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By Itself, Knee "Crunching" Sound Generally Not Cause For Concern
December 6 , 2013
Dear Mayo Clinic:
One of my knees makes an odd crackling sound (like the sound you might hear when scrunching plastic wrap) when I go down a flight of stairs. However, I do not have any knee pain. Should I be concerned?
The crunching sound from your knee is crepitus. If you do not have any other symptoms, no specific treatment is necessary for crepitus. If you develop other knee problems, however, you should see a doctor to have your knee evaluated.
Crepitus is caused by the rubbing of cartilage on the joint surface or other soft tissues around the knee during joint movement. When knee snapping or catching is painful, that is usually a result of scar tissue, a meniscus tear or a tendon moving over a bony prominence within the knee joint.
The patellofemoral joint — where your knee cap meets your thigh bone, or femur — is typically the source of knee crepitus. Cartilage, the smooth, elastic tissue that covers the ends of bones, normally allows the bones to glide easily in the joint. But over time, the cartilage surface may start to lose its smoothness. The crunching you hear likely is due to the cartilage in your knee becoming rough, so the bones cannot slide as easily in the joint as they normally do.
Knee crepitus typically happens when the knee is bent, such as when you are squatting, going up or down stairs, or rising from a chair. By itself, crepitus generally is not a cause for concern. Once the cartilage gets rough, though, it may be at risk to begin to wear down, leading to arthritis.
To help prevent additional knee problems, work on strengthening the muscles in the front of your thigh, called the quadriceps. Walking, biking and swimming can all be useful for strengthening the quadriceps muscle. A variety of exercises that directly target the quadriceps, both with and without weights, also may be helpful. If you have questions about specific exercises or if you have other medical conditions, talk to your doctor or a physical therapist before beginning a new exercise program.
Strong quadriceps can take some of the load off your patellofemoral joint. That makes it less likely the cartilage in the joint will wear down. Also, to help prevent further cartilage damage and other knee injuries, avoid overloading the joint when your knee is bent.
If you start to notice additional knee symptoms such as knee pain or fluid in the joint along with crepitus, that could signal the beginning of other problems. For example osteoarthritis, a common cause of knee pain and excess fluid around and in the joint, can develop if the cartilage in your knee wears down.
If other knee symptoms do develop, it is important to have your situation evaluated right away. When left untreated, some knee conditions including osteoarthritis can lead to increasing pain, joint damage and, eventually, disability. But if identified and treated promptly, most knee problems can be successfully managed.
— Michael Stuart, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.
JACKSONVILLE, Fla. — Like a car with a front and back end, a steering mechanism and an engine to push it forward, cancer cells propel themselves through normal tissues and organs to spread cancer throughout the body. Researchers at Mayo Clinic in Florida, however, have managed to turn these cells into shapes like a round fried egg and an exaggerated starfish that sticks out in many directions — both of which cannot now move.
In research published in the December issue of Molecular and Cellular Biology, investigators reveal how interplay of molecules keeps cancer cells moving forward, and how disturbing the balance of these proteins pushes their shape to change, stopping them in their tracks.
Investigators say they have already identified a number of agents — some already used in the clinic for different disorders — that may force shape-shifting in tumor cells.
"We are starting to understand mechanistically how cancer cells move and migrate, which gives us opportunities to manipulate these cells, alter their shape, and stop their spread," says the study's lead investigator, Panos Z. Anastasiadis, Ph.D., chair of the Department of Cancer Biology at Mayo Clinic in Florida.
"It is the spread — the metastasis — of cancer that is largely responsible for the death of cancer patients, so stopping these cells from migrating could potentially provide a treatment that saves lives," he says.
The study was conducted using tumor material from breast and brain (glioblastoma) cancer. Both of these tumors are generally lethal when they spread — breast to other organs, and brain cancer as it crawls throughout the brain.
The researchers found that a protein called Syx is key to determining how tumor cells migrate. When researchers removed Syx from the cancer cells, they lost their polarity — their leading and trailing edges — and morphed into the fried egg shape. "They are now unable to sense direction, so they are not going anywhere," Dr. Anastasiadis says.
Treatment for Kidney Stones Depends of Type and Cause of Stones
November 8, 2013
Dear Mayo Clinic:
I continue to get kidney stones despite drinking plenty of water. They are quite small and I haven't had to be treated yet. But my doctor said if my symptoms get worse, I will need treatment. What would that involve?
Treatment for kidney stones depends on the type of stone and their cause. In many cases, dietary changes and medication are all that's needed for small stones. Larger stones may require additional treatment.
Kidney stones form from minerals and acid salts. About 85 percent of kidney stones are calcium based, typically calcium oxalate. Less common are uric acid stones, struvite stones and cystine stones. Your doctor can use blood and urine tests to find out what kind of stones you have. If you have passed a stone, a laboratory analysis can reveal the make-up of the stone.
If your stones are calcium oxalate — as most kidney stones are — you need to keep doing what you have already started: drink lots of water. The typical recommendation is to drink about 8 to 10 ounces of water every hour you are awake.
