Ask MetaFilter questions tagged with arthritis

Writer meets arthritis

grumblebee — Thu, 03 Dec 2009 11:18:40 -0800

Mac voice-recognition software for a writer with arthritis. My father's arthritis is making it more and more difficult for him to type. This is hard for him, because he's been a writer for decades (over 25 books and countless articles). He is considering switching to voice-recognition software.

Here are some things to note:

- He is originally from England but has lived in the US since the 1950s. He is a very clear speaker, but his accent is a mix of British (cockney originally) and American.

- He owns a Mac.

- He is not highly computer literate, but he lives in a university town and could find people to help him set things up if necessary. He probably will have trouble if the voice-recognition software itself is overly complicated to use.

I am looking for any advice and experiences with this. What is the state of the art these days? What's available for the Mac? What is the experience like for people who are heavy users?

Spandex is not a right

Anonymous — Mon, 19 Oct 2009 14:25:51 -0800

Knee surgeries, spinal injuries and systemic arthritis. No heath insurance. This has stopped me from moving around very much. Now I'm Rubenesque. There's been a ton of advice on exercise, but none of it seems to be aimed towards the movement impaired. Yoga has been helpful for regaining some mobility, but isn't helping with weight loss. My diet has been designed by a nutritionist, and I stick to it...about 1200 calories a day, with allowances for desserts sometimes. It's not an "eat less, fatty" situation, so please, let's avoid that conversation.

What I need is direction towards some exercises for people who cannot run, sprint, jog, bounce up and down, lift their arms above their head, or do any of those other things that I used to be able to do. Any (non-pharmaceutical) suggestions for controlling pain from said exercise would be welcome.

I think once I lose about 50 pounds, the pressure will be off my knees and back, and more vigorous exercise will be possible, but how do I lose that 50 pounds without aerobic workouts?

Wife stopped prednisone, swelling way up despite other meds, new diganosis?

IzzeYum — Sat, 22 Aug 2009 08:38:52 -0800

My wife went off of one medication for arthritis and it made a huge difference, even though the other two meds didn't. She is getting a second opinion. What else might she have? (you are not a doctor) My 32 year old wife was told she has rheumatoid arthritis after she had pain in her joints and swelling (she actually gained weight she was so swollen). The doctor put her on Prednisone (5 mg) as well as Hydroxychloroquine and diflunisal. She was told to stop taking the prednisone after, I think like 3-4 months. While she was on it the swelling went totally away, she didn't hurt and had more energy. Since she has come off it the swelling is returning (3 weeks after being off it), as has the tired and the pain. She IS STILL on the other two arthritis meds but without the prednisone they seem to be making no difference. She was already planning on getting a second opinon, but this makes me even more suspicious it was a wrong diag or at least the wrong meds.

She also was having dry skin problems as original symptoms and that has also returned (flakey scalp and stuff) with the removal of the prednisone.

So what else might it be? Some weird allergy? She does has a nut allergy already, not severe but still.

Help our Pomeranian's Paws!

spacefire — Thu, 08 Jan 2009 06:06:33 -0800

What are some recommended Joint Supplements for a Pomeranian mix (17 lbs)? Our doctor warned us that the breed is susceptible to arthritis and at one point in time surgery might be needed. Are there any canine supplements, preferably in a tasty form, that could make our dog's life easier?

He is a 6 year old, 17lbs Pomeranian, possibly mixed with Eskimo (Pomino), we don't know, since he was a rescue. He likes to run around the house a lot. Unfortunately we have hardwood floors and he often slips, which the doctor said could cause joint damage. In the morning he stretches a lot, and she said that could be an early sign of arthritis as well. So we want to provide him with the best protection now, for a better life when he gets old.
We feed him Purina Dog Chow dry food.

Yoga or Pilates in the capital

freshwater_pr0n — Sat, 08 Nov 2008 18:15:13 -0800

Tell me about some great yoga or Pilates teachers in DC who work with older students. My mom has chronic pain issues, arthritis and osteoporosis. We would like to work with someone to set up a gentle routine that she can do at home.

