DR MARTIN SCURR: If I’ve arthritis, do I’ve to cease working?

I’ve had arthritic pain in my left thumb for five years — and now have a similar pain in my right thumb and along the outside of my wrist. Would steroid injections help? I’m a self-employed tiler and, at 62, don’t want to stop working yet.

Frank Martin, Glasgow.

I can see why this would be a concern for a craftsman such as yourself. I suspect the pain is caused by osteoarthritis — joint damage caused by wear and tear in the cartilage.

The thumb has two bones (‘phalanges’), and is connected to the hand by the metacarpophalangeal joint. This forms part of the ball of your thumb and gives your thumb dexterity.

The next bone, a metacarpal, joins the wrist at another joint, the carpometacarpal.

If there is pain at the base of the thumb, one or both of those joints will be involved, and if you’ve had it for months then it’s likely to be osteoarthritis.

I’ve had arthritic pain in my left thumb for five years — and now have a similar pain in my right thumb and along the outside of my wrist. Would steroid injections help? (stock)

As well as pain, the joints will typically be swollen and the area tender due to inflammation. Your grip may be weaker and you may note a crunchy sensation (‘crepitation’) on moving your thumb. Patients with osteoarthritis of the thumb base are often offered steroid injections but, disappointingly, research has shown these aren’t more effective than a dummy injection.

However, topical treatment using a non-steroidal anti-inflammatory drug (NSAID) containing ibuprofen or diclofenac has been shown to help.

You mention in your longer letter than you cannot take NSAIDs due to the risk of ulcers. However, a study with more than 900 patients who used NSAID gel for knee arthritis showed it was safe in the long-term — even in those who were at high risk of NSAID side-effects.

I’d suggest seeing your GP to confirm this diagnosis. Then try diclofenac gel, twice daily, available without prescription.

If the pain remains, a last resort is surgery to replace these damaged joints. But if you went down this route, a specialist would also advise you to stop work. I know it’s not what you want to hear, but it might be time to consider early retirement.

My Apple watch says my VO2 max, at 18.7, is below average. I exercise for 55 minutes daily, but can’t seem to increase my VO2 max. What else can I do? I’m a 73-year-old woman and take felodipine and simvastatin.

Janet Sawyer, Sutton Coldfield.

Many people now use technology of some description to monitor their health, so will relate to your question.

First, let me explain VO2 max. This is a measurement of the amount of oxygen your muscles use when exercising.

It’s a measure of your cardiovascular fitness: the higher the number, the more efficiently your body takes up oxygen and the better your fitness.

My Apple watch says my VO2 max, at 18.7, is below average. I exercise for 55 minutes daily, but can’t seem to increase my VO2 max. What else can I do? (stock)

It’s hard to get accurate readings unless you’re wearing a mask that enables precise measurement of the amount of oxygen you breathe in (and carbon dioxide you breathe out) while exercising on a treadmill or static bike. Home-testing devices are less accurate and calculate an approximate VO2 max.

A fair measurement for your age group would be 20.2 to 24.4, while a good result would be 28.1.

Given that you exercise regularly, the question is, why is your VO2 max result a little low?

I wonder about the cardiovascular side of things: the felodipine you’re taking is for high blood pressure, and perhaps the dose needs checking with your GP.

I note you’re also on 40mg simvastatin, the maximum, suggesting it might have been prescribed because you’ve experienced chest pain at some point.

To improve your VO2 max, I’d suggest engaging a qualified personal trainer to supervise a programme of aerobic training.

I’d also urge you not to fret too much about these readings. Focus on how much better you will feel within yourself as you get fitter.

In my view… The office doctor will see you now  

Should big companies be incentivised to offer GP services to their employees?

Twice a week, I am the on-site doctor for an organisation that’s set up a medical facility in its workplace.

Here, employees can receive prompt attention for any concerns which need medical care, saving them from waiting for an appointment and diagnosis with their own GP (or, all too often, a physician associate or practice nurse) and avoiding time away from the office.

Many of the problems I’ve seen here are minor, including sports injuries, hay fever, eye infections, contraception and foreign travel advice, but on occasions I have identified more serious concerns, including catching cancer early.

While the employees enjoy access and continuity of care from a doctor who they get to know, and the reassurance that there is an informed expert in the office, the employer sees less absenteeism. Employees also appreciate the benefit of the service being part of their employment and the NHS is relieved of some burdens.

A stitch in time …