Three shoulders and a back.

Case 1.

   She swam back and forth like a shark cutting through the water. Every time I went to the pool she was there and really meant business. She would do two or three lengths in the time it took me to do one. She did the crawl like Johnny Weismuller (Olympic star and then the best Tarzan that ever there was - check Turner Classic Movies, if you don't believe me.). We knew each other well enough to say 'good morning' and that was it. Then , one morning, the pool was so busy we had to share a swimming lane.  
   "I'll take the left side of the lane and you take the right so we won't run into each other," I said. She smiled and nodded in agreement.
    At the completion of three lengths for her and one for me, we both docked at the end of the pool at the same time.
    "How many lengths do you do every morning?" I asked her.
    "Eighty" she said. That was pretty impressive to someone who could barely do half of that amount, but I figured she was in her fifties and I'm eighty!
   "Are you training for something? Are you a competitive swimmer?" I asked.
    "No, I used to do a bit years ago, but I developed some shoulder problems that took me some while to get over."
(Everyone at the pool knows I'm a retired doc, even folks I don't know from Adam, much as I have tried to keep it secret! So I asked the obligatory question.)
    "Oh, what was wrong with your shoulder?"
    "About twenty-five years ago," said she, "I developed a really painful shoulder, so painful, I could hardly swim, so I went to see my doctor. He sent me for physio and put me on some pills , but that didn't do much for me, so he sent me to an orthopedic surgeon. The orthopedic man told me to stop swimming for six months and then to come back to see him. When I did, my shoulder wasn't any better and I felt a whole lot worse. He did a few further investigations and then told me I would need surgery or I would never be able to swim properly again."
    "So what did you do?' I asked.
    "There was no way I was going to have surgery and I told him that. So he told me that there was nothing he could do for me. The following morning I started back at the pool and it was pretty painful. I went every day and it was hell for quite a while but gradually it started to feel better. That was twenty five years ago and now I do eighty lengths at least three times a week, sometimes four or five times."
   " And  does it bother you much?"
   " No," she said, "an occasional twinge," that's all.

Case 2.
    He was in his seventies, with a history of shoulder pain.  He went through an early period similar to the above, but after a trial of the conservative therapy when the orthopedic consultant recommended surgery, he proceed with it.  The end result may have been as good as case one, but certainly no better.  Fortunately, other health risk factors that could have been serious complications did not complicate the case.

Case 3.
    A younger man, with neck and shoulder symptoms and pathology decided to avoid the surgical option and follow conservative treatment.  Improvement has been slow but definite, but it is easy to imagine that an aggressive surgeon could have and would have operated on this patient.  The long term results are not yet known.

The Back.
    A number of years ago, a patient of mine with a long history of worsening low back pain but no progressing neurological systems was seen by a very competent orthopedic surgeon who concluded that she required disc surgery to relieve her pain and prevent further damage.   The patient was admitted to the hospital and booked for surgery the next day.  Following admission to the hospital the patient stated her pain  had abated and on the  morning that she was scheduled for surgery she decided that she did not need it and signed herself out of hospital.  She remained my patient for a considerable time after this event and despite occasional mild low back-pain never required anything more than non narcotic medication.


If you know any stories like this, send them to me.