Mom N' Pot Business

redsparkler — Thu, 23 Oct 2008 19:11:40 -0800

Please direct me towards some respectable, wholesome looking websites about medical marijuana usage, especially if they're intended for older folks and/or the Oregon Medical Marijuana Program. My mother is in her sixties, and suffers from terrible chronic arthritis pain. I'm convinced that medical marijuana would be a terrific option for her, and at the the very least, much better than the cocktail of various medications that she currently takes. The most recent time we discussed it, she seemed a lot more open to it, especially when I brought up the possibility of tinctures, which a friend of mine uses. The next obvious step is to give her a couple of websites to look at, right?

Fun Facts!
1.) She's super sweet, religious, bakes cookies, and only recently started regularly imbibing alcohol (boxed sangria, at that.).
2.) She's mildly competent at the internet, but probably won't want to read pages and pages of text, like New Yorker articles or the Mother Jones article I found called "Respectable Reefer".
3.) I'm pretty sure she's never smoked pot before, and I haven't, either, so there's no first hand experiential data from either of us, as far as the effects of it go.

Also welcome are anecdotes or cautionary tales about older parents, chronic pain, and medical marijuana usage.

Once I "pop," I can't stop

np312 — Thu, 09 Oct 2008 23:32:06 -0800

"Pop!" goes... my entire body? I've looked at the other "back/neck cracking" threads here, but mine seems a bit different. I'm a young female who works out and stretches 3x a week, yet I'm constantly "popping" or "cracking" my joints without meaning to. Especially when I'm lying down, but not limited to that.

We're talking ankles, knees, elbows, back, hips and pelvis all the time, shoulders, fingers, toes, you name it. Not even just when stretching. When I take a deep breath, my back pops. Shrug one shoulder-- Pop! When I tie my shoelaces-- hoo boy it's a staccato symphony. Friends have commented on it, saying how weird it is. I can also pop every joint in my fingers three or four different ways... Though I try not to do it often. That urban myth (?) about arthritis has me spooked.

None of the popping comes with pain of any sort. But it's a little embarrassing, and I'm wondering what I can do about it, and why it's happening. I stretch, I'm active, I'm young. I do have some slight scoliosis and am a tad duck-footed, but otherwise there's nothing wrong with me.

Any thoughts? Also, any truth to the popping --> arthritis myth?

Help me unearth the svelte person that I really am!

sgmax — Wed, 01 Oct 2008 13:20:35 -0800

How can a vegetarian lose weight with arthritic knees? I have let my weight creep up astronomically over the last few years because of a stressful working situation that led to me overeating and lacking time for exercise. The stress is now tailing off (I have a permanent job at last) but I now weigh over 250lbs, not good for a 5'7" female in her mid-50s. I recently discovered that I have osteoarthritis in my knees, which is making it very painful to exercise. I can't walk more than a few hundred yards.
I need to lose serious weight, to relieve stress on my knees, avoid type II diabetes, and lower my blood pressure. I am looking at diet as a separate issue (I am a vegetarian with a tendency to eat comfort foods). For now, please advise me how to get some exercise with arthritic knees. What types of exercise can I do without injuring myself and hurting overmuch, to build up strength and lose weight?

Stuff for grandpa to use.

Salmonberry — Thu, 06 Mar 2008 20:48:36 -0800

Can anyone recommend any adaptive devices for someone who enjoys computers, but suffers from severe arthritis in his hands? We're looking for gift ideas. He is a senior and his fingers are thick thanks to the arthritis. It would be great to find things that would help him when he's on the computer.

I tried to do some research but most sites focus on sight problems when it comes to computer device adaptation, so the few options that are available I can't find any reviews on. I'd hate to get something that didn't work. If you have experience with anything that has worked with arthritic computer nerds, I'd love to hear about it!

What can you tell me about how to treat rheumatoid arthritis?

orange swan — Thu, 31 Jan 2008 09:10:09 -0800

My father has a severe case of rheumatoid arthritis. I’m hoping those of you who have arthritis or have loved ones who do will have some information to share. My dad was first diagnosed 24 years ago, and is now 69 years old. He has unfortunately never been very good at either managing his medical care or at taking reasonable physical care of himself. It’s recently occurred to me that neither he nor any of my family has ever done any real research into his illness. I’m under no illusions that my doing research now will result in him being cured, but I am in hopes that his quality of life can be improved at least somewhat. This thread is my starting point for research, so I would like it to become a compendium of information on rheumatoid arthritis. I am hoping that any MeFites who have experience in dealing with arthritis will be willing to share their accounts of what worked and didn’t work for them, and/or point me to resources on the net and in southern Ontario (my parents live two hours from Toronto and 50 minutes from Kitchener).

