All of us MD types are trained to use the history of the present illness -- as the patient tells it -- to make the diagnosis. The physical examination, the lab results, and the x-rays serve only as a confirmation of the information from the history.
As time passes I have come to realize that we often fail to ask key questions that would give away the diagnosis. E.g.: 1) Doctor: "You have chills and fever, parasites in your blood stream, and black urine. Have you been to Central Africa?" 2) Doctor: "You seem doubled up and your white blood cell count is 12,000. Is there a tender area in the lower right side of your abdomen?" 3) Doctor: "You have a terrible, fetid odor to your breath. Did you stick a bean up your nose last week?"
Patient: "It was a peanut, and I did it three weeks ago."
For 16 years I had a dull ache in my right deltoid muscle severe enough to preclude arm abduction and necessitating aspirin use. I even went to a chiropractor in Ohio who helped me for a while as he felt my teres was weak and I needed Lugol's solution. I was okay until I got home. Then the pain began again.
"Aha!" you say, "domestic stressors." Well, yes and no. The pain disappeared shortly after May 18, in 1980. You may recall Mount St. Helens blew up then; we can see it from our kitchen window. "What does an exploding mountain have to do with pain relief?" Hang on a minute. You will think that the stress of that potentially lethal ash would make my symptoms worse. Not so.
The story: Some 26 years ago I got a miniature poodle in payment for a medical bill (first mistake). My wife and our eldest daughter loved, cuddled, petted, and fed "Sarge." I had to bathe and trim this beast. They do not shed, so they need clipping around the various orificia (mistake #2). He hated me. Sarge slept between my wife and me (third mistake); I sleep on the right side of the bed to be near the phone. When I would change positions during sleep to lie on my left side, this "darling," protective, black fur-ball with teeth would be right there "gr-r-r-r-r-r" in my face. To avoid an angry confrontation I would resume sleep on my right side (fourth mistake). Right deltoid aches. Maybe it's age. I cannot even put on a sweater on without help. Time passes.
The dog is now 16 years old. Mount St. Helens blows her stack when my wife and I are out of town. The dog is with my son and daughter-in-law -- strangers. Too many stressors for this touchy dog, Sarge. He runs into the street and puts his head under a moving tire. A quick, albeit messy, death. My wife is devastated. I am less so.
In ten days my right deltoid is as good as new. It was not the teres, or age, or alkalosis, or my thyroid. It was the d---- dog.
The moral of the story: 1) Keep asking questions. "Do you carry a bowling ball in your purse?" He who hesitates to ask, hesitates to learn. 2) If adjustments and nutrition do not work, shoot the dog.