On sore shoulders
About two weeks ago, I started having pain from a pinched axillary nerve in my right shoulder. (File it under “mediocre once-college athlete still competing in things in which he has no business competing”) At times, the pain has been pretty bad, probably a 5 or 6 on the admittedly-subjective 10-point scale we use in the hospital.
In that time, I’ve probably taken two or three doses of ibuprofen. The nerve is pinched between some shoulder muscles, and decreasing inflammation can help loosen the stranglehold that the muscles have on the nerve. However, most of the time I’ve just tried to relax, exercise lightly, and allow the condition to run its course. I’m almost there.
Why haven’t I taken more ibuprofen? Well, I’ve done a risk/benefit analysis at all times and found that the risks of ibuprofen, although small in someone my age, probably outweigh the benefits. I tend to believe that things like diet, exercise, and stress control can help with lots of conditions, particularly injuries and the aches and pains of aging.
I usually try to convey this to my patients. I think that good foods can be healing, appropriate exercise can treat many conditions, and that learning to control stress can put the brakes on many illnesses.
I trained as a geriatrician, and one thing that a physician learns during that particular training is that the side effects or interactions of medications, even ones given for very good reasons, can themselves be a cause of impairment and illness. Just this past week, my team and I concluded that the cause of two patients’ hospitalizations was “polypharmacy.” We adjusted their medications downwards, found them feeling stronger, and sent them on their way. Medications need to be used with the utmost care.
Vaccines are medications, and they should similarly be approached with care. However, if we step back (to the 30,000 foot view, as I like to tell those I teach), in COVID-19 we have an infectious disease that has killed nearly 600,000 Americans, or almost 1 in 500 of our friends and neighbors. Vaccines, while not without risk, nearly reduce the risk of death to zero.
I watched dozens of my patients die of COVID-19 over the past 14 months. I probably had more of my patients die in the hospital in 2020 and 2021 than I had in the ten years preceding 2020. At the beginning of the pandemic, the majority of patients dying were residents of nursing homes. Now, nearly all nursing home residents in the US are vaccinated.
Since January 2021, I have not admitted a single nursing home resident to the hospital for COVID-19 illness. Think about that. Not a single person in a population that is extremely frail to begin with and for whom effective social distancing is difficult or impossible.
I respect the harm that medications can do. However, the demonstrated efficacy of the available COVID-19 vaccines exceeds any reasonable estimate of possible harms. For younger populations, that is almost certainly the case as well.
Your shoulder might hurt. Chances are it won’t hurt as much as mine has lately.
