Thanks man. Since I read your comment, I've been doing all sorts of (careful, careful) stretches and it's helping. I got a bit freaked out about it; my shoulder's feeling a lot better gradually over the past three days ... it's been bad for about six weeks. After Christmas, Ill make an appointment. have a wonderful holiday and thanks for being here.
I’m sorry that you’re suffering and hope that you are correct in thinking that your symptoms are abating.
I’m not a ‘health care provider’ of any kind (e.g., a physician) and I’m in the US. I have however known a lot of sick people, taken care of a few long-term, and have dealt with chronic pain on and off (mainly on) during the past 70+ years. When I was in my late 40s, I began to suffer right shoulder pain very similar to the sort that you describe.
Given your symptoms as described, it sounds like a rotator cuff problem. If so, oral NSAIDs should help. But especially in larger daily doses, long term, NSAIDs have side effects like GI bleeding (mainly esophagus or stomach); chest pain and anemia can result. Omeprazole (a proton-pump inhibitor) can help to prevent the bleeding. Oral Prednisone should also help; long term it has some very bad side effects.
What’s helped me are steroid injections into the shoulder done by an orthopedic surgeon who’s a shoulder specialist. The injections hurt for <10 seconds, take 1-2 weeks to become effective, and provided me with 6-12 months of complete relief. Unless a patient is diabetic, such steroid injections are, unlike long-term oral steroids, quite safe, I’ve been assured on good authority. (Such injections also helped me with a glenoid labrum tear.)
Last time I checked, about five years ago, surgery was not likely to help. But five years is a long time.
My long experience with US medicine has led me to follow this motto to the extent feasible:
In seeking medical care, start at the top and work your way up.
That can be challenging but longer term will result in substantial savings and efficiencies.
I don’t know enough about Australian medicine to know if following that motto is at all feasible there. If Australian GPs are gatekeepers (i.e., care-blockers), then ... try New Zealand??
I appreciate all this. I'm still processing the situation, and feel this daily, urgent desire to do push-ups, and v-push-ups in particular. Last year, I was running about 5k a coupla times per week during the spring, but I neglected my upper-body these past few years and now I'm paying the price. Meanwhile, I'm waiting for the issue to subside somewhat, and I think it seems to be (slowly) provided I dont move my arm or roll onto it during the night. Then again, I've always been a shameless optimist.
If I can get to a point of being able to do a few pushups - and I'm probably weeks away from even daring to try - then I'll be spending a considerable part of next year targeting every shoulder-related muscle, via exercise, that I possibly can. I've always had good shoulders; I feel betrayed.
I appreciate your comment here a great deal; I'll let you know how it goes. I will, at some point, be seeking out professional help, but again - Boston doctors were in a different league. It illustrates how important your zip-code is, in today's world. My doctor friends moved to Boston for college or residency, liked the city and stuck around, so there's a lot of competition in that job market. My friend was a medical director at one of the colleges. That's another life hack - it pays to have smart friends.
(I should have mentioned that I think specialists here in Australia seem fine. My retina-specialist reminds me of the excellent GP I had, when working at Harvard. Medical specialists always are less hit-and-miss)
I'm glad to hear that there are signs of improvement and I hope that the trend continues. Not only does exercise protect against injury, but, I've been told by physicians, it is often anti-inflammatory because increased blood flow reduces the concentration of inflammatory substances.
Having benefited from the expertise of two Boston (Harvard) super-specialists, and having made the acquaintance (socially) of two others, I find it easy to believe that Boston attracts some of the best. It seems more generally that proximity to major medical centers (e.g. , the Research Triangle, NC, NYC, San Francisco, New Haven, CT) helps with quality of medical care in the US. I'd guess that holds also for Australian locations. Sydney and Melbourne certainly show up often as the locations of medical publications.
Hey, great read as always. Your candid observation that GPs are 'not very good, as a rule' really resonated, as it articulates a frustration many experience. Do you think technology, perhaps some AI-driven diagnostic tools, could offer a viable alternativ or support system in the future?
I think there'll be major improvements re: diagnostic tools. But I think only wealthy/fortunate people will have a good GPs. MBAs will continue to lead medicine into a corporate dystopia until everybody, en masse, realizes that MBAs ruin medicine, destroy healthcare, etc. I can imagine GPs becoming a luxury service. I think there will continue to be a growing disparity between good GPs and bad ones. Already, the idea of a good GP is becoming an almost mythical experience to many. I have encountered a fair few, but only in the Greater Boston Area. I think many of them start with good intentions, but this corporate healthcare 'franchise' model is dispiriting and dehumanizing for everybody.