There are several benefits to drinking that much water when dealing with kidney stones. First, it flushes out your urinary system and helps small stones pass more easily. Second, diluted urine lowers the chances that calcium oxalate stones will form in the first place. Drinking plenty of water can help prevent uric acid stones and cystine stones, too.
A variety of changes in your diet can lower your risk of forming new calcium oxalate stones. Oxalate is a substance found in certain foods. For people at risk for these kidney stones, eating fewer oxalate-rich foods can help. They include foods such as spinach, beets, Swiss chard, rhubarb, almonds and granola, among others.
A low-salt diet can be useful in preventing calcium oxalate kidney stones, as can getting the right amount of calcium from the foods you eat. Some people with kidney stones are advised to eat more citrus fruits because a substance in those fruits, called citrate, can naturally inhibit stone formation.
For uric acid stones, cutting back on the amount of protein you eat — especially protein from animal sources — may help prevent new stones.
Ask your doctor to recommend a dietitian you can talk with about a diet that is right for you. He or she can review food choices that may lower your risk of new kidney stones and help you plan some sample menus to get started.
In some cases, medication also can treat kidney stones and prevent new ones from forming. Again, the specific medicine you need depends on the type of stone you have. Doctors often prescribe a thiazide diuretic — a water pill — for people with calcium stones. In addition, a citrate supplement may be appropriate for people with very low levels of citrate in their bodies.
Medications can help lower the amount of uric acid in the blood and urine for people who tend to form those types of stones. Struvite stones are associated with infections. In some cases, long-term use of antibiotics in small doses may help keep urine free of bacteria that can cause infection. Medicines can sometimes be used to lower the amount of cystine in the urine for people who have cystine stones.
If you develop larger kidney stones, you may need more invasive treatment. Procedures are available to break up large kidney stones into small pieces that can pass through your urinary tract. For very large stones, surgery is sometimes necessary to remove them.
Right now, the best step is to talk with your doctor about tests that can show what type of kidney stones you have. Once you know that, you can make a plan to help prevent and treat new stones.
— Vincent Canzanello, M.D., Nephrology, Mayo Clinic, Rochester, Minn.
Surgery Could Be Best Option For Biceps Injury
September 27, 2013
Dear Mayo Clinic:
I recently had a non-contrast MRI which showed a biceps tendon tear. I've already tried four months of physical therapy, rest, ice, anti-inflammatory medications and cortisone injections. Is surgery necessary and, if so, what does the recovery involve?
It sounds as if surgery could be a reasonable next step in treating this injury. Several surgical techniques can be used depending on the location and nature of the tear. The type of technique used determines your recovery time, which can range from just a few days to about three months.
Your biceps is the muscle at the front of your upper arm. You use it when you rotate your forearm and bend your elbow. Two tendons attach the bicep to your shoulder. These tendons combine into one that crosses the elbow and attaches to your forearm.
A biceps tendon tear can be either partial — the tendon is not completely severed through — or complete. A partial biceps tendon tear can be very irritating and lead to symptoms such as pain, tenderness and aching. A complete biceps tendon tear does not cause ongoing pain. But it does lead to a loss of forearm rotation strength, along with some pain if it occurs at the elbow.
Several treatment options are available for biceps tendon tears. Because you have already tried a number of more conservative treatments without success, surgery may be appropriate.
For a partial biceps tendon tear in the shoulder, one surgical approach is to complete the tear and release the damaged tendon from its attachment to the shoulder joint. As a result, the tear no longer irritates the joint and symptoms disappear.
With this procedure, called a tenotomy, you will lose little function in your biceps muscle. The other tendon that attaches to your shoulder can do the work instead. But because the tendon no longer keeps the muscle tight against the upper arm bone, it will leave a bulge in your upper arm. Some people are fine with that extra bulge. Others prefer to eliminate it by having the tendon reattached to the bone further down the arm.
A biceps tendon tear at the elbow is much less common than at the shoulder. Most often, elbow biceps tendon tears are complete. These tears usually are the result of a forceful extension of the elbow when, for example, you try to hold a heavy object with your palm up. The injury results in weakness when rotating the forearm and bending the elbow.
Surgical repair for complete tears should take place as soon as possible. If left untreated, the muscle and tendons begin to shorten and scar, making surgical repair difficult later.
If an elbow biceps tendon tear is partial and causes ongoing symptoms, it may be treated surgically by removing the affected tissue and reattaching the tendon to the bone using stitches or special screws. A similar technique can be used when a shoulder biceps tendon needs to be reattached.
Recovery time after surgery varies, depending on the procedure you have. When the shoulder tendon is simply released and not reattached, recovery is almost immediate. There are usually no restrictions on activity following that type of surgery.
When the tendon is reattached to the bone, healing takes about three months. Patients should not lift anything heavy for about six weeks after surgery. Manual labor, sports and other physical activities that involve your arm may be limited for another six weeks. Physical therapy can be done with a home-based program to regain the arm's strength and range of motion.
The long-term outlook often is good after surgery to treat a torn biceps tendon. The surgery typically relieves pain symptoms. Most people recover a full range of motion in their arm, and arm function is effectively restored.
— Mark Morrey, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.
