DEAR DR. DONOHUE: My doctor tells me I have degenerative arthritis in my knees. What kind of arthritis is that? I would appreciate your suggestions on how to control its pain. I take Tylenol now. It helps some, but many nights I can’t fall asleep because of the pain. – H.R.

Degenerative arthritis is another name for osteoarthritis, the most common kind of arthritis, the kind that more than 21 million Americans have.

Osteoarthritis is an erosion of the cartilage that covers the two ends of bones. Those two bone ends make a joint. A cartilage cover permits the ends to glide over each other with no friction. When the cartilage frays, pain follows. Time and constant use are causes of osteoarthritis, but they are not the only causes.

In addition to pain, stiffness is sign of osteoarthritis. Stiffness is worse in the morning when you first take steps. It gradually decreases, and is usually about gone in half an hour. Too much activity increases joint pain. Rest eases it.

The knees are common targets for osteoarthritis. Padded shoes with soft heels cushion the shock that comes when the foot hits the ground. The shock is transmitted to the knees. Shoe inserts can provide the same relief. Hot packs on the joint ease pain and stiffness. Heat should be left on for 15 to 20 minutes, and applied three times a day and again at bedtime. If heat isn’t effective, cold might be. Biking, swimming and walking are exercises that keep joints limber without adding stress to them. Recently it’s been reported that Swedish massage – not to the knees, but to the whole body – takes some arthritis pain away.

Tylenol is an appropriate osteoarthritis medicine. If stronger medicines are needed, aspirin, Aleve and Advil – nonsteroidal anti-inflammatory drugs – calm pain and reduce inflammation. Inflammation is part of the osteoarthritis joint picture. Injecting the joint with cortisone provides relief for a number of months.

When medicines cannot stop pain, then a person ought to consider joint replacement.

The booklet on arthritis deals with osteoarthritis, rheumatoid arthritis and lupus. 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 am a diabetic and on a lot of medications. Physically I feel OK and have no problems with any diabetes-associated symptoms. However, I have to urinate constantly, especially at night. I seldom get a full hour of sleep without having to get out of bed to urinate. Consequently, I feel rough the next day, and it is difficult to function normally. Surely there must be some medication on the market that would reduce the number of times I have to get up at night. I would appreciate some suggestions. – E.B.

Frequent urination is a sign of high blood sugar. Do you know for certain that your blood sugar is controlled?

If it is, then the likely cause is an enlarged prostate gland, since you are a man. There are medicines that can release the hold of the gland on the urethra, the tube that drains the bladder. When the gland chokes the urethra, the bladder doesn’t empty completely, and men must make repeated bathroom trips. Flomax and Uroxatral are examples. Proscar and Avodart are medicines that shrink the gland, but it takes months before an effect is seen. There are many procedures that free the urethra. Some can be done in the doctor’s office with lasers, heat probes or through gland incisions without cutting through the skin. The time-honored TURP – transurethral resection of the prostate gland – has permitted many men to sleep through the night without having to run to the bathroom.

DEAR DR. DONOHUE: I am 75, in excellent health and got the shingles out of nowhere. Would you please explain shingles and what to expect in the future? My skin is still sensitive. – L.L.

You didn’t get shingles out of nowhere. You got it from the chickenpox virus that infected your body, most likely in childhood, and has stayed with you ever since. Ninety percent of adults have that virus living in some of their body’s nerve cells, even if they can’t remember ever having had chickenpox. Later in life, when the body’s immunity wanes a bit, the virus leaves the nerve cells and travels to the skin, where it causes the rash and pain of shingles.

Most often, the rash and pain are gone in three to four weeks, but pain can linger after the rash has gone. If it stays longer than three months, then a person has postherpetic neuralgia, nerve damage so great that it takes a very long time for healing. That’s not likely to happen to you. You have only sensitivity at this stage.

You’re not likely to have a repeat with shingles.

A new vaccine, Zostavax, can prevent shingles or make it a less harrowing experience. People 60 and older should consider getting it. The vaccine is not a treatment for an actual case of shingles.

Shingles is an illness that prompts an inordinate amount of mail. People can find the answers they seek in the booklet on that topic. To order a copy, write to: Dr. Donohue – No. 1201, 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.

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

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