This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
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 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.
One of the reasons I left Canada was it took me 6 months to get an MRI after a severe head injury in 2017. I have since gladly paid nearly 500k in taxes to other countries. Fuck Canada.
No, that's illegal. Thats what single payer means, only one payer is allowed [1].
Is meant to encourage rich people to support the health system since everyone's in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.
It's also not lost on public policy experts that MAID has the potential of "solving" a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.
That's not what single payer actually means, since Australia has both a single payer public system and a separate private system. The part that allows these to both exist is that the public system has vast resources (i.e. an entire national/set of state governments) that can act as one for immense negotiating power. This does not preclude a private system from existing.
It's not meant to "encourage the rich to support" the health system, it's meant to avoid completely gutting the public health system by creating a parallel pay-for-play system where only the richest pay and subsequently suck up all of the already finite resources and talent.
Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.
There's no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.
In most other contexts, rich people being able to spend money for some good or service would simply induce more supply ultimately making the product cheaper and better for the masses as well. The rich get to be "early adopters" buying a product when it's expensive and not very good; the poor as "late adopters" get to buy a product that is cheaper and works better once the bugs have been worked out. So...why exactly are resources and talent considered "finite" when it comes to health care and shouldn't we maybe look at FIXING that rather than take it for granted?
Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se "suck up all the resources" needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald's by making it harder to find burger-flippers? And does McDonalds in turn "suck up all the resources" thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?
That is kindof crazy! Imagine you are suspicious that something is awry in your soft tissue, in which case I think MRI is the main diagnostic (?). Then you don’t find out for ten weeks, plus some for analysis!
> MRI's are expensive and difficult to amortize for poorer countries or ones that don't have a great healthcare system
Canada is towards the bottom. I see what you did there. I guess I never considered Canada a poor country or one with a bad healthcare system. But at the same time I was only there a few times to a major city and never interacted with their healthcare system.
Waiting 10 weeks for an MRI is consistent with my experience in the US. This could be a regional thing. When my mom lived in her home state, she had nearly same-month or even same-week access to specialists. Now, living in my state, most appointments are booked more than a year out. She has talked about flying back to her home state every year to have her annual appointments. This is medical tourism within the country.
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
Also citing Fraser Institute, a known extremely right-wing hack "think tank" is like citing a used car salesman on the benefits of buying a car. Their entire raison d'etre is to privatize any remaining public good in Canada, so they will always hunt for any kind of information or data they can to paint whatever picture they want from their lobby funds.
>"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.
Yep. Wealthy Canadians often come to the USA as medical tourists and pay cash to skip the queue at home for elective procedures like MRIs or joint replacements.
That’s about 2X as expensive as the cash pay MRIs near me in the United States, which is interesting. You don’t have to wait a week here, but that’s to be expected with how many MRI machines are all over the place. For specialty imaging like contrast or doing time resolved MRI you do have to wait a little longer to get someone qualified to do it properly. Some of those take a little more expertise that the cash walk-in places aren’t good for.
Hmm, that's good information to have, I had no idea. I just had an MRI appointment that I had completely forgotten about or what it was for I was waiting so long (and obviously not having the issue for anymore). I'll know this for next time and consider it.
Yeah is it legal to finance MRI machines as a business then and sell fast imaging? If it’s that bad near a big city could have a batch running constantly. Of course until the government healthcare system finds a bunch of money in a suitcase somewhere and decides to finally buy more machines, which would kill this business.
I'm happy to confess I don't understand US medical care but OP was saying that $800 was the price they paid but you're saying that if one had "US insurance" it would be "less than half of that" ?
I mean if you have insurance I don't know why it's costing you anything but regardless it's hardly surprising that you're cost is less than the person paying cash ?
Most people with insurance in the US have something called a “copay” although not all. And yes I’m surprised that it’s quicker or cheaper here than Canada.
> 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.
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.
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.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
Careful which Cambridge you are on about. I take you are referring to Cambridge MA, US and not Cambridge, Cambridgeshire off of England, UK.
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
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.
There's a huge amount of confirmation bias in the process of diagnosing musculoskeletal conditions based on imaging studies. When a patient presents with a complaint about pain or lack of mobility then the care team will order imaging, and when they see some anatomic abnormality they'll assume it's causing the symptoms and needs to be surgically repaired. But studies have shown that if we perform the same imaging studies on a random population of subjects we'll find a lot of abnormalities and yet most of those subjects are asymptomatic.
