My hand hurts. Help it feel better.
July 23, 2007 2:03 PM
YANADfilter: Why does my hand hurt and what can I do to make it hurt less until I can see a doctor?
Every so often, I have arm or wrist pain and some occasional hand tingling. I'm a computer geek, so I assumed carpal tunnel. The pain/tingling usually go away fairly fast, so I haven't been treated for it.
However, today my left hand has been causing me a LOT of pain. I flew on a redeye from LA-NYC last night, and when I woke up a few minutes before landing, I noticed it felt very achey and stiff. I massaged my wrist and hand and proceeded home. As the day progressed, it started hurting more. I took a nap and when I woke up it was very painful, but only when I perform certain movements.
It hurts if I bend the wrist back, as if I were pushing on a door, and when I bend the wrist down. I also experience some pain when I move the wrist laterally. It hurts more if the fingers are together when I move the wrist back - if my fingers are spread apart it hurts less. The pain is localized in the hand - from where the thumb meets the rest of the hand across the middle of the metacarpals, but does not hurt up near the knuckles, on the outside of the hand (the pinky side) or higher on the wrist. It hurts just a little when I keep the wrist in a neutral position and type. It doesn't hurt if I just keep the wrist in a neutral position and sit here. It also doesn't hurt if I pick stuff up with my fingers, like a purse, but does hurt if my thumb is involved in picking up stuff, like the cat.
I am going to the doctor, but my GP can't see me until tomorrow afternoon. I would like to know the following: has anyone experienced something similar? (I read this and this but they aren't quite what I'm experiencing.) If so, what was it? Should I go get a wrist brace until I can see the doctor? Is there anything you did that helped relieve the pain (medication, massage, voodoo, etc.)? Is there anything in particular that I should ask or tell the doctor besides what I've mentioned here?
I am not looking for actual medical advice, just "I've been there, this is what I did" kind of anecdotes. I realize IANAD, YANAD, etc. and I do have an appointment to see one. I just want to make it feel less sucky before I get there.
Every so often, I have arm or wrist pain and some occasional hand tingling. I'm a computer geek, so I assumed carpal tunnel. The pain/tingling usually go away fairly fast, so I haven't been treated for it.
However, today my left hand has been causing me a LOT of pain. I flew on a redeye from LA-NYC last night, and when I woke up a few minutes before landing, I noticed it felt very achey and stiff. I massaged my wrist and hand and proceeded home. As the day progressed, it started hurting more. I took a nap and when I woke up it was very painful, but only when I perform certain movements.
It hurts if I bend the wrist back, as if I were pushing on a door, and when I bend the wrist down. I also experience some pain when I move the wrist laterally. It hurts more if the fingers are together when I move the wrist back - if my fingers are spread apart it hurts less. The pain is localized in the hand - from where the thumb meets the rest of the hand across the middle of the metacarpals, but does not hurt up near the knuckles, on the outside of the hand (the pinky side) or higher on the wrist. It hurts just a little when I keep the wrist in a neutral position and type. It doesn't hurt if I just keep the wrist in a neutral position and sit here. It also doesn't hurt if I pick stuff up with my fingers, like a purse, but does hurt if my thumb is involved in picking up stuff, like the cat.
I am going to the doctor, but my GP can't see me until tomorrow afternoon. I would like to know the following: has anyone experienced something similar? (I read this and this but they aren't quite what I'm experiencing.) If so, what was it? Should I go get a wrist brace until I can see the doctor? Is there anything you did that helped relieve the pain (medication, massage, voodoo, etc.)? Is there anything in particular that I should ask or tell the doctor besides what I've mentioned here?
I am not looking for actual medical advice, just "I've been there, this is what I did" kind of anecdotes. I realize IANAD, YANAD, etc. and I do have an appointment to see one. I just want to make it feel less sucky before I get there.
Don't get a wrist brace unless it is recommended by a medical professional. It can make things worse.
Rest. Stop typing until you see your physician. Seriously. Afterwards, install Workrave.
Medication: non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can work. You can also get NSAIDs in gel form to apply directly to your wrist.
Ice can help.
I was going to ask if you are left handed, but you shouldn't type the answer right now. If you mouse with your left hand you might want to consider switching after you see your doctor. And get an ergonomic mouse (like a vertical mouse) or trackball.
posted by grouse at 2:12 PM on July 23, 2007
Rest. Stop typing until you see your physician. Seriously. Afterwards, install Workrave.
