here's the sitch: i have arthritis, fibromyalgia and tenosynovitis in my wrists. what i need is to have my arms recalled and get new ones seriously though, i'm not able to work the Maya wrap very much anymore. if my husband or someone else does all the adjusting, i can wear it a bit, but once i loosen the top rail enough to lift her out, i can't tighten it back up next time. i just can't do the grabbing motion with thumb anymore, there's no strength and it's painful. (i'm trying to find a rheumatologist to get it taken care of.) anyway, i want to try a pouch, but then i realized i'd still be off balance/assymetrical, which isn't good for fibromyalgia across the upper back. so i was thinking of a MeiTai or other wrap ... how hard are they to wrap and tie? do you need to reach your arm behind you at any point? or up over your head? and how hard do you have to pull to adjust and tie it? thanks!