Ask Dr J – Issue 198 – NSAIDS: Killing you softly with their love


I have been taking ibuprofen for many years, intermittently but consistently, for various recurring sorts of ills. Sore elbows, twanged fingers, sore back. I probably take ibuprofen no more than once or twice a week on average, with none for many weeks, and it would usually be 200 milligrams but occasionally twice that amount. What is the latest thinking and research on moderate but longterm use? Do climbers’ livers start screaming, “No more!” or just silently fall apart?

Alison Osius | Carbondale, CO

Aversion to pain is the second-biggest preoccupation of modern society. Money, the driving force of the Machiavellian pharmaceutical giants, is the first. That’s right, ladies and gents, you are being turned into a bunch of Nancies by corporate puppeteers to the point that the prospect of removing a superficial splinter without an anesthetic will cause you to faint.

Pill popping is all the rage. From lolly stores to disco floors, from truck drivers to gym junkies, the problem can be resolved by the magic pill that will transport you to the place you need to be. In fact, 16,500 peeps each year will transcend themselves all the way to heaven by way of NSAIDS like ibuprofen, more than are killed in the USA by AIDS and cervical cancer.

Whoa! Life does not have a reverse, so if you want to go at it full throttle on jet fuel, you might want to remember the steering wheel.

Damage by way of minor acute injury will do better with a bag of ice than anti-inflammatory (AI) drugs. Chronic issues such as sore elbows and a bad back will do better if you actually do something about fixing the problem rather than applying Band-Aids. Out of sight, out of mind is the trick of a dyslexic mentalist with an equally inept audience. Or possibly just human nature.

Although a few NSAIDs may not be too harmful, the notion that they are without risk is categorically incorrect. Recent data suggests that there is no safe dose in young people and, like a lightning bolt to the forehead of modern medicine, the greatest risk for ulcers is in the first two weeks of use, contrary to previous understanding.

I would guess that you could quite easily not take any medication. The pain you do feel may well propel you into doing something constructive about the injury. If it’s a minor acute issue, toughen up, princess.




I hurt my shoulder several months ago and after six weeks of PT I feel about 50 percent better. My orthopod has me doing another six weeks in the hopes that I will continue to improve. Two radiologists viewed my MRI. The first said I had a partial tear of the supraspinatus and labral tear, and the other said I had a borderline partial/full tear of the supraspinatus and labral tear. What are the odds of being able to recover from this? Should I have surgery or continue with therapy?

Michael Denkovich | Plainview, NY


You’ll be fine. I foresee that your shoulder will recover and you will find happiness in a dark-haired girl with ash-green eyes and a smile of pearls. You will reach a new high point in climbing by the end of next year, having spent a few months using mind power, food and sex to heal and strengthen your shoulder. You’ll appear on NBC in a TV series that will empower the American people with your recipe to life and happiness. God knows the Americans currently need it.

Most labral tears will settle without surgical intervention. The primary two symptoms that would propel you into the surgical theater are ongoing pain (beyond six months) and locking of the shoulder whereby you cannot continue to move it without first reversing it and giving it a little shake out. That’s the cartilage tear wedging in the joint. BADNESS.

Going to surgery before either occurs is hastier than a Middle Eastern invasion. The dilemma here is that even with an MRI it’s difficult to elucidate the extent of damage. Because of this there is little data for physicians to extrapolate what injuries are likely to settle down without surgery.

At face value your injury looks no worse than most and should continue to settle. There is, of course, a chance that it won’t, so keep communicating with your ortho; it sounds like she is on the ball.




I had a very bad bouldering accident in February 2008 and suffered a compound fracture and total dislocation (bone sticking out) of the ankle. After eight surgeries and almost two years on crutches I am climbing a lot better than I am walking! I have no range of motion in the ankle joint, no cartilage at all, and severe osteoarthritis (which I put up with; I’m drug free). But the stiff ankle has led to severe tendonitis in the knees. Do you think I could still climb with an ankle fusion? And do you think the twisting and drop-knee moves are going to lead to the ultimate death of my knees as well?

Jenny Zhuang | Hong Kong, China


I’d rather lose a testicle than be in your shoes.

Yes, you can still climb. That’s the short answer. I know several climbers who have a fused ankle. They boulder and climb quite well, actually.

There are almost no down sides to having a fusion since, in functional terms, your ankle has pretty much fused already. The up side to a fusion is that you will only have a mild gait anomaly and you can remove the leather patches from your pants since you will be crawling a lot less. And your ankle pain will be vastly reduced. When your gait normalizes somewhat, the tendon issues will also largely resolve.

I am pretty sure a fusion will make you feel much closer to your old self. Hanging onto an ankle that doesn’t work is ironically making you feel much older. The knee and hip on that side will certainly suffer some increased wear and tear, but likely much less than in the current situation.


The dangers of NSAIDS

➊ NSAID’s side effects such as sudden hearing loss and kidney failure are compounded if you drink alcohol.

➋ According to the American Gastroenterological association, 100,000 people are hospitalized each year for complications related to the use of NSAIDs and thousands die.

➌ Persons at the greatest risk are those who take NSAIDs for long periods of time, and exceed the recommended dosage, such as climbers.