I would posit this is more of a function of Canada having too few machines, with a median wait of 10 weeks for an MRI. [1]

To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.

[1] [https://getmrifast.ca/mri-wait-times]

>"I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada."

Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.

> I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.

I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.

Canada's population is incredibly spread out, but also concentrated in about 5 major cities.

When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.

It's a triage system, although I wouldn't want to suffer through a "less important" issue.

At least most medications and interventions have to go through RCTs and tend to be quite standardized.

Don't even get me started with mental health therapy...

People love to complain about health insurance companies denying claims and prior authorization requests. While there are frequent errors and abuses on the payer side, the reality is that about a fifth of all treatments are "low value care" which aren't justified by evidence-based clinical practice guidelines and may even harm patients. If we want to reduce healthcare costs and improve outcomes then we've got to get that under control.

https://www.bloomsbury.com/us/price-we-pay-9781635574128/

A lot of surgery that isn't directly saving you from death is worthless if you're lucky...

To be fair to your latter point, Massachusetts is arguably the biomedical research capital of the world, those MRI machines are being put to research purposes.

It's not strictly a US health care problem either - I've been dumbfounded by foreign coworkers pressing for totally unnecessary medical interventions as if there's no risk associated with doing such things. It's most apparent from the socialized states where the healthcare is ~free.

My impression is this is a modern civilization stupidity in general.

apropos Dead Kennedys track: https://www.youtube.com/watch?v=lVULKYbAeEo

https://www.howardluksmd.com/sometimes-our-joints-just-hurt-...

Many MRI “abnormalities” are, well… normal. “Age-appropriate” findings on MRI readings are vastly under-appreciated. If you are over 50, have no pain, and place you into an MRI, you have at least a …

A 20% chance of having a meniscus abnormality. An 80% chance of something being listed as an abnormality in your knee. A 10-15% or higher chance of having a rotator cuff tear. An 80% chance of having a disc bulge in your back or neck.

One thing that bodybuilding taught me is to never underestimate how significantly you can change how your body works through weight training, mobility work and physical therapy.

I used to suffer from chronic low back pain. It hurt to get out of bed every day for years. 1-2 years after getting into bodybuilding the pain disappeared and didn’t come back. Not only that, but I’m not physically limited by my back whatsoever.

I’m not suggesting you start bodybuilding. But the things I think that helped was 1) weight training, 2) mobility work / stretching, 3) physical therapy. That combo can be really powerful.

Single anecdata here.

My mother-in-law has spinal surgery last christmas, the pain for her, prior to the surgery, was unbearable so it's hard to justify not running from that into the arms of a surgeon. The surgeon showed exactly what was to repair though so it was simple enough to understand and clear in the way it was going to help her.

About 9 months out from that surgery and she doesn't have anymore pain.

I’ve had two shoulder surgeries (one on each side) and they have been life-changing. On one side I’ve gone from extremely restricted movement and severe pain to complete freedom of movement and no pain. On the other side I now have total freedom of movement and some pain returned after 5 or so years so but whereas the pain before was more or less constant and completely unbearable now it aches a little sometimes when I have a bad day.

Just my anecdote but I would say it clearly matters a lot how good your surgeon is and also how seriously you take recovery (which is a slow and painful process in itself). If you have a good surgeon and you do your physio exercises like a good invalid it seems to make a big difference.

I would say ask your surgeon what the reasonable expectation for recovery would be. Mine was pretty frank with me that there isn’t 100% relief in 100% of cases but I felt comfortable enough with the error bars she gave me that I went ahead and in my case that turned out to be a great decision (whereas for example I talked to an eye place about Lasik and it turned out my current vision is within the range of what they would consider successful surgery so I decided not to go ahead in that case).

The question you want to ask is what is the long-term outcome. In 10-20 years time will you have better usage of the shoulder with or without the surgery?

As an anecdote: Family member has a partial lateral meniscus tear in the knee. Surgery was considered as if successful then returning to running might have been possible. Specialist opinions varied as did their reading of the MRI scans.

