I'm a left handed quilter also. I don't use a hoop, I use one of those finger cots that money handlers use on my thumb....( you can get a whole box of them from Office Max for a couple of bucks or so)...not only protects my thumb, but is excellent for pulling the needle through. I use a leather thimble on my middle finger and I tread lightly with my "under" finger on my right hand by "loading" the stitches on the needle with it instead of just feeling for the needle and letting it prick me. Takes practice but it is achievable.
If you use a hoop, you can place it loosely in the hoop and use an Aunt Becky tool to do what I do with my "under" finger. I have and Aunt Becky but I don't use a hoop right now. They are about $5.
Counting stitches.......I don't bother.......I just concentrate on making them the same size.