DEAR DR. DONOHUE: I am approaching 88 years of age. Both knees are bothering me now. What kind of medication, ointments, therapy and exercise can be used to prevent surgery? – J.V.

ANSWER:
I’m assuming you have osteoarthritis – the most common kind of arthritis, the kind most older people have at least a touch of. All the same, play it safe. Have your doctor confirm my assumption.

Have you tried treatments not involving medicines? Hot compresses to the knee, three to four times a day and lasting 15 minutes, can limber them and reduce pain. How about the many arthritis creams and ointments available without a prescription? Bengay and Aspercreme are two popular ones. There are many others. As for exercise, walking won’t add any further damage to the joints if you stop when they hurt. Arthritis patients need strong muscles to protect joints. As for a detailed exercise program, a physical therapist can devise one especially for you. Every hospital has a physical therapy department.

The most popular medicines for osteoarthritis are the nonsteroidal anti-inflammatory drugs – Advil, Motrin, Aleve and many others. Their use has a serious drawback: It can lead to ulcers. So start with a medicine that has few complications – Tylenol. If it doesn’t relieve your pain, advance to the nonsteroidal anti-inflammatory drugs. Protect your stomach by taking medicines like Pepcid or Prilosec to decrease stomach-acid production.

Two new products, both requiring a prescription, are available. One is the Flector Patch, which you put on the skin over the painful joint. The other is Voltaren Gel, another medicine applied to the skin over the involved joint. They pose less of a threat to the stomach when they’re used in this manner. They contain the anti-inflammatory medicine diclofenac.

Joint injections of hyaluronic acid have benefited some. The occasional injection of cortisone often brings immediate relief that lasts for months.

DEAR DR. DONOHUE: I saw your recent article on peripheral neuropathy. My father, now 84, developed it about seven years ago. He thinks it was caused by walking barefoot on a carpet that was chemically cleaned. About five years ago he was diagnosed with Parkinson’s disease. Is neuropathy a precursor to Parkinson’s?

My sister is 53. She developed peripheral neuropathy a year ago. No cause has been found. She’s scared of coming down with Parkinson’s disease like our father. Is there a connection? – L.B.

ANSWER:
Peripheral neuropathy has to do with nerves serving the legs and arms, mostly the legs. When “sensory” nerves are involved, the person has numbness, tingling, burning or other painful sensations of the feet and legs. When “motor” nerves are affected, muscle weakness is the result. A foot drop can develop; that’s when the leg is raised, the foot flops downward.

Parkinson’s disease comes about from the depletion of the brain chemical dopamine from an area of the brain that controls movement. The signs of Parkinson’s disease are a resting tremor, slowness of movement, muscle rigidity and a shuffling gait.

These two conditions are quite different from each other. Neuropathy doesn’t turn into Parkinson’s. In the early stages, it could be mistaken for it, but tests can usually distinguish between the two.

DEAR DR. DONOHUE: I have been on a list of medicines for anxiety and depression. They don’t help me. Here’s the mystery: I go to bed at night in excellent mental and physical health, but wake in the morning very ill. I experience fear and despair, with a knot in my stomach. As the day goes by, symptoms diminish, and by bedtime I feel good again. Do you have the answer to this? – G.W.

ANSWER:
Depression and the anxiety that goes with it are, almost as a rule, worse in the early-morning hours and tend to lessen in the evening. Be patient with medicine. It can take many weeks for it to take hold. You should be in close contact with a therapist too. That’s as important as taking medicine. Nearly everyone gets over depression, but it takes time.

DEAR DR. DONOHUE: I am an 83-year-old man who has a diagnosis of prostate cancer. My doctor has given me a number of choices for treatment. I have chosen hormone shots. Would I be better off if I had the gland removed? I have no pain whatsoever. – E.F.

ANSWER:
A number of factors have to be considered to arrive at the best treatment for prostate cancer. The stage of the cancer is an important determinant. Stage is determined by the depth to which the cancer has invaded the gland and whether it has spread to tissues surrounding the gland or to distant sites. The Gleason score is another consideration. It’s a measure of the cancer’s aggressiveness. A high Gleason number – 10 is the highest – indicates a cancer that multiplies and spreads quickly. A low number – 2 is the lowest – is given to a cancer that grows slowly. The degree of PSA elevation – the blood test for prostate cancer – is factored into the decision, as are a man’s age, his general health, his expected longevity and the potential complications of treatment.

If the cancer is confined to the gland, then surgery or radiation is the usual treatment. If the cancer is far advanced and has spread out of the gland, eliminating testosterone production is often the choice. Testosterone spurs the growth of prostate cancer. Testosterone production can be stopped by removing the testes or giving hormone shots.

Another alternative is watchful waiting. Many older men with a slowly growing tumor do not die from prostate cancer but from some other problem, like heart disease. Therefore, if a man’s life expectancy is less than 10 years and his tumor doesn’t have the characteristics of rapid growth, that man can choose to have his doctor follow the course of his tumor and withhold treatment until there are signs that the tumor is enlarging.

The choice of treatment is your call. However, your doctor has to provide you with relevant information so you can make an informed choice.

The prostate-gland booklet describes enlargement and cancer of the gland. To obtain a copy, write to: Dr. Donohue – No. 1001, 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 www.rbmamall.com.


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