Hold the Phones!

As we become a nation of text-obsessed, smartphone wielding citizens, there are a few rules of thumb to follow to (pardon me) save the thumbs we spent millions of evolutionary years to develop.

People tend to text with their thumbs simply because the phones are ergonomically designed to be held by the fingers and manipulated by the thumbs.

The saddle joint on which your thumb spins is especially agile, similar to your shoulder set inside a shallow socket, allowing for relatively free motion in many directions.  We are familiar with baseball pitching injuries of the shoulder due to repetitive stressors on the rotator cuff attachment sites.  In like manner, the tiny whirling motions of your thumbs flashing across the glass keyboard take the joint through a redundant set of motions hundreds, perhaps thousands, of times per  day.  Unlike the shoulder, the thumb is designed for minute, fine motor tasks requiring controlled dexterity within a small radius of motion.

How do we keep our thumbs pain-free in a world seemingly designed of thumb-manipulated gadgets?

Here are two ways to understand your actual grip and your astounding thumb dexterity as different entities:

1.  Grip heavy objects with your hand/palm, not your thumbs and index and middle fingers.

Grip strength comes from the pinky and ring finger side of your hand.  Don’t believe me?  Find a hefty textbook or reference book at least 1″ deep and weighing 3-5 lbs.  First hold it with your “hammer/tennis racquet” grip of mainly thumb, index, and middle fingers, right in the webbing of your hand.  Now pull or have a friend try to pull the book from your hand.   You should have medium grip strength, barring you are a professional hammer or racquet user.  Here is the second part of the experiment:  hold the same book in your hand as you would a guitar neck, with the weight of the spine right where all four fingers bend at the knuckles.  Instead of pressing with your thumb tip on the other side, use the meat of your thumb (thenar eminence) to apply counter pressure against your fingers. You’ll notice your thumb has to move to the side and the stress of the joint is now cushioned by the large thumb muscles.  Pull that book out of your hand or ask a friend to give it a shot.  You should feel a difference immediately in the strength, the contact, of your proper grip as opposed to your fine motor grip in the first scenario.  If the experiment does not make sense to you, try doing a pull-up on a chin bar with your palms facing away (weaker grip) or your palms facing towards you (stronger grip).  Same principle.

2.  Now that you are aware of and can respect the strength of your amazing hand, let’s try a quick couple of strength versus dexterity tests for the thumb.

Make an OK sign with your thumb and index finger; now try to pull the ring apart with your other hand.  Pretty strong, eh?  Place your thumb flat against your palm in line with your index finger; try to lift your thumb off your palm with your other hand.  Again, strong.  Now, spread your fingers and thumb wide; use your opposite palm to apply pressure to the outside of the spread thumb, pushing it towards your palm.  Not so strong.  Hold your hand as though you were about to grasp a round object (baseball, doorknob) and gently try to pull your thumb out as though you needed to grip a larger object such as a softball or grapefruit.  Can you see and feel that this is another weak position for your thumb?  These last two positions are “open”, leaving the thumb vulnerable in its mobility.  They are also the most common positions for your thumb while texting:  lifting the thumb away and then swiveling the joint as though holding a round object, returning to the screen for each individual letter.   Each individual letter!

“Okay, so she wants me to carry heavy objects with my palms up, fingers to the base of my thumb instead of palm down, and my thumbs are consistently being put through the paces in their weakest positions when I’m texting.  Am I supposed to stop texting?”

Yes, you are supposed to stop texting exclusively with your thumbs.

Use a stylus, your  index fingers, your pinky finger to mix things up, or make your texts shorter when you do use your thumbs.

After talking with several 19-24 year olds who already have basal (thumb) joint pain from texting, not to mention mouse and touchpad use, I am making an educated prediction that orthopedic surgeons are going to see a great deal of early onset basal joint arthritis in the current generation of texters.  I also am predicting that middle aged texters who grew up on the QWERTY typewriter and then computer keyboard are going to experience greater incidence of osteoarthritis at the basal joints due, in part, to the addition of texting to the normal thumb stressors of Western culture (driving, opening jars, turning screwdrivers, cutting hair, writing, ironing, etc.).