Well, Kris, I consulted Dr. Google and my neighbor and my sister, and my entirely unprofessional opinion is it's your rotar cuff. Welcome to old age, sorry bud. Go see a physiotherapist. They can actually help and often give a shit, too. Mostly. Sometimes.
Here in Canada, our health care is free. Awesome, right? Nope. NOT.
It does not work either. Doctors are overburdened, overwhelmed, and over it completely. In Nova Scotia alone, my wee province, 160,000 people have no family doctor. There are none to be had. They've all fled for greener pastures, i.e., more moolah. Those who do have doctors have the exact same experiences as you in Australia, unhelpful and uninterested 'professional body mechanics '. And if you need to see a specialist, well, I'm waiting to see an ENT... minimum wait 2 years.
There is one silver lining here, and that is nurse practitioners. I have one, and she's amazing. That is not everyone's experience, but it has certainly helped to fill the gaping void in our medical system. Also, our pharmacists are allowed to diagnose and treat simple illnesses, like strep throat, ear/bladder infections, etc, which takes some pressure off our completely crushed emergency departments. These aforementioned ERs are often closed. Yeah, closed. Like, 'sorry you're having a stroke, fellow, but we have no doctors staffed for the next 3 days, turn around and go back to GO'. It's literally scary to be ill in Canada, especially in our poorer provinces, as often there is no one there to help you.
Thanks Denise. The general idea, among neoliberals, is to defund government services then blame them when they stop working. Then replace them with for-profit solutions. Then those just nickle-and-dime everybody, try to make as much money for the c-suite and pay peanuts to everyone else, cut every conceivable cost and axe any service deemed unprofitable - like services in outlying communities.
The idea that businesses are more efficient than government-run organizations is a pernicious myth. The idea that everything is better if run as a business is rapidly becoming one of those lies that everybody knows is a lie. I'm sorry about what's happening there in Canada. Still, fortunate that a trip to a hospital won't bankrupt you. On the other hand, is the US fated to be the worse-case scenario for the rest of us? 'be grateful for your lousy healthcare cause at least you're not in Kentucky!'
Thank you for sending a newsletter despite your obvious pain. I hope you feel better soon. Have a wonderful holiday!
Not a GP…see a physical/occupational therapist—you have a “frozen shoulder.”
Been there done that, fixed.
Thanks man. Since I read your comment, I've been doing all sorts of (careful, careful) stretches and it's helping. I got a bit freaked out about it; my shoulder's feeling a lot better gradually over the past three days ... it's been bad for about six weeks. After Christmas, Ill make an appointment. have a wonderful holiday and thanks for being here.
I’m sorry that you’re suffering and hope that you are correct in thinking that your symptoms are abating.
I’m not a ‘health care provider’ of any kind (e.g., a physician) and I’m in the US. I have however known a lot of sick people, taken care of a few long-term, and have dealt with chronic pain on and off (mainly on) during the past 70+ years. When I was in my late 40s, I began to suffer right shoulder pain very similar to the sort that you describe.
Given your symptoms as described, it sounds like a rotator cuff problem. If so, oral NSAIDs should help. But especially in larger daily doses, long term, NSAIDs have side effects like GI bleeding (mainly esophagus or stomach); chest pain and anemia can result. Omeprazole (a proton-pump inhibitor) can help to prevent the bleeding. Oral Prednisone should also help; long term it has some very bad side effects.
What’s helped me are steroid injections into the shoulder done by an orthopedic surgeon who’s a shoulder specialist. The injections hurt for <10 seconds, take 1-2 weeks to become effective, and provided me with 6-12 months of complete relief. Unless a patient is diabetic, such steroid injections are, unlike long-term oral steroids, quite safe, I’ve been assured on good authority. (Such injections also helped me with a glenoid labrum tear.)
Last time I checked, about five years ago, surgery was not likely to help. But five years is a long time.
My long experience with US medicine has led me to follow this motto to the extent feasible:
In seeking medical care, start at the top and work your way up.
That can be challenging but longer term will result in substantial savings and efficiencies.
I don’t know enough about Australian medicine to know if following that motto is at all feasible there. If Australian GPs are gatekeepers (i.e., care-blockers), then ... try New Zealand??
https://emedicine.medscape.com/article/1262849-differential?form=fpf,
https://www.aaos.org/aaos-home/newsroom/press-releases/aaos-updates-clinical-practice-guideline-for-the-management-of-rotator-cuff-injuries/ and
https://www.orthoguidelines.org/topic?id=1051&tab=all_guidelines
might yield some useful hints. Medscape keeps their information pretty up-to-date and organizes it fairly well.