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.
As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.
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.
Any anecdotes or other experiences/thoughts are appreciated.
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.
Double down on this. I had a way worse back and bad pain in my early 20s than now later in life. I started with just walking an hour a day, later added gym. You don't need to become the next Arnold, just show up consistently.
One side note: There are core strength/posture issues but also issues that need medical attention. The tricky part is figuring out which.
Yes me too! I used to have back problems all the time, sometimes it would give out for no reason and I'm stuck in bed for a week. I started lifting from nothing, just the 45lb barbell, using a simple program called Stronglifts. That was probably 10 years ago, I have had some ups and downs of course, but overall my back has been solid since.
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.
> My mother-in-law has spinal surgery last christmas
I dunno if spinal surgery is comparable to shoulder surgery.
I had spinal surgery; the scans were conclusive (specific disks had ruptured), the surgery to put in prosthetic disks (2x in total) is apparently quite routine, and the procedure itself is simpler (limited 3D motion in each vertebra - if you lose motion between any two vertebra after surgery, you might not even notice).
Compare to shoulder surgery where the scans are frequently inconclusive ("we think this surgery might fix the pain, but we are not sure"), and the surgery is uncommon, and the procedure itself is complex (large range of large movements across a large number of axes).
I know about a dozen people in real life who have had spinal fusions, but not one who has had shoulder surgery.
Of course there are reasons to do surgery, it's not all make believe. The point is more that it is overprescribed and that most nonspecific back pain does not correlate well with imaging "abnormalities" and surgery may be the wrong treatment.
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.
What? No, tears do not 'heal on their own', that's completely wrong. Famously, labral tears of the shoulder and hip do not heal in the slightest without external surgery- even tiny ones.
That doesn't mean that surgery is always the appropriate treatment (I'm living with a shoulder labral tear that's untreated). But it is not even remotely true that tears heal on their own. Example, I just had an MRI on my tear, and the ortho said it looked exactly the same as the last MRI I had 8 years ago- no better, no worse
Sorry to hear about your issue, that must be really aggravating.
Labral tears look bad, yes, I'm talking more about tendon partial tearing here, which I think is more common than labral tearing (though I think, like the meniscus in the knee, after a certain age we probably all have tears in these tissues that are asymptomatic, so it's really a matter of degree).
For a long time it seemed to be accepted wisdom that even a partial tendon tear required surgery, but there's a lot of newer evidence that the body can recover from these with the right rehab protocols and time.
Labral tears however are also commonly asymptomatic and occur in a large fraction of athletes and people who train. I don't think surgerizing those is usually indicated.
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 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.
Not posture. My particular issue seems to be either injury or something resembling an injury. Pain is part of it, but range of motion is (currently) the bigger problem. And it happened pretty quickly.
I’ve had a Stanford orthopedist (remotely) review my records, and he feels that surgery may be the only thing that can get me back to 100% (RoM or pain).
PT may help, but it can’t heal the damage that’s been done.
Pain is a very strong feedback signal. The memory of the pain helped me to keep my posture right. Though, I'd prefer to become aware of my posture before the pain emerged.
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
Eleven years ago, I was in a horrific car accident and messed my back up. The ortho said it wasn't debilitating - I just had the spine of a 50 yo in the body of a 30 yo. He said I could try to work my back out so the muscles could provide the support my spine couldn't.
I've been on and off with being consistent with that over the years and was dealing with lots of back pain. Having a desk job doesn't help.
But when COVID hit, I dedicated myself to Olympic weightlifting and pilates by paying (quite a lot) to have coaches and trainers. Since then I've had zero back pain. I recently quit both to get into long distance running because I was getting to be pre-diabetic, despite eating decently well and doing the aforementioned exercise. (Probably genetic - my dad's mom and my mom's dad were both diabetic.)
After all that - my one anecdata point is that pilates is the absolute best and most sustainable for life. My increased flexibility and core strength have totally changed my life. I couldn't even tie my shoelaces before but now I can squat almost to the ground to pick up my son. I'd put running second because I genuinely think the human body is designed to run and your body will figure itself out once you get into running shape. I love Olympic but you'd really need a good coach and be committed to do it well and not injure yourself.
