DEAR DR. ROACH: I recently read that a large percentage of orthopedic injury to the elderly is directly related to their falling while walking large animals, specifically dogs over 20 pounds. Can you shed light on this please?

— M.F.

ANSWER: A March 2019 study in JAMA Surgery did identify dog walking as an increasing cause of fracture. Over 4,000 fractures were identified among dog walkers over 65 in 2017, about triple the number 10 years earlier. However, this wasn’t a large proportion of fractures (only about 2% of total fractures), and the authors did not identify the size of the dog as a risk factor, although they did suggest that clinicians recommend a smaller (and well-trained) dog as a wiser choice.

Dogs not only provide some social support, they also encourage exercise. I have had many patients (and a few family members) who have very meaningful connections with their dogs and other animals. In fact, I have seen many people who describe their animal companions as the most important relationship in their lives.

DEAR DR. ROACH: I’m an 82-year-old woman experiencing mucus in my rectal area. What causes this?

— M.C.

ANSWER: The cells lining the rectum normally make small amounts of mucus to help a bowel movement pass easily. Large amounts may be seen in people with irritable bowel syndrome, rectal fissures or prolapse, or a rectal ulcer, among others.

This is something to discuss with your doctor the next time you visit. An exam will be able to identify most of the serious causes. Irritable bowel syndrome is a clinical diagnosis made in people with abdominal pain that is often relieved by a bowel movement, along with changes in their bowel habits (diarrhea and/or constipation) that are unrelated to other known causes.

DEAR DR. ROACH: I so much want to lose 20 pounds. Of course, I want it now. I have tried cutting carbs, but it’s not working. I’m 70, 5 feet 4 inches tall and have a fat belly. All of a sudden, I’m 175 pounds. Does CoolSculpting work? Is it worth going for consult? I need help. I am depressed over my look.

— B.R.

ANSWER: CoolSculpting is a brand of a fat removal technique that works by freezing and killing fat cells.

It does work in that it is effective in removing subcutaneous fat from most people (86% saw improvement) in cosmetically important areas. However, the effect is cosmetic, and it does not significantly reduce weight. Liposuction, which typically removes much more fat than either freezing-based or laser-based treatment, did not improve blood pressure, cholesterol, sugar or inflammatory markers in the blood, so it is unlikely that CoolSculpting or similar methods would do so.

So, if your goal is to look better, CoolSculpting and similar techniques are effective for most people. If you want to be healthier, then weight loss through a healthy diet and regular exercise is still best. However, you can certainly do both. I do understand that losing weight can take a frustratingly long time. Remember, though, that you don’t need to lose a pound to get benefit from improving diet (such as decreasing processed carbohydrates) and from even modest amounts of regular exercise.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.