DEAR DR. ROACH: I am 80 years old and have been told that I have severe osteoarthritis of the shoulder and that I should have a shoulder replacement. I was hoping that a lesser treatment could be found, but the surgeon said the shoulder is too far gone. I am concerned that at this age I should try to live with it without having the operation, because it is a major operation, and then the rehabilitation would be quite painful. I have also heard that anesthesia at my age can bring on dementia.

What is your opinion in a case like this? My primary doctor feels that I should have it done, but he also knows how I feel about an operation. — J.B.

ANSWER: Osteoarthritis is the most common arthritis in the elderly, and a leading cause of pain and disability. There are many treatments, including medication, such as Tylenol or ibuprofen, that work for many people. Prescription medicines are more risky, but more effective in some people. Injection of a steroid into the joint gives months of relief for most people. Exercise, often guided by a physical or occupational therapist, helps almost everybody.

The most effective treatment for severe arthritis is replacement of the joint. If both your primary doctor and your surgeon are recommending it, you should give it serious consideration. However, the person who ultimately makes the decision is you, and if you aren’t comfortable with the surgery and are able to live with the symptoms, then you should not have it done. However, let me give three pieces of advice:

The first is that anesthesia does not cause dementia. In people who have a little bit of dementia already, anesthesia, and especially being in a new and unfamiliar environment, can cause things to get worse, usually temporarily.

The second piece of advice I have is that, having had more than 100 patients undergo joint replacement, by far the biggest regret I hear is that people wish they had done the surgery sooner.

Finally, the rehab is difficult, but good-quality rehab makes the difference between a good outcome and a spectacular outcome.

DEAR DR. ROACH: My friend has been unable to say a word for four weeks. He went to a doctor and is on antibiotics, but they don’t seem to be doing anything. I have never heard of someone losing his or her voice for so long. Have you any idea what might be causing it, and the cure? — E.B.

ANSWER: We are all aware of acute laryngitis, where you can lose your voice, usually for a few days, around the time of a viral respiratory infection. This is caused by swelling in and around the vocal cords, and it’s treated by resting the voice. Chronic laryngitis causes the same symptoms but may last for weeks or even months. Causes of this can include severe acid reflux, infection and voice overuse. However, in my experience, these are far more likely to cause a hoarse voice than complete voice loss.

For voice loss lasting this long, it’s time to find out what’s really going on. A direct look at the vocal cords is a good first step. The best person to see is an ear, nose and throat specialist (ENT). If your friend was a smoker in the past, this information is very important; smoking increases the risk of tumors that can paralyze the vocal cord.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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