Carpal Tunnel: How Do You Combat It?

66 comments

Over the last couple of weeks, my wrists have hurt so bad I'm starting to look into alternative ways to get information into the computer. Last week, my left hand was so weak, I couldn't lift a glass to drink or fork to eat. You'll notice this post is short: I can't type much beyond a couple minutes at a time before I must stop.

I'm looking into the following:

Foot mice Downside: Requires an adaptor for USB
Head Mice (I'm not too proud to wear a dot on my head at this point.)
Dictation software

I personally have a hard time with ergo keyboards because they are usually too big for my little hands: I think the "standard" keyboard size is for someone who is 6 feet tall. It sucks being petite.

I'd like anyone and everyone's opinions of how you combat carpal tunnel syndrome and if any of you have had experience with the above items.

Thanks.

Comments

what Google says about it

Google recently blogged about this, so their entry on Repetitive Stress Injury (RSI) might be one good place to start.

My mother had a carpel tunnel surgery, and it fixed her right up. If you do both hands in one surgery, though, you need someone living with you in the weeks after to help you out.

I'd maybe try taking megadoses of Aspirin, since it reduces inflammation, and it's relatively safe -- hard to OD on it. (I'm not a doctor, so this should not be taken as professional medical advice.)

UK: I've already switched

UK: I've already switched sides. I'm out of sides to switch to! HA!

This is listed in a few

This is listed in a few spots as a mini ergnomic keyboard:
http://www.kinesis-ergo.com/max-spec.htm

maybe what your looking for

try the glusosamine

Wrist straps are the most effective cure I have found, there is a brand called bandit that is best, you can get them on ebay for like $20

Also try the glusosamine

I have been taking it now for a bit and it seems to help, even if its only in my head

I have been able to start lifting weights again, partially because of it.

The head/ foot pedal mouse works ok but you tend to get stiff neck, I have extra head mouse If you want to buy one for next to nothing. I am not using it.

I also looked into touch screen moniters, you can get a cheap touch screen that lays over the moniter, for a few hundred bucks, it would be a totally different motion the regular mousing, they sell full touch screen moniters for like a few thousand.

There is a cortisone shot that knocks tendoitis right out, but it is just a temporary fix.

Anii-inflamatories are the best medicine for it, its too bad vioxx is bad because it works great on tendonitis, but you should also try alleve.

buddy of mine had cts really

buddy of mine had cts really bad as well - ice every night etc. He started getting Active Release Therapy and doing a simple set of stretches every hour for about a min. His CTS is virtually gone now. Didn't take much time at all to fix him up.

This may sound lame, but I

This may sound lame, but I don't type. I am still a hunt and pecker, and I think it has saved my wrists. I also switch the mouse from one hand to another a lot.

Try this . .

Made a big difference for me. www.ergorest.com/eng/index.htm

good luck

I think you need to switch *and* give the wrist/arm/shoulder a break. Cranking a fishing reel or swinging a golf club may be a switch from typing but it is not a break, for example.

I find switching to a tablet/stylus sitting back in a recliner for a while is a god restful change from the mouse and kb. I also find the Starbucks table height to be quite different form my normal desk height, which gives my shoulders a break. I have determined that the little mouse-pointer-spindle thingy on my IBM Thinkpad is very, very bad for CTS

Sounds severe. See a doctor.

Sounds severe. See a doctor.

Rest followed by physiotherapy helped me. See a specialist first, physiotherapy exercises could make the condition worse if not done properly.

Similar Case Here

With all possible disclaimers possible, I went through a similar situation and this is what the doc had me do and it worked great. No problems since years ago.

It came down two two things, 1) sitting and/or mouse use position at my computer station and 2) Strength and muscle development in the affected wrist.

I first had to stop using the mouse for a number of days and take regular doses of Ibuprophen to completely get rid of the imflamation so that it felt pretty normal again. Then I was put on a regiment of small strength building exercises to build more muscle in my wrist. The reason given was there was excess sliding going on due to weak muscles. I eventually worked up to a 10 lb weight that I do curls with. I now have a very powerful wrist. (no jokes about that)

Secondly, I had to adjust to what was called a bottom-up appraoch to my seating at the computer. It starts at your feet and ends at your eye level. Basically you 1) have a chair that is posisitioned so your feet are flat on the ground when sitting upright. 2)Then with your arms at your side you adjust the surface your mouse is on, to the bottom of your elbow. This makes a right angle of your arm as you grasp the mouse. 3) At this point the monitor is adjusted about 1 inch below eye level while maintaining good posture so that your head is tilted ever so slightly down. Done.

