Dear Dr. Roach: I am a 78-year-old polio survivor with severe osteoarthritis in my left shoulder, which is the side also affected by polio. I experience pain in varying degrees throughout the day, but at night the pain often wakes me up. I recently had my shoulder X-rayed. My orthopedic doctor said it was 鈥渂one on bone.鈥� He ruled out a total shoulder replacement, citing my age and a six-month recovery period that would severely limit use of the arm.
I live alone and need both arms due to the poliomyelitis affecting my left leg. He also recommended against a steroid injection into the joint because this isn鈥檛 generally effective, in his experience, and the pain relief is short-lived. Since I do not tolerate most pain medication, he recommended Tylenol, CBD salve, alternating hot and cold applications and Voltaren gel. He did say that he would give me a steroid injection if none of that worked and if I was 鈥渄esperate.鈥� I feel hopeful that I will get at least some relief but am wondering if there are other alternatives that might offer me relief.
J.S.B.
Poliomyelitis is an infection with polio virus, which may have many complications, including decades after the infection. Weakness in specific areas of the body are among the most common. The damage to the joint may be in an area affected with polio. In this case, it is thought that muscle weakness leads to abnormal motion of the joint, which over many years leads to progressive damage to the joint. It may also be the case that weakness and abnormal movements in one area of the body leads to overuse by another. Mobility aids, such as cane or crutches, can place a great deal of stress on the shoulder, which over decades may lead to damage to the joint.
When the surgeon says 鈥渂one-on-bone,鈥� it means that the cartilage in the joint has been destroyed. In most cases, joint replacement is indicated. Shoulder replacement is not often done, but I did find a 2016 review from the Mayo Clinic showing generally good results for shoulder replacement in people with poliomyelitis. Still, I understand why your particular circumstances led the surgeon to not recommend surgery in your case.
Joint injections with the combination of steroids and local anesthetics can sometimes have pretty good results, although several studies have shown that they can damage cartilage with long-term use. In your case, you apparently don鈥檛 have much cartilage to lose. Other options to consider would be hyaluronic acid injections and platelet-rich plasma. Both of these have strong anecdotal evidence but so far only weak clinical studies proving effectiveness, and both are much more commonly used in the knee than the shoulder.
Dear Dr. Roach: What are your thoughts of Pepcid versus Prilosec for stomach reflux? My husband isn鈥檛 getting much relief from Prilosec, and his doctor recommended switching.
D.L.G.
Omeprazole (Prilosec) is a much more effective suppressor of acid reflux than famotidine (Pepcid), and is more effective for most people 鈥� if it is used daily. Omeprazole is not a good choice for intermittent use. It takes a few days for the medicine to reach full effectiveness. Famotidine works well and very quickly, and is a good choice for people with more occasional symptoms.
When omeprazole isn鈥檛 working, a trial of famotidine is reasonable, but I would reconsider the diagnosis if he doesn鈥檛 get relief. People can have stomach upset without reflux. The older term 鈥渄yspepsia鈥� or 鈥渇unctional dyspepsia鈥� is used. Further evaluation may be indicated.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