To give you more specifics about my dad’s condition and history…

The medical care my father has received has been less than stellar. In the mid-eighties he was put on gold pills, which nearly killed him. He’s a 6’ man who was always a lean and muscular 190-195 pounds; the gold pills reduced him to 130 pounds and made him cough blood. It’s no exaggeration to say he looked like a concentration camp inmate. At that point he went to a naturopath, whose only effective method of treatment was to tell Dad to stop taking the gold pills.

Since then Dad periodically goes to a rheumatologist. The medications that the rehumatologist prescribes do work somewhat, but have horrific long-term side effects. He’s been told that the medication will make him go blind and give him cirrhosis of the liver. To quote my father, he’d “rather be crippled than half-crippled and blind”. So his practice has been to avoid taking the medication for as long as he can (i.e., until the arthritis is making it almost impossible for him to walk), then take it until he stops improving, then stop taking it until he’s worsened again.

At present he’s at that “worsened” point and has made a doctor’s appointment to get a referral to the rheumatologist again. He has had a CCP test within the past few months. If I’ve got this right, an arthritis level of “4” is considered under control; his tested at “20”.

His knees are quite badly affected and he has been told he needs knee replacements but it’s obviously something he doesn’t particularly look forward to and so hasn’t agreed to it so far. His feet are quite deformed, and he needs surgery on one toe in particular that sticks up and gets rubbed raw by his shoes. His hands are deformed as well, but not nearly as badly. He has had to give up wearing t-shirts because he has too hard a time getting them on and off. He has difficulty with buttons, and socks with too snug an elastic band. He has difficulty with climbing stairs (my family moved to a bungalow in 1989 because of this). He is fairly active despite this and always up for going anywhere. He is retired now, but he worked several years beyond the age of 65 because he enjoyed his job as a trucker. He does award-winning woodworking, though of course he has to pace himself at it. He can ride a bicycle because he has one with a 36” frame that doesn’t make it necessary for him to bend his knees much.

Dad also has had a chronic cough for the past decade or so. It’s always present, but several times a year it kicks into high gear and gets so bad that he coughs until he can’t breath and is vomiting. This cough may or may not be related to his arthritis, but it has defied treatment so far. (It also might be related to a broken nose he received in a trucking accident in 1993.) His lungs have been tested repeatedly and are always clear. His GP just keeps telling him it’s a virus and he’ll get over it, and prescribes antibiotics and inhalers. The inhalers seem to break up the worst of the cough, but it never really goes away.

Dad also sometimes gets horrible, itchy, open-sore rashes on his legs. He hasn’t had this rash for quite awhile and I’m pretty sure it’s a side effect of his medication.

A few days ago, knowing what an Internet fiend I am, Dad asked me to do research on possible causes and treatments for his cough. Since I think his cough may be related to his arthritis, I’m broadening my area of research. Any help or information you can give me will be appreciated. Thank you.

Drug interactions while taking Mobic (meloxicam)?

verytres — Mon, 26 Nov 2007 21:52:06 -0800

Due to a recent injury, my ortho has prescribed 15mg daily doses Mobic. I seem to have escaped any sort of stomach/g.i. issues that can be associated with this drug, but I seem to have a cold looming on the horizon... Assuming no stomach, kidney, liver, heart, blood pressure issues what sort of over the counter flu meds can I take while on NSAIDS ? What if I get just an average, everyday headache?

Yes, I know YANAD, but my ortho's out of town for the week. And yes, I'll call my local Walmart pharmacy in the morning, for what its worth. No, I don't plan on popping 6 Advil a day for any extended period of time.

But I do wonder what folks on these meds do for the occassional, unrelated, aches and pains of life.

My 12-yr old German Shepard. It's not hip dysplasia but is it more than arthritis?

doppleradar — Fri, 31 Aug 2007 06:43:58 -0800

My 12-yr old German Shepard. It's not dysplasia, but is it more than arthritis? My elderly german shepard had a sudden change in health and started having incontinence and difficulty walking. It seems that his back legs actually cross each other when he walks and sometimes it looks like his back end is jack-knifing. He seems entirely unaware of his bowel movements (poops where he's laying), but gets up and urinates just fine.

