DEAR DR. ROACH: I am a 70-year-old female in fairly good health with a number of diseases/conditions that are fairly well-controlled. I take about 15 prescription and over-the-counter meds a day (including methotrexate) for my Sjogren’s symptoms and other conditions, plus a statin.

Nine weeks ago, I had shoulder surgery for a torn bicep tendon, a torn rotator cuff, arthritis on my clavicle, and a general “60,000 mile tune up” as my surgeon described it. He warned me that it was a difficult surgery, and recovery has been hard. I took oxycodone for about a week and a half after the surgery, and since then, I have been on the maximum dose of 4,000 units a day of Tylenol for pain.

I have a high pain threshold, but the pain continues to be more than I can tolerate without Tylenol, especially with physical therapy twice weekly and doing 90 minutes of exercises at home every day.

Is there harm in continuing to take this much Tylenol daily? I know there can be stomach damage. At what point should I be concerned about this? I get complete blood counts (CBC) and comprehensive metabolic panels (CMP) done every three months. Would damage show up in these test results? — S.B.

ANSWER: Acetaminophen (Tylenol) is a commonly used pain reliever that is in a unique class and whose mechanism isn’t entirely certain, although it seems to work directly in the brain.

Unlike nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, acetaminophen seldom causes significant damage to the stomach. The major toxicity with acetaminophen is to the liver, and it is dose-related. At 4 grams a day, there is often an elevation of liver enzymes. (The CMP does contain liver tests that are commonly elevated with acetaminophen.) Elevated liver enzymes by themselves are not harmful to healthy adults, but I do have some warnings:

One is that acetaminophen is in many OTC medicines, so if you are taking the maximum dose, you need to look carefully at any other medicines you are taking that might contain it. Oxycodone, for example, is often combined with acetaminophen, as are many cold medicines.

There are some drug interactions with acetaminophen but none with the medicines you mentioned. People who drink alcohol habitually, even at moderate levels, may be at a higher risk, and I recommend no more than 3,000 mg a day for people who drink moderately. The data are mixed on how dangerous this is, but I recommend this level to be safe.

DEAR DR. ROACH: In your column about how to prevent skin from thinning, you mentioned the importance of moisturizing daily. Please tell us your recommendations of what to look for in a good moisturizer and any brand recommendations. With so many brands on the market, it’s a difficult task without having some knowledge on what to look for. — B.G.

ANSWER: The best moisturizer for one person may not be as good for another, so I can’t give an answer for everyone. But for the column you mentioned on solar purpura (with dark discolorations on sun-exposed, thinned skin), I emphasize broad spectrum sun protection as part of the skin care regimen.

Dermatologists often recommend ceramide-containing moisturizers, with retinol and peptides recommended by some. Vitamin-K-containing creams or ointments may also speed up healing.

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. (c) 2025 North America Syndicate Inc.

All Rights Reserved