This is episode 1 of my medical mystery. As all medical mysteries, it led me to physiotherapists and doctors – but, in contrast to most medical mysteries, it also led me to stuff my scrotum into a leather-lined pouch. And I also ended up shooting gut bacteria into various cavities of my body. But let’s start at the beginning. It all started with back pain – or rather, shoulder pain.
Quick preface: I am a huge procrastinator. I’ve procrastinated every possible task in my life. This mostly concerned school homework and University studying, but also more “grown-up” tasks like my personal tax returns, my company’s bookkeeping and preparing my talks at major conferences. But all of these things pale in comparison to this, because this is my procrastination masterpiece. I’ve procrastinated writing this for six years (and counting!) while feeling guilty about it all the time. Imagine that, thinking about something for six years and not making any progress towards that. Well, all of this doesn’t have to interest you, but the result should, because it lead me to split this post into multiple episodes so that I can at least get the task partially done and feel slightly better.
Let’s get started.
It was October 2017. After having graduated a year ago, I had spent the last year in a cave, coding all day long, guided by programming books and driven by questionable projects: I developed a deep learning model for breast cancer detection (no success), built a better website for medical internships (terrible user interface, but more importantly, no visitors, so no one was even using that terrible user interface – no success), and launched a better tinder app on both app stores (questionable success, story for another day).
But what was my plan? Nowadays, businesspeople like to ask people in interviews: What’s your five-year plan? Where do you see yourself?
My answer was both novel and simple: I would still be sitting in my cave. That cave was my tiny student flat in Heidelberg. I would sit there and write code. Because writing code and building thing was, and is, the most fun activity which is know to me.
So there was no end goal. The main comparison which comes to my mind are those people in medical school who had gone to these super-strict, gender-separated catholic high schools. Once at University, they would discover all that sweet freedom around them and become unleashed, hooking up with any eligible person in plain sight. I’m generalizing, of course, and this doesn’t apply to all of those people, but if you were at University or at a super-strict, gender-separated catholic high school, I’m pretty sure you know what I’m talking about.
I felt quite similarly, except that I was unleashed at my computer! Finally, I had no distracting exams to study for and no internship at the hospital where someone expects me to roam the hallways in a white coat, jabbing needles into patients occasionally. No, now I could finally spend all of my time doing what I loved to do most, writing code and building things.
And there was so much to write, and so much to build! I dove head first into Clojure, Elixir, both beautiful languages! And then I did an online course about machine learning, and I read a few books on algorithms. Good times.
There was a problem though. My parents were concerned. I was slowly tiptoeing towards the so-called “Heisenberg-threshold of son’s homelessness” – that’s the duration which you can continue living on your parents expense after graduating from college. The current scientific consensus seems to estimate the median tolerated homelessness duration at around 12 months. It has “Heisenberg” in its name because you can’t measure the exact time span beforehand. You only notice it after you’ve surpassed it and your parents start yelling at you to find a job. Luckily, that didn’t happen to me.
Because then, in October 2017, I got hired as an intern at Merantix to write code for their breast cancer detection software! A real job at a startup, and they pay me to write code? Awesome! How did I get away with this? I felt like an impostor. But I got to write code! And, remarkably, I got to work on actually-working breast cancer software, in contrast to the broken software I had “developed” earlier in my cave.
So now, you might interject, what the hell does all of this have to do with back pain? We’ll get there, don’t worry.
Now, thinking back to my cave in Heidelberg, before I got hired, while I spent most of my time writing code, my remaining time was still spent on what doctors would describe as healthy recreational activities. I would go to the gym every two to three days, meet friends and well, that’s it already, because my friends were all working as doctors, just like normal people do after medical school, and there was only so much time they could spare to meet their homeless cave friend from college. Still, I went to the gym regularly, that was good and we shall keep this in mind as this story progresses.
Now, at my newly-found job at Merantix, a few things changed: I moved to Berlin, I was hyper-motivated to ship this breast cancer detection software, and I wasn’t going to any gym.
It’s hard to overstate how motivated I was. I would get up at 7, be at the office at 8, write code, have lunch, write code, have dinner, head back to the office after dinner, write even more code, and go home at around 10. Those were easily 12-hour days, but it still was incredibly fun! I also got to observe some interesting phenomena, like how my performance would degrade over the course of the week. While I would start out with a fresh brain on Monday and perform pretty well, come Friday, I would be a programmer zombie, writing questionable code which possibly had a net negative impact on the overall code base.