The weapon you have is control.  While texting is a relatively new phenomenon, it will do the damage before it is replaced by new technology.  In fact, you probably already have the precursor to the new technology on your smart phone:  voice recognition.  No, you cannot speak in a robotic monotone during a meeting or in the classroom but yes, you can while sitting in front of the TV or in bed or, heaven forbid, while driving.  I do not condone talking on a phone much less texting while driving but there are people out there who do both.  Turn on voice activation if you insist on texting while driving and tell your friend that you will call or text him when you reach your destination.  If you must text and not talk during a meeting or the like, keep thumb texting to a minimum.

On a train, bus, or plane, it is great to keep a stylus handy.

When using a tablet, invest in a cheap external keyboard instead of the onscreen keyboard, or, again use the stylus to hunt and peck.

My hope as a chiropractor who has already suffered through basal joint arthroplasty (removal of a destroyed wrist bone due to thumb overuse) is that none of you will consider an “LOL” more important than the precious evolutionary marvel which is your thumb.  The surgery has a 6 year recovery for 92% restoration of strength.  Now in the middle of my 3rd year, I drop heavy objects or yelp when I hyperextend my thumb joints.  I have the thumb joints of an 80-year old farmhand: distorted, painful, and now only partially in place.  I am 43 years old.

Save your thumbs.  You need them for just about everything except sleep and pain can wake you up from sleep - that’s no safe haven from osteoarthritis.  Feel free to contribute in the comments section ways in which you have conserved your thumb health and how texting has so far affected your wrist and thumbs.  In the next post, we will discuss ways to preserve wrist strength and joint health.

Namaste.

Wrist Braces: Exploring your options

Last week at the local Wal-Mart, I discovered a cheap wrist brace in the sporting goods section.  The Gold’s Gym Wrist Wraps were staring right at me. Why hadn’t I thought about weight lifting wrist braces before?  Clearly I do not spend enough time at the gym!

The box contains 2 wraps, touted to ‘increase stability’ and are made of a heavy-duty poly and elastic material.  In other words, they are flexible but not overly so and the folks at Gold’s were nice enough to include 2 in each box, unlike many of the medical brace manufacturers.

Price: $5.97

Uses: Keyboarding, hobby crafting (sewing, model building – think of the thing you like to do but gives you wrist pain), weight lifting, etc.  I typed for 6 consecutive hours the first night I owned them and had very little soreness as opposed to wearing the basal joint (thumb) braces I have also recommended on this page.

Specs:  The wraps have a thumb loop useful for getting a secure finished support, however you may find you can take them off and tuck them inside the braces while you work.  If you cut them off, you may compromise the leverage they afford when you secure the wraps.

Cautions:  Use common sense when tightening the wraps around your wrists.  You know when you have put a Band-Aid too tightly around your finger and you will know when you have made these wraps too tight, as well.  During keyboard use particularly, experiment with the tightness: if it is uncomfortable to hold your hands prone/palm down, then the wraps are too tight.  View it as the same learning curve you used to decide how tight to tie your sneakers or dress shoes – too loose and what’s the point?  Too tight and your toes go numb.

If you are a person with diabetic neuropathy (numbness or tingling) in your hands or fingers, or you have nerve damage from carpal tunnel surgery or have undergone repair for a FOOSH (Fall On Outstretched Hand) fracture, then ask your primary care physician if compression at your wrists is both safe and encouraged.  No need for the cure to cause more pain or damage!

*Depending on which way you wrap these braces, your wrists will either be guided more into pronation (palm down) or supination (palm up) so make sure you wrap them to suit your comfort level.  If you are currently being treated by a physician for post surgical pain or an OT for rehab, then ask which is more appropriate to your particular healing needs. 

Good luck!

If you find other brands or retailers you would like to recommend, please do so in the comments section under this article. Happy typing!  Gold's Gym wrist wraps

Achenbach’s Syndrome

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The Paroxysmal Purple Finger

As I write this post very gingerly due to the large blue and purple swelling at the last knuckle of my middle finger, I can attest that paroxysmal hematoma of the finger or Achenbach’s syndrome is no joke.  Earlier today when opened the hatchback, I again felt the ominous burning sensation in my finger I have been experiencing 3-4x a year since my 20’s.  Sure enough, when I looked down, my finger had already begun to swell and turn an unsightly bluish purple.  I went inside for ice and a kiss immediately.

