When I arrived in this country at the age of 28, I started taking cod-liver oil regularly with breakfast every single day. When a nephew of mine from Norway visited some time ago, I asked him what he thought of the value of cod-liver oil. Arthritis was his specialty, and he thought it was useful against rheumatoid problems. He said it works painlessly, almost like oiling a joint.

I have basically no signs of pain anyplace in my body, except I fell off a roof and broke my leg when I was 78. That hurt! I still swim one lap over one-quarter mile once a week and keep telling my relatives in Norway I think I’ll swim a kilometer some day and get my name in the paper. I could do it. I don’t remember the last time I had a cold or was ill for any reason. I never have to get up in the night.

The last time I went to see my physician for a regular checkup, he had another doctor examine me. Afterward when they reviewed my lab results, my doctor said they were incredible and that he thought maybe he should eat the way I do. Part of my health is no doubt due to my genes, but I believe it is also due to the fact that I, especially during the last 20 to 25 years, have begun realizing that our bodies are made up of everything we eat. In order to stay healthy, we ought to consume a great variety of foods and include cod-liver oil.

DEAR READER: What can I say? As I have written in the past, it was common in my generation for parents to force their children to take cod-liver oil, which was thought to be healthful. Today, it is known to be. It is a good source of omega-3, vitamins A and D, and essential fatty acids EPA and DHA. These fatty acids appear to provide resistance to illnesses such as the common cold and influenza. Omega-3 fatty acids are a form of polyunsaturated fats the body derives from food. Because the body cannot produce fatty acids, they must be obtained through the foods we eat or supplements we take. Studies are limited and inconclusive but suggest this addition may be beneficial for cardiac conditions, eczema, behavioral disorders, inflammatory disorders such as arthritis and more. The jury is still out as to whether it can actually lower cholesterol levels. Cod liver acts as a natural anticoagulant, so if readers choose to add the supplement, I suggest they run it past their primary-care physician before doing so. The Food and Drug Administration has not approved it, but there is little harm (and perhaps a great deal of good) in adding cod-liver oil to the diet. Heaven knows you appear to be a walking, talking testimonial to this theory.

To provide related information, I am sending you a copy of my Health Report “Vitamins and Minerals.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I am now 50 and have just been diagnosed with ankylosing spondylitis and several herniated and bulging discs following an MRI of my spine.

I have pain down my legs into my feet and am unable to bend my legs sometimes. I received a spinal injection but it didn’t work. I experienced extreme pain in the joints of my fingers, wrists, hips, neck, and legs. My two pinky fingers have bent inward and I can no longer straighten them.

I have seen a neurologist who disclaimed nerve damage. I have even experienced severe needle-like sticks in my skin and am totally exhausted.

Is all of this really the result of arthritis?

DEAR READER:
I believe most of your symptoms are directly due to the ankylosing spondylitis. There is one, however, that I am unsure of — the needle-like skin pain. Before I go into that I would like to take the opportunity to explain first about this form of inflammatory arthritis.

Ankylosing spondylitis is truly arthritis, but it is more related to with rheumatoid arthritis than osteo- or age-related arthritis. It primarily affects the spine, but can also occur in the ribs, hips, shoulders, feet, and eyes. It affects other joints less commonly.

As the inflammation persists and the condition worsens, new bone begins to form as the body attempts to heal itself. This can cause restricted movement, stiffness, inflexibility, bone outgrowths, and more. If the ribs are affected it can reduce lung capacity, leading to difficulty breathing.

Symptoms vary with the severity of the ankylosing spondylitis. Early signs often include pain and stiffness of the lower back and hips, usually following periods of inactivity, such as in the morning after sleeping all night. Over time, this feeling may progress up the spine and into the shoulders or down into the knees and feet.

Advanced symptoms include fatigue, loss of appetite, weight loss, iritis (eye inflammation), stooping, restricted expansion of the ribs and chest, bowel inflammation, and more.

There is no cure for ankylosing spondylitis but there are some treatments which are geared toward alleviating symptoms.

There are several types of medications to reduce inflammation, pain and joint damage. Some, such as Aleve, are available over-the-counter. Others, such as prednisone, are available only by prescription.

Physical therapy may provide pain relief and improve flexibility. By keeping the joints active, it can reduce or prevent inappropriate new bone growth, allowing for fuller range of motion.