Stress May Play A Role In Hair Loss, But Other Triggers Could Be The Cause
August 30, 2013
Dear Mayo Clinic:
Is it true that chronic stress can cause hair loss, and if so, is the hair loss reversed once the stress is lessened?
There isn't an easy yes or no answer to this question. Some hair loss may be related to stress, and, in some cases, it is possible that hair loss could be reversed. But it depends on the type of hair loss you have and other triggers for the hair loss that could be at work.
It is generally accepted that some connection between high levels of stress and hair loss is likely in certain situations. But that connection has not been proven in clinical research trials in people. Research on mice and human hair that has been grown in laboratories seems to show that stress may play a role in two specific kinds of hair loss: telogen effluvium and alopecia areata.
The first, telogen effluvium, is the more common of the two. This type of hair loss involves shedding hair faster than normal from all over your head. It typically does not lead to baldness, but your hair does become thinner than usual. Telogen effluvium has been linked to a range of triggers, and some of them do involve stress.
One trigger that is frequently noticed by women with infants is the hair loss that often starts about three to five months after the birth of a child. While you are pregnant, you lose less hair than normal. Several months after delivery, the body then sheds hair down to its typical level. That hair loss may be concerning, especially if you did not notice the buildup of hair during pregnancy. But for most women, the loss tapers off once the hair has returned to its usual thickness.
Other triggers that can cause telogen effluvium include thyroid problems, massive weight loss, significant medical illness and general anesthesia. If you have recently stopped using a method of birth control that contains hormones, that also could lead to this kind of hair loss. A few specific medications may trigger telogen effluvium, too, although that is rare.
The other type of hair loss that may be linked to stress is alopecia areata. It usually involves patchy hair loss, with bald patches about the size of a quarter or half-dollar. In extreme cases, alopecia areata may affect all the hair on a person's head, including eyebrows and eyelashes.
In most people with alopecia areata, the hair grows back in one to two years. Treatment with steroid injections into the affected areas can often prompt the hair to regrow faster. The larger the area of hair loss, though, the less effective treatment tends to be.
If you are dealing with hair loss, whether you think it is related to stress or not, keep in mind that there are many variations of hair loss, and many medical diagnoses that can lead to hair loss. Some kinds of hair loss may be reversible, while others are not. In some cases, treatment may be able to reverse hair loss. But that is not always the case.
Be very cautious of products and services that claim to restore hair in all cases. Many products related to hair loss available in the marketplace today are expensive but do little, if anything, to effectively treat hair loss. If you are concerned about hair loss, see a dermatologist who specializes in hair issues. He or she can help you investigate the cause of hair loss and decide on possible treatment options.
— Rochelle Torgerson, M.D., Ph.D., Dermatology, Mayo Clinic, Rochester, Minn.
Shingles More Common After Age 50, but Can Affect Younger People as Well
August 9, 2013
Dear Mayo Clinic:
I was diagnosed last year, at the age of 38, with shingles. What causes someone who is relatively young to get shingles? Does this mean I am more likely to get it again? Should I get the vaccine at this point or wait until the recommended age of 60?
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Once you have had chickenpox, varicella-zoster stays in your body for the rest of your life. When the virus is reactivated, the result is shingles.
Shingles typically involves a band-like rash on one side of the chest, abdomen or face. The rash is usually quite painful. Most people recover from shingles over several weeks. A small number have lingering severe pain, called post-herpetic neuralgia, along the nerve that was irritated when the virus came back.
Shingles often occurs when a person's immune system is impaired. A weakened immune system can be part of the aging process. That's why shingles tends to be more common in people older than 50. The risk of shingles continues to increase as people age. Some experts estimate that half the people who live to age 85 will get shingles at some point.
Shingles can affect younger people, too, as a result of factors that can affect the immune system. Periods of high stress, depression and prolonged fatigue may weaken the immune system in otherwise healthy young adults and lead to shingles. Chronic illnesses such as chronic kidney or lung disease, cancer, HIV/AIDS or other diseases that affect the immune system also may increase the risk of a shingles eruption, regardless of age.
Certain medications — such as steroids or immunosuppressive medications used to treat autoimmune diseases or to prevent rejection of transplanted organs — weaken the immune system, as do some types of medical treatment, such as chemotherapy. These also can make a person more vulnerable to shingles.
The fact that you had shingles at your age does not necessarily mean you are at high risk for developing the illness again. In general, only about one to four percent of people who have shingles once go on to have a recurrence. That percentage is higher in people who have chronic diseases that affect their immune systems or who are on long-term drugs to suppress the immune system.
The shingles vaccine can help prevent the disorder and lower the likelihood of complications, such as lingering pain. The Centers for Disease Control and Prevention recommends that all adults age 60 and older who have had chickenpox get the shingles vaccine, even if they have already had shingles. Studies also have shown the vaccine to be effective in patients between 50 and 59 years of age. Because it has not been studied in younger people, it is not clear how effective the vaccine is for healthy adults younger than 50 in lowering the risk of recurrent shingles.
The vaccine is made from a weakened form of the live shingles virus, but it does not cause the illness in healthy people. For those who have chronic diseases or who are on chronic medications that weaken the immune system, the vaccine is not an option due to a risk that it may cause shingles in those groups.
