DEAR DR. DONOHUE: I have degenerative arthritis. What is it? I have it in my knees and hips. I take Tylenol for it, and that seems to work for me. Should I be on any other medicine – something that would make it better instead of only pain medicine? I am 84. – R.W.

ANSWER: The two major kinds of arthritis are osteoarthritis and rheumatoid arthritis. Degenerative arthritis is another name for osteoarthritis and a name that isn’t much used these days.

Osteoarthritis is the kind of arthritis that comes from aging, from genes and from the environment. Sometimes it comes from old joint injuries, so it’s a common complication of having had an athletic career.

The basic problem is a cracking and fraying of the cartilage, which lines all joints. Cartilage is like the Teflon covering of joints. When it cracks and flakes off, the two ends of bones that make a joint rub against each other, and that’s painful. Bone spurs form at the joint margins and add to the pain of cartilage loss.

There is no medicine that can reverse the cartilage defect. There are medicines that ease the pain and make life more livable. If Tylenol works for you, so much the better. It has the fewest side effects of any arthritis drug. If it doesn’t work, then aspirin or one of the anti-inflammatory, pain-relieving drugs generally do. Those drugs include Advil, Motrin, Aleve and Naprosyn. Joint injections of hyaluronic acid or cortisone can bring temporary pain relief. Nondrug therapies don’t receive the attention they should. Exercise strengthens muscles adjacent to joints, and strong muscles take the stress off of arthritic joints. Weight loss, when indicated, relieves the joints of a great burden and often, by itself, gets rid of arthritic pain and prevents further joint damage.

Rheumatoid arthritis is the product of an errant immune system. It’s a story I have to leave for another day.

The arthritis booklet details both kinds of arthritis and their treatments. Readers can obtain a copy by writing: Dr. Donohue – No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I use a sunscreen every time I go outside and have been doing so for a number of years. I am 29. I wonder how this affects my vitamin D production. Do sunscreens lessen vitamin D production? Is this something I need to worry about? – K.C.

ANSWER: You’re using your head. It’s healthy to protect the skin from the ultraviolet rays of the sun. Professional models put sunscreen on all year round, even in winter. Excessive sunlight — and it’s a cumulative effect over the years — leads to skin cancer and skin aging.

However, as you say, the skin contains a precursor of vitamin D. Sunlight turns that precursor into the real vitamin. Sunscreens and sun blockers reduce its production.

This isn’t something to lose sleep over. Fifteen minutes of sunlight to the face or arms two or three times a week gives you enough exposure to provide you with all the vitamin D you’ll need. If you aren’t getting that amount of sunlight, you can get your vitamin D requirement in pill form or in foods fortified with the vitamin. Dairy products are examples of such foods.

DEAR DR. DONOHUE: I had a series of blood tests done at my doctor’s office. The office sent me a copy of the laboratory report. Creatinine was circled because the value was high. What is creatinine? How do I get it down? – M.E.

ANSWER: Creatinine comes from muscles, and a standard amount appears in the blood daily. It’s filtered into the urine by the kidneys. The level of creatinine is an indicator of how well the kidneys work. High levels indicate kidney problems.

You can’t do anything on your own to lower creatinine. You shouldn’t be left at sea about your creatinine. Call the doctor back and speak to him or her. Find out if your level of creatinine indicates kidney trouble, and ask what’s planned for the next step. Something should be.

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. Readers may also order health newsletters from www.rbmamall.com

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