DEAR DR. ROACH: I have a very scary situation. About six weeks ago, I was sent to a heart specialist because of a lot of heart palpitations. After a short visit, the doctor told us that he was quite sure I had a leaking valve, so he ordered a cardiac catheterization, and I found that I had no clogged arteries, no heart disease and no reason for palpitations. They told me to avoid caffeine. I still have heart palpitations, every time I go walking or go up a slight incline, and sometimes they start again for no reason. Is there any logical reason for this? — H.L.

ANSWER: Sometimes there is no logical reason for palpitations — everybody gets irregular heartbeats on a daily basis, and sometimes we notice it. However, some palpitations represent serious problems with the heart. Your cardiologist has made sure you don’t have blockages in the arteries, and a cardiac catheterization also can assess the mechanical function of the heart.

It is not so good at determining the cause of palpitations, which are caused by electrical impulses going awry. If you still have symptoms from palpitations, you might ask about wearing a Holter monitor, which is an EKG that records continuously for 24 to 48 hours.

Readers wishing for more information on heartbeat irregularities can order the booklet on that subject by writing: Dr. Roach — No. 107, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: My knees are killing me! It seems that I have arthritis in both my knees. But my left one is more bothersome. I have a difficult time walking, which I love to do, but sometimes even standing causes pain. My orthopedist usually just gives me a cortisone shot, and I go on my way. This time the shot lasted only a couple of days before the pain returned, with a vengeance. I am a 64-year-old man who officiated basketball for 25 years and taught school for 35 years. Now I work part time and have trouble standing for four to five hours a day. — L.C.

ANSWER: We have three kinds of treatment for joint pains: medicines, physical therapy and surgery. The medicine you have been getting, a steroid injection directly into the joint, is very effective for many people, but doesn’t always work, and can only be given three to four times per year safely. Oral medications — Tylenol, anti-inflammatories or pain medications like tramadol or narcotics — have some benefit. I find that ibuprofen is a good starting place, but it sometimes takes a few tries before finding a medicine that works.

Exercise, best supervised by a physical therapist, helps almost everybody with arthritis, but there comes a time that the symptoms are so bad you just can’t exercise any more. At that point, it’s time to contemplate surgery.

Surgery shouldn’t be ever entered into lightly, and there is never a 100 percent guarantee of success, even with the best surgeon. However, surgery at the appropriate time can make people feel like they have been given their life back.

DEAR DR. ROACH: I’d like to know if frequent swimming in a saltwater pool can have any ill effect on a person with high blood pressure who is supposed to maintain a very low salt intake. Can salt from a saltwater pool be absorbed through your skin? — M.K.S.

ANSWER: Salt can’t be absorbed through the skin. You’d have to swallow a fair bit of the water to get into trouble.

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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