YANMD, but am I being ridiculous?

February 11, 2013 3:09 PM

YANMD: I have pain in my left shoulder blade, I can feel a muscle "knot", and I'm convinced I have cancer.

20 year old female, seemingly healthy other than occasional health anxiety. 5' 2", 138 pounds, eat fairly well. Social smoker for ~3 years in the process of quitting, been exposed to secondhand smoke my whole life.

About 7-8 months ago I noticed a tension/ache in my left shoulder blade that extends up to the top of my shoulder occasionally. Of course I had to Google it, and I found out that lung cancer can cause shoulder pain (could have gone my whole life without knowing that... ignorance is bliss). It's an on and off pain, but it seems to be worse when I sit in my office chair at work - I hunch over and sit with my spine curved. When I massage the area, I feel a knot of tight muscles and adding pressure makes the pain worse. It helps a lot to lay on my back and roll on a tennis ball (the localized pressure causes almost a shooting pain but it improves the overall pain) and then lay on a heating pad. Massages also help.

I do have anxiety and spend a lot of time stressing and worrying. I experience a lot of fatigue, but I work full time and am a full time college student that rarely has a day off. I have no chronic cough or any cough at all (other than from sinus drainage), no bloody sputum, no weight loss (however I've been eating a lot of fast food and not gaining weight), no bronchitis or pneumonia. I do sometimes have a hard time getting a full breath and occasionally get short of breath with activity but it doesn't hinder me (I'm not in great shape, but not in terrible shape). The only other symptoms I can think of are pain in my legs and knees (my knees are bad anyway), and occasional shooting pain in my ribs (a couple of my good friends have experienced this too). Also, when I experience heartburn, the pain is in exactly the same spot as the shoulder blade ache.

Am I crazy for being this anxious? Should I take the time to go to the doctor or is it reasonable to write this off as just a tight muscle?

posted by sarahgrace to Health & Fitness (28 answers total)

It could be a lot of things, honestly, and all of varying severity (the tons of fast food plus shoulder-area heartburn-ache thing reminds me of my Season Of Gallbladder Fun, by the way...), and also totally maybe you just need to watch your posture. Do you have health insurance/can you afford the doc? If so, why not just make an appointment, outline your pain and such, and see what they say?
posted by like_a_friend at 3:13 PM on February 11, 2013

Yes, you should go to a doctor to get your anxiety treated.

I can't tell you for certain that you don't have any kind of cancer including lung cancer. Nobody who's not a doctor can tell you that. But FWIW I think that if you ask a doctor, you will find that you don't have cancer.

And after you quit smoking you won't have all that much risk of lung cancer any more, and your breath control will improve a lot.

After you visit your doctor you might also like to order a book called "Towards Perfect Posture" by Brian Door, which is an Alexander Technique workbook. You need to repeat each movement a lot in order to perfect it. I always repeat each movement - and in this case each step of a movement - 128 times. I don't have to do all the reps in one session, I spend about an hour a day on exercise and at the end of the hour I make a note of how many reps I've done and resume from there at the next session. Following the techniques in this book will help you to learn to sit comfortably. Improving your posture will also help you to breathe better, and breathing better will in turn contribute to reducing your anxiety.
posted by tel3path at 3:18 PM on February 11, 2013 [3 favorites]

Or, go see a reasonably experienced massage therapist (possibly more expensive than an MD co-pay, but more rewarding). That will help with the pain, and they can tell you whether the knot seems like something besides muscle tension.
posted by amandabee at 3:19 PM on February 11, 2013 [1 favorite]

Am I crazy for being this anxious? Should I take the time to go to the doctor or is it reasonable to write this off as just a tight muscle?

Here's the thing. If we say YES! YOU'RE WAY OVERREACTING! then at best, you don't have cancer, and at worst, you do, and have lost important time in the treatment process. More likely is that you don't believe us, and continue to be anxious anyway.

If we say NO! WE HAVE NO IDEA IF YOU HAVE CANCER! then you go to the doctor, and at best, get a referral for PT and anxiety treatment, and at worst, lose an hour or two of your life.

Are you really going to believe us either way?

It's scary to take the first step. But hey, guess what! You already posted here, so now that first step is done.