Yah, switching sides is good

Yah, switching sides is good if you have a side left to switch to. I use an Evoluent VerticalMouse:
http://www.evoluent.com/vmouse2.html

It makes your default resting position much more natural, in my opinion.

hey matt

hey Matt do you think it is the mouse use or the keyboard use or both that creates the problems? That's an interesting idea for mouse use, if the mouse use is causing the most trouble. I just shifted my arm imagining that mouse in my hand, and I felt relaxed.

An Optical Mouse helped me

The rubber ball in a conventional mouse clogs up and tends to need more oomph to move it.

The optical or wireless mose is much smoother.

I think it's both the

I think it's both the keyboard and the mouse. I want to hoard the old Microsoft Natural Keyboards, because those are the only ones that I really like. Um, these suckers:

http://www.oucs.ox.ac.uk/enable/images/natural-keyboard.jpg

Great stuff. Since switching to that + the new mouse, I haven't had much carpal pain.

Linux desktop?

If you get your husband to set you up a Linux computer, there are window-managers that don't need a keyboard at all. You could check out IceWM, fvwm2, wmx, XSWM, EvilWM or Ratpoison.

Hmm not sure Rat Poison is a cure...

...given that grnidone said she is petite :)

On a more sensible note, I've had a lot of problems recently too.

Have just this week started on the Micorsoft Natural keyboard it is more comfortable for me (but as you pointed out it does suit someone who is fairly large - I'm strectching for some of the keys)

The best thing so far have been the stretches, as oilman mentioned - personally I visited a Sports Therapist who does a lot of work with muscle injuries in sportsmen/women - this is in the UK so I don't know what you'd call them in the states. She pulverised and streetched my arm muscles a few times and gave me a load of arm stretches to do, basically to stretch out the biceps and strengthen the should and back muscles.

I can send you details if you like.

Too much time behind a PC!!!

Too much time behind a PC!!! It’s bad for you, start doing physical exercise… gardening, kick boxing… whatever… You won’t regret it, you might even get to like it :)

wristpad

i've had a belkin mousepad with a soft wrist cushion for my mouse and have always been comfortable.

Belkin makes an ergonomic

Belkin makes an ergonomic keyboard, but I like the looks of the Microsoft keyboard. (Also tend to like the "clicky" noise of MS keyboards.)

The Active Release Technique therapy sounds interesting, especially if it resolves the problem.

Microsoft Natural Keyboards,

I still have mine on one of my computers...but I never really weas that happy with it.

If they don't sell them any more, happy to donate it to grnidone (or even Matt if she doesn't need it!)

Um....

...don't switch to another mouse/keyboard/whatever just yet. See a doctor first (good tip, PaulH).

You may have to quit working on the computer (cold turkey!) for a while and not do anything similar like knit, text message, drive a car with a manual gearbox or even «snip*».
A good doctor should be able to tell you that.

If anything: get someone else to do your computer work for you :-]

* target=_self LOL

Whatever you do don't mask

Whatever you do don't mask it with drugs, get to the root of the problem. Also don't see a doctor see a physio or someone who deals specifically with these sorts of injuries.

Long time lurker, first time poster

I'm no health freak but I can offer a suggestion to ease the CTS pain. Hit up your local gym, pay for a couple of months and get a weight training routine going. Half hour to an hour a day away from the computer pushing weights has eased my joint pains and probably added a few years.....
My hands and wrists were becoming frozen but in less than a month I had reversed the progression. 1 and 1/2 years later I have no symptoms.
Good luck with your wrists!

Swimming.

Combats other ailments as well. Improves overall health and is fantastic for circulation. Sitting in a chair for extended periods is hard on you. Trust me, I have the hospital bills to prove it.

An hour a day swimming laps will make you feel like new. I manage about three trips a week.

Surgery

I'm a lawyer and when I practiced my base was in the middle of the largest UK coalfields. I dealt with scores of claims for carpal tunnel syndrome in miners. As far as I'm aware there's only one cure which is surgery and its not always successful with many victims needing repeat surgery. There's really no alternative as once you have it you can’t just ignore it.

