality is that four o’clock is simply when you gave up on checking.

    The study didn’t misrepresent this, by the way, but the popular press did!

    Another 2012 study looked at various metrics of brain development, and found:

    • Synapse overproduction into the teens
    • Cortex pruning into the late 20s
    • Prefrontal pruning into middle age at least (they stopped looking)
    • Myelination beyond middle age (they stopped looking)

    Source: Experience and the developing prefrontal cortexcheck out figure 1, and make sure you’re looking at the human data not the rat data

    So how’s the most recent research looking?

    Here’s a 2022 study that looked at 123,984 brain scans spanning the age range from mid-gestation to 100 postnatal years, and as you can see from its own figure 1… Most (if not all) brain-things keep growing for life, even though most slow down at some point, they don’t stop:

    Brain charts for the human lifespancheck out figure 1; don’t get too excited about the ventricular volume column as that is basically “brain that isn’t being a brain”. Do get excited about the rest, though!

    Want to know how not to get caught out by science being misrepresented by the popular press? Check out:

    How Science News Outlets Can Lie To You (Yes, Even If They Cite Studies!)

    Take care!

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  • Stop Using The Wrong Hairbrush For Your Hair Type

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When you brush your hair, you’re either making it healthier or damaging it, depending on what you’re using and how. To avoid pulling your hair out, and to enjoy healthy hair of whatever kind you have and whatever length suits you, it pays to know a little about different brushes, and the different techniques involved.

    Head-to-head

    Brush shapes and sizes are designed to achieve different effects in hair, not just for decoration. For example:

    • Rat tail combs are excellent for parting and sectioning hair with clean lines. The rat tail part is actually more important than the comb part.
    • Regular combs are multipurpose but best for use with flat irons, ensuring straighter hair for a longer time.
    • Wide-tooth combs should not be used for detangling as they can cause breakage; instead, use a proper detangling brush. Speaking of detangling…
    • Detangling brushes are essential for daily use. Whichever you use, start brushing from the bottom to prevent tangles from stacking and worsening. As for kinds of detangling brush:
      • The “Tangle Teaser” is a good beginner option, but it may not detangle well for thicker hair.
      • Wet Brush (this is a brand name, and is not about any inherent wetness) is the recommended detangling brush for most people. It can be used on wet or dry hair.
      • Mason Pearson brush is a luxury detangling brush (see it here on Amazon) that works slightly more quickly and efficiently, but is expensive and not necessary for most people.
    • Teasing brushes are for adding volume by backcombing—but require skill to prevent visible tangles. Best avoided for most people.
    • Ceramic round brushes are the best for blow-drying, because they hold tension and help hair dry smoother and shinier.
    • Blow-dryer brushes are great for easy blow-drying but should not be used on dry hair, to avoid damage.
    • Denman brushes are for people with natural curls, enhancing curls without straightening them like a Wet brush would.

    For more on all of these brushes, plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Gentler Hair Health Options

    Take care!

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  • The Hormone Therapy That Reduces Breast Cancer Risk & More

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    The Hormone Balancing Act

    We’ve written before about menopausal HRT:

    What You Should Have Been Told About Menopause Beforehand

    …and even specifically about the considerations when it comes to breast cancer risk:

    Menopausal Hormone Replacement Therapy

    this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.

    Hormone Modulating Therapy

    Hormone modulating therapy, henceforth HMT, is something a little different.

    Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…

    MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,

    Isn’t that the opposite of what we want?

    You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).

    However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.

    In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.

    Here’s a pop-science article that goes into the details more deeply than we have room for here:

    Hormone therapy for breast cancer linked with lower dementia risk

    And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:

    Alzheimer Disease and Related Dementia Following Hormone-Modulating Therapy in Patients With Breast Cancer

    Want to learn more?

    If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:

    The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons

    Take care!

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  • 7 Essential Devices For Hand Arthritis: Regain Control of Your Life

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    Dr. Diana Girnita is a double board-certified physician in rheumatology and internal medicine. With a PhD in immunology (on top of her MD), and training at Harvard and top universities, she founded Rheumatologist OnCall, offering integrative medicine to broaden rheumatology access. Here’s what she has to say about things that make life easier:

    Get your hands on these…

    The seven devices that Dr. Girnita recommends are:

    • Hand grip strengthener: helps build grip strength with a spring-loaded mechanism. Regular use can improve strength and reduce pain.
    • Finger exerciser: different device; similar principle: it strengthens hand and finger muscles using resistance, enhancing hand function.
    • Moisturizing paraffin bath: a heated paraffin wax bath that soothes hands, providing heat therapy and moisturizing the skin.
    • Weighted silverware: weighted utensils (knives, forks, spoons) make gripping easier and provide stability for eating.
    • Foam tubing grips: foam covers to make kitchen tools, toothbrushes, and hairbrushes easier to grip.
    • Electric can-opener: reduces strain in opening cans, making meal preparation more accessible.
    • Compression gloves: provide gentle compression to reduce swelling and pain, improving hand flexibility and circulation.
    • Door knob cover grips: make it easier to turn doorknobs by providing a larger surface to grip.
    • Wider-grip pens: ergonomically designed pens with a larger diameter and softer grip reduce hand strain while writing.

    This writer, who does not have arthritis but also does not have anything like the grip strength she used to, also recommends a jar opener like this one.

    As a bonus, if you spend a lot of time writing at a computer, an ergonomic split keyboard like this one goes a long way to avoiding carpal tunnel syndrome, and logically must be better for arthritis than a regular keyboard; another excellent thing to have (that again this writer uses and swears by) is an ergonomic vertical mouse like this one (aligns the wrist bones correctly; the “normal” horizontal version is woeful for the carpal bones). These things are both also excellent to help avoid worsening peripheral neuropathy (something that troubles this writer’s wrists if she’s not careful, due to old injuries there).

    For more on the seven things otherwise listed above, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

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    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

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