Next step: make an appointment with your doctor and discuss the knot and anxiety. Go on -- make the call -- and report back here when you're done!
posted by barnone at 3:19 PM on February 11, 2013 [1 favorite]

I have pain in my left shoulder blade, I can feel a muscle "knot", and I'm convinced I have cancer.

That's the "crazy" part: the automatic assumption of the most catastrophic thing possible. We can't tell you if you have cancer, but we can tell you that most 20-year-olds don't, and that most tight muscle symptoms are caused by tight muscles.

Here's the thing: nobody can self-diagnose complicated medical issues because they read a web page. Doctors train for many, many years because systematically identifying disease is a non-trivial problem. You are a college student, not an experienced doctor. At best, you're guessing based on poorly understood information; many things can cause shoulder pain, and the first item on a differential diagnosis list would not be cancer.

Chill out. See a doc if you're having shoulder pain, but (1) also find a way to discuss your anxiety, and (2) stop looking at WebMD (or whatever), because that is indeed the path of craziness and hypochondria.
posted by ellF at 3:26 PM on February 11, 2013 [3 favorites]

I agree that you should go to a doctor, tell them what you've told us, and have them check you out.

Whether or not it is cancer (and no we don't know, but I do feel like that's a big conclusion you are jumping to) you should still talk to a therapist about your anxiety. Anxiety and stress can have profound effects on your physical health.
posted by sweetkid at 3:33 PM on February 11, 2013 [1 favorite]

I like to play a fun game on webmd. It's like the kevin bacon game, but it's for cancer. Find the most innocuous ailment you can think of, and if it isn't a symptom of cancer, YOU WIN!

You are gonna die, but not from this. You probably don't have cancer. Go to the doctor and find out what it is and you will get it fixed.

Worrying is wishing something bad would happen.
posted by bensherman at 3:34 PM on February 11, 2013 [5 favorites]

One thing you can do quickly: pay attention to ergonomics and see what you can do to rearrange your desk setup, chair adjustment, and work habits. A little thought here can pay off greatly in physical comfort. Consider a bit of exercise, too -- greater muscle strength does wonders for preventing and alleviating back and shoulder pain.

Sure, you may or may not have other problems that a physician or physical therapist or regular therapist can help you with, but I can't imagine that spending all day hunched over would not result in pain.
posted by asperity at 3:50 PM on February 11, 2013 [2 favorites]

I get this a lot. Sometimes the pain radiates from my shoulder and down into my chest. And yeah, I freaked out that it was either lung cancer or I was having a heart attack.

So I went to the doctor. And I found out it's not lung cancer or a heart attack.

It's upper trapezius strain. I carry all of my stress in my shoulders, I sit poorly at work, when I'm anxious my shoulders creep up toward my ears, and sometimes I sleep incorrectly which can lead to neck and shoulder pain so bad that I can't move my head.

Trigger point therapy/massage generally fixes the acute issue, but chilling the fuck out and finding new types of stress relief is what's fixing the chronic aspect of it.

So go to the doctor already!
posted by elsietheeel at 3:50 PM on February 11, 2013

See a doctor. The chances are that this is a symptom of cancer rather than of muscle strain are low, but the doctor will be able to determine that and suggest an appropriate course of treatment, whatever it is.
posted by Sidhedevil at 3:53 PM on February 11, 2013

IANAD, but I have basically the same problem and it is just a muscle knot. Anxiety makes you tense all of the time and there is a little muscle back there that is hard to stretch and hard to relax and it gets grumpy over time. Mine started spasming a few years ago and I had to do almost three months of physical therapy for it. But if you start taking care of it now, it probably won't get so bad.

Get a massage, see your doctor if you feel you need to do so, but don't stew about it because that'll make it worse.
posted by monopas at 3:55 PM on February 11, 2013

I'm right-handed, use mouse with right hand. I've noticed that my left shoulder gets painful sometimes when I've been at the computer for hours- and my jobs entails many such hours. I recently made them buy me one of those under-desk keyboard trays at work and it's helped a whole lot. Try that once you've ruled out the scary stuff. Does your college have a clinic? And are you covered by your parents' health insurance? Just go see a doc and stop imagining the worst.
posted by mareli at 3:55 PM on February 11, 2013

The chances of being 20 years old and having lung cancer are very, very slim. The chances of being 20 years old and having a relatively minor musculo-skeletal injury that will only get worse and worse if left untreated are - in a computer-using world - pretty good.