I also learned another bunch of really interesting things – like that working from home is hugely helpful if you need to focus on a particularly hard problem and that the office is often a bad place to get that sort of work done. Also, open offices are bad places to get anything done really.
And then the pain started.
It was very subtle at first. It seemed to have been triggered by sitting at a desk and using a mouse, because it was located somewhere on the inner side of my right shoulder blade. It’s surprisingly hard to describe: Not a sharp pain like when you strain a muscle. But also not a “sour” pain like when you get muscle ache after working out too much. Somewhere in between. It was very weird.
But, as a doctor with tons of clinical experience (= 1 year of internships with a varying degree of learning experiences), this was easy to solve, right? It clearly was some sort of repetitive strain injury due to my mouse ergonomics (or rather, non-ergonomics) as I was right-handed and that was the side I was using the mouse on. Also, the pain would get worse after long days at work, and it would get better at the weekend when I was working less.
So the solution to this problem was very obvious – no, I didn’t work less, that’s way too simple. You underestimate how hyper-motivated I was to write code! Instead, I just trained myself to use my mouse with my left hand. Yes, seriously. I was that motivated.
What happened next was predictable and mildly hilarious, in a tragic way. Due to the general non-ergonomics of my desk and mouse setup remaining unchanged, I started to develop shoulder pain in my left shoulder blade now. That was to be expected. The good news was that the pain in my right shoulder was getting much better. The bad news was that it was getting better slower than the pain was getting worse in the other side. So, frustratingly, now I had pain in both shoulders, and swapping my mouse side would only lead to minor improvements.
But, no worries, you might think, right? I mean, I’m a doctor and solving highly complex coding problems all the time, so I’m also probably smart. Surely I could solve my shoulder pain by tasking my brain with solving it.
Apparently, that was not the case. My supposedly-smart brain deprioritized this task and I continued to swap mouse sides regularly with worsening pain in both sides. Finally, I had bad shoulder pain in both sides and swapping sides no longer yielded any improvement.
(This is another data point for (male) doctors possibly being the worst patient demographic ever, because they think they’re fine, because they’re doctors)
So, there you have it – a few weeks in and I’ve transitioned from acute shoulder pain to chronic pain. Imagine that, a twenty-seven year old with chronic pain, who has ever heard about that? Well, that’s the thing with chronic pain: It creeps up on you and you laugh it off for the first few weeks. Weeks become months and months become years. Only then do you realize that you might have a problem. But then you might be screwed already, just like I was, because fixing the problem is much harder now.
Looking back, what was going on here? Quite possibly, this was some sort of repetitive strain injury due to excessive desk work, specifically using a mouse. There’s actually a disease called “mouse shoulder” which characterizes this exact problem.
The treatment is rather simple: Work less. Sure, you can move to all sorts of ergonomic equipment and get all fancy, and sure that helps, but in the end it just boils down to reducing the strain.
Working less was out of the question for me (facepalm emoji), so I got an ergonomic mouse and started working at a standing desk. Both seemed to help.
But the pain wouldn’t go away any more.
The pain had changed – and I didn’t notice this at the time as I only noticed this looking back. What had changed?
Let’s look at the initial pain which I refer to as “phase 1”:
- Pain on the side of the strain (e.g. mouse on right side, pain on right shoulder).
- Pain gets better when reducing strain, e.g. when switching sides.
But now we had transition to phase 2, specifically:
- Pain on both sides.
- Pain doesn’t get better when reducing strain.
- Pain also randomly gets worse even when not exposed to strain.
Notice something? The last point is especially intriguing. We’ll get to that later.
Regardless, all of this looks clear now, but at the time, I didn’t have such a clear understanding. I just thought “hm, I have pain in both sides, I probably need an even more ergonomic setup”. Male doctors, a catastrophic patient demographic.
So did a more ergonomic desk setup help (you might guess the answer to this one)? And what was up with the pain getting worse even when resting (many doctors might not know the answer to this one)?
Stay tuned for episode 2, and I hope I don’t take another 6 years to write that up, because this story is far from over.
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