If you are one of the (un)lucky few, you may have a condition in which small physical insults cause the skin over finger or toe joints to suddenly burst superficial vessels.  It looks scary:  it hurts, burns, and swells quickly, but it is not usually a sign of a more insidious condition.  The etiology (reason) for Achenbach’s syndrome remains a mystery.

The signs of redness, swelling, and warmth are typical as is the spreading discoloration directly across the joint.

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Women are more likely to suffer from paroxysmal hematomas of the hand, and the condition may also be related to Raynaud’s disease and migraines, two more conditions associated with a higher incidence in women.  Raynaud’s Disease (unlike Raynaud’s phenomenon, which is a sign of more serious underlying pathology) is idiopathic or of unknown origin.  Raynaud’s Disease is spontaneous vasoconstriction of the tiny blood vessels in the extremities, usually fingers and toes, which causes them to blanch or turn white when a person becomes too cold.

Migraines are the result of a vascular constriction then dilation of the blood vessels around the brain, the sudden change in which causes the nauseating, one-sided pain well known to migraine sufferers.  Achenbach’s syndrome, migraine and Raynaud’s Disease all share slightly irregular vessel activity.

What to do when you have a paroxysmal (sudden) hematoma (bruise) of the finger:

  • Ice in 5 minute increments with at least 30 minutes in between, and remove the ice if it becomes uncomfortable.  Do this in the first 24 hours.
  • After the initial stage of injury, you may apply warm compresses to draw blood to the area and encourage the escaped venous blood to clear out.  Warm compresses but not heat may be used for 5-10 minutes with 30 minute breaks in between.  Do this after the first 24 hours.
  • The joint may feel hot, swell, and be difficult to bend.  If the swelling and redness has not begun to recede within the first 1-2 days, get it checked out by a medical professional.

There are other conditions resembling the purplish-blue discolorations of fingers and toes which may be ruled out by your doctor.  If you or a loved one have the symptoms of Achenbach’s but your bruise does not begin to heal within 3 days or you have the bruise or a bluish discoloration in more than one finger or toe at a time, you should ask your healthcare professional for an assessment.  Blood thinners and ibuprofen or other NSAID’s may be necessary for your health but cause you to bruise easily.  Do not stop taking your medication without first consulting your doctor.

If you have been diagnosed with Achenbach’s syndrome by a health professional and would like to share your experience, please add to our comments section.

CAVEAT: the Internet is not a substitute for healthcare or education.

Use the information you find here and wherever you look to help you pay detailed attention to yourself and your loved ones.  Healthcare professionals are paid by us to serve us, and each of us deserves thoughtful consideration. 

~Enjoy the sunshine

 

Don’t let the mouse bite your wrist

 

Logitech Wireless Touch Keyboard K400

Is your wrist or hand sore from long hours using the computer mouse?

Have you had any numbness or tingling in your thumb or index finger after you spend time using the mouse?

A simple stop-gap solution for those of us who must continue to work on the computer is to purchase a wireless keyboard with a built-in touch pad.  This is the same idea as the one on your laptop, however more ergonomic (wrist friendly) in that the pad is positioned to the right of the keyboard instead of centered below it.

Benefits of the wireless keyboard with touch pad:

  • Any finger can move the cursor from the touch pad.
  • Because the keyboard is wireless, you may hold it in any position you please, including like a guitar or accordion!
  • Wireless keyboards allow you to place them in your lap while you type, decreasing the angle you must maintain in a flexed elbow and wrist position on tethered keyboards that rest on a desk surface.
  • The keyboard has a range extender – you may sit as far back as you like from the screen, so long as you can read it.
  • Control your laptop when it is hooked to your TV (for all you tech savvy types).

I purchased the k400 Wireless Touch Keyboard from Logitech at Wal-Mart for $29 last week.

I am delighted to report that despite an average of 4-5 hours each evening on the keyboard, using the touch pad has lessened my evening wrist pain by 50% in 3 days.  I also have some peripheral nerve damage on the end of my ‘mouse’ index finger so clicking the mouse button aggravates my fingertip until I have to stop working.  Since I can now use my middle, ring, or pinky finger to maneuver the mouse and no longer have my wrist locked in the flexed position for hours on end, I have had very few symptoms of carpal tunnel in my right wrist as related to the computer mouse.