Cure v. Relief

No cure for arthritis either, and I'm sure lawyers would like everyone to think that sans cure, surgery is needed for CTS.

Look for relief first. Surgery is often suggested too quickly.

CTS didn't get me but another form

of repetitive strain injury did Trigger Finger. My doctor said I needed a corticosteroid injection. Matts Evoluent VerticalMouse wouldn't help me there I'm afraid.

BTW: When Matt said

"I want to hoard the old Microsoft Natural Keyboards, because those are the only ones that I really like."

Is that Matts first endorsement of a Microsoft product?

stretches, repositioning, and natural keyboard

I solved my pains years ago. I was having pain in the wrist and in the shoulder. I switched to the Natural keyboard (the one Matt likes) and now I'm on this one : http://www.microsoft.com/hardware/mouseandkeyboard/ProductDetails.aspx?pid=014&active_tab=overview

I repositioned my body much like Jon King says. I found that the shoulder pain was due to the fact that I was having to reach for the mouse so now its closer to me.

I also have been doing these stretches for years and they really help the wrists:
http://www.eatonhand.com/hw/ctexercise.htm

Heh. I wonder if Matt Cutts

Heh. I wonder if Matt Cutts noticed the title tag on that Evoluent mouse page:


Evoluent VerticalMouse, Vertical Mouse, ergonomic mouse, ergonomic computer mouse, computer mouse, optical mouse, carpal tunnel syndrome, repetitive stress disorder, RSI

Matt's not that bright, really...

...and I don't think that he pays a lot of attention to what's going on around him. So, I doubt he noticed it.

(Hey Matt...how's it going?) :p

So Matt, if you like that MS thingy, you might love this: http://ergopages.com/comfort_keyboard.html

Bizarre as it may seem, it works like a charm.

I was suffering from left elbow and severe upper back (inside shoulder blade) pain. After this baby, it's all good. I'm no ergoexpert, but I think it has a lot to do with the same reasons that the vertical mouse works so well (yeah, I got that first, then the keyboard followed): Basically they both eliminate the need for the forearms to pronate, or whatever you call it when they rotate inward. With these vertical devices, it's sorta like holding little melons in your hands. :)

Between these (vertical) operating instruments, and making sure that my feet are flat on the ground, my arms are parallel to the floor, and my monitor is just a tiny bit below eye level, I'm set.

This egro stuff will kill you if you don't attend to it. Like DG says, I speak from experience. And I'm older than most of you jokers (which means wiser). ;-)

I was reading a lot about

I was reading a lot about Tarsal Tunnel recently because I fucked my leg royally in an accident and severed the nerve to my foot. Tarsal tunnel is the leg equivalent form of Carpal Tunnel.

Basically the problem is that the nerves run down your arm and somewhere you've trapped them. This means that spurious signals are being sent to your brain. It thinks your hand/wrist is in pain because you are pushing on the nerves which terminate further down on your hand.

From what I read there are a lot of things you can try before surgery. Some herbal remedies, ice packs and rest. Exercise is unlikey to help. If it goes untreated it's unlikely to get better on its own. The surgeon tries to identify the pressure point on the nerve and release it, but it's not always obvious where the pressure is coming from. I feel sorry for you. I still feel nothing in my right foot. Just pins and needles the whole time. It's a pain in the ass and it makes it impossible to get a decent night's sleep.

Acupuncture

Digitalghost.
Lawyers make much more from chronic incurable conditions compared to those that can be remedied. It would be in a lawyers interest for the client NOT to have surgery. Fact is, if you feel the effects of this condition for more than a few months then it’s not going to go away and the only sure cure is surgery. I didn’t make the rules and relevant clients usually only come to lawyers AFTER the surgery, upon which of course lawyers have no influence.
There has been some interesting research recently on the use of acupuncture but no conclusion has yet been reached.

Wow. I took the day off

Wow. I took the day off from the computer yesterday to find this huge thread today. And a post by a lurker. And Mattie Cutts. I feel the love. Thanks, you guys.

I have decided to see a doctor and will probably buy some wrist braces depending on what she says. I purchased ViaVoice yesterday and will report back on how that works.

And, I think a new keyboard and mouse are in order. Interestingly enough I need to lift weights anyway (osteoporosis) so I guess I have to stop putting that off. And, I need to learn how to swim since I never learned how.