Medication: non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can work. You can also get NSAIDs in gel form to apply directly to your wrist.
Ice can help.
I was going to ask if you are left handed, but you shouldn't type the answer right now. If you mouse with your left hand you might want to consider switching after you see your doctor. And get an ergonomic mouse (like a vertical mouse) or trackball.
posted by grouse at 2:12 PM on July 23, 2007
Yeah, that sounds like a variant of tendinitis/carpal tunnel. I haven't had that specific problem (I had DeQuervain's, which is focused around the thumb), but all the moves that are painful to you are ones that would stress your tendons, so I'm pretty sure that's the likely culprit here.
There isn't a lot you can do before tomorrow. I'd suggest taking some ibuprofen to take the edge off.
The general approach to treating carpal tunnel without surgery is to reduce the inflammation, and then strengthen the muscles so that they take more of the load and the tendons take less. Most likely, your doctor will get you in for X-rays or an MRI to make sure you don't have other damage, and then will put you on a fairly strong anti-inflammatory. I was on 800mg of ibuprofen 4 times a day. Once the pain diminishes, they'll start you doing things like squeezing a ball or those hand-grip things.
Don't worry about 'hiding' the pain and damaging yourself worse; tendinitis is so excruciating that you can't hide it with OTC painkillers. And it's the pain that's DOING the damage, so any reduction in pain from anti-inflammatories is good for you anyway.
Tendons heal pretty well, btw, so they may very well be able to contain this without surgery.
If you don't have good insurance, this may also qualify for Workers' Compensation.
posted by Malor at 2:17 PM on July 23, 2007
There isn't a lot you can do before tomorrow. I'd suggest taking some ibuprofen to take the edge off.
The general approach to treating carpal tunnel without surgery is to reduce the inflammation, and then strengthen the muscles so that they take more of the load and the tendons take less. Most likely, your doctor will get you in for X-rays or an MRI to make sure you don't have other damage, and then will put you on a fairly strong anti-inflammatory. I was on 800mg of ibuprofen 4 times a day. Once the pain diminishes, they'll start you doing things like squeezing a ball or those hand-grip things.
Don't worry about 'hiding' the pain and damaging yourself worse; tendinitis is so excruciating that you can't hide it with OTC painkillers. And it's the pain that's DOING the damage, so any reduction in pain from anti-inflammatories is good for you anyway.
Tendons heal pretty well, btw, so they may very well be able to contain this without surgery.
If you don't have good insurance, this may also qualify for Workers' Compensation.
posted by Malor at 2:17 PM on July 23, 2007
I'm sure grouse is right about braces making things worse, but I just ran out to Long's Drugs and bought a brace (one of the higher end ones)) and wore it at work and also while I slept (I tend to do weird hand positions while I sleep!) and after 4 or 5 days it went away.
A good exercise to do to take a break from typing etc is:
touch thumb to index finger,
thumb to middle finger,
thumb to ring finger,
thumb to pinky,
reverse
repeat
posted by lil' ears at 2:20 PM on July 23, 2007
A good exercise to do to take a break from typing etc is:
touch thumb to index finger,
thumb to middle finger,
thumb to ring finger,
thumb to pinky,
reverse
repeat
posted by lil' ears at 2:20 PM on July 23, 2007
I am right-handed. I do not use a mouse. I use a Thinkpad with the little nubbin and my right hand does all the mouse/nubbin action. I use my right hand very dominantly for most things. It doesn't hurt at all.
The reason I thought it might be something else is because the pain went from 0-60 in like 5 hours.
I'll stop typing now. Or type one-handed with my right hand to answer anything else.
posted by bedhead at 2:24 PM on July 23, 2007
The reason I thought it might be something else is because the pain went from 0-60 in like 5 hours.
I'll stop typing now. Or type one-handed with my right hand to answer anything else.
posted by bedhead at 2:24 PM on July 23, 2007
There's an exercise that I do that really helps. Basically, you make a swimming motion with your arms, sort of. Start with your hands together in a prayer-like position. Then, move arms up until full extended. Turn elbows outward and start pulling elbows down, with your forearms as close to your sides as possible.