Here are some options for purchase. Copy and paste them to your address bar:

http://www.amazon.com/Logitech-Wireless-Keyboard-Multi-Touch-920-003070/dp/B005DKZTMG

If you are one of my dear left-handed readers, please consider purchasing an external touch pad to save your wrist:

http://www.ergonomictouchpad.com/ergonomic_touchpad.php?gclid=CI6hzNn4_LcCFZOk4Aod4B8A1g

Possible considerations before purchasing the Logitech keyboard with touch pad:

  • 2 batteries are included; an ON/OFF switch on the keyboard allows you to save battery life when not in use.
  • The touch pad is more versatile than the mouse.  Like a smartphone, it allows you to expand or shrink the view by spreading or closing your fingers as a pincer motion.  Many other features are included for Windows 8 but can disabled by you if using an earlier version.
  • The ‘shift’ button on the right side is slightly further away than the typical large control shift bar and takes a little getting used to.  I hit ‘page up’ by accident frequently and insert text where I don’t want it.  This may cause you to consider simply buying a touch pad for your regular keyboard.
  • The keyboard has a range of 33 ft., in case you are controlling your TV viewing with your computer.

As always, research many different touch pad keyboards and detached touch pads by reading the Amazon customer reviews.  They are excellent and often written by seasoned technology reviewers.

Please add your finds, experiences, and helpful hints for wrist health while using the mouse to the comments section of this post.  I welcome your life experience and wisdom.

Carpal Tunnel Syndrome (CTS) can become a serious impairment to your overall quality of life.  If you are having ongoing wrist pain exacerbated by activities such as keyboarding, please see your chosen health care provider to be evaluated for CTS.  The orthopedic tests are slightly aggravating but not painful and they only take a few minutes.  CTS will not go away unless you make a lifestyle change and can eventually damage the nerves which feed the main portion of your hand.  Since CTS is preventable and easily diagnosed, do yourself a favor and just ask your doctor to evaluate your symptoms.  That is what practitioners get paid to do – help you.  

Be a wise health consumer and be your own advocate.  If you cannot speak up for yourself to your satisfaction, ask a trusted friend or family member to accompany you to the doctor’s office. Take care of yourself and expect your healthcare provider to address your concerns to your satisfaction.

Thanks again for reading all the way to the end!

 

 

Some stories were meant to be repeated…

 

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(Sixth century B.C.)  Fables.
The Harvard Classics.  1909–14.

The Man, the Boy, and the Donkey
A man and his son were once going with their Donkey to market. As they were walking along by its side a countryman passed them and said: “You fools, what is a Donkey for but to ride upon?”   1
  So the Man put the Boy on the Donkey and they went on their way. But soon they passed a group of men, one of whom said: “See that lazy youngster, he lets his father walk while he rides.”   2
  So the Man ordered his Boy to get off, and got on himself. But they hadn’t gone far when they passed two women, one of whom said to the other: “Shame on that lazy lout to let his poor little son trudge along.”   3
  Well, the Man didn’t know what to do, but at last he took his Boy up before him on the Donkey. By this time they had come to the town, and the passers-by began to jeer and point at them. The Man stopped and asked what they were scoffing at. The men said: “Aren’t you ashamed of yourself for overloading that poor Donkey of yours—you and your hulking son?”   4
  The Man and Boy got off and tried to think what to do. They thought and they thought, till at last they cut down a pole, tied the Donkey’s feet to it, and raised the pole and the Donkey to their shoulders. They went along amid the laughter of all who met them till they came to Market Bridge, when the Donkey, getting one of his feet loose, kicked out and caused the Boy to drop his end of the pole. In the struggle the Donkey fell over the bridge, and his fore-feet being tied together he was drowned.   5
  “That will teach you,” said an old man who had followed them:

        donkey4

   “PLEASE ALL, AND YOU WILL PLEASE  NONE.”

 Translation: If you try to please everyone,  you might as well kiss your ass goodbye.

 

  6

Why can’t I get comfortable at my desk?

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Do you have a 12-hour desk or does 30 minutes in your office chair leave you squirming around and fighting a headache? 

The most important component of a daily sitting marathon is small breaks of standing and walking, even if you are in a cubicle.  Set a small alarm on your phone or get the app which reminds you to take a break every hour.  Just stand up, shrug your shoulders, wiggle your toes, and shake out your arms.  Easy!

