DEAR DR. DONOHUE: For quite some time, my right shoulder has hurt. I saw an orthopedic doctor, who says I have a tear of my rotator cuff. He suggested surgery. What do you think of surgery for this? I am scared that I could be worse off after the operation than I am now. I am only 44 and am quite active. K.M.
ANSWER: The rotator cuff is a band made up of the tendons of four back muscles. The tendons wrap around the topmost part of the upper arm bone, the humerus, to keep the bone in the shoulder socket.
Tears of the rotator cuff are a common problem and one of the principal causes of shoulder pain. Small tears can heal on their own. Larger tears almost always require surgical correction. All surgical procedures demand respect. Something can always go wrong. Most people who have had surgery to correct a rotator cuff tear are glad they had it. By most, I mean more than 95 percent. I would not hesitate to have this surgery.
DEAR DR. DONOHUE: Five years ago, my left breast was removed because of cancer. Some lymph nodes also were removed. The surgeon told me never to have blood pressure taken in my left arm. I haven't. Sometimes I get a funny look, but I will not allow my left arm to be used. Someone asked why I can't have my pressure taken there. I was abashed. I'm not sure why. Please tell me. -- R.M.
ANSWER: Removal of the breast and lymph nodes often disturbs lymph drainage in the involved arm. Lymph is fluid that comes from the blood and circulates around tissues and cells to nourish and protect them. It makes its way back to the circulation through vessels called lymphatics. Removal of lymphatics can produce swelling of the arm, as the fluid cannot find its way back to the circulation.
Pressure from the blood pressure cuff could add to the disruption of fluid return to the circulation.
The booklet on breast cancer presents the details of its recognition and treatment. To order a copy, write: Dr. Donohue -- No. 1101W, Box 536475, Orlando, FL 32853-6475. 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. DONOHUE: I just survived pneumonia. I was told by the lung specialist that I should get the pneumonia vaccine every year. I am 66. My sister-in-law told me that her doctor said pneumonia shots are not needed after age 65. Who is correct? - D.T.
ANSWER: The "pneumonia" shot is for one kind of pneumonia, pneumococcal (NEW-moe-KOK-ul), the most common bacterial pneumonia, one that can be quite life threatening for older people.
The current recommendations call for a single shot of the vaccine for those over 65. If the vaccine was given before age 65, a second dose should be administered five years later.
If people have any illness that weakens their immune system, they, too, need a booster shot of the vaccine.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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