dr. roach

DEAR DR. ROACH: I have arthritis in both knees, but otherwise, I’m in good health (I’m 5’6” and weigh 130 pounds). My Fitbit indicates I get about 9,000 steps per day. I am ready for knee replacement, but I’m concerned about one activity I do. We usually spend two consecutive weeks at the beach, and I love to boogie board. When the tide is strong, it can take a lot of effort to get out to where the waves are.

Will I still be able to do this after knee surgery? I only do this activity during those two weeks. I live in Ohio, so I am not sure that doctors here understand beach life. — B.H.

ANSWER: In general, people may expect to return to most activities after knee replacement surgery. Prosthetic knees are very sturdy, but there are still some activities that are generally not recommended after a knee replacement, and these are ones that can cause high impact to the knee. It’s not the degree of effort; it’s avoiding sudden trauma to the new knee.

Repetitive high-impact activities, such as running, are not good for people with prosthetic knees. Activities where very high impact is likely, like football, hockey and rock climbing, are not recommended. By contrast, walking, hiking, swimming and cycling are recommended to do after surgery.

The most expert opinion I found on surfing advised that surfing is considered OK after a knee replacement, and I found many testimonials by surfers who have done well after surgery. However, I would ask you to have some common sense and avoid dangerous conditions, such as waves that should only be attempted by experts.

Since you only surf two weeks out of the year, I’d strongly urge you to do as much strength and stamina building exercise prior to your water adventures (I give the same advice to my patients who are passionate about skiing). When you are there, start slow and make sure your muscles are up to the task.

DEAR DR. ROACH: Your recent column on Voltaren gel said something about insurance not covering it for neck and shoulders. Correct me if I’m wrong, but isn’t it now sold over the counter? I know I use to buy it with a prescription, but now I just buy it off the shelf. Or, is there a prescription form for it as well? — S.T.

ANSWER: Yes, just like many drugs, there is an over-the-counter strength and a prescription strength. The prescription strength is more effective. Unlike oral medicines, where you can essentially take the prescription dose just by taking more of the pill than it says on the bottle (but because toxicity also increases, you shouldn’t do that unless your doctor says it’s OK for you), you can’t get prescription strength topically, since it’s the concentration, not the amount you put on, that best predicts effectiveness. Even at high strength, these medicines are very safe.

For people with arthritis of the neck and shoulder, the topical formulation will probably not work since it can’t penetrate deeply enough, but other people with shoulder or neck pain from other sources may still get benefit, whether you buy the medicine over the counter or by prescription.

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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.

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