You should also try drinking plenty of water, a little more than you're used to. This helped a lot for me when my CT was bad; no explanation for it; my guess is that it helps flush out whatever's in there making it hurt.
I found that stress had an overwhelming effect on my likelihood of having pain, so unless you slept real well on the flight that would be my first guess as to why you had the flareup.
If your carpal tunnel has similar origins to mine, you should feel a popping in your shoulders as the ligaments that were tight and constricted relax and realign (or whatever it is that they're doing). It should really help.
You can do this on your back; when on your back, again move your elbows in tight, trying to press them against your ribs as you move your hands down along your sides.
When you finally do go to a doctor, go to a physical therapist, preferably one who uses a variety of techniques -- massage, exercise, manipulation, and electropressure were what my physical therapist used. 7 years on and I get the occasional tingle if I work for longer than 9 hours, but the radiating pains along my arm and wrist are gone and never came back. No surgery needed. I know someone else who got carpal tunnel surgery from a highly respected orthopedic surgeon (as in, "has a building named after them"). It "did the trick", but they still have occasional pain in their arm and hand. I don't. See a physical therapist.
I realize that you are not looking for medical advice, which is why I offered recommended exercise and water. But when you do go to your doctor, s/he might recommend surgery first. I'd make it a last resort, after physical therapy.
posted by Deathalicious at 2:29 PM on July 23, 2007
You should also try drinking plenty of water, a little more than you're used to. This helped a lot for me when my CT was bad; no explanation for it; my guess is that it helps flush out whatever's in there making it hurt.
I found that stress had an overwhelming effect on my likelihood of having pain, so unless you slept real well on the flight that would be my first guess as to why you had the flareup.
If your carpal tunnel has similar origins to mine, you should feel a popping in your shoulders as the ligaments that were tight and constricted relax and realign (or whatever it is that they're doing). It should really help.
You can do this on your back; when on your back, again move your elbows in tight, trying to press them against your ribs as you move your hands down along your sides.
When you finally do go to a doctor, go to a physical therapist, preferably one who uses a variety of techniques -- massage, exercise, manipulation, and electropressure were what my physical therapist used. 7 years on and I get the occasional tingle if I work for longer than 9 hours, but the radiating pains along my arm and wrist are gone and never came back. No surgery needed. I know someone else who got carpal tunnel surgery from a highly respected orthopedic surgeon (as in, "has a building named after them"). It "did the trick", but they still have occasional pain in their arm and hand. I don't. See a physical therapist.
I realize that you are not looking for medical advice, which is why I offered recommended exercise and water. But when you do go to your doctor, s/he might recommend surgery first. I'd make it a last resort, after physical therapy.
posted by Deathalicious at 2:29 PM on July 23, 2007
I'm sure grouse is right about braces making things worse
No, they can make things worse. But someone with no medical training is unlikely to know when they are more likely to make things better or worse. For that matter, the particular type of brace can be important too.
posted by grouse at 2:33 PM on July 23, 2007
No, they can make things worse. But someone with no medical training is unlikely to know when they are more likely to make things better or worse. For that matter, the particular type of brace can be important too.
posted by grouse at 2:33 PM on July 23, 2007
Take breaks often. Go to a physiotherapist. It's rarely CTS.
Check out this book, also:
http://www.amazon.com/Carpal-Syndrome-Therapy-Computer-Professionals/dp/0965510999
posted by PowerCat at 2:38 PM on July 23, 2007
Check out this book, also:
http://www.amazon.com/Carpal-Syndrome-Therapy-Computer-Professionals/dp/0965510999
posted by PowerCat at 2:38 PM on July 23, 2007
Try lying on your side and rotating your arm at the shoulder socket, slowly around back and forth in each direction as it feels comfortable. This will release a lot of problems in the shoulder, which may not be supported properly and so your upper arm is pressing down on your hand and wrist. This is based only on my experience. I invented that exercise. It feels great and releases a lot of tension and pain. Do it on both sides. Don't stretch and push, just gently move around. I also found this guy's site helpful. I am not a medical person of any sort, just someone who has dealt with the pain.
posted by Listener at 2:56 PM on July 23, 2007
posted by Listener at 2:56 PM on July 23, 2007
It sounds pretty carpal-tunnel-like, but I only say this because I know you are going to a doc tomorrow. In the meantime, rest it as much as you can, don't type or pick stuff up with your thumbs, and do your best to not put it into positions that hurt.
