San Antonio Express-News (Sunday)
Exploring cause of mobility issues
Q: I’m 79 and can move around without any problem. However, it seems that many people — some younger than I am — have mobility problems. I wonder what causes this problem: lack of exercise, genes, weight, etc.? I walk five days a week, and my weight is normal.
A: Be very grateful that you can move around without a problem, as most people in their late 70s do have mobility issues. The most common reason is osteoarthritis, but there are many causes. Neurological diseases, cardiovascular issues and other types of arthritis are additional causes. While it is true that not exercising can lead to poor tolerance, most of the time, it isn’t a person’s fault that they have difficulty with mobility. Arthritis can happen to a person of any weight and any level of exercise.
Exercise helps the vast majority of people improve their mobility, but there are exceptions. Many people with myalgic encephalomyelitis/chronic fatigue syndrome are intolerant of exercise, and overdoing it can lead their condition to worsen. This syndrome has also been known as systemic exertion intolerance disease. Well-meaning physicians, friends and family could have recommended exercise, which may have caused the person to have a flare-up.
Although being very overweight increases the risk of arthritis, having a normal weight doesn’t prevent development of arthritis. Genetic influences are very complicated, but they also have a role in the development of osteoarthritis. Osteoarthritis can also come about as a result of significant trauma to a joint.
Q: I am an 80-year-old woman who recently had a right hip replacement. Shortly after surgery, I required around-the-clock oxygen support at home. I am able to go all day without needing supplemental oxygen and only occasionally use the spirometer. How do I go about not needing oxygen at night? Is there something more I could be doing?
When I use the spirometer, I can bring the oxygen level up. Is this all I need to do when the oxygen level drops?
A: This is very concerning to me, and I am worried that something happened at the time of surgery. A sudden change in the ability to breathe or maintain your oxygen level at the time of joint replacement surgery is suspicious for a pulmonary embolism — a blood clot to the lungs. With great care, the risk for this has decreased to about 1 in 200 people.
Pneumonia is always a concern after surgery, and in 80 year olds, the common symptoms and signs of fever, cough or shortness of breath are sometimes absent. You need an evaluation for both of these possibilities (and other lesscommon causes of post-operative low oxygen that I don’t have the space to go into).
However, the fact that your oxygen level goes up when using the spirometer (a device that encourages deep inhalations) suggests that part of the problem is a collapse of some of the tiny air sacs of the lung.
You should start with a visit to your regular doctor right away.
Q: My mother-in-law died at age 73 from amyotrophic lateral sclerosis (ALS).
There was no family history of the disease. My sister-inlaw, age 72, is now experiencing occasional problems with lisping. Could this be the first sign of her developing familial ALS? She is in great physical condition otherwise, and she has no complaints of cramps or muscle weakness.
A: ALS, sometimes called Lou Gehrig’s disease, is a disease of the parts of the brain and spinal cord that are responsible for movement. The most common initial symptom is weakness, usually more on one side than the other and typically in an arm or a leg. However, 20% of people will have symptoms in their muscles of eating and speaking, so it is unfortunately possible that lisping could represent the onset of muscle weakness in the lips and tongue.
While the average age of onset is 55, with most occurring between the ages of 40-70, cases can occur as young as 20 and as old as 87. Physicians sometimes fail to realize that ALS can and does happen in older individuals.
Of the people who develop ALS, 90% do not have a family history, but when there is a family history, the risk is much higher. When there is a family history, genetic testing can be helpful when combined with an evaluation by a neurologist. I’d recommend that your sister finds a neurologist specifically trained in neuromuscular diseases.
Q: In 2018, at age 86, I had a colonoscopy where some benign polyps were found. I was recommended to come back in three years for another colonoscopy, but in 2021, procedures were not being done because of COVID. Once they started doing them again, I consulted with my primary care doctor about the risks and benefits. We decided not to do the colonoscopy.
Recently, my bowel movements have changed, becoming less frequent and more difficult. I am worried that I should have gotten the colonoscopy and that perhaps colon cancer is developing. I don’t have blood in my stool and have taken the fecal occult blood test with negative results. Are there any other tests that you recommend?
A: Although a screening colonoscopy is not usually recommended in people over
85, there are sometimes reasons to do them, such as in an extraordinarily healthy person with a family history of colon cancer. However, the issue for you is no longer about screening; it is about finding out why you are having these symptoms.
Any change in bowel habits, especially in older individuals, should get your physician to think that there might be a new medical problem. Colon cancer is not the most likely cause, but it is on the list.
One consideration would be a fecal DNA test, which is pretty sensitive (although not perfect) at identifying colon cancer. It would likely save you from needing the colonoscopy, which has increased risk in a person in their 90s. A consultation with your gastroenterologist could be appropriate, but a colonoscopy still might be the best test.
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 Drive, Orlando, FL 32803.