All the above took me years of consistency and commitment, but now I'm on pace for a 3:10-3:15 marathon next month and I'm in the best shape of my life with zero back pain. I think losing a ton of weight from running has also lifted the stress from my back.
That's my experience, fwiw. Good luck man, hope whatever you end up doing will improve yourself.
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.
As someone with herniated discs, spinal stenosis, degenerative disc disease and scoliosis for decades, who's already had surgery but still got worse... what else even is there besides more surgery?
I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.
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.
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.
I have been trying many different types and combinations of stretches and various prolonged physical therapies (in-office and not) for many years... unfortunately nothing has ever helped, not even the McGill Big 3.
Sitting and laying is fine, but walking I can manage maybe 10 minutes max before it starts to hurt, and only gets worse quickly from there. Then I must rest for at least as long as I was walking to get another 10 or so minutes.
Sometimes manually stretching my spine out can help reset that time limit (like lay down with knees up and push down on my thighs to stretch it, it usually pops), but it's only temporary.
If I'm walking on uneven terrain then my muscles go into wild inflammation mode and are hard as rocks... on top of the spinal/nerve pain.
Well, sample size of 1 but a family member was in debilitating pain all the time until they had a couple vertebrae fused. They can walk and life is mostly normal for them now.
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.
Our grandma got a huge pain relief from her lower back pain by replacing her hips earlier this year. She had some back operations previous years but they haven't helped at all. She starts a pilates session next week :)
Strengthening my posterior chain solved my back pain from desk based living. I didn't realize how weak it actually was. It is almost like strong muscle structure helps brace and hold the bones in better position.
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
I know a surgeon who says it’s the extended enforced rest after surgery that heals the original problem. He says most people aren’t very good at resting properly without being forced by surgery.
I wasn't able to read the full article because of the paywall, but as someone who had back surgery and live with complications from it (mainly from spending a decade postponing going to a competent doctor to have a diagnosis and a healthy fear of hospitals - don't be me, if you feel regular back pain or if you sometimes feel back pain that is incapacitating, seek proper medical care - things tend to degrade, and I'm actually quite lucky I'm not in a wheelchair, not kidding) I think I'm entitled to say a thing or two:
We have a statistics problem. Thing is, the way successful surgeries vs botched procedures are measured isn't transparent; as an example, my mother died 2 years ago victim to a routine procedure; It was a combination of both "bad luck" (something went wrong with the procedure) with laxity (prolonged weekend, nobody cared about complaints). Because she didn't died on the table, instead from "complications in recovery" (fyi they accidentally perfurated the intestine during the procedure), its "natural causes".
Many years ago, my dad died from meningitis, 8-10 months after a surgery and a very long recovery. I'd bet a couple of fingers it was a hospital-contracted infection during either the surgery or the recovery. Again, a routine surgery took 8h instead of the expected 2.5-3h. Shit happens, we know - surgery is extremely dangerous, and there is a shit ton of stuff that can go wrong.
Thing is, none of this get into the statistics; There are no reliable survival metrics; The papers you sign are riddled with medical terms to isolate you from the consequences (would you do a non-critical surgery if you could end up shitting on a stomach bag for the rest of your life?), and many many doctors are quite happy into "selling you" their trade option. To be clear, the number any doctor presents you is *wrong*; it has no connection with reality; failure rates measure deaths on the table (the best kind of death, btw), and studies extrapolate from badly measured (per-hospital metrics) or non-existing data.
Tl,DR: avoid surgery if you can; If you really need it (after asking for at least 2 more opinions), your health (and often life choices) matter - bad kidneys, weak liver, etc may be the difference between someone rushing it up or giving an extra 20 min to ensure everything is kosher.
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.
Very happy for you! Maybe I wasn't clear, Im quite better now thanks to surgery - still, because some damage is irreversible, I have nerve damage that creates a whole new set of problems; In my case, what the surgeon did was almost short of a miracle, given the state of my hernias. He would also agree with this assessment, btw; these things, in the state I was, usually end up much worse.
(Below has nothing to do with people who need surgery due to catastrophic injury or congenital defect.)
Most surgeries are followed by more surgeries.
And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.
Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.
Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.
In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.
But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.
So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.
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!