At your age, whether or not you get the vaccine is an individual decision that should be based on your medical history and what, if any, other health conditions you may have. Talk with your health care provider to see if the shingles vaccine is a good choice for you at this time.
— James Watson, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Likelihood of Child Outgrowing Food Allergy Depends of Type, Severity of Allergy
July 26, 2013
Dear Mayo Clinic:
Is it possible for children to outgrow food allergies?
Some children may outgrow their food allergies. But the likelihood of that happening depends in large part on the type of food a child is allergic to, as well the severity of the allergy.
In people who have a food allergy, the body's immune system mistakenly identifies a specific food or part of a food as something harmful. When that happens, the immune system releases into the body immunoglobulin E, or IgE, antibodies. The next time the IgE antibodies sense that food, they cause a variety of chemicals, including histamine, to be released into the bloodstream.
Those chemicals trigger the symptoms of the food allergy, such as hives, skin or throat swelling, gastrointestinal problems, or breathing problems. In some people, a food allergy may lead to a life-threatening reaction known as anaphylaxis. Symptoms of anaphylaxis can include the above symptoms as well as severe tightening of the airways (causing breathing problems), rapid pulse, drop in blood pressure, and/or loss of consciousness. Without emergency medical treatment including epinephrine, anaphylaxis may result in death.
Food allergies affect about 6 to 8 percent of children under age 5, and about 3 to 4 percent of adults. Food allergies often are confused with a much more common reaction known as food intolerance. While bothersome, a food intolerance often is less serious. Usually, its symptoms come on gradually and are limited to digestive problems. Testing generally is not available for food intolerance. A severe form of food intolerance called food protein-induced enterocolitis syndrome, or FPIES, should be evaluated by an allergist or gastrointestinal specialist. Most children outgrow FPIES.
It is possible to have an allergic reaction to almost any type of food. But some foods lead to allergies more frequently than others. Of the common food allergies, milk, egg, soy and wheat allergies are the ones children most often outgrow by the time they are in their late teens.
About 60 to 80 percent of young children with a milk or egg allergy are able to have those foods without a reaction by the time they reach age 16. Recent studies suggest that children with egg or milk allergies who can eat those foods in a baked form, such as a muffin, without an allergic reaction are very likely to be able to tolerate plain egg or plain milk in the future.
Some other food allergies are much less likely to be outgrown. These foods are also common allergens and include peanuts, tree nuts, finned fish and crustacea. They tend to cause a more severe food allergy reaction. Only about 20 percent of children who have a peanut allergy outgrow it. An even lower number of those with tree nut allergies — 14 percent — will lose that allergy. And only 4 to 5 percent of children with a fish or crustacean (shellfish) allergy will go on to be able to eat those foods without a reaction later in life.
In many cases a blood test or an allergy skin test, combined with a thorough assessment of a child's health history, can help determine how likely it is for that child to outgrow his or her food allergy.
If it seems a child has outgrown a food allergy, a test called a food challenge may be recommended. It involves giving the child small amounts of the food in a controlled setting. A very small amount is given first. It is then doubled every 15 to 30 minutes until the child eats one serving size. This test is not recommended for children who are at high risk of anaphylaxis.
If your child has a food allergy, it is a good idea to work with a doctor who specializes in childhood allergies. An allergist can help you monitor and manage a food allergy over time as your child grows.
— Nancy Ott, M.D., Pediatric Allergy and Immunology, Mayo Clinic, Rochester, Minn.
When Diagnosed Early, Stopping Diabetic Kidney Disease May Be Possible
July 12, 2013
Dear Mayo Clinic:
My father was recently diagnosed with diabetic kidney disease. Is there a chance this can be reversed, or will he have it for life? What changes, if any, should he be making to his diet?
It is not uncommon for people who have diabetes to develop kidney problems. When diagnosed early, it may be possible to stop diabetic kidney disease and fix the damage. If the disease continues, however, the damage may not be reversible.
Diabetic kidney disease, also called diabetic nephropathy, happens when diabetes damages blood vessels and other cells in the kidneys. This makes it hard for them to work as they should. In the early stages, diabetic kidney disease has no symptoms. That's why it is so important for people with diabetes to regularly have tests that check kidney function.
In later stages of the disease, as kidney damage gets worse, signs and symptoms do appear. They may include ankle swelling, test findings that show protein in the urine, and high blood pressure. Over time, diabetic kidney disease can lead to end-stage kidney disease.
If your father is in the early stages of diabetic kidney disease, there are several steps he can take to help protect his kidneys. First, it is critical to keep blood sugar as well controlled as possible. This not only helps the kidneys, but decreases the risk of other serious problems that can come from diabetes, such as blindness, heart attack and damage to the blood vessels and nerves.
Keeping blood pressure under control also is important. High blood pressure can speed up the process of diabetic kidney disease and make kidney damage worse. In general, blood pressure of 140/90 in the doctor's office and 135/85 at home is a good goal. But your father should check with his doctor to find out what's appropriate for him.