After a lot of research there was emerging evidence that long-term, surgery was more likely to result in osteoarthritis. So had to weight up long-term mobility over short-term pain relief and not having a major lifestyle change.

You see professional athlete undergoing surgery the next day, but their income relies on regaining usage as quickly as possible. The alternative is physio exercises to strengthen the supporting muscles and avoiding anything that might cause a re-injury.

Read the Substack of Howard Luks, he's an orthopedic surgeon who has a lot of experience.

At the least I would heavily consider exhausting conservative treatment first. All but the worst tears can heal on their own, it just takes time and steady effort.

No matter what you choose to do, the adherence to rehab will determine your ultimate outcome.

Anecdote: My dad has had two shoulder surgeries, one to repair his rotator cuff +15 years ago on his right arm, one back in March of this year on his other shoulder. I couldn’t tell you what specifically was wrong with it this time.

He was a regular golfer until last year when the pain got too bad to play through. He just started playing golf again at the beginning of September. He told me after three or so rounds he can’t even tell he had surgery or any previous pain in that shoulder.

He’s had one doctor do his knee surgery and the aforementioned shoulder surgery and he’s really happy with all of their work.

I hope you have as good of an experience as my dad has had.

Go see a specialist sports doctor. They deal with lots of these types of injuries. My physio sent me to one when I did my shoulder in a motorcycle accident and for my case, the data showed that it was better not to operate.

As a someone living with a person suffering from shoulder issues, im offering no advice, best wishes and a hug. Hope you'll be good soon.

> As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.

I was in the same position at age 42-ish. Shoulder pain in right shoulder so bad that I could not even lift a cup of coffee.

> I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.

I heard the same thing from 3x different surgeons (orthopedic, I think), which lead to...

> Any anecdotes or other experiences/thoughts are appreciated.

... not having any surgery. Over the course of the next 3 months it remained the same in severity (did not get worse, may have gotten better slightly or else I started learning to live with it). The subsequent six months the pain started abating. Over the next 6 months the pain went away almost totally. Now, 8 years later, I don't feel any pain at all.

Of course, I am diabetic, so make of that what you will. When the first surgeon checked my scans (MRI, Xrays and something else - ultrasound, maybe), and said they are not sure if surgery would fix it, I went to a second surgeon with the same scans, got told the same thing. When the third surgeon said the same thing, I decided to wait and see.

Good thing I did; surgery doesn't always turn out well.

Related to posture or something else? It took me about a year to fix my posture but I no longer have back/neck pain. It basically meant being aware of it all day and consciously adjusting, but now I feel a lot better. It's hard to undo a decade of potato in chair.

Obviously, don't take medical advice on HN too seriously, but my uncle had shoulder surgery and was happy with the results. I have heard many more complaints about back surgeries making things worse than shoulders.

However, if available I would try to find a good Pilates/dance/sports instructor that has a Gyrotonic machine, which is built for repairing and strengthening shoulder muscles. I had debilitating back issues from sitting in a chair all day and a good instructor fixed it over a year through low impact Pilates. YMMV and group classes tend to be ineffective because so much of it is doing the exercises precisely correct - they were built for injury recovery

Shoulder surgery was the best thing I ever did. I regretted wasting a year seeking opinions for what ended up being a minor fix. No more pain

I had a remplessage in February and I’m probably at 80% mobility now.

Previously if I coughed my arm would fall entirely out of socket and I would need a propfol shot to allow the doc to relax it to get it back in.

In my case I was basically immobilized and in excruciating pain and fear 100% of my day.

Now thats only like 50% of the day

exercises that place the arm above the head become difficult if not impossible after some shoulder surgeries. these exercises position the shoulder in a comfortable locked in position. training in this position (eg. pull-ups) serves to strengthen muscles like the lats, which in turn support the shoulder in its resting position. i cant say avoiding surgery is fool proof - there is a markedly higher risk of dislocating, and many exercises (eg. bench press) become impossible with a loose shoulder joint. but personally i dont care, my destroyed shoulder becomes fixed after consistent pull-up training, do not see a need to lose half a year in recovery atm.