Surgery is not commonly performed, but for those with severe joint damage or deformities, repair or replacement might be necessary.

Now, you will notice that nowhere in the above information, did I mention skin tingling. I am, therefore, unsure whether this is related or not. It may be completely unrelated, or it could be directly related. If the nerves that supply sensation to the skin are pinched or otherwise compromised by the ankylosing spondylitis, you could experience this sensation.

I urge you to make an appointment with a rheumatologist who will be your best resource for more information and treatment.

Everyday I run into people that notice when I limp or move slowly in pain and ask what’s wrong. I inform them I have rheumatoid arthritis and before I can finish my sentence they are telling me how they have the same thing and start telling me how bad it is in their knee, etc.

When I question them, I realize they have normal aging and osteoarthritis. People do not understand RA patients and the difference because both have arthritis in the name.

Please dedicate one column to this subject. Your column will help educate the public as it has helped educate me on so many disorders.

DEAR READER:
I will gladly take your request because you make an excellent point; many people are not aware that there are several types of arthritis. I will start with typical age-related osteoarthritis.

Osteoarthritis is the result when the lining of joints begins to wear out. The most common cause of this is the aging process but athletes, landscapers and manual laborers also are prone to developing this condition earlier in age because of the constant wear and tear on their joints.

As the lining wears away, pain and stiffness develop because there is no longer a cushion to protect the sensitive nerves, muscle and bones. Osteoarthritis commonly develops in the knees, hips, wrists and hands as these areas are the most used in everyday activities.

Treatment consists of over-the-counter medications such as, acetaminophen and ibuprofen, hot or cold packs, menthol or capsaicin rubs, and topical castor oil. Low-impact exercise such as walking, water aerobics and swimming are also beneficial. Alternative treatments include glucosamine and chondroitin supplements, MSM and others may provide relief to some sufferers.

If symptoms become severe and interfere with daily activity, joint replacement may be an option. Commonly replaced joints are knees, hips and shoulders. This drastic measure is usually reserved for individuals who are affected at a younger age or lead an active life.

Rheumatoid arthritis on the other hand is not the result of age-related deterioration, rather it is caused by the bodies’ own defenses. Mild cases can last from a few months to a year or two while severe cases can last for several years or even a lifetime and lead to serious joint damage. Others may have repeated flare ups followed by periods of remission.

The most common symptoms include joint pain, swelling and stiffness. Some may experience fatigue, fever, weight loss, firm bumps of tissue under the skin on the arms, red, puffy hands and joint tenderness. Symptoms generally appear in small joints such as the wrists, hands, ankles and feet first. Over time the knees, hips, jaw, shoulders, neck and elbows may become effected.

Rheumatoid arthritis is caused by the body’s white blood cells (infection fighters) when they move from the blood stream to the membranes that around the joints (synovium). They then appear to cause the synovium to become inflamed which releases proteins that, if untreated, leads to thickening of the membrane. Cartilage, bone, ligaments, and tendons can also become affected which, over time, leads to malignment of the joint and the bone to lose its proper shape.

Doctors do not know what causes this process to start but suspect it may be the result of a combination of factors such as lifestyle choices, genetics, and environment. Risk factors include smoking, family history, age, and gender. Rheumatoid arthritis commonly affects women between the ages of 40 and 60. It is not thought that RA is passed from one parent to the child but that a predisposition to the disorder is passed down.

There is no cure for RA but several treatments are available. Ibuprofen and naproxen sodium are helpful in reducing inflammation in mild cases and are available over-the-counter or in stronger doses as prescriptions. Some individuals may need temporary treatment with steroids. Other medications include disease-modifying antirheumatic drugs (to limit joint damage), immunosuppressants (to bring the immune system under control), TNF-alpha inhibitors (to block the inflammatory agent associated with RA) and anakinra (to stop a chemical signal from causing inflammation).

Both osteo- and rheumatoid arthritis can be diagnosed and treated by a general practitioner or internist. Rheumatoid sufferers, however, should also be seen by a rheumatologist who specializes in disorders of the joints and bones. Only severe or disabling symptoms caused by osteoarthritis may require the assistance of this type of specialist.

