DEAR DR. DONOHUE: As a lady of 87 years, I do all household chores and gardening. I have arthritis of my knees and take Tylenol once or twice a day. Since I read the enclosed article about Tylenol, I have stopped taking it. I would like to know what you think of it. I would like to take it at least once a day. — N.C.

ANSWER: Tylenol (acetaminophen) has been around for many, many years, and millions of people have safely used it for pain relief. Not many medicines can compete with Tylenol for effectiveness and lack of serious complications.

When taken in doses exceeding those recommended, Tylenol can cause liver damage. In fact, it is one of the leading causes of liver failure, but a proportion of those cases occurred in people deliberately overdosing in a suicide attempt. Chronic, heavy alcohol consumption lowers the safety threshold for Tylenol. People who drink considerable quantities of alcohol should not use it. Furthermore, Tylenol is often combined with other medicines, like cold products, and that amount of Tylenol has to be figured into the daily amount consumed.

The Food and Drug Administration recently turned its attention to reducing the chances of liver damage from Tylenol. It reduced the recommended daily dose from 4 grams a day (4,000 milligrams) to 3.25 (3,250 mg). If a person is taking a 325-mg tablet, at the reduced daily dose that would mean that he or she could take up to 10 tablets a day. (Tylenol also comes as 500-mg and 650-mg tablets.) Your couple of daily tablets is nowhere near the upper limit, even if you’re using the high-dose pills. You can take Tylenol in the doses you use without fear of liver damage.

DEAR DR. DONOHUE: Greetings and salutations! My question is about iron. It is a much-needed mineral. Why do we not find it in all multivitamins? I take one iron tablet a day (325 mg of ferrous sulfate, the equivalent of 65 mg of elemental iron) with a meal. Iron helps in the production of red blood cells. We hear little about it. What foods provide the most? — R.E.

ANSWER: Greetings and salutations back to you. Iron is an important mineral. It is incorporated into hemoglobin, the stuff inside every red blood cell and the stuff to which oxygen sticks as though it were an oxygen magnet.

Adult males and nonmenstruating women need 8 mg of iron a day; menstruating women need 18 mg. Animal meats are the best source, and animal iron is more easily absorbed than plant iron. Spinach, most beans, lentils, peas, asparagus, dates and prunes have iron. Many cereals and grains are fortified with it. Most people on this continent have ready access to foods with iron, and that’s one reason why it’s not incorporated into many multivitamins.

You don’t really need an iron tablet if you’re eating a balanced diet.

DEAR DR. DONOHUE: The subject of my curiosity is the parotid (salivary) gland. I read that a stone can obstruct this gland from providing saliva. Why, and how does this stone come to be? Is there a way to get rid of it other than surgery? — M.F.

ANSWER: Inflammation, increased viscosity of saliva, infection and even gout can lead to stone formation in the ducts of the salivary glands. The parotid glands are the largest salivary glands, and are located in the cheeks. They’re what swell when a person has mumps. More salivary glands are located below the jaw — the submandibular glands — and they’re the ones most likely to have a stone.

If the stone is small and near the duct opening, a doctor can massage it out. Or a doctor can make a small incision in the duct and grasp the stone with an instrument. If the stone is in an inaccessible place, retrieval presents a greater challenge and requires more-involved surgery.

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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