> How long does the gift recipient have access to the story? The recipient has seven days to access the story and can open it five times before it expires.

Sadly I wasn’t in the first five! Thanks anyway.

This missing bit is that many people are pain free with the same scans as you have. Surgery does help people, but it’s clear that the signals we use to say surgery is needed are very noisy and not as accurate as the surgeons would have you think.

Have you ever tried serious strength training of your posterior chain? That fixed me up although my back wasn't as bad as yours. I feel that if the muscles are weak they fail to support the spine in an appropriate way.

IIRC, besides being pain caused by physical problems, it can also be pain caused by nerve issues (slightly different), and pain caused by your brain (very different, could be multiple causes there).

If surgery doesn't help, and/or like the other commenter mentioned, people with similar physical characteristics don't have pain, then it's time to explore the other two.

Soon you will be able to put more stuff in your discs. It’s coming https://regeltec.com/hydrafil/

I'm sorry you're suffering. There are several regenerative approaches getting ever closer which will be able to help your body re-grow cartilage. Hopefully they'll be FDA approved sooner than later.

Physical therapy helps. Check this out https://youtu.be/n9CDhcVTAdc and https://youtu.be/k1luKAS_Xcg (I only started paying attention after my emergency back surgery)

Try a ring dinger

[dead]

I am one of those people. Obviously the example says nothing about the norm. The article was behind a pay wall so I didn't read it. But the title is about an insanely broad set of surgeries. Bet there is a lot of nuance within.

kind of a bold claim without evidence, but sedentary lifestyle does seem to play a role. what does not matter for most people is nebulous objectives like "mobility" or "good posture".

but yea, everyone should lift weights for various reasons, not just to reduce the chance of random pain.

This. Even if you're struggling with pain after surgery, moderate activity, a well regulated diet (to control inflammation) and stress management can do wonders. I know from experience :p

Thanks - added above.

Counterpoint to this: I'm 37, premature wear on the hips. Saw 14 doctors before one took me seriously. 2 others wanted to do repair (labral tear repair, after 2 failures), one wanted to do big repair (PAO).

Eventually found a doctor at Mayo who looked at the x-rays differently. He replaced my hips and life is 100x better.

There is an even stronger version of your argument, one that works without shifting to the same old "you don't need the expensive stuff, just get your life together" advice that already has kind of a bad rep for not fixing depression. You can accept that you cannot inject much more of necessary discipline and motivation into people after they leave school.. and still argue against many types of surgery in mostly the same way: by strictly comparing them to other costly endeavors that could bring about those probably-helpful life changes. Many more people could work towards that "real solution" by benefiting from some other spending.. which merely happens to be cheaper than surgery, while still not being entirely up to them.

Example: My town installed an outdoor "grown-up playground" in the nearby park. Probably cost a little over two complicated surgeries. Already saved 10 people from neglecting upper body workout. Just 10 people having a really low-barrier-of-entry gym available to them whenever walking their dog. I suspect its already been cost-effective. Plus, it is reusable and low-maintenance. Try to beat that in the operating room!

It’s worth recalling that a large (possibly majority) share of the population has extreme limits on their time imposed by economics.

While I’m fortunate now to be able to dedicate time to the gym and other physical fitness, this was not always the case.

We lack the societal incentive structure to allow someone working 60-80 hours a week to reduce their workload to physically recover. We do allow that same person to spend 5-10 years income on surgeries which have 4-6 week recovery times.

It might work, it might be quackery.

https://moonshotmp.com/learn/wolverine-blend/ "Educational information only. The peptides discussed here are not approved by the FDA for the uses described, and nothing on this page is a recommendation to obtain, self-administer, or dose them. Any peptide therapy at Moonshot Medical is individualized and provided only under medical supervision after an in-person evaluation. This is not medical advice — consult a qualified healthcare provider." https://en.wikipedia.org/wiki/TB-500 https://en.wikipedia.org/wiki/BPC-157

If there are any scientific studies or governments that have approved the use of Wolverine blend, I could not find them. I'd be interested if anyone else has better information.

The latter link is also paywalled for me.