I'm relieved to know that this can be combatted without surgery, and am willing to try anything before I do that.

Thank you so much.

Definitely get checked out

A friend of mine recently got checked out for what he thought was CTS and the doctors found he had some sort of "straight line cancer" shit. He had to have his left arm lopped off at the elbow to stop the cancer's spread. He thinks they got it all, but they said if he had waited and it reached a bit further to his lymph nodes he would have been all done. :-(

A friend of mine recently

Quote:
A friend of mine recently got checked out for what he thought was CTS and the doctors found he had some sort of "straight line cancer" shit.

OK. I'm officially freaking out.

Heres a list of what works best for me.

I have CTS REALLY bad and was afraid I would have to use a foot mouse or get out of the biz. Came close to surgery but for many people it really does not help, so decided I would try everything possible 1st. Here are some things that have helped a ton! If I'm careful and stick to the things that work, I am now almost pain-free.

GELATIN - Yep plain old Knox gelatin. Don't pay for the combo that has glucosamine or get the one for nails. Just the plain gelatin. Get it in a big box that has the individual packets. Take one pack a day - stir in water or juice and drink down fast before it gels. Totally tasteless. GUARANTEED that in a week or less your pain will be better. A client told me about it and made me the guarantee above. I was considering surgery and this stuff saved me. If I stop taking it the pain comes back. Start taking again and in about 2 days the pain is almost completely gone, so I know its the Knox and not something else.

MSM - it helps with any type of pain and helps Carpal a lot.

Carpal problems really originate in the neck and shoulders, so watch your posture and do frequent neck and shoulder stretches. We tend to hunch over to type, so grip hands behind back and pull shoulders backwards several times a day.

For me mousing is the culprit, not typing. Clicking the mouse is really what does it. So I use my keyboard to click and scroll and only use mouse for positioning pointer. Sometimes I use an old one button mouse on the floor to just click with my foot. ;-) Also I am trying to switch hands more often.

Here are my fav carpal mice. I've tried them all!!!
Whale mouse is my #1 fav because you move your whole hand, not your wrist, so the bigger muscles in your arm do all the work.
http://www.humanscale.com/txmas/whalemouse.htm

My #2 fav is the Quill Mouse. Similar to the Evoluent VerticalMouse but much better IMHO because it has a tray for your whole hand to rest in. Very comfortable and your hand just glides. I use them both and switch off because they each use slightly different muscles and I still get pain if I use one of them exclusively. http://www.aerobicmouse.com/

Last but not least chiropractic helps! As I said, carpal problems really start in your neck, so having a properly aligned spine can work wonders. Also sometimes when the pain gets really bad I use the soft tissue laser at my chiropractor's office. He says for many patients one treatment totally cures them. I find that after I use the laser on my wrist for about 1/2 an hour it helps for 2-4 weeks, then if I overdo it, I need to go use the laser again.

Hope this helps and best of luck!

Workrave

Why not give Workrave
It's a very neat tool and designed to rehabilitate people suffering from RSI!

Same Problem

I had the same problem as you. I was in constant pain every night and it made it hard to even pick up a bag of groceries.

The first step I made was buying a wrist wrest for my new keyboard. It's the magnetic kind (I don't know) and magnets supposedly can help increase blood flow and whatever. It's probably just nonsense but it has helped.

I also looked up some good stretches that I do throughout the day to help keep my hands and fingers loose.

Finally, I've just forced myself to take breaks more often. If I've been typing for 3-4 hours straight, I force myself to get up and not type for a 20 minutes or so. Stretch out my wrists and just give them a rest.

I still get pain from time to time but it's 100 times better.

Re: Magnets I know horse

Re: Magnets

I know horse people who swear by magnets for their cutting horses. And, on a cellular level, magnets make perfect sense.

Athletes Too

Tons of athletes use magnets too. A lot of your NHL goalies sleep on mattresses filled with them. Pitchers where custom arm braces with them in it after a start. I don't know if it's hokey or not, but if you can come across a magnetic wrist rest for your keyboard, give it a shot.

Yes, forget the magnets

As a sometime physicist I am with NFFC on this... mumbo jumbo

As an "educated" ergonomics specialist...

...I stand by my earlier comments.

