DEAR DR. ROACH: I usually walk 45 minutes daily for a cardio workout. However, the Florida summer heat can be brutal, so instead of walking, I swim and walk one hour in the pool. Is that as good a cardio workout as walking? – R.G.
ANSWER: I think that having several different ways to exercise is a good idea, since the muscles used will always be at least somewhat different and it can keep you from being bored when doing the same thing day after day. In your situation, I think that it makes a great deal of sense to avoid the heat by getting in the pool.
The intensity of a cardiovascular workout can be measured simply by your pulse rate. A rough but commonly used guide is that moderate cardiovascular exercise is 50 percent to 70 percent of your age-predicted maximum of 220 minus your age. So for age 50, your maximum is 170, and moderate exercise is a pulse of 85 to 119. You can check your pulse at the wrist with a clock, or wear a heart monitor.
Swimming almost always is a more-intense workout than walking (race walkers certainly can get a very fast pulse rate), and walking in the pool is a good exercise for your heart and many muscles.
If the pool is outdoors, as is usual in warm, sunny places, you need to wear and reapply plenty of sunscreen to protect your skin.
DEAR DR. ROACH: In 1978, I was diagnosed with a benign brain tumor. It was on the pituitary gland and pushing on the optic nerve. I had surgery, but only half was removed because of the optic nerve. The other half was shrunk with chemo and radiation. I am concerned about the long-term effects of radiation, because I had a stroke in 2012 and the doctors said this stroke might have been a link to long-term effects of radiation. But 36 years later? Can you confirm or deny that the long-term effects of radiation cause stroke? – B.R.
ANSWER: I can't tell you whether your stroke was caused by the radiation you received; however, I can confirm that high-dose radiation (from radiation therapy for your tumor, not from a diagnostic CT scan) increases the overall risk of transient ischemic attack and stroke. A well-done study from Australia in 2011 showed that radiation treatment approximately doubles the risk of TIA and stroke.
This does not mean that the treatment you had in 1978 was inappropriate. Treatment of a brain tumor, even a noncancerous one, is critical, because there is very little room in your head for a tumor in that position. The medical treatment we have now for these kinds of tumors was not available in 1978.
What this means for people with a history of radiation treatment to the head is that they should do everything to reduce their risk of stroke, which means no smoking, careful control of blood pressure and cholesterol, careful diet including low sodium and low sugar, and discussion with a doctor about aspirin therapy.
Is Knee Replacement Surgery the Only Option?
DEAR DR. ROACH: I am a female in my 60s, and for the past couple of months I have been having some discomfort and swelling in my right knee. I am slightly overweight and have osteoarthritis. I have no pain when walking, but when leaning over, I get a tight pain in the front of the leg, below the knee. I saw my orthopedic doctor, who told me that the cartilage is worn away, and said that I would need a knee replacement. I was given a cortisone shot, which helped the pain.
Would losing weight help me avoid surgery? I take an anti-inflammatory and rubbed Bengay on the knee, which helped. I went for another opinion from a second orthopedic surgeon, had more X-rays taken and was given the same diagnosis. Is there anything more I can do to avoid having a knee replacement soon? – C.W.
ANSWER: Osteoarthritis of the knee can cause permanent loss of the cartilage. Once the cartilage is gone, the knee replacement is by far the best option to reduce pain and improve function. However, there are some things you can do to delay the need for surgery, as well as to feel better. Losing weight is important, if you are carrying more than you should. Your body weight is multiplied when you are going up and down stairs, so losing even a few pounds means much less pressure inside the knee.
Anti-inflammatories and Tylenol reduce pain but don't affect the progression of disease. Bengay, topical anti-inflammatories and capsaicin creams help some people. Steroid injections are a good option for some: Hyaluronic acid shots, such as Synvisc, help many as well. Exercise, however, definitely improves both pain and function. Walking a little bit farther each day means being able to walk still more without pain.
A joint-replacement surgery shouldn't be undertaken lightly. Not everybody has a good outcome, and an infection in an artificial joint can be devastating. However, it has been my experience that most people who have gotten a joint replacement wish they had done so sooner, so don't suffer for too long if these treatments aren't helping.
The arthritis booklet discusses osteoarthritis, along with rheumatoid arthritis and lupus. Readers can order a copy by writing: Dr. Roach -- No. 301W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: What do you know about Himalayan salt? Is it harmful to take every day? I am told that it can help lower blood pressure, because it has minerals and trace elements. – M.S.
ANSWER: Himalayan salt, though it has a pretty pink color and trace minerals, is still almost all table salt – sodium chloride – and salt raises blood pressure for most people. Keeping sodium intake down is likely to reduce risk of heart disease and stroke. Generally, people with a healthy diet get all the trace minerals they need. Most studies on multivitamin and mineral supplements have shown no benefit.
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 [email protected]. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.
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