DEAR DR. DONOHUE: Will you provide information on osteoarthritis of the knee? Please include steps to take if you have it. Does it hurt a lot after surgery? Do vitamins or calcium help? — W.J.
ANSWER: Osteoarthritis is the most common kind of arthritis. One-third of the population age 65 and older has it. It’s a cracking and crumbling of the cartilage inside the joint, which makes for bone rubbing against bone. The result is pain and stiffness. Age isn’t the sole factor causing it. Being overweight, heredity, misalignment of the joint bones and previous injury all contribute to its appearance. Climbing stairs, getting out of a chair and walking become challenges.
A cure has yet to be found, but there are steps to take to manage it. Weight loss, if that applies to you, makes a huge difference. Loss of only 5 percent of current weight increases joint mobility and lessens pain. Exercise helps. Walk to the point of pain, rest and then continue on your way. Strengthening the thigh and hamstring muscles protects the knees. A warm shower or bath on rising decreases stiffness.
Tylenol is a safe and effective pain reliever. Nonsteroidal anti-inflammatory drugs (NSAIDs) — Aleve, Advil, Motrin and many others — work well, but their downside is stomach irritation and the possible promotion of an ulcer. Simultaneously taking medicines that blunt stomach-acid production affords protection against these side effects. Prilosec and Zantac are two examples of protective drugs. Voltaren gel, an NSAID medicine that’s applied directly to the skin over the knees, reduces the threat of stomach irritation yet eases joint pain. Your doctor can inject the knee with cortisone, which often affords three or more months of relief.
Calcium and vitamins don’t work. People often ask about chondroitin and glucosamine. In spite of testimonials praising them, little evidence exists for their efficacy. If you want to try them, they won’t hurt.
The ultimate treatment for severe knee osteoarthritis is replacement of the joint. I know few people so happy with their treatment than are the ones who have had this surgery. Pain after surgery is not great and is not long-lasting.
The booklet on arthritis deals with the common forms of this prevalent disorder. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, 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: My problem is excessive yawning. I will yawn 10 to 12 times in a minute or two, and do so as often as three to four times a day. What’s going on? — D.B.
ANSWER: Sleepy people and bored people yawn more than people who are neither. Staying stimulated decreases yawning. What are you doing during the day? You have to be doing something that keeps your brain active, or you’ll start to yawn.
I don’t know an illness that provokes yawning. Yawning occurs in all members of the animal kingdom. It even occurs in birds and fishes.
It does not provide more oxygen for the brain. That explanation has been disproved.
DEAR DR. DONOHUE: My adult daughter is unable to take vitamins without upsetting her stomach. She has taken them with and without food, and at different times of the day, to no avail. She takes no medicine except for thyroid. She has no gastrointestinal problems. — V.H.
ANSWER: Has your daughter tried different brands of vitamins? The filler in some brands might be the cause of her stomach upset. Fillers are inactive ingredients that keep the tablet together.
The question really is: Does your daughter, or anyone, need to take a vitamin (multivitamin or otherwise) daily? Vitamins are nutrients that the body doesn’t make for itself (except vitamin D). They’re needed in extremely small amounts. The era of beriberi, scurvy and rickets is all but over since the discovery of vitamins. Most doctors have never seen a case of those vitamin deficiency illnesses.
Vitamins don’t pep us up and they don’t prevent heart disease or cancer as was once thought. In excess, they can be troublemakers. In spite of this, we’re conditioned to believe that we need a daily multivitamin. Half of the adult American population swallows one every day.
We can meet all vitamin needs through foods, with the possible exception of vitamin D. A diet that supplies fruits, vegetables, grains, dairy products and some meat provides the necessary vitamins. Meat is the source for vitamin B-12, but vegetarians can get that vitamin in other ways. Vitamin D is a problem for many. Sunshine converts a substance in the skin into this vitamin. Many people don’t get enough sunshine exposure to achieve skin production of D, and people in northern climates can’t get enough during winter months. All it takes is 15 minutes of sun exposure on the face, arms and legs three times a week. Age is another possible factor in failing to meet vitamin demands if older people subside on a marginal diet of tea and toast.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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