Set your monitor 30 degrees below the horizon of eye level.  You want to look down at the screen, not directly at it, in order to avoid eye and neck strain.   How does that avoid neck strain?  Try this experiment:  sit upright and stare straight ahead at an object directly at eye level.  Now slump forward slightly, as though tired, and notice your gaze drops as well.  In order to correct it, you naturally lift your chin and crane your neck to maintain a level gaze in the ‘tired’ position.  Craning your neck forward like a turtle puts undue strain on the muscles which are meant to stabilize your head in space, not hold it up like reinforced steel beams.  That is the job of the spinal column, so take the weight off your muscles and give it back to your spine!

Place the keyboard in your lap, if possible, and use a wireless mouse.

Reach forward with your hand and touch the desktop screen with your fingertips.  The screen should be at arm’s length from your face.  We get eyestrain and our lids begin to close, and as mentioned above,  we tilt our heads back and crane our necks slightly.  When you find yourself getting sleepy or wondering if you are still sitting upright, reach out and touch your screen.  Sit back comfortably, tuck your chin a little, and look down at your screen.  When it becomes impossible to maintain this position, it is time for a 20 minute break.

Whether you work for yourself or slog hours at a company desk, remember:  there is only one you.  Stoic resignation to work through the pain is for people in athletic competitions and pinned down by sniper fire during a rescue mission.  You are not at work to hurt yourself or be hurt.  The company will never have neck pain or carpal tunnel surgery.  The company does not lie awake at night because it cannot sleep on a sore hip or shoulder.  And if you are the company, would you want to work for you?

Change your work station little by little to make it comfortable.  You will get more accomplished and take fewer days off due fatigue or pain.  If you sit for a living, you have every right to be your own comfort advocate!  Easing the time you spend in a chair is a gift you give yourself that benefits everyone else.

*Stay tuned for a post on choosing the right office chair for your frame.

Choose the correct brace for thumb joint pain

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comfort cool futuro

Thumb pain from osteoarthritis can ruin your day, all day.  If you have been diagnosed with this disabling condition and you need a little extra support from a brace, consider…

Have you gone to open a jar of salsa only to have searing pain shoot through you wrist at the base of your thumb?  Hissing and cursing, you schlep over to your spouse and hand over the jar to be opened.  You don’t know how often you rely on your grip until you lose it!  If you have trouble turning doorknobs, opening jars, or writing with a pen for too long, then you may have changes to the bones which form the saddle joint in your hand.  While life with basal joint arthritis can be full of surprisingly painful activities, it is also especially frustrating in this world of computer mouse work and typing for hours on a keyboard each day.

There are two good braces on the market for under $25 that stabilize the thumb joint and allow you to control the amount of compression for comfort, versus a ‘glove’ type support which could be too tight or too loose for effective support.  One brace lends more support to the wrist and does not allow too much of the motion which causes pain, and the other allows more motion and stabilizes across the thumb joint directly.

You may have to experiment with both types to see which support is more effective for you, and you may use one for computer work and the other for general wear.  Which brace you choose may also depend on the severity of the changes to the joint: more motion could be irritating if the bones have developed pointy little outcroppings known as osteophytes; less motion might be irritating if you feel as though you are fighting the brace in order to type.

Here are two good braces for your consideration:

  • Futuro Deluxe Thumb Stabilizer The Futuro is made of soft neoprene.  It has two stays (plastic supports) inserted in exterior sleeves along the outside of the thumb, and a tiny band of Velcro at the top of the thumb which can be drawn around and down to restrict motion even more.  Besides the supportive stays, this brace also has a Velcro strap which wraps around the wrist, adding compression support for the wrist itself.  This brace keeps the thumb in a neutral, grasping posture which slightly opens the saddle joint and disallows much of the grinding of bone on bone.  In this case, restrictive is better.  This brace also limits wrist extension and flexion, the killers of long hours at the keyboard and mouse. The Futuro can be had at local drugstore chains or ordered off Amazon.  You can find packs of two on Amazon.  This brace fits either hand, so you need not choose right or left, but you will need to choose the size.