I must say - though - that I really like magnets: they look very colourful on my fridge door and my kids love 'em.............

No, don't forget the magnets

Why do we continue to apply generalizations to people? It will be our downfall as a species.

Magnets *might* work for some people. We are not all the same. Why is it impossible for magnets to work for some people some of the time? Oh, I get it... you were just generalizing... in order to help one person with their particular problem.

For every website purporting to disprove any modality, I can find (or make) two to support the same modality. For every study that criticizes a flawed control or a participant selection bias in a clinical trial, I can highlight ways that the "gold standard" double-blind sham-controlled randomized clinical trial is useless for human study. And let's stay away from the Bayesian stuff for now, as I still have work due today.

Why not put some of these bright minds to work building community sites and product cooperatives so each of us can try these various things without shelling out $40 for a doodad we might use for a day and toss into a toxic waste dump somewhere in the salt mines our kids will inherit?

Unbridled consumerism can continue, but how about we feed the masses more information and less plastic for a change. Link love goes to..... freecycle

Came back from the Doc...

It's not Carpel Tunnel.

It's Cupital Tunnel Syndrome, an inflammation of the ulnar nerve, the major nerve in y9our arm that rund down into yoru hand.

The difference is simple: Carpel tunnel is in the wrist and affects the thumb, middle and pointin' finger.

Cupital tunnel syndrome is in teh elbow and will affect the ring and pinky finger and up the arm.

I am to ice the hell out of my elbow and do some exercises that were given to me, and take Aleve to rid myself of the swelling so it can heal.

Kensington Expert Mouse Trackball

Try a big ball trackball. A top of the line number.

The cheaper, smaller ones work badly and only make matters worse.

The Kensington Expert Mouse comes with a ball as big as a billiards ball and you can sweep across two screens with a single push.

Moreover, use multiple input methods. Trackball for a while. Mouse for a while. Drawing tables for a while if you have one. That way it's not exactly the same muscles, same posture.

Cut back the hours. Going over 10 hours/day on a long term basis brings eye strain and various carpal tunnel syndrome issues.

Good luck.

I also have an adjustable

I also have an adjustable pneumatic chair; it shifts up/down and the backrest tilts backwards/forwards. I reset it every so often (for comfort), move the keyboard around a little (as suits me at the time), and shift/tilt the monitor. While this may sound odd, it also means that the body doesn't get too "set" in any particular pose.

trackball

Believe it or not, a trackball is something completely different from a mouse. You don't physically move the trackball around like you do with a mouse, in stead your hand *rests* on the trackball and you move your fingers (usually just the thumb) slightly to navigate. It's also more precise and has a whole lot less friction than a mouse.

That, and a wacom tablet for precision graphics.

Not just that Claus

That, and a wacom tablet for precision graphics.

I use a tablet for pretty much everything, have for years. I sometimes use the mouse for scrolling on long pages, but that's it.

Took a while to get used to (I use it in so called 'mouse mode' as opposed to exact screen mapping), but no more sore neck/shoulder/hand. Has to be a Wacom mind, the cheap ones are shit.

yes of course, stupid me

.. of course you can use the tablet for anything you use the mouse for (+ a whole lot more).

I'm sure it's pretty good ergonomics, as if you can use a pencil you can use a tablet. And, after all pencils, pens, and styluses have been used for a few centuries if not millenia ;-)

It really is just like an advanced pencil with a buit in two-button mouse. Draw with it, select text with it, turn it upside-down and erase with it. No more friction than a pencil has, and much less weight than an expensive pen. Plus, it's pressure sensitive, and even angle sensitive, so in some kinds of software (eg. photoshop) you can do lots of things that you simply can't do with a mouse.

A tablet is pretty expensive as compared to a mouse - I paid around US$500 for mine because it's too big for most people (DIN A5 size active area is really big although it does not sound big). But, if you're not going to use it for digitizing / graphics, or artistic work (like drawing with big hand movements) you should choose one of the smallest models as you will be configuring it to use only a small part of the active area anyway. So, buying too big will be a waste of money.

>> Has to be a Wacom

That's funny; everyone I've ever talked to about this have said exactly that, literally. That's really a company that has managed to "turn it's customers into ambassadors" - to use a marketing phrase. Awesome.

I wouldn't know myself as I've never tried other ones, but I do recommend the Wacom variety nevertheless - I've never had less trouble with any kind of PC hardware. Perhaps my USB memory stick, but seriously, I even doubt that.

