DEAR DR. ROACH: 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. — 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. 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.

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 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? — S.R.

ANSWER: 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 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 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.

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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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