The thing is, the fitness level OP is talkign about is not going to be compatible with the grown up playground sort of activities. You need to get jacked basically. You need to be lifting to failure 3x5ish hitting all muscle groups 2x a week with compound lifts. You should be struggling to go up stairs after working legs.
Working out is good, yes, but you need to actually work the body and make it suffer so that it may actually be damaged enough for high rates of muscle growth. So many people do not do enough because they don't like to push themselves, they take it easy and they end up wasting their time in the gym. Even more true as you get older and natural testosterone levels start declining and limiting your muscle growth.
This is why people end up taking spin classes when they can just do it at home on their own stationary bike. For some people, they need a jockey who will kick their ass along with the peer pressure of a room full of people dumping out sweat.
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.
Note how two job holder average is barely above single job holder average. These are probably people working two part time jobs with a 4-5 hour shift each.
You could do a lot of good with a 3 day a week 30 min compound lift strength training workout. Deadlifts, squat, bench press, overhead press, pull ups.
The thing is, exercise becomes a thing time is even a concern for only if it has been neglected for long enough. It is as important as bathing or brushing and the primary issue is that its not framed as equally important as those things. If it was, people would do it every single day. If they did it every single day, 15 minutes a day is more than enough.
However, given that people "graduate" their 20s without having done this, then everything you say becomes true, people end up so weak that they have to rebuild even basic core strength and posture. So practically what I suggested is useless except for maybe the next generation.
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-500https://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.
In the 90s my mother went through three back surgeries due to problems she was experiencing, but it turned out she had MS and that was the source of her problems. She had terrible doctors.
This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
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 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]
One of the reasons I left Canada was it took me 6 months to get an MRI after a severe head injury in 2017. I have since gladly paid nearly 500k in taxes to other countries. Fuck Canada.
If I were waiting that long I’d fly to SE Asia. I got one in Cambodia same week for $1200.
Clearly you had the means... was it not possible to pay for private healthcare?
No, that's illegal. Thats what single payer means, only one payer is allowed [1].
Is meant to encourage rich people to support the health system since everyone's in it. But in reality the very wealthy go to Buffalo and immigrants visit their home countries.
It's also not lost on public policy experts that MAID has the potential of "solving" a lot of structural problems in Canadian health care and... long and behold MAID has expanded tremendously in ten years.
[1] with some exceptions largely grandfathered in
That's not what single payer actually means, since Australia has both a single payer public system and a separate private system. The part that allows these to both exist is that the public system has vast resources (i.e. an entire national/set of state governments) that can act as one for immense negotiating power. This does not preclude a private system from existing.
Legal definitions vary from legal jurisdiction to jurisdiction, and in Canada?
That's what it means. In Australia it can mean something different.
Not how it works in the UK, everyone pays into public single-payer healthcare, but you’re free to buy your own private healthcare on top if you like.
It's not meant to "encourage the rich to support" the health system, it's meant to avoid completely gutting the public health system by creating a parallel pay-for-play system where only the richest pay and subsequently suck up all of the already finite resources and talent.
Introducing parallel private health care is just accelerationism for privatization wonks who want to just see the death of universal healthcare by sucking it dry for those willing to pay.
There's no magic wand with the resources available for healthcare. Creating private systems so rich people can skip the line doesnt magically create that capability, it means taking that capability from someone who maybe needed it more in the public side of things.
In most other contexts, rich people being able to spend money for some good or service would simply induce more supply ultimately making the product cheaper and better for the masses as well. The rich get to be "early adopters" buying a product when it's expensive and not very good; the poor as "late adopters" get to buy a product that is cheaper and works better once the bugs have been worked out. So...why exactly are resources and talent considered "finite" when it comes to health care and shouldn't we maybe look at FIXING that rather than take it for granted?
Consider, say, food distribution: McDonalds has traditionally made far more money as a private business catering to the tastes of the poor and middle-class than any fancy restaurant ever made catering to the rich. Do fancy restaurants like Per Se "suck up all the resources" needed to cook and serve food? Does the existence of fancy restaurants hurt McDonald's by making it harder to find burger-flippers? And does McDonalds in turn "suck up all the resources" thereby making it harder for people in some other context to find and acquire food? If not, what makes healthcare so different?
> But in reality the very wealthy go to Buffalo
This has to be a brand new sentence (post 1950s anyway).
For ~90% of the population, it’s right there under 200km away.