Also, when you sleep, your wrists naturally flex -- do your best to sleep in a position where they aren't all folded up, and you might have less pain in the morning.
posted by jennyjenny at 3:18 PM on July 23, 2007
Also, when you sleep, your wrists naturally flex -- do your best to sleep in a position where they aren't all folded up, and you might have less pain in the morning.
posted by jennyjenny at 3:18 PM on July 23, 2007
Could it be a ganglion cyst? Most of the pain you describe has happened to me. The pain occurs before the bump appears in my wrist. But usually the pain is limited to the wrist, not most of the hand as in your case. When it gets really bad, though, it does kind of spread and I'll get some tingling too.
posted by CrazyLemonade at 3:21 PM on July 23, 2007
posted by CrazyLemonade at 3:21 PM on July 23, 2007
I had something similar a few years ago. I went to bed one night just fine. I woke up to a wrist so painful when moved that I woke up gasping from the pain. I tried to tough it out for a day or two but it was agonizing pain. My wrist was very swollen and I didn't even want to breath because I was afraid I'd move my wrist on accident. The doctor told me I had tendonitis and gave me some anti-inflammatories and vicodin. He also gave me a wrist brace which cut the pain by about 10-20% immediately. I know one of the posters above suggested against it but if I ever get tendonitis in my wrist again, I will slap a wrist brace on so fast it would make your head spin. Between the anti-inflammatories and the wrist brace I ended up only taking one vicodin because the pain was manageable with the wrist brace. However, it took about 6 weeks before I was back to normal and no longer needed the brace. Hope you feel better soon. I remember that kind of pain and it was not much fun that's for sure. Oh, and my doctor recommended ice packs on my wrist for a few minutes at a time throughout the day. He said never to use heat for that type of injury because it would only make the pain worse.
posted by GlowWyrm at 3:37 PM on July 23, 2007
posted by GlowWyrm at 3:37 PM on July 23, 2007
If it is C/T or tendonitis (and I've had both) and you get a brace or splint, it helps a lot to wear it when you sleep. Quite often we bend our wrists or elbows at extreme angles during sleep (like folding hands in prayer position and tucking them under the head under the pillow) which only aggravates the problem.
posted by Oriole Adams at 4:16 PM on July 23, 2007
posted by Oriole Adams at 4:16 PM on July 23, 2007
It certainly sounds like an inflammation of sorts, and possibly a compound problem. The advice above about anti-inflammatories and drinking lots of water is very good. See if you can get a friend to (gently!) massage inbetween your shoulderblades, because it is possible that the radial pain in the outside of your hand is referred pain from muscular tension in your back.
You mention you use a thinkpad and mouse with your right hand, which would mean you tend to use your left to hold the laptop steady when you're using it on an unsteady surface, I would imagine. I would say, drawing parallels from my own experience, that it is possible that you have some left/right imbalances in your posture also. Once the immediate issue is resolved, consider incorporating some stretching into your daily work life, especially of the shoulders and spine.
posted by ysabet at 6:00 PM on July 23, 2007
You mention you use a thinkpad and mouse with your right hand, which would mean you tend to use your left to hold the laptop steady when you're using it on an unsteady surface, I would imagine. I would say, drawing parallels from my own experience, that it is possible that you have some left/right imbalances in your posture also. Once the immediate issue is resolved, consider incorporating some stretching into your daily work life, especially of the shoulders and spine.
posted by ysabet at 6:00 PM on July 23, 2007
If it's coming and going, with much pain, I'd be more tempted to guess tendonitis or something more along that route. It's possible that you have an RMI w/o it being CTS. (repetitive motion injury.)
NSAIDS like said above, Aleve being your best bet. (Naproxen versus Naproxen Sodium.) Wonderdrug, but you WILL build an immunity quickly if you use it often.
Ice as well. If you can, isolate the joint above and below the source of pain. This does NOT mean to apply pressure (but pressure should be ok if you are able to STOP using the limb) to the source of pain, it means splint wrist and elbow in position causing the LEAST pain. You'd probably be advised to put a spacer between your forearm and belly too, it'll help keep your shoulder from aching.