Eating a diet low in salt, quitting smoking, and limiting alcohol can all lower blood pressure. In addition to these lifestyle changes, medication to control blood pressure may be useful. The most common blood pressure medications for people with diabetes are angiotensin converting enzyme, or ACE, inhibitors and angiotensin receptor blockers, or ARBs.
Healthy cholesterol levels can help kidney function, too. Typical recommendations include keeping the level of "bad" cholesterol — called low density lipoprotein cholesterol, or LDL — to less than 100 milligrams (mg) of cholesterol per deciliter (dL) of blood. An ideal level for someone with diabetes is 80 mg/dL.
Diet has a direct impact on cholesterol. A diet rich in fiber, vegetables, fruits, heart-healthy fish and whole grains that is also low in fat and dietary cholesterol can go a long way toward lowering LDL cholesterol. Eating a healthy diet can also help shed extra pounds. That's good for the kidneys because being at a healthy weight helps keep blood sugar, blood pressure and cholesterol levels down.
In addition, your father needs to be careful when taking medications. He should not take over-the-counter medications that belong to the group of drugs known as nonsteroidal anti-inflammatory drugs, or NSAIDs. These include ibuprofen and naproxen. Some prescription medications may lead to kidney damage, too. If a doctor recommends a new medication to him, your father should ask about the possible impact on his kidney disease. Some medications may need to be avoided completely. But many more simply need the dose adjusted to fit his kidney function.
If he needs medical imaging tests that normally use dye, such as CT scans, your father should remind his health care providers that he has diabetic kidney disease. Because these dyes may lead to kidney damage in people with kidney disease, it is generally recommended they avoid them.
Finally, to monitor his condition and to help protect his kidneys' long-term health, encourage your father to see a nephrologist regularly.
— John Graves, M.D., Nephrology/Hypertension, Mayo Clinic, Rochester, Minn.
Steps Can Be Taken to Relieve or Prevent Night Leg Cramps
Dear Mayo Clinic:
As I've gotten older I seem to get leg cramps at night more
frequently. Is there anything I can do once it begins, or do I
just have to wait it out? Are there ways to prevent them from
occurring in the first place?
Anyone who has ever woken up with a leg cramp knows how painful
it can be when one of their muscles suddenly contracts. Night leg
cramps typically involve calf muscles. Yet, it's possible to
get these cramps in the feet or thighs as well.
In most cases, night leg cramps are harmless and can be
relieved or even prevented with some simple stretching or other
self-care measures. However, if they occur regularly and cause
severe discomfort, see your doctor. This is particularly true if
leg cramps are interfering with your sleep or you're having
muscle weakness, swelling, numbness or pain that lingers or
continues to come back.
Although the risk of getting night leg cramps increases with
age, it's often difficult to pinpoint the cause. In fact,
these cramps often occur for no known reason.
Dehydration, prolonged sitting, or not getting enough
potassium, calcium or magnesium in your diet can be associated
with leg cramps. So can certain medications - including
diuretics, beta blockers and other blood pressure drugs.
Sometimes, these cramps also may be related to an underlying
metabolic condition, such as an underactive thyroid
(hypothyroidism) or a parathyroid condition. Diabetes or other
conditions that disrupt your metabolism can also cause muscle
Night leg cramps are sometimes confused with restless legs
syndrome (RLS). With RLS, you feel throbbing, pulling or other
unpleasant sensations in your legs and have an uncontrollable
urge to move your lower limbs. These symptoms primarily occur at
night or when at rest. However, muscle pain is less common with
restless legs syndrome than it is with night leg cramps. Pain
from swelling caused by excess fluid (edema) may feel like leg
The pain caused by leg cramps can vary in intensity and last
from just a few seconds to 15 minutes or more. To get relief,
gently rubbing a cramped muscle can help it relax. Stretching
also can ease a spasm. For a calf cramp, try standing and putting
your weight on the leg in question and then slightly bending your
knee. If you're in too much pain to stand up, straighten your
leg and flex the top of your foot toward your head.
Applying cold or heat also can offer some relief. To relax
tense muscles, apply ice or a cold pack directly to the area
where you feel cramping. Applying heat with a warm towel or
heating pad, or by taking a hot bath or shower, also can make you
feel better by reducing muscle pain or tenderness.
Although night leg cramps can take you by surprise, prevention
is possible. These steps can help:
Staying hydrated — Drinking water and
other liquids throughout the day can keep you from becoming
dehydrated. It can also help your muscles contract and relax more
easily. It's especially important to replenish your fluids
when engaging in physical activity and to continue drinking water
and other liquids after being active.
Stretching before bed — If you have
night leg cramps, it's a good idea to stretch before turning
in for the night.
Doing light exercise — Riding a
stationary bike for a few minutes before bedtime may help prevent
cramps while you're sleeping.
Choosing the right shoes — Wearing
shoes that have proper support may help prevent leg cramps.
Untucking the covers — Loosen or untuck
the bedsheets and other covers at the foot of your bed.
If self-care strategies aren't keeping cramps at bay, pain
relievers such as acetaminophen (Tylenol, others) may be of
— Paul Takahashi, M.D., Primary Care Internal Medicine,
Mayo Clinic, Rochester, Minn.