What does that have to do with the conversation here?
Some countries have a dual insurance system that might allow wealthier people to get better access.
Think of Steve Jobs jumping to the head of the line for a liver transplant
he was already at the head of the line where he got the liver.
the article below is interesting, as it goes into the hearsay you repeated and the facts of how the system works.
https://www.nytimes.com/2009/06/23/business/23liver.html
That is kindof crazy! Imagine you are suspicious that something is awry in your soft tissue, in which case I think MRI is the main diagnostic (?). Then you don’t find out for ten weeks, plus some for analysis!
MRI's are expensive and difficult to amortize for poorer countries or ones that don't have a great healthcare system.
https://www.statista.com/statistics/282401/density-of-magnet...
Japan is a standout, and then you see most of the West just below them... Canada is way down the list.
> MRI's are expensive and difficult to amortize for poorer countries or ones that don't have a great healthcare system
Canada is towards the bottom. I see what you did there. I guess I never considered Canada a poor country or one with a bad healthcare system. But at the same time I was only there a few times to a major city and never interacted with their healthcare system.
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Waiting 10 weeks for an MRI is consistent with my experience in the US. This could be a regional thing. When my mom lived in her home state, she had nearly same-month or even same-week access to specialists. Now, living in my state, most appointments are booked more than a year out. She has talked about flying back to her home state every year to have her annual appointments. This is medical tourism within the country.
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
>https://getmrifast.ca/mri-wait-times
It's sad that seemingly the top result for this search term is an AI slop lead-gen site, rather than the actual source:
>Disclaimer: Wait times shown are estimates based on publicly reported data from the Fraser Institute, CIHI, and provincial health authority reports.
Also citing Fraser Institute, a known extremely right-wing hack "think tank" is like citing a used car salesman on the benefits of buying a car. Their entire raison d'etre is to privatize any remaining public good in Canada, so they will always hunt for any kind of information or data they can to paint whatever picture they want from their lobby funds.
>"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.
Yep. Wealthy Canadians often come to the USA as medical tourists and pay cash to skip the queue at home for elective procedures like MRIs or joint replacements.
You can pay for MRIs in Canada. My friend needed one and he had it within the week for $800.
I think private MRIs have been around, at least in my province anyways, for close to 30 years.
That’s about 2X as expensive as the cash pay MRIs near me in the United States, which is interesting. You don’t have to wait a week here, but that’s to be expected with how many MRI machines are all over the place. For specialty imaging like contrast or doing time resolved MRI you do have to wait a little longer to get someone qualified to do it properly. Some of those take a little more expertise that the cash walk-in places aren’t good for.
$800 CAD is around $600 USD
Hmm, that's good information to have, I had no idea. I just had an MRI appointment that I had completely forgotten about or what it was for I was waiting so long (and obviously not having the issue for anymore). I'll know this for next time and consider it.
Yeah is it legal to finance MRI machines as a business then and sell fast imaging? If it’s that bad near a big city could have a batch running constantly. Of course until the government healthcare system finds a bunch of money in a suitcase somewhere and decides to finally buy more machines, which would kill this business.
$800!!
Jesus... I can get a chest-abdomen-pelvis MRI on US insurance for less than half of that, and the lead time is measured in weeks at most.
I'm happy to confess I don't understand US medical care but OP was saying that $800 was the price they paid but you're saying that if one had "US insurance" it would be "less than half of that" ?
I mean if you have insurance I don't know why it's costing you anything but regardless it's hardly surprising that you're cost is less than the person paying cash ?
Most people with insurance in the US have something called a “copay” although not all. And yes I’m surprised that it’s quicker or cheaper here than Canada.
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I think the actual issue is that America often has infinite wait times because people can't afford the procedure.
Oh yes I see, America bad, got it.
> 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.
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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.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
Careful which Cambridge you are on about. I take you are referring to Cambridge MA, US and not Cambridge, Cambridgeshire off of England, UK.
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
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There’s no evidence that Covid started in wuhan. The wet market was ruled out.
Wow, amazing how wrong such a short comment can be!
That's an odd point to make when in the actual world we live in, Cambridge was where the first COVID vaccine was developed.
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An elderly relative of mine went to get an MRI to prove the occult fracture of the sacrum that was hobbling him.
