### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Severe shoulder pain after drinking alcohol-extreme pain until alcohol (which is only a couple of drinks) is out of system at 5 or 6am, no relief or worsening of pain on movement of arm. No relief from painkiller or anti-inflammatory tablets. Occasional dizziness, blurred vision, ankle swelling-all mild & ignorable. Unexplained weight loss- 1 to 2lbs per week for 1 year. Long term rash on upper outer arms & on shoulder blade area for 6 months. Never itchy - dry rash & burns if any creams etc applied. Initially looks like large area of ringworm in different sizes but now looks like a general patchy rash. Comes in waves with circles first, then patchy, back to circles, then patchy again etc. Doctor insisted it isn t fungal. Low bicarbonate levels of 19, high chloride levels of 109. Low folate levels of 2.5, now on prescribed folic acid. NRBCs 0.01 on differential blood count. Awaiting coeliac screen blood test. Hypothyroidism for 5 years, levels all ok at present. Not a diabetic. Any advice appreciated.

### output:

Cannot say in your particular case, but there are particular clues about pain. While the pain may be felt in the shoulder region, unless pressing on the shoulder also causes it, it probably is not FROM the shoulder. Irritation of the diaphragm, stomach, esophagus, pancreas can all be felt in the shoulder. Irritation of the stomach is very, very common with alcohol. There can be some irritation of the breathing muscles especially if there is vomiting. Pancreatitis which is often from alcohol common causes abdominal pain with some throbbing straight through to the upper back, BUT people with that are VERY sick and don't get over the pain quickly and usually have to be hospitalized for a few days.