Treatment Of Gallstones With "Cleanse" Not Shown To Be Effective
June 7, 2013
Dear Mayo Clinic:
I have been diagnosed with gallstones. I read about a gallbladder "cleanse" that may get rid of gallstones. Is this safe? If it does not work, what are the treatment options? I would like to avoid surgery if possible.
A variety of remedies that claim to treat gallstones by cleansing the gallbladder are sold without a prescription. None of them have been shown to be effective. Several prescription medications are available that may dissolve gallstones in some patients. This treatment typically is reserved for people who cannot tolerate surgery, and it is not always effective. For gallstones that are causing symptoms, the most reliable treatment choice usually is gallbladder removal.
Your gallbladder is a small organ on the right side of your upper abdomen, just beneath your liver. The gallbladder contains a digestive fluid called bile that's released into your small intestine. Gallstones are hardened deposits that form in your gallbladder.
If gallstones are not causing symptoms, they usually don't need treatment. Gallstones can lead to problems, though. The most common is pain in your abdomen after you eat — a symptom called biliary colic.
If left untreated, gallstones that cause symptoms can lead to inflammation of the gallbladder, a condition known as cholecystitis. Gallstones also may pass out of the gallbladder and into the bile duct, blocking the duct. When that duct is blocked, enzymes from the pancreas cannot flow to the small intestine. Instead, they are forced back into the pancreas where they can cause inflammation, a serious condition known as pancreatitis. Because of these potential symptomatic complications, it is important to consider treating gallstones.
The gallbladder cleanse you mention is touted as an alternative remedy for getting rid of gallstones. In most cases, a gallbladder cleanse involves eating or drinking a combination of olive oil, herbs and fruit juice over several hours. Proponents claim that gallbladder cleansing helps break up gallstones and stimulates the gallbladder to release them in the stool.
People who try gallbladder cleansing may see what looks like gallstones in their stool the next day. But what they are really seeing is globs of oil, juice and other materials. None of these cleansing treatments have been shown to be effective for gallstones.
Gallbladder cleansing is not without risk. For some people, it may cause nausea, vomiting, diarrhea and abdominal pain. In addition, some components of the herbal mixtures used in a gallbladder cleanse may present their own health hazards.
Prescription medications that dissolve gallstones may be an option for some people. They can only be used in specific situations, though. The stones must be made up of mostly cholesterol, and they have to be small. Even if they are the right type of stone, it can take months or years for gallstones to dissolve completely with medication. For the medication to be effective long-term, your gallbladder must be functioning correctly. If not, stones are less likely to respond to dissolving medications and new stones are more likely to form.
As long as you do not have an underlying medical condition that makes surgery dangerous, removing the gallbladder usually is the best treatment for gallstones. Gallbladder removal — a procedure known as cholecystectomy — can often be performed using a minimally invasive, or laparoscopic, technique. Many people who have laparoscopic cholecystectomy go home the same day.
Side effects from gallbladder removal usually are minor. The most common problem after surgery is mild diarrhea. It may last for several days to several weeks, but it usually goes away without treatment.
Discuss the treatment options for gallstones with your doctor. Together you can review the choices available to you and decide on the best one for your situation.
— Michael Picco, M.D., Gastroenterology, Mayo Clinic, Jacksonville, Fla.
Despite Claims, Synthetic Growth Hormone Not Effective as Anti-aging Treatment
May 3, 2013
Dear Mayo Clinic:
My sister goes to an anti-aging specialist who recommends she take HGH to slow aging. Does this work? Is it safe?
Human growth hormone, or HGH, in a synthetic form can be safe and useful as a treatment for some medical conditions. However, it is not intended to be used as an anti-aging medication. No evidence exists that shows HGH works against the effects of aging. In fact, taking HGH may be dangerous for some people.
HGH is a hormone produced in the pituitary gland — a small structure at the base of your brain that makes hormones to regulate important body functions, such as growth, blood pressure and reproduction. As a child, having the right amount of HGH in your body is essential to achieving normal adult height. Because of this, our bodies make a significant amount of HGH in childhood and adolescence. HGH production then decreases throughout adulthood.
Even though there is less of it in adults, HGH is still important as we age. It plays a key role in regulating our body composition, including the amount of muscle mass versus fat mass we have. HGH also helps to sustain healthy bone density and aids in metabolism. Research suggests it may play a role in maintaining our cognitive abilities, too.
Synthetic growth hormone, which is given by injection and available only with a prescription, is used most often in children whose bodies do not make enough HGH. These children usually have some kind of pituitary disease that does not allow their pituitary gland to produce adequate amounts of HGH. Receiving synthetic growth hormone can help them reach a normal adult height. Children with short stature from chromosomal abnormalities or kidney failure also may benefit from growth hormone therapy.
HGH may be used in adults who have pituitary disease and are deficient in growth hormone. In addition, the hormone has been shown to be useful in some people with short bowel syndrome and AIDS who have lost a significant amount of muscle mass from the disease. Although safe and effective for people who have one of these medical conditions, synthetic growth hormone is not recommended for anyone who has normal levels of HGH.