Oh, keep your fingers straight, which leaves muscles in the forearm relaxed, and don't squeeze/grip anything if you can possibly avoid it.
posted by TomMelee at 6:06 PM on July 23, 2007
NSAIDS like said above, Aleve being your best bet. (Naproxen versus Naproxen Sodium.) Wonderdrug, but you WILL build an immunity quickly if you use it often.
Ice as well. If you can, isolate the joint above and below the source of pain. This does NOT mean to apply pressure (but pressure should be ok if you are able to STOP using the limb) to the source of pain, it means splint wrist and elbow in position causing the LEAST pain. You'd probably be advised to put a spacer between your forearm and belly too, it'll help keep your shoulder from aching.
Oh, keep your fingers straight, which leaves muscles in the forearm relaxed, and don't squeeze/grip anything if you can possibly avoid it.
posted by TomMelee at 6:06 PM on July 23, 2007
bedhead's bf here - taking dictation.
I took some ibuprofen and that seems to have helped slightly. Pain is still there but duller. I am also drinking extra water. Thanks!
We are going to try ice tonight to see if that helps as well. I am also looking into a physical therapist and will suggest that to the doctor tomorrow.
The info is great so far. Does anyone have any other tips on keeping this from happening again?
posted by bedhead at 6:35 PM on July 23, 2007
I took some ibuprofen and that seems to have helped slightly. Pain is still there but duller. I am also drinking extra water. Thanks!
We are going to try ice tonight to see if that helps as well. I am also looking into a physical therapist and will suggest that to the doctor tomorrow.
The info is great so far. Does anyone have any other tips on keeping this from happening again?
posted by bedhead at 6:35 PM on July 23, 2007
There are already many threads about RSI, which might be helpful.
For my own recovery, I think Workrave has been the most important element. Followed by physical therapy and a proper ergonomic keyboard tray, keyboard (Kinesis Advantage) and mouse (AirO2bic Quill Mouse). I never use a laptop keyboard.
posted by grouse at 6:42 PM on July 23, 2007
For my own recovery, I think Workrave has been the most important element. Followed by physical therapy and a proper ergonomic keyboard tray, keyboard (Kinesis Advantage) and mouse (AirO2bic Quill Mouse). I never use a laptop keyboard.
posted by grouse at 6:42 PM on July 23, 2007
bedhead:
Get workrave, and use it religiously. Follow any advice your doctor gives you. And don't slack off because it hasn't happened in a while.
Note: my husband and I both have RSI, of different sorts. So, yeah, painful experience says don't ignore it, because it won't go away.
posted by ysabet at 7:22 PM on July 23, 2007
Get workrave, and use it religiously. Follow any advice your doctor gives you. And don't slack off because it hasn't happened in a while.
Note: my husband and I both have RSI, of different sorts. So, yeah, painful experience says don't ignore it, because it won't go away.
posted by ysabet at 7:22 PM on July 23, 2007
deQuervain's tenosynovitis. I have battled with a form of this and I can offer you the following advice:
RELAX. Do not try stretching the wrist or hand to the point of pain as that won't help; it is inflamed and will take a while to feel better. A brace or ace bandage can help you keep it in place. Also try alternating ice and heat therapy (don't apply either longer than 10-12 minutes at a time).
Good luck.
posted by wondermouse at 8:21 PM on July 23, 2007
RELAX. Do not try stretching the wrist or hand to the point of pain as that won't help; it is inflamed and will take a while to feel better. A brace or ace bandage can help you keep it in place. Also try alternating ice and heat therapy (don't apply either longer than 10-12 minutes at a time).
Good luck.
posted by wondermouse at 8:21 PM on July 23, 2007
Sorry to double post, but I wanted to add this about the brace: don't try to do what you normally do while wearing the brace, as this can cause more tension in the wrist. Just let the brace act as a reminder to rest the wrist and hand, and really try to keep it from doing things while you wear it. Open doors with the other hand, don't type much, etc.
posted by wondermouse at 10:26 PM on July 23, 2007
posted by wondermouse at 10:26 PM on July 23, 2007
Just piling on all the above comments. I had similar symptoms in the past at it was repetitive stress and just plain overuse. Wearing the brace at night was huge. Also, I learned to vary my input devices – trackballs to grip mouse to regular mouse – and to use both hands. But by far the best thing was switching to a pad and stylus instead of a mouse.
posted by lpsguy at 6:07 AM on July 24, 2007
posted by lpsguy at 6:07 AM on July 24, 2007
I had a pretty bad case of tendonitis and went to the doctor, and he gave me a brace and said to take ibuprofen for a few days. It came back right after I stopped with both, so I have come up with the following successful preventative regimen:
- I make sure to have at least one oz. of olive oil a day. (It's a natural anti-inflammatory agent, and unlike ibuprofen, you can take it for extended periods with no worries.)