Pros: more stability, more wrist support, less grinding of bone on bone, less wrist fatigue, ambidextrous fit, stays cool to the skin, can be bought at local drugstore

Cons:  pincer motion and wrist motion restricted, slightly bulky

  • Comfort Cool Thumb CMC Restriction Splint  CMC means carpometacarpal, the anatomical description for the joints formed between the wrist and hand bones.  The Comfort Cool does not contain special cooling gels but because the interior is lined with a soft fabric that keeps the neoprene off your skin, it is supposed to stay cool.  Personal experience tells me this brace is not, in fact, as cool as the Futuro outlined above.  It will get warm eventually, but no brace was meant to be worn for more than a few hours at a time.  The Comfort Cool is a totally soft brace; it has no supportive stays and the thumb is allowed to move in its familiar circular pattern while being supported by a sturdy neoprene strap.  The strap wraps from the underside of the wrist, over the top of the painful joint, and through the webbing area between the thumb and index finger.  Because of its design, the Comfort Cool provides a unique couple of features: the neoprene strap keeps your thumb joint in a more widely extended posture than the Futuro, which is a more natural and relaxing all around position for the thumb joint; the neoprene strap goes directly across the base of the thumb, acting as a support for the joint itself.  The Comfort Cool allows more freedom of motion when typing and less restriction.  An added bonus, probably unintentional, is the neoprene attaches on the palm side at the base of the thumb, providing an extra 2 layers of padding against the pressure of the keyboard.

Pros: freedom of motion, compression support directly over thumb joint, easier to wear during typing or writing, recommended by a hand occupational therapist, non-bulky, freedom of wrist motion

Cons: warms up quickly despite the name, no wrist support, must be ordered online or through a hand occupational therapist (at least in my area of NY), can feel tight at edge where meets thumb – quick trim with the scissors solves this.

 Washing either brace is easy.  A little liquid soap and a plastic container of lukewarm water with a tight lid can make a mini-washing machine.  Agitate by shaking the container a few times over the sink, then let it soak 1-2 hours so the emulsifiers in the soap can break down oils.  Rinse, wring out, and hang to dry.

You only get two thumbs, two wrists, and one brain.  If you plan to use your body for the rest of your life, then use it with the intention to make it last, rather than just get it done fast.  Ask a licensed health care professional you trust to have a discussion with you about your hand and wrist health.  Know that claims of ‘arthritis relief’ from over the counter pills and gels are ineffective against the permanently altered bone architecture of osteoarthritis.  Ask your medical doctor directly for help, and utilize the scope of expertise found in your community of chiropractors, occupational therapists, orthopedic surgeons, and acupuncturists.  Each professional has a unique set of skills to manage your pain, but they cannot do it telepathically!  Take gentle care of yourself ~

Copy and paste these addresses to view each brace:

http://www.activeforever.com/comfort-cool-arthritis-thumb-splint

http://www.amazon.com/Futuro-Deluxe-Thumb-Stabilizer-Small-Medium/dp/B000FKJPEW

 

Pop bottle terrarium for pain relief

example

example

No weeding required!

Patients often tell me they are frustrated with the physical limitations of chronic pain.  While this may be an obvious conclusion to people who actually suffer from chronic pain, it may not occur to their healthy counterparts who go about doing daily activities unhindered.  If nagging back pain keeps you in bed for hours and you miss being creative, consider making a terrarium.

Today’s Take Your Mind Off Your Mind activity is a 5 minute video on how to construct a terrarium out of a 2 liter soda bottle.  The Memorial University of Newfoundland has made a clear and simple instructional video.  Before you start, you will need the following items:

  • 2 liter soda/pop bottle
  • scissors or X-acto knife to cut the bottle
  • pebbles, aquarium rock, or sand
  • activated charcoal (*not required)
  • potting soil from a bag, not the yard
  • a few native plants (moss, a sapling, just go look outside!)
  • spray bottle of water

That’s it!  If your hands won’t let you manipulate scissors safely to cut the bottle, then use a jar instead of the soda bottle.  I have two violets that have been growing happily in pickle jars for years.

There are plenty of videos on You Tube which explain ways to make a terrarium.  The MUN staff in the link below recommends bagged potting soil instead of dirt from the backyard because it is sterile and will not promote fungus or bacteria.  Also, be sure to follow the recommendation to use plants found together, as these plants need similar amounts of sunlight and water.

Here’s the link:

Soda bottle terrarium