It took about 12 hours, much of it waiting for his blood pressure to subside low enough to get admitted (a pre-requisite for the MRI).
This is in a city with of about 750k people and nowhere near Massachusetts.
Did that study involve contrast?
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
There's a huge amount of confirmation bias in the process of diagnosing musculoskeletal conditions based on imaging studies. When a patient presents with a complaint about pain or lack of mobility then the care team will order imaging, and when they see some anatomic abnormality they'll assume it's causing the symptoms and needs to be surgically repaired. But studies have shown that if we perform the same imaging studies on a random population of subjects we'll find a lot of abnormalities and yet most of those subjects are asymptomatic.
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.
As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.
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.
Any anecdotes or other experiences/thoughts are appreciated.
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.
Double down on this. I had a way worse back and bad pain in my early 20s than now later in life. I started with just walking an hour a day, later added gym. You don't need to become the next Arnold, just show up consistently.
One side note: There are core strength/posture issues but also issues that need medical attention. The tricky part is figuring out which.
Yes me too! I used to have back problems all the time, sometimes it would give out for no reason and I'm stuck in bed for a week. I started lifting from nothing, just the 45lb barbell, using a simple program called Stronglifts. That was probably 10 years ago, I have had some ups and downs of course, but overall my back has been solid since.
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.
> My mother-in-law has spinal surgery last christmas
I dunno if spinal surgery is comparable to shoulder surgery.
I had spinal surgery; the scans were conclusive (specific disks had ruptured), the surgery to put in prosthetic disks (2x in total) is apparently quite routine, and the procedure itself is simpler (limited 3D motion in each vertebra - if you lose motion between any two vertebra after surgery, you might not even notice).
Compare to shoulder surgery where the scans are frequently inconclusive ("we think this surgery might fix the pain, but we are not sure"), and the surgery is uncommon, and the procedure itself is complex (large range of large movements across a large number of axes).
I know about a dozen people in real life who have had spinal fusions, but not one who has had shoulder surgery.
Of course there are reasons to do surgery, it's not all make believe. The point is more that it is overprescribed and that most nonspecific back pain does not correlate well with imaging "abnormalities" and surgery may be the wrong treatment.
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.
Yes and a lot of these old pro athletes are in agony when older as a result. Hip and knee replacements in their 40’s for example.
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.
What? No, tears do not 'heal on their own', that's completely wrong. Famously, labral tears of the shoulder and hip do not heal in the slightest without external surgery- even tiny ones.
That doesn't mean that surgery is always the appropriate treatment (I'm living with a shoulder labral tear that's untreated). But it is not even remotely true that tears heal on their own. Example, I just had an MRI on my tear, and the ortho said it looked exactly the same as the last MRI I had 8 years ago- no better, no worse
Sorry to hear about your issue, that must be really aggravating.
Labral tears look bad, yes, I'm talking more about tendon partial tearing here, which I think is more common than labral tearing (though I think, like the meniscus in the knee, after a certain age we probably all have tears in these tissues that are asymptomatic, so it's really a matter of degree).
For a long time it seemed to be accepted wisdom that even a partial tendon tear required surgery, but there's a lot of newer evidence that the body can recover from these with the right rehab protocols and time.
Labral tears however are also commonly asymptomatic and occur in a large fraction of athletes and people who train. I don't think surgerizing those is usually indicated.
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.
Not posture. My particular issue seems to be either injury or something resembling an injury. Pain is part of it, but range of motion is (currently) the bigger problem. And it happened pretty quickly.
I’ve had a Stanford orthopedist (remotely) review my records, and he feels that surgery may be the only thing that can get me back to 100% (RoM or pain).
PT may help, but it can’t heal the damage that’s been done.
How did you manage to keep being aware of it all day? In my experience that's nearly impossible.
Pain is a very strong feedback signal. The memory of the pain helped me to keep my posture right. Though, I'd prefer to become aware of my posture before the pain emerged.
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
> Obviously, don't take medical advice on HN too seriously
100%. But I do like to hear anecdotes, since I know no one personally that's had shoulder surgery.
But agree that everyone's different, and everyone's experiences are different, so I take it with a grain of salt for sure.
But still appreciated!
Eleven years ago, I was in a horrific car accident and messed my back up. The ortho said it wasn't debilitating - I just had the spine of a 50 yo in the body of a 30 yo. He said I could try to work my back out so the muscles could provide the support my spine couldn't.