You don't have to have cancer to go to the doctor.
posted by Lyn Never at 3:57 PM on February 11, 2013 [2 favorites]

See a doctor and request a referral to a physical therapist. I am seeing one for my mid-upper back and it's been incredible what she's been able to do in just a few sessions... knots that accumulated over years of desk work, and that have never gone away with massage or chiropracty, are going away.

I got the referral from an orthopedist but a GP should be able to give it to you just as well.
posted by fingersandtoes at 3:59 PM on February 11, 2013

I have health anxiety and carry a lot of tension in my shoulders. There is a pressure point exactly where you are describing and I get a palpable muscle knot there pretty regularly. A kind person pressing hard on it for ~20 seconds (which hurts) and then massaging the shoulder really helps.

Sometimes it extends to my shoulder. Sometimes I am convinced it is a heart problem, or esophageal cancer. I have had my self checked for these things and nope, it's just a tense shoulder.

IANAD, IANYD, but this sounds like perfectly ordinary muscle tension exacerbated by anxiety - particularly if you don't do any upper body strengthening exercises. Sure, go to the doctor (and I suppose there's a tiny chance that it is Something Awful) but I bet that your doctor will diagnose you with a muscle thing and recommend stretches, ibuprophen and light weight lifting.
posted by Frowner at 4:01 PM on February 11, 2013

Oh, sweetheart, I get knots like that all the time and it is NEVER cancer. It's just a plain old muscle knot.

I agree, though, that you should go see a doctor to discuss the anxiety, because you've been putting yourself through all this stress and worry when you really didn't need to.
posted by EmpressCallipygos at 4:04 PM on February 11, 2013 [1 favorite]

I know someone who had shoulder problems, and also had lung cancer. This person was in their 50's, and had a bunch of other stuff that it doesn't sound like you have.

Another thing? The shoulder pain was so unbearable that he was basically mainlining OTC painkillers all day. Like, seriously, dude had a family sized bottle of Advil on his desk and set an alarm for when he could take more. Because he hated doctors and was afraid to have an MRI and, look, it's just a rotator cuff thing and...

This is very much not your situation, from the sound of things.

If you've got minor "end of day soreness" type pain, I wouldn't worry about it.

Frankly, while I think it might be worth seeing your doctor, first things first, if I were you I'd get a massage.
posted by Sara C. at 4:06 PM on February 11, 2013 [1 favorite]

IANAD, etc. But I would be curious to know if the doctors here on Metafilter would agree that this is something worthy of an immediate office visit. There is such a thing as health care overutilization, and not every simple ache and pain -- especially one that sounds like the simple muscle tension experienced by most of us who sit in office chairs -- requires professional assessment. I would try to address this at home first, experimenting with ergonomics, massage, stretching, and judicious use of NSAIDs, and reassess in a few weeks. If you're still hurting, then go. However, if I may -- what you *should* go to your doctor for is help with smoking cessation.
posted by Wordwoman at 4:11 PM on February 11, 2013 [1 favorite]

Within a 99.999 degrees of accuracy, you do not have cancer and you do have a muscle knot. You should see a doctor not for a cancer diagnosis but for anxiety treatment. It's really, really treatable!
posted by DarlingBri at 4:21 PM on February 11, 2013 [2 favorites]

A little rundown of my experiences: I get shoulder knots. I had one for several months, the doctor had no solution. I had to change my workouts because i couldn't lift with that shoulder.

I tried a Chiropractor, which didn't help, then finally acupuncture. The acupuncture did not seem to help, but I did get a great piece of advice from her. She recommended I take a magnesium supplement, and provided a few samples. These eased and then got rid of the knot. This might not apply to you, but it may be worth a try. This is what I take, in smaller amounts since it can act as a stool softener. I couldn't care less about all the other hype in the packaging, and there are other magnesium supplements out there. Heck, Epsom salts are cheaper, even if they taste nasty.

So, I guess I would recommend trying magnesium first, then going to the doctor. Even if your knot gets better, it sounds like your anxiety is a bit overwhelming. It's doubtful you have cancer. No more Googling, it will just add to your anxiety!
posted by annsunny at 4:36 PM on February 11, 2013

I am a doctor but not your doctor but based on the history alone, the pain is obviously musculoskeletal with the biggest hints being the pain getting worse with massage, getting worse while at work and being "on and off" in nature. A lung tumour wouldn't give a damn about any of these things and would hurt all the time. Get your anxiety treated, get a chest x-ray done to prove to yourself it's not cancer and find yourself a good physiotherapist.
posted by ianK at 5:12 PM on February 11, 2013 [1 favorite]

I am not a physician but I'm an epidemiologist. (I am not your epidemiologist.)