Using a tablet for hours and hours...

...is just as bad as doing the same with a mouse.

Or a keyboard.
Or a trackball.
Or a guitar.
Even an anti-stress ball!
How 'bout eating crisps or picking your nose....

If anything try to switch regularly.

On /. today there was mention of a voice recognition thing, but as the first commenter already pointed out, yapping away for 12 hours a day will surely cause RSI to the jaw :-]

Simple stretches have eliminated my wrist, neck and forearm pain

I am on the computer 6 to 8 hours per day selling on eBay and I have struggled with wrist pain, loss of full use of my left ring finger, waking up with a stiff neck, etc. for three years. Recently, I found a software program with desktop stretches that pop up at your chosen time interval throughout the day. The stretches take about 2 minutes to do when it pops up, and you can do it right at your desk. I have been free of pain for two weeks. I do not need to buy a special chair, ergonomic keyboard or anything else. This software will be available to the general public in about one week. For more information you can go to //edit - daft link removed//

Nice ad...

...and I think a grain of salt would be in order here.

Stretching/exercising might be a good idea BEFORE it's too late. Not after.

{goes off to set (cheap) egg timer for a little stretch break later}

i think the removal of the

i think the removal of the link is more the correct thing to do Wit ;-)

Stretching and exercising is the best thing you can do plus I always keep my wrist and arm supported up to the elbow when I am using the mouse, as soon as I stop doing that I feel the pain

another problem what has not been mentioned if you spend hours and hours in front of a screen is every now and then turn your head away from the screen to focus your eyes on something else further away, health advice says you should not spend more than 2 hours at a time in front of a screen without a break.

I actually do more than I

I actually do more than I said, but not much. First, my desk is L-shaped, where I am sitting "in" the L, so my mouse arm rests on the desk rather than hovering in mid-air; I can't imagine working like that.

Secondly, I have reasonably comfortable ergonomic chairs -- two of them -- one has a high back (for resting the head) and both tilt and have back/lumbar support. I switch when I feel like it, but the point is that I'm not always sitting in one position and, if for example some portion of my spine starts to hurt a bit, I simply switch chairs; a few hours later, I feel just fine.

In fact, I don't actually type all day; there's a portion of time sitting back in the "tall" chair with my feet up when I'm catching up on my daily reading.

i think the removal of the link is more ...

I agree, and have broken the habits of a lifetime and removed it!

If some idiot wants to drop a link, then it needs to be domne more subtly that that one.

So whatever happened with

So whatever happened with grnidone? Are the symptoms better?

If We're Dropping Links

Workrave - stoopid name, but free and it works - is a program that does whatever the loon above was trying to promote. Set it to be strict, it'll even give you some exercises to do whilst cursing and waiting for your screen to come back.

I still struggle with wrist

I still struggle with wrist and elbow pain, but it is much much better. A fall on the bicycle on my left elbow really exasperated things, but an ergo keyboard, sideways mouse and voice software to write has helped tremendously.

I also unbend my elbow and let it hang when I only need to use the arrow keys for navigation. I do stretches as well, and those seem to help.

I'm glad to hear it. I often

I'm glad to hear it.

I often think many of us sit in the same positions too long. And who wants to get away from the monitor? :)

I am frustrated that

I am frustrated that workrave does not come in a Mac version. I'm trying to figure out how to use Fink to port the linux version into an easy to use Mac program.

Exactly what is offensive about what I said

Is it that you think it's an ad and not true?
I probably get up 10 times a day to get something to eat, use the restroom, answer the phone or the door...but I still have wrist and neck problems, and I still sit at the computer for long periods of time. Stretching at the computer with a guide helps A LOT, and when is it too late? I guess it's not too late when you can't even use your left hand to open a bottled water get shooting pains in your wrists.... and thanks for not holding back...

I don't think you could possibly like me less anyway so

I checked out workrave and it's a reminder that tells you to get up. I don't see where it has graphics that display stretches to do periodically.. did I miss that?

Shari, Yeah, it does have

Shari,

Yeah, it does have stretches. when the little box pops up and sayd take a break, then a big box pops up after the little one goes away (like 30 seconds or some such) and it displays stretches. You can also get the stretches to come up by clicking the little box.

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