I've been on and off with being consistent with that over the years and was dealing with lots of back pain. Having a desk job doesn't help.
But when COVID hit, I dedicated myself to Olympic weightlifting and pilates by paying (quite a lot) to have coaches and trainers. Since then I've had zero back pain. I recently quit both to get into long distance running because I was getting to be pre-diabetic, despite eating decently well and doing the aforementioned exercise. (Probably genetic - my dad's mom and my mom's dad were both diabetic.)
After all that - my one anecdata point is that pilates is the absolute best and most sustainable for life. My increased flexibility and core strength have totally changed my life. I couldn't even tie my shoelaces before but now I can squat almost to the ground to pick up my son. I'd put running second because I genuinely think the human body is designed to run and your body will figure itself out once you get into running shape. I love Olympic but you'd really need a good coach and be committed to do it well and not injure yourself.
All the above took me years of consistency and commitment, but now I'm on pace for a 3:10-3:15 marathon next month and I'm in the best shape of my life with zero back pain. I think losing a ton of weight from running has also lifted the stress from my back.
That's my experience, fwiw. Good luck man, hope whatever you end up doing will improve yourself.
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.
Here’s the accompanying article from the Science & Tech section.
https://www.economist.com/science-and-technology/2026/09/23/...
Gift link: https://www.economist.com/science-and-technology/2026/09/23/...
> 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.
As someone with herniated discs, spinal stenosis, degenerative disc disease and scoliosis for decades, who's already had surgery but still got worse... what else even is there besides more surgery?
I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.
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)
I have been trying many different types and combinations of stretches and various prolonged physical therapies (in-office and not) for many years... unfortunately nothing has ever helped, not even the McGill Big 3.
Sitting and laying is fine, but walking I can manage maybe 10 minutes max before it starts to hurt, and only gets worse quickly from there. Then I must rest for at least as long as I was walking to get another 10 or so minutes.
Sometimes manually stretching my spine out can help reset that time limit (like lay down with knees up and push down on my thighs to stretch it, it usually pops), but it's only temporary.
If I'm walking on uneven terrain then my muscles go into wild inflammation mode and are hard as rocks... on top of the spinal/nerve pain.
Try a ring dinger
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Well, sample size of 1 but a family member was in debilitating pain all the time until they had a couple vertebrae fused. They can walk and life is mostly normal for them now.
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.
Our grandma got a huge pain relief from her lower back pain by replacing her hips earlier this year. She had some back operations previous years but they haven't helped at all. She starts a pilates session next week :)
I'd encourage anyone with chronic pain to explore the work of Dr. John Sarno.
https://en.wikipedia.org/wiki/John_E._Sarno
https://en.wikipedia.org/wiki/Tension_myositis_syndrome
These ideas and methods cured my back pain.
Strengthening my posterior chain solved my back pain from desk based living. I didn't realize how weak it actually was. It is almost like strong muscle structure helps brace and hold the bones in better position.
Most back and shoulder pains are caused by bad habits. Cutting something from your body doesn't help a lot. Go to gym or physical therapist first.
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.
For those interested in pricing transparency, check out https://www.dolthub.com/repositories/dolthub/standard-charge...
and the Dartmouth Atlas of Health Care - https://www.dartmouthatlas.org/
Surgeons often jump too quickly to the knife. Effective physical therapy or lifestyle adjustments frequently offer superior, less invasive outcomes.
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
I know a surgeon who says it’s the extended enforced rest after surgery that heals the original problem. He says most people aren’t very good at resting properly without being forced by surgery.
https://archive.is/j6oeD
Thanks - added above.
I wasn't able to read the full article because of the paywall, but as someone who had back surgery and live with complications from it (mainly from spending a decade postponing going to a competent doctor to have a diagnosis and a healthy fear of hospitals - don't be me, if you feel regular back pain or if you sometimes feel back pain that is incapacitating, seek proper medical care - things tend to degrade, and I'm actually quite lucky I'm not in a wheelchair, not kidding) I think I'm entitled to say a thing or two:
We have a statistics problem. Thing is, the way successful surgeries vs botched procedures are measured isn't transparent; as an example, my mother died 2 years ago victim to a routine procedure; It was a combination of both "bad luck" (something went wrong with the procedure) with laxity (prolonged weekend, nobody cared about complaints). Because she didn't died on the table, instead from "complications in recovery" (fyi they accidentally perfurated the intestine during the procedure), its "natural causes".