The vet said it was not hip dysplasia, and has put him through different rounds of incontinence and arthritis medication. He is currently on a thyroid medication and a steroidal arthritis med. When first transitioned to these from the the incontinence med it was a radical change for the better, but only for a couple of weeks.

Any insight would be appreciated.

Worker's comp for thumb pain?

Muu — Wed, 02 May 2007 08:05:33 -0800

Should I ask for worker's comp on what may be thumb arthritis? What's the chance the case would be considered? I am usually in an office environment; most work is on the PC, but not necessarily all of it typing (I do prefer the keyboard, but working on CAD and ladder logic does necessitate greater use of the mouse). A few days ago I suddenly started having a little annoyance on my left thumb joints when using it. Today it's gotten to the point that typing on the left hand transmits some pain to the thumb joints. Just as a little note, I usually input "space" with my left thumb. Also, I am right-handed.

I am also somewhat of a console gamer; the left thumb is oft-used for movement controls. I cant say that either one of these caused this state, though i'm sure both contributed.

Obviously I need to see a doctor, and soon at that, but upon calling for an appointment I found out that if I plan to get any sort of worker's comp for this I need to file that first. It can be one or the other, but the decision cannot be switched after the initial appointment. Is this a worthwhile case to pursue? Even if I do pay the bills on my own, and even if they go as far as to do a MRI for this I probably won't have to pay more than $200~$300 in total for dr visits, etc. and sick leaves are given by default. The only different case would be if, down the road, I end up having to get surgery to remedy this problem.

Since I'm in the process of negotiating a raise as well, I'm not sure how asking for compensation on arthritis may affect negotiations at this point. Since I'm right-handed this really doesn't significantly slow down what I have to do for work (assuming it really is arthritis and I get thumb splints or something), and I'm sure my manager knows this, but I can't confidently say the same for the HR.

Seeking physical therapist

smartypanties — Wed, 08 Nov 2006 14:11:46 -0800

Need recommendations for a great physical therapist in NYC that is good with hips. I have significant arthritis, despite a preventative major surgery (ganz osteotomy) last year I am "looking forward" to a hip replacement within the next 5 to 10 years. I am 33 and dance in a troupe. Having major trouble finding good therapy and massage that falls within my Aetna hmo. Don't worry about the insurance, I will check that out. Just give me recommendations, pls.

Mother Nature

billtron — Mon, 21 Aug 2006 13:04:54 -0800

Where can I go car camping with my arthritic mother-in-law near Lake Tahoe? Two siblings, their spouses and their parents are going to Lake Tahoe for a week. They ambitiously have decided to go camping, for at least one night, even though the mother has never camped, ever. She will be getting knee surgery in the next few months, and hiking is out of the question, but sitting under the stars eating smores is not. Any suggestions would be greatly appreciated.

The trip is next week.

Is indomethacin still being manufactured?

Ethereal Bligh — Wed, 10 May 2006 15:04:43 -0800

(Note: I'm in the US) My pharmacist this week was unable to fill my prescription for indomethacin. I was able to find it at another pharmacy; but several pharmacies are out of it and my regular pharmacist says that the manufacturer has stopped making it. Does anyone have any information about this? I'll consult my doctor, of course, but I doubt he'll know anything. My pharmacist didn't tell me much (actually, one of their staff said this was temporary, the other said it was permanent).

I'm very alarmed by this because nothing I've taken for my osteoarthritis (and related; results from collagen gene mutation) has worked as well as indomethacin. Vioxx is the only thing that has come close. Celebrex worked better than ibuprofen, but not as well as Vioxx did.

Because my pharmacist couldn't fill the scrip, I've gone about five days without the indomethacin and I can barely walk at all. It's a bit frightening to see how much the indomethacin has helped me—my disease is progressive and in the year since I switched to indomethacin it's gotten quite a bit worse. My doctor also prescribes a narcotic (was hydrocodone, now 65mg of codeine or whatever the dosage is in in the Tylenol #4) for me, as well; I've tried taking it both regularly and only when I've needed it for acute pain and, frankly, it doesn't help all that much. I'm taking four a day now as I don't have my indomethacin, and it's not doing much good. I mention this only to give a sense of why I'm alarmed at the possibility of not getting any more indomethacin.

Thanks to anyone with any information.

