Dear Dr. Gott: Could you tell me how often someone can have cortisone injections? My mother had some in her shoulders. They worked great, but now the pain and stiffness are back with a vengeance.

Reply: Cortisone can be injected into joints such as the ankle, knee, shoulder and other areas to relieve pain and inflammation. They have been known to help osteoarthritis, gout, carpal-tunnel syndrome, bursitis, plantar fasciitis and a host of other conditions. About 30 years ago, corticosteroids were given with great regularity. Today, however, a different approach is taken. Some physicians restrict a person to three injections a year, others to three in a lifetime. This has resulted from research indicating that repeated injections can cause damage to tissues over time when given in excess quantities to one area of the body. One consideration is whether or not the injections work. If one or two are unsuccessful for reducing pain, it's rather unlikely that additional ones will respond any differently.

Side effects include a cortisone flare, in which the injected material crystallises, causing pain for up to two days that could be greater than what was experienced prior to the injection. Tendons can be weakened, there can be pain at the injection site, and the colour of the skin at the site can change. The most common systemic reaction is observed in diabetic patients, who should monitor their readings, because cortisone can cause a rise in blood-sugar levels. Long-term risks of high doses with frequent administration can include weight gain, facial puffiness, cataracts, osteoporosis, hypertension and rare but serious damage to the large joint bones, known as avascular necrosis.

So, in answer to your question, your mother should return to her orthopaedic surgeon or the physician who gave her the injections. If that specialist (who is familiar with her medical history) feels strongly that no more should be administered, then I suggest you heed the warning. If, however, your mother is aging, her quality of life is affected, and she cannot find relief from pain through other means, perhaps she will receive a favourable response. The pros and cons can be answered only by the person behind the needle.

To provide related information, I am sending you a copy of my Health Report 'Osteoporosis'. Other readers who would like a copy should send a self-addressed stamped number ten envelope and a $2 cheque or money order payable to Newsletter and mailed to Newsletter, PO Box 167, Wickliffe, Ohio 44092-0167. Be sure to mention the title.

Dear Dr. Gott: I am on your no-flour, no-sugar diet and using your cookbook. One recipe calls for dates. The dates I purchased have dextrose in them. Is this ingredient a sugar that is taboo on your diet?

Reply: Dextrose, sucrose and glucose are all simple sugars. The primary difference between all three is in the way the body metabolises them. Some manufacturers and packers for food-industry products prefer to use the word dextrose instead of sugar because the public is becoming more savvy and might not purchase a product if weight is an issue for them.

Dates that are dried are usually packed in sugar as a flavour enhancer. Organic or natural-food stores may have alternatives without sugar added, but as it stands, the dates you purchased aren't allowed. Check the packaging label to verify the packaging content.

Dr. Peter H. Gott's books include 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook', which are available at most bookstores or online. His website is www.AskDrGottMD.com.