In summary, osteoarthritis is a common, age-related deterioration of the joints. Rheumatoid arthritis is caused by an auto-immune response and can occur in anyone at any age.

To give you related information, I am sending you copies of my Health Report “Understanding Osteoarthritis” and “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My over-the-counter drugs are a one-a-day multi-vitamin, calcium 1000 mg plus D daily, and calcium citrate 315 mg with 200 IU of vitamin D.

Years ago I noticed hair loss and attributed it to the metoprolol. The problem keeps increasing and, in fact, if it continues, I will need a wig in another year. I mentioned the problem to my doctor and her reply was that all medicines make people lose hair. Would I be wrong in asking my doctor to take me off the metoprolol and prescribe another medication for my high blood pressure? I showed her the drug information provided by my pharmacy indicating hair loss as a side effect.

I recently changed primary care physicians since my first doctor wasn’t concerned at all about my hair loss. What can I do?

DEAR READER:
Let me begin with some general information. Medications must go through several clinical studies before being approved. This is done by giving thousands of people a drug, while others are given a placebo. During the studies, no participant knows if he or she is taking the real thing or a placebo. An adverse consequence in more than 1% of the people studied in both categories is referred to as a common side effect, while less than that amount is referred to as rare. Once a drug is approved, it is no longer studied.

Now for the bad news. You are on lisinopril, metoprolol and prednisone. Rare side effects of all three drugs list hair loss as a possibility. Steroids are known to precipitate hair loss in men, yet all women have some male hormones. Therefore, of the prescription medications you take, all three share a similar consequence. The good news, according to my resources, is that the hair loss is generally reversible once a drug is discontinued.

It could be difficult in your situation to determine which drug might be causing your hair loss, unless you kept meticulous records indicating when the pattern began. As we age, we suffer wrinkles, heart problems, hypertension, arthritis and more. It’s difficult enough dealing with the problems over which we have little control. We shouldn’t have to deal with balding when it might be preventable. I recommend you speak with your new primary care physician who might be able to prescribe different medications in each instance without such an emotionally devastating side effect, no matter how rare it might be.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I am only 47 years old and have been healthy my whole life. I need a diagnosis or at least a hint of what could be wrong with me.

DEAR READER:
I urge you make an appointment with a rheumatologist (immune system specialist).

Inflammation of the throat, sinuses, area behind the eyes, and anemia suggest to me you have an autoimmune disorder. These symptoms are common in Wegener’s Granulomatosis, a rare disorder that involves vasculitis (inflammation of the blood vessels). Wegener’s could also explain your Meniere’s type symptoms because ear infections are common and can cause hearing loss, tinnitus, pain, and more. Blood pressure is also affected by vessel inflammation.

I suggest you mention the possibilities of Wegener’s and vasculitis to the specialist, as well as requesting an anti-neutrophil cytoplasmic antibody test (positive in 80-95% of sufferers). Wegener’s may be fatal if left untreated so I urge you to seek medical help.

If I am off base, I apologize. However, based on your symptoms and tests, a rheumatologist is your best bet. You should also be tested further for rheumatoid arthritis, lupus and similar disorders to explain your abnormal rheumatoid factor and Ig antibodies.

I may be wrong but he seems to be in his glory when he has a drink in his hand.

DEAR READER:
Your friend appears to be drinking inappropriately. I would likely label him an alcoholic if I had more information about his drinking habits. What you have to remember is that he will not make significant changes in his lifestyle (and alcohol consumption) until HE is ready to do so. Such a change in attitude is often the product of a DWI (driving while intoxicated), a DUI (driving under the influence) or a serious accident or illness. If I were you I’d pull back, tell him about your concerns and hope that your friend will moderate his drinking or — better yet– stop altogether.

To give you related information, I am sending you a copy of my Health Report “Mental/Substance Abuse”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
No.

Several groups of people should not receive the vaccine. They include women of childbearing age or who are pregnant, anyone taking medication that affects the immune system, those with an allergy to any of the vaccine components, and individuals with a history of primary acquired immunodeficiency (such as HIV).

Because your husband is on immunosuppressive therapy he is not a candidate for the vaccine. His age also is a factor. The shingles vaccine is primarily recommended for individuals age 60 and older.

I recommend that you and your husband speak with his primary care physician and rheumatologist. They are familiar with his case and can answer your concerns.