Aging Cat

Eothele — Fri, 03 Mar 2006 16:49:22 -0800

17 yo cat with advanced arthritis (or something). She been getting wobblier over the last year or two, and her condition has flushed in the last couple of months- wobble to hobble to limp to worse. In the last week her limp became very pronounced, and as of today she's walking on three legs without using her back right leg at all. The vet was not helpful on the phone, and discouraged a visit. I should mention at this point that my cat is a raging psycho bitch who has trashed many exam rooms and turned the tables on many techs who intended to draw her blood, and now when I update her shots I have to pay extra $$$ to have her sedated. Anyway, here're my questions

The internet recommends weight management and exercise, but also early diagnosis. Are these approaches still useful at this late stage?
Anyone have good or bad experience with glucosamine and/or chondritin?
Any non-arthritis explanations I should consider?
Does all of this portend a near demise?

My jaw has shifted

karmaville — Tue, 28 Feb 2006 21:30:41 -0800

It seems as if my jaw has shifted forward about an inch. How is that possible? On waking Sunday morning, I noticed that my jaw had shifted forward. It took me from a very small overbite to a pronounced underbite. My teeth no longer "fit" together properly.

I have had some minor jaw pain recently, TMJ-like, from a flare of chronic arthritis. It felt like a ball bearing stuck in the hinge causing pain when I bit down. I still have a slight burning sensation and some tightness under my right ear. This has been going on for about two weeks after stopping an anti-inflammatory due to side effects.

Unfortunately, I have neither access to neither my rheumatologist or a dentist for at least a week or so. Is it possible that the joint inflammation is pressing my jaw forward causing the problem? Have you experienced anything similar? Should I seek emergent care?

I am worried that I take too much vicodin.

Anonymous — Mon, 06 Feb 2006 23:29:58 -0800

I am worried that I take too much vicodin. I have two forms of degenerative arthritis for which I take vicodin for pain, DMARDs (Humira and azathioprine), an NSAID (diclofenac), and as of this weekend, prednisone.

Over the last few months, due to a combination of the stress of my mother's death and general bad health, my arthritis has flaired causing me to take up to six or seven 5/500 or 7.50/750 vicodins a day to reduce my pain. On the pain scale it takes me from a 9 to a 6 or 7. Basically, it allows me to walk or do what most would consider limited daily activities.

My concerns are threefold. First, I am very concerned about addiction. I tell my family and friends that at my level of pain, addicition is unlikely since it is for true pain and not recreational. Am I deluding myself?

Second, I have common opiate side effects. Zero energy, constipation, interruption of sleep patterns, and inability to concentrate. I cannot sleep well unmedicated due to the arthritis pain, but the vicodin affects my ability to sleep deeply. Any advice on how to mitigate these side effects?

Third, while my rheumatologist has been excellent in treating the arthritis, and sympathetic to my pain, she has been leery about stronger pain medicine. My thought is since she is a high profile doctor, she is worried about increased DEA attention for prescribing narcotics. She did take me from a 5/500 to a 7.5/750 prescription. I worry about how to be honest about my pain without seeming like I am just looking for a high. What is the best way to talk to my current or a new physician about my pain management?

I can deal with some chronic pain, but at this level, with this amount of pain killers, I worry that I will never feel normal again. I appreciate your help and advice.

Ouch!

Malor — Sat, 26 Nov 2005 02:07:17 -0800

My mother is developing severe arthritis in one finger, and can't take most anti-inflammatories. Options? Just thought I'd see if the collective expertise here extends to arthritis. She was showing me her right index finger yesterday, and the joint at the tip is actually becoming deformed... it looks terribly painful. Medications like Celebrex seem to work well, but even Celebrex gives her stomach problems. (I gather that one is supposed to be easier on the digestive system.) Ibuprofen is right out. I think the other mainstream ones all give her trouble too. I believe she's taking a glucosamine/chondroitin/MSM supplement, but I'm not sure how much that's helping.

I'm thinking she'll perhaps have to go to some kind of topical remedy... or, if there's some medicine out there that will improve digestive tolerance of anti-inflammatories, that would be good too. I don't think all that much of her doctor, from what she's told me, so I'm hoping for good ideas here.

As an aside, we easily forget what a blessing the modern painkillers are. What an amazing improvement they make to quality of life. If you're short on things to be thankful for, aspirin and ibuprofen definitely rate up there.

