To Your Good Health: Mobility Issues
By Dr. Keith Roach
Looking at the Causes Behind Mobility Issues
DEAR DR. ROACH: I am 79 and can move around without any problem. I walk five days a week, and my weight is normal. However, it seems to me that many people -- some younger than I am -- have mobility problems. I wonder what causes this problem. Is it lack of exercise, genes, weight, etc.? -- E.G.
ANSWER: 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, such as neurological diseases, cardiovascular issues and other types of arthritis. While it is true that not exercising can lead to poor mobility, 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 at 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 might have recommended exercise to a patient, which could have caused them to have a flare-up.
Although being very overweight increases the risk of arthritis, having a normal weight doesn't prevent its development. 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.
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DEAR DR. ROACH: 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 without supplemental oxygen all day and only occasionally use the spirometer. But 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? -- S.R.
ANSWER: This is very concerning to me, and I am worried that something might have 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 of fever, cough, or shortness of breath are sometimes absent. You need an evaluation for both of these possibilities (and other less-common 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 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.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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