- I do exercises with small weights, and also ones like lil' ears suggests: fingertips to base of fingers, then to middle of palm, then to base of palm, then thumb to pinky.
- I run cold water from the tap over my wrists when things start to feel a little dicey, and then rest until they warm up.
- I exercise a lot more. This does wonders.
- I stretch before and after intensive wrist use.
- I do progressive muscle relaxation with the muscles of my fingers and forearms, except that I usually omit the tension part. (It's amazing how much you can relax your muscles just by concentrating on "emptying" them of all energy/tension. They usually stay that way with a bit of attention.)
- Most important, I REST FROM WHATEVER ACTIVITY I'M DOING AT LEAST EVERY HALF HOUR. This is at least as important as most of the other tips combined.
This is all assuming that your pain is the result of a Repetitive Stress Injury, which it might not be, and in which I case I don't have really have much experience to help with. If it is, though, these things should help you.
posted by invitapriore at 6:22 AM on July 24, 2007
- I make sure to have at least one oz. of olive oil a day. (It's a natural anti-inflammatory agent, and unlike ibuprofen, you can take it for extended periods with no worries.)
- I do exercises with small weights, and also ones like lil' ears suggests: fingertips to base of fingers, then to middle of palm, then to base of palm, then thumb to pinky.
- I run cold water from the tap over my wrists when things start to feel a little dicey, and then rest until they warm up.
- I exercise a lot more. This does wonders.
- I stretch before and after intensive wrist use.
- I do progressive muscle relaxation with the muscles of my fingers and forearms, except that I usually omit the tension part. (It's amazing how much you can relax your muscles just by concentrating on "emptying" them of all energy/tension. They usually stay that way with a bit of attention.)
- Most important, I REST FROM WHATEVER ACTIVITY I'M DOING AT LEAST EVERY HALF HOUR. This is at least as important as most of the other tips combined.
This is all assuming that your pain is the result of a Repetitive Stress Injury, which it might not be, and in which I case I don't have really have much experience to help with. If it is, though, these things should help you.
posted by invitapriore at 6:22 AM on July 24, 2007
Quick update: I visited the doctor today. GP referred me to their on-staff physiatrist and he diagnosed it as a ganglion cyst. I'm scheduled to go in for an MRI to see how big and how many there are, and will probably need to have surgery to take it out. For now, he's told me to rest, use ice, and use a wrist brace when I sleep.
Thanks everyone!
posted by bedhead at 6:31 PM on July 24, 2007
Thanks everyone!
posted by bedhead at 6:31 PM on July 24, 2007
Bedhead, I hope you come back. From the ones you marked as best... you're gonna screw yourself up.
DO NOT try to stretch or strengthen anything until you see the doctor!! If you try to stretch while inflamed you can really fuck yourself up. You have to wait until the inflammation subsides and THEN work on fixing it.
posted by Malor at 11:39 PM on July 24, 2007
DO NOT try to stretch or strengthen anything until you see the doctor!! If you try to stretch while inflamed you can really fuck yourself up. You have to wait until the inflammation subsides and THEN work on fixing it.
posted by Malor at 11:39 PM on July 24, 2007
Oh, I didn't fully read your lst reply, my apologies.
That'll teach me to post before reading every single thing in the tread. :)
Sorry about the cysts... hope they can fix them easily.
posted by Malor at 11:40 PM on July 24, 2007
That'll teach me to post before reading every single thing in the tread. :)
Sorry about the cysts... hope they can fix them easily.
posted by Malor at 11:40 PM on July 24, 2007
« Older Washington DC securoty deposit disagreement (more... | Irn-Bru makes me sleepy. Any idea why? Newer »
This thread is closed to new comments.
posted by ThePinkSuperhero at 2:05 PM on July 23, 2007