Thanks in advance for any suggestions.

acupuncture for dogs

vito90 — Fri, 28 Oct 2005 20:23:11 -0800

Experiences with acupuncture for your doggie, in particular an older companion with arthritis? My 10.5 year old Basset Hound Lou (still kicking!) has added arthritis to her current list of maladies. I have one acquaintance who used acupuncture on her dog, to good effect. I am interested in hearing more opinions. Did it make a difference? Did your dog freak out the first time or first couple times? How frequent were your treatments? How much did they cost? I am pretty sure my dog's oncologist can recommend a good canine acupuncturist, as she is a big believer in natural/holistic treatments as a supplement to hard science. Thanks in advance for replies. Shane, still have the biscotti signal? :)

An arthritic at age 30??

mragreeable — Thu, 22 Sep 2005 14:25:09 -0800

I'd like a little help diagnosing joint pain in my fingers. (This is kinda long - sorry.)

The most obvious guess, to me anyways, is arthritis. I went to the doctor about this and he looked at my fingers and felt them for a moment and said "well you certainly don't look arthritic" and that was the end of it. (That makes him sound like a pretty crappy doctor but I went in for a couple of other issues. I wish I had pressed the issue a bit more in retrospect.)

In particular, it's the joints closest to my fingertips that hurt. I've read rheumatoid arthritis tends not to hit these particular joints. It's worse when I first wake up. It hurts to make a fist but goes away after a few minutes of moving my hands. Even if I take a brief nap in the afternoon my hands will hurt when I wake up then too. If I grab that joint and squeeze it, it hurts even now, though.

The joints aren't swolen or warm or anything.

Some background - I'm 30. BMI calculators put me safely in the "normal" range. Low blood pressure. Don't know about blood sugar level or anything like that, if it matters. I don't know of any health problems I have, except I have psoriasis, which apparently can cause its own unique variet of arthritis as well. I exercise daily and my diet is... well, not terrible.

Also, the pain sorta coincided with my taking up Brazilian Jiu-Jitsu, which was about three months ago. I go five days a week. BJJ generally leaves me sore and bruised all over, though we are not allowed to attack fingers, and what's going on with my fingers doesn't seem like normal soreness/minor injury to me. To defend against chokes and arm bars I will often hold on to my lapel or sleeve, so I do end up clenching my fists pretty tightly from time to time there. Though I wouldn't expect that to cause my fingers to ache only after I wake up.

Does anyone have any ideas? This doesn't seem consistent with any list of symptoms for any variety of arthritis I've read about.

British National Health Service for Americans spending year in London

lukemeister — Sun, 21 Aug 2005 11:03:06 -0800

I'm planning to spend most of next year at a university in London on a sabbatical from my job at a nonprofit research institute in the US. My wife, son, and I are American citizens. I'll still be paid by my US employer. What will be covered by NHS? My wife takes an expensive medication (Remicade) each month for her rheumatoid arthritis. Our insurance in the US covers it, and it looks like it's covered *in principle* in the UK, but I have some doubts. Our US insurance will not cover us when we're out of the country, except in case of emergency.

Assistive Animation Technology for Creative 17 Year-Old with Chronic Pain

abbyladybug — Mon, 30 May 2005 18:10:06 -0800

I am working with a 17 year-old boy who has Juvenile Rheumatoid Arthritis. He loves doing animation on the computer, and he has been using Windows Movie Maker. In recent months, he has been in a chronic flare and is unable to use his hands. He is also very depressed, and I believe that being able to do something he loves may help his current mental state. Does anyone know of any animation software that has adaptations for use with voice commands? (I know about Dragon Dictate for Word Processing, but can it be used with other types of software?) Bonus points if you can tell me about any benevolent companies or agencies that offer this kind of software/hardware at a discounted or pro bono rates. This boy is not from a wealthy family and he has only the most basic health coverage.

Taking notes without a pen

sixpack — Mon, 18 Apr 2005 09:53:48 -0800

Severe hand pain (arthritis) is hampering a friend's note-taking abilities. What are her alternatives? She has problems holding a pen for long periods. She's an excellent typist and may be able to use a small keyboard on the job. I've come across Dana by AlphaSmart and JVC MiniNote - anyone have any experience with these, or other alternatives, suggestions?