Many years ago, my dad died from meningitis, 8-10 months after a surgery and a very long recovery. I'd bet a couple of fingers it was a hospital-contracted infection during either the surgery or the recovery. Again, a routine surgery took 8h instead of the expected 2.5-3h. Shit happens, we know - surgery is extremely dangerous, and there is a shit ton of stuff that can go wrong.
Thing is, none of this get into the statistics; There are no reliable survival metrics; The papers you sign are riddled with medical terms to isolate you from the consequences (would you do a non-critical surgery if you could end up shitting on a stomach bag for the rest of your life?), and many many doctors are quite happy into "selling you" their trade option. To be clear, the number any doctor presents you is *wrong*; it has no connection with reality; failure rates measure deaths on the table (the best kind of death, btw), and studies extrapolate from badly measured (per-hospital metrics) or non-existing data.
Tl,DR: avoid surgery if you can; If you really need it (after asking for at least 2 more opinions), your health (and often life choices) matter - bad kidneys, weak liver, etc may be the difference between someone rushing it up or giving an extra 20 min to ensure everything is kosher.
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.
Very happy for you! Maybe I wasn't clear, Im quite better now thanks to surgery - still, because some damage is irreversible, I have nerve damage that creates a whole new set of problems; In my case, what the surgeon did was almost short of a miracle, given the state of my hernias. He would also agree with this assessment, btw; these things, in the state I was, usually end up much worse.
(Below has nothing to do with people who need surgery due to catastrophic injury or congenital defect.)
Most surgeries are followed by more surgeries.
And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.
Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.
Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.
In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.
But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.
So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.
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!
The thing is, the fitness level OP is talkign about is not going to be compatible with the grown up playground sort of activities. You need to get jacked basically. You need to be lifting to failure 3x5ish hitting all muscle groups 2x a week with compound lifts. You should be struggling to go up stairs after working legs.
Working out is good, yes, but you need to actually work the body and make it suffer so that it may actually be damaged enough for high rates of muscle growth. So many people do not do enough because they don't like to push themselves, they take it easy and they end up wasting their time in the gym. Even more true as you get older and natural testosterone levels start declining and limiting your muscle growth.
This is why people end up taking spin classes when they can just do it at home on their own stationary bike. For some people, they need a jockey who will kick their ass along with the peer pressure of a room full of people dumping out sweat.
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.
People have more time than they expect. Very few people are working 16 hour days.
https://www.bls.gov/charts/american-time-use/emp-by-ftpt-job...
Note how two job holder average is barely above single job holder average. These are probably people working two part time jobs with a 4-5 hour shift each.
How about activities? BLS has some data there.
https://www.bls.gov/charts/american-time-use/activity-by-age...
Note the leisure column.
Screen time average is about 7 hours a day (not the best source I guess compared to say if apple published their data): https://www.demandsage.com/screen-time-statistics/
You could do a lot of good with a 3 day a week 30 min compound lift strength training workout. Deadlifts, squat, bench press, overhead press, pull ups.
The thing is, exercise becomes a thing time is even a concern for only if it has been neglected for long enough. It is as important as bathing or brushing and the primary issue is that its not framed as equally important as those things. If it was, people would do it every single day. If they did it every single day, 15 minutes a day is more than enough.
However, given that people "graduate" their 20s without having done this, then everything you say becomes true, people end up so weak that they have to rebuild even basic core strength and posture. So practically what I suggested is useless except for maybe the next generation.
I've had a searing rotator cuff for over 2 years. Someone recommended peptides called Wolverine Blend. It is now healed after 3 weeks of injections.
The thing is, this seems to be rather common.
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.
In the 90s my mother went through three back surgeries due to problems she was experiencing, but it turned out she had MS and that was the source of her problems. She had terrible doctors.
The same could be said about economist articles behind paywalls; worse than useless as it prevents linking to an article covering it at a different source. Perhaps https://www.unsw.edu.au/newsroom/news/2022/03/three-orthopae... or https://www.thetimes.com/life-style/health-fitness/article/h... instead
The latter link is also paywalled for me.
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