In healthy people, taking growth hormone can cause joint and muscle pain, as well as swelling in the arms and legs. It can also lead to carpal tunnel syndrome and can contribute to other health problems, including diabetes, high blood pressure and heart disease. Research suggests HGH can cause tumors to develop or grow, making it potentially quite dangerous for anyone who has cancer or who has been diagnosed with cancer in the past.
There is no scientific evidence that shows taking synthetic growth hormone slows aging. Be very wary of people who claim otherwise. Some websites sell a pill form of human growth hormone and claim that it produces results similar to the injected form of the drug. Sometimes these dietary supplements are called human growth hormone releasers. Avoid them. There is no proof that these claims are true. Likewise, there's no proof that homeopathic remedies claiming to contain human growth hormone work.
If you want to feel and look your best as you age, it is much better to make healthy lifestyle choices than to turn to so-called anti-aging "solutions," such as HGH. Eat a healthy diet. Exercise regularly. Don't smoke. Get medical care for any chronic health problems. If you have specific concerns about aging, talk to your doctor about proven ways you can improve your health.
— Todd Nippoldt, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.
For Successful Treatment Of Chronic Runny Nose, First Identify Underlying Cause
May 24, 2013
Dear Mayo Clinic:
I am an 85-year-old man who has had a postnasal drip problem since childhood. Years ago, after many tests, I was diagnosed with nonallergic rhinitis. I have tried pills and sprays to help the symptoms, but nothing works very well. I feel as though I'm constantly blowing my nose and often clearing my throat. Do you have any suggestions that will allow me to go more than an hour with some relief?
The problems of a chronic runny nose and postnasal drip — excess nasal drainage that runs down the back of your throat — can be challenging to effectively manage. Although they may not seem to be major medical problems, these symptoms can have a big impact on a person's quality of life. Successful treatment often depends on identifying their underlying cause.
Even though your symptoms have appeared to be the same for many years, it is possible that the source of those symptoms actually may have changed over time. The potential causes of a chronic runny nose and postnasal drainage can vary as people age.
In younger people, for example, a chronic runny nose along with other symptoms such as congestion or sneezing could be a symptom of allergies, a condition called allergic rhinitis. Or, as you mention, it is sometimes linked to nonallergic rhinitis. Nonallergic rhinitis can be due to different causes like irritation from smoke or vasomotor rhinitis, which is hypersensitivity of the lining of the nose to odors, temperature or barometric changes. There is also a condition called nonallergic rhinitis with eosinophilia, which causes symptoms similar to those of allergic rhinitis, but no triggering allergen can be found.
A runny nose with considerable postnasal drainage could be linked to chronic sinusitis. In this common condition, the cavities around nasal passages, called sinuses, become inflamed and swollen. Some people with chronic sinusitis also have sinus polyps that may make the problem worse. A runny nose that seems to affect one side of the nose more than the other side could signal an anatomical problem, such as a spinal fluid leak. When symptoms include obstruction to air flow, other conditions such as a deviated nasal septum need to be considered.
All of these causes of chronic runny nose and postnasal drainage may happen in older people, but several additional disorders that can cause these symptoms to become more frequent with age.
For example, gustatory rhinitis is more common in older populations. Symptoms of this type of nonallergic rhinitis may be triggered by eating any food, and is an exaggeration of the runny nose that we all get when we eat spicy food. It is also more common for minor temperature changes to induce a runny nose in older adults.
In many older people, the sensation of postnasal drainage may be the result of nasal airway dehydration. This can be a side effect of medications for high blood pressure, sleep disorders and bladder problems, among others. Drinking too much coffee, tea or alcohol, or not drinking enough water is also more likely to produce nasal dehydration in older adults. Finally, in some people symptoms of certain kinds of gastroesophageal reflux may be mistakenly identified as postnasal drainage.
Effective treatments are available for many of these conditions. Finding the best treatment, however, hinges on correctly pinpointing the underlying problem.
Because it has been some time since you were originally diagnosed with nonallergic rhinitis, it may be helpful to have your condition re-evaluated now. Consider making an appointment with a physician who specializes in ear, nose and throat disorders (otorhinolaryngologist) or an allergist with a particular interest in disorders of the nose and sinuses. After a thorough evaluation of your symptoms and your overall medical condition, he or she will likely be able to provide advice on how to best manage these bothersome symptoms.
— Juan Guarderas, M.D., Otorhinolaryngology/Allergy, Mayo Clinic, Jacksonville, Fla.
Mild Leg Swelling Can Be Easily Managed, but Check with Doctor First for Accurate Diagnosis
May 17, 2013
Dear Mayo Clinic:
For the past couple of weeks my calves have been swollen. They don't hurt, but I definitely notice that my socks are tighter than normal. What could be the cause?
There are numerous causes of painless swelling of the legs (peripheral edema). If there are no other symptoms, mild leg swelling is relatively common and easily managed. But peripheral edema is sometimes associated with a more serious underlying disease, so it's important you see your doctor for a thorough exam and accurate diagnosis.
Edema is the result of a buildup of excess fluid in your tissues. Normally, the body maintains a balance of fluids between the network of blood vessels, the lymph system and all of the tissues outside of these vessels. However, if the balance is disturbed, the tiniest blood vessels (capillaries) may leak fluid that builds up in surrounding tissues. The result is edema.
