DEAR DR. ROACH: I have been trying to increase my upper body strength, but am having difficulties. I am almost 70 and female, and have been moderately active. I exercise daily for 30 minutes using a stationary bike or a treadmill. I injured my rotator cuff last summer playing an exercise video game. There is hardware from a previous surgery for cancer in my humerus, which complicates surgical options. But I’m not ready for surgery yet, as my range of motion and pain levels are acceptable.

In order to try to improve my function and upper body strength, I worked with a physical therapist on stretching and exercises. I’m using free weights, maximum 5 pounds, and started with three sets of 15 on Mondays, Wednesdays and Fridays, once a day. I’m doing biceps, triceps and presses as tolerated by pain level. When I left physical therapy three months ago, my goal was to slowly increase reps, and then slowly increase weight. Unfortunately, I am at a standstill, and some days I can’t even manage to do the three sets of 15! I’m frustrated and concerned, and I don’t understand why I’m not able to achieve my goal. Is there something else I should be doing, or should I go back to discuss this with the physical therapist? — T.M.H.

ANSWER: It’s definitely appropriate to discuss with the physical therapist again. There are many reasons you might not be progressing. It could be inflammation or some other issue in the shoulder. The therapist may suggest additional exercises for specific muscles. They may also use other ways to treat the affected area, such as therapeutic ultrasound.

Opinions differ when it comes to the best way to increase strength, but sometimes the therapist will increase the weight level, even before you get more repetitions. I have learned that an experienced physical therapist is a highly valued professional whose expertise should be listened to.

If you really and truly aren’t getting any better, another visit with the orthopedic surgeon, or with a specialist in physical medicine and rehabilitation, would certainly be indicated.

DEAR DR. ROACH: I have some anti-aging, wrinkle-reducing serums that are ceramide time-release capsules (for external use). Are these ceramides related to the ceramides in cholesterol? Will your body absorb extra cholesterol if you use them? Are the serum capsules safe to use on my skin? — S.B.

ANSWER: Ceramides are a diverse group of waxy molecules that form part of the protective layer of the outer skin. Free fatty acids and cholesterol are also fatty molecules found in the outer skin, but ceramides are not closely related to cholesterol. Ceramides are increasingly used for skin care creams. Some creams use the same ratio of ceramides, cholesterol and free fatty acids as is found in the skin. These are safe to use and effective for many people. Your body does not absorb them or use them for energy, so they do not affect your blood cholesterol or risk for heart disease.

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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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