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Dear Frank, I haven't had any problems during my 20+ years as a librarian, but my colleague at the high school suffers from carpal tunnel problems in BOTH wrists. For a time, both of her arms were in slings and the district authorized her secretary to accompany her to all meetings to take notes for her. My colleague still uses pens and pencils with a triangular wrap around them, thus increasing their diameter and making them easier to grasp. She hasn't had surgery, but does attend physical therapy sessions. Sincerely, Shirley Ellis Cambridge, WI