In the half-decade of 2005 to 2009, there was one case of lung cancer per million women aged 15 to 19, and 3 cases per million women aged 20 to 24 (source). In 2010 (close enough to contemporary for these purposes), the death rate for women aged 15-19 was 281 per million, and for women aged 20-24 was 448 per million (source pdf). Women your age who die, we can conclude, are several hundreds of times more likely to die of something else.

Another way of looking at it: using the 2009 Census data, the whole US female population in those age bands was about 21 million women - so we're talking about four cases a year in your age and gender group in the whole US. That's big-jackpot lottery odds.

To underscore ianK's point, I have known a lot of people with cancer, and I am well-read on the subject, and I have never heard of cancer pain that could be relieved by rolling on a tennis ball.
posted by gingerest at 6:06 PM on February 11, 2013 [2 favorites]

IANAD, but I used to work with a woman who, sadly, eventually died of lung cancer (she was a long-time smoker). One of her first symptoms was, in fact, arm/shoulder pain, but it wasn't like you describe yours. Hers was more of a constant dull ache...I remember when it first started bothering her, she kept saying she couldn't get comfy at her desk, or sitting anywhere. She wasn't sleeping well at night because of that dull ache. She brought a heating pad with her to work, but it didn't seem to work. Nothing seemed to relieve the ache. Shortly after that she developed a hacking cough, and was constantly coughing into a tissue, bringing up what looked like coffee grounds.

Please see your doctor and try not to stew about it in the meantime. Best of luck to you!
posted by Oriole Adams at 6:46 PM on February 11, 2013

I get something like this- a knot between my shoulder blade and spine, either side but usually the right, and the pain can shoot up to my neck. I recommend shelling out for a good professional massage if you can (don't just go to Massage Envy, research on Yelp first) and for maintenance use a ball smaller than the tennis ball. I use a solid rubbery ball about the size of a ping pong ball and press it against the spot while leaning against a wall. I press against the knot as long as I can stand it and it prevents the shoulder from locking up entirely.

And nthing everyone else on seeing a doctor to reassure yourself that it is not serious and to get help for your anxiety. Best of luck!
posted by fozzie_bear at 8:04 PM on February 11, 2013

There are a lot of really well-intentioned people posting here who probably don't have a ton of experience with hypochondria. I do, so I'll just say this: you do not have cancer. You can see a doctor if it will make you feel better, or you can see a doctor because doctors can sometimes help with shoulder pain that is not caused by cancer. But you definitely don't need to go see a doctor for anything related to cancer. This sounds 100% like muscular-skeletal pain.
posted by Ragged Richard at 8:13 PM on February 11, 2013 [3 favorites]

See a doctor of course. But you're in college and working full-time, of course that's going to lead to anxiety, which can lead to tight and sore muscles. I know you're busy (l've been there!), but consider trying something like meditation or yoga for an hour each week. It won't solve those deep-down knots (keep getting those massages!), but for me it got rid of a lot of physical pain and discomfort, along with feeling more mentally calm.
posted by deinemutti at 8:56 PM on February 11, 2013

I'm not your doctor, but I'll give you a prescription anyways.

This weekend score some good weed and make some delicious food. Smoke said weed and eat said food and relax and stretch your shoulder out. Get a really good nights rest with a very full belly and nicely relaxed head and you'll feel much better in the morning. If weed isn't available a really nice scotch will work as well, especially coupled with an asprin or ibuprofin but not tylenol or paracetamol. Avoid caffeine and stretch and sleep. It will work fine and you'll be all set on sunday to head out and get some moderate exercise walking around. You'll feel fine on monday.
posted by koolkat at 2:13 AM on February 12, 2013

Ibuprofen and alcohol can interact negatively and cause bleeding of the stomach. Aspiring reduces your rate of metabolism of alcohol. (Maybe instead of drugs, you should just get a massage.)
posted by ellF at 4:15 AM on February 12, 2013 [1 favorite]