DEAR DR. DONOHUE: For quite some time, my right shoulder has hurt. I saw an orthopedic doctor, who says I have a tear of my rotator cuff. He suggested surgery. What do you think of surgery for this? I am scared that I could be worse off after the operation than I am now. I am only 44 and am quite active. — K.M.
ANSWER: The rotator cuff is a band made up of the tendons of four back muscles. The tendons wrap around the topmost part of the upper arm bone, the humerus, to keep the bone in the shoulder socket. Tears of the rotator cuff are a common problem and one of the principal causes of shoulder pain. Small tears can heal on their own. Larger tears almost always require surgical correction. All surgical procedures demand respect. Something can always go wrong. Most people who have had surgery to correct a rotator cuff tear are glad they had it. By most, I mean more than 95 percent. I would not hesitate to have this surgery.
DEAR DR. DONOHUE: Five years ago, my left breast was removed because of cancer. Some lymph nodes also were removed. The surgeon told me never to have blood pressure taken in my left arm. I haven’t. Sometimes I get a funny look, but I will not allow my left arm to be used. Someone asked why I can’t have my pressure taken there. I was abashed. I’m not sure why. Please tell me. — R.M.
ANSWER: Removal of the breast and lymph nodes often disturbs lymph drainage in the involved arm. Lymph is fluid that comes from the blood and circulates around tissues and cells to nourish and protect them. It makes its way back to the circulation through vessels called lymphatics. Removal of lymphatics can produce swelling of the arm, as the fluid cannot find its way back to the circulation.
Pressure from the blood pressure cuff could add to the disruption of fluid return to the circulation.
The booklet on breast cancer presents the details of its recognition and treatment. To order a copy, write: Dr. Donohue — No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Would you kindly advise us on fatty liver? What can be done for it? What does it lead to? — H.C.
ANSWER: The liver should have no fat. Fat infiltrates it for a couple of reasons. One is excessive alcohol. Another is nonalcoholic fatty liver disease, a common occurrence. It doesn’t always cause damage, but it can progress to something called NASH, nonalcoholic steatohepatitis — a condition that can further progress to cirrhosis. This stage is best discovered through a liver biopsy. The first treatment for liver fat, including NASH, is weight loss. For many, it’s the only treatment needed to correct the situation.
DEAR DR. DONOHUE: I hear that taking 10,000 steps a day is all that a person needs to stay healthy. Is this so? How much time does that take? Do you count all the steps you take in a day, or are these 10,000 steps in addition to what you normally take? — G.D.
ANSWER: The 10,000-steps-a-day program originated in the Surgeon General’s office some years back. It’s been shown, more than once, that people who increase their total daily steps to 10,000 (counting the ones they normally take) have less body fat, lower blood sugar and lower blood pressure. There is more to staying fit than taking 10,000 leisurely steps. Strength building is also important.
Ten thousand steps are approximately 5 miles (3.6 to 4.9 miles; 6 to 8 kilometers). How much time does this take? The walking should be brisk. That’s defined as taking 90 to 100 steps a minute. For the entire time involved, you can do the math. However, these steps don’t all have to be taken in one session. You can amass them throughout the day. A hundred steps a minute is a quick pace. You might not be up to it. It’s OK to start more slowly and gradually work your way to the 100-steps-a-minute goal, and not all the 10,000 steps have to be such fast ones. The goal of 10,000 steps is another thing that can take you a while to reach. Don’t try to do all this on the first day. Start out by taking an extra 200 steps a day, and gradually work your way to 10,000 over a couple of months.
You can’t count these steps without driving yourself crazy. You need a pedometer, a gadget that records your steps. Pedometers range in cost from $17 to $80. They can be worn on a belt, put in a pocket or worn around the leg. They register steps by the movement of the hips or the impact of the foot against the ground.
If you want to be really healthy, you have to add some resistance exercise to your program. Resistance exercise is lifting weights.