I appreciate all this. I'm still processing the situation, and feel this daily, urgent desire to do push-ups, and v-push-ups in particular. Last year, I was running about 5k a coupla times per week during the spring, but I neglected my upper-body these past few years and now I'm paying the price. Meanwhile, I'm waiting for the issue to subside somewhat, and I think it seems to be (slowly) provided I dont move my arm or roll onto it during the night. Then again, I've always been a shameless optimist.
If I can get to a point of being able to do a few pushups - and I'm probably weeks away from even daring to try - then I'll be spending a considerable part of next year targeting every shoulder-related muscle, via exercise, that I possibly can. I've always had good shoulders; I feel betrayed.
I appreciate your comment here a great deal; I'll let you know how it goes. I will, at some point, be seeking out professional help, but again - Boston doctors were in a different league. It illustrates how important your zip-code is, in today's world. My doctor friends moved to Boston for college or residency, liked the city and stuck around, so there's a lot of competition in that job market. My friend was a medical director at one of the colleges. That's another life hack - it pays to have smart friends.
(I should have mentioned that I think specialists here in Australia seem fine. My retina-specialist reminds me of the excellent GP I had, when working at Harvard. Medical specialists always are less hit-and-miss)
I'm glad to hear that there are signs of improvement and I hope that the trend continues. Not only does exercise protect against injury, but, I've been told by physicians, it is often anti-inflammatory because increased blood flow reduces the concentration of inflammatory substances.
Having benefited from the expertise of two Boston (Harvard) super-specialists, and having made the acquaintance (socially) of two others, I find it easy to believe that Boston attracts some of the best. It seems more generally that proximity to major medical centers (e.g. , the Research Triangle, NC, NYC, San Francisco, New Haven, CT) helps with quality of medical care in the US. I'd guess that holds also for Australian locations. Sydney and Melbourne certainly show up often as the locations of medical publications.
That should be "medical publication _authors_." I'm not sure where the publications are located.
Hey, great read as always. Your candid observation that GPs are 'not very good, as a rule' really resonated, as it articulates a frustration many experience. Do you think technology, perhaps some AI-driven diagnostic tools, could offer a viable alternativ or support system in the future?
I think there'll be major improvements re: diagnostic tools. But I think only wealthy/fortunate people will have a good GPs. MBAs will continue to lead medicine into a corporate dystopia until everybody, en masse, realizes that MBAs ruin medicine, destroy healthcare, etc. I can imagine GPs becoming a luxury service. I think there will continue to be a growing disparity between good GPs and bad ones. Already, the idea of a good GP is becoming an almost mythical experience to many. I have encountered a fair few, but only in the Greater Boston Area. I think many of them start with good intentions, but this corporate healthcare 'franchise' model is dispiriting and dehumanizing for everybody.
Well, Kris, I consulted Dr. Google and my neighbor and my sister, and my entirely unprofessional opinion is it's your rotar cuff. Welcome to old age, sorry bud. Go see a physiotherapist. They can actually help and often give a shit, too. Mostly. Sometimes.
Here in Canada, our health care is free. Awesome, right? Nope. NOT.
It does not work either. Doctors are overburdened, overwhelmed, and over it completely. In Nova Scotia alone, my wee province, 160,000 people have no family doctor. There are none to be had. They've all fled for greener pastures, i.e., more moolah. Those who do have doctors have the exact same experiences as you in Australia, unhelpful and uninterested 'professional body mechanics '. And if you need to see a specialist, well, I'm waiting to see an ENT... minimum wait 2 years.
There is one silver lining here, and that is nurse practitioners. I have one, and she's amazing. That is not everyone's experience, but it has certainly helped to fill the gaping void in our medical system. Also, our pharmacists are allowed to diagnose and treat simple illnesses, like strep throat, ear/bladder infections, etc, which takes some pressure off our completely crushed emergency departments. These aforementioned ERs are often closed. Yeah, closed. Like, 'sorry you're having a stroke, fellow, but we have no doctors staffed for the next 3 days, turn around and go back to GO'. It's literally scary to be ill in Canada, especially in our poorer provinces, as often there is no one there to help you.
But, hey, it's all free 😆
Thanks Denise. The general idea, among neoliberals, is to defund government services then blame them when they stop working. Then replace them with for-profit solutions. Then those just nickle-and-dime everybody, try to make as much money for the c-suite and pay peanuts to everyone else, cut every conceivable cost and axe any service deemed unprofitable - like services in outlying communities.
The idea that businesses are more efficient than government-run organizations is a pernicious myth. The idea that everything is better if run as a business is rapidly becoming one of those lies that everybody knows is a lie. I'm sorry about what's happening there in Canada. Still, fortunate that a trip to a hospital won't bankrupt you. On the other hand, is the US fated to be the worse-case scenario for the rest of us? 'be grateful for your lousy healthcare cause at least you're not in Kentucky!'