In addition to swelling, other signs and symptoms of edema may include stretched or shiny skin, skin that stays indented after being pressed for at least five seconds, or an increase in abdominal size.
Peripheral edema typically affects both legs. Edema in only one leg may be related to something in that leg or the groin on the same side.
In some instances, edema can affect the lungs and lead to shortness of breath and difficulty breathing, which requires urgent medical care.
A physical exam can help sort out the cause of peripheral edema and help determine if there is a serious underlying condition. Certain blood tests and urinalysis may be done, as well an electrocardiogram, chest X-ray and possibly additional imaging, such as such as an ultrasound of the affected leg or even the pelvis.
Mild edema without symptoms such as shortness of breath, abdominal swelling or high blood pressure usually signals a less worrisome cause. The benign causes can include having consumed more salt than usual, being overweight, standing or sitting for an extended period of time, and your age (older adults are more susceptible to swollen legs).
Sometimes, peripheral edema is a side effect of a drug. Among the many drugs known to cause swelling are calcium channel blockers, corticosteroids, nonsteroidal anti-inflammatory drugs, the anti-seizure drug gabapentin (Neurontin), and certain drugs for diabetes — particularly thiazolidinediones.
Peripheral edema can stem from a number of conditions, notably:
Weak or damaged leg veins — Over time, one-way valves that keep blood moving toward your heart can weaken and stop working properly, allowing fluid to pool in your lower limbs.
Deep vein thrombosis (DVT) — Edema may develop if blood clots form in the deep veins of your leg. Clotting usually affects only one leg and may produce swelling, pain and tenderness.
Congestive heart failure — If one of your heart's lower chambers loses its ability to pump effectively, blood can back up. Right-sided heart failure produces lower limb edema and, if severe enough, can lead to abdominal swelling. If the left side of the heart is affected, shortness of breath with exertion and when lying flat in bed can occur due to fluid in the lungs.
Scarring of the liver (cirrhosis) — Scarring related to end-stage liver disease creates serious obstacles for blood flow through the liver. This results in abdominal swelling and peripheral edema, especially as the liver becomes less capable of producing albumin, one of the proteins that keeps fluid in the blood vessels.
Chronic kidney damage — Damage to tiny, filtering structures (glomeruli) in your kidneys can produce a cascade of changes. These include sodium retention, increased protein in the urine and an abnormally low level of albumin in the blood. Fluid buildup in combination with a low albumin level may produce peripheral edema and swelling, which involves the entire body.
Damaged lymphatic system — The lymphatic system helps clear excess fluid from your tissues. Damage to that system — particularly to lymph nodes in the groin area due to cancer surgery or radiation therapy — may impair normal lymph drainage and result in lower limb swelling.
Tumor — Rarely, leg swelling may be associated with pelvic tumors.
To help prevent fluid retention, your doctor may recommend limiting salt intake. Wearing special compression stockings may help prevent fluid retention in your legs and feet. Mild edema related to prolonged standing or sitting can usually be managed by lying down with the legs elevated for an hour or two a day. Water aerobics or walking in a swimming pool also may help redistribute excess fluids. For more severe peripheral edema, a water pill (diuretic) may be prescribed.
— John Wilkinson, M.D., Family Medicine, Mayo Clinic, Rochester, Minn.
THIS WEEK'S TOP STORY
Stress assessment: Rate your stress — Don't wait until stress has a negative impact on your health, relationships or quality of life. Start practicing a range of stress management techniques today.
Hygiene hypothesis: Early germ exposure prevents asthma?
Menstrual cycle: What's normal, what's not
Health savings accounts: Is an HSA right for you?
Slide show: Healthy meals start with planning
HEALTH TIP OF THE WEEK
Laugh more, stress less
Humor can help reduce stress by providing a positive way of looking at problems. Humor can also help you perceive what's ridiculous or absurd in a situation. To promote humor in your life, follow these steps: 1. Be open to humor. Give yourself permission to laugh, even during tough times. 2. Surround yourself with humor. Try hanging cartoons in your workstation. 3. Seek out humor. Look for humor in everyday situations. Or watch a favorite comedy DVD. 4. Share your humor. Tell a funny true story to a coworker or friend.
Recovery Time from Disorder Affecting Nerves That Control Shoulder, Arm and Hand Can Vary
April 26, 2013
Dear Mayo Clinic:
I was recently diagnosed with Parsonage-Turner syndrome following a rotator cuff repair. There is not much information out there. Can you tell me more about it? I am currently going through weekly steroid infusion treatment. I have pain in my arm and do not have a lot of feeling in my thumb, index and middle finger. Is treatment usually successful?
Parsonage-Turner syndrome (PTS) is a rare disorder that affects the nerves controlling the shoulder, arm and hand. It usually causes severe pain, weakness and numbness. Nerve inflammation is a hallmark sign of the disorder. The cause of PTS is not clear. In a small number of people, PTS may be the result of a genetic abnormality. Treatment with steroids may be helpful. The amount of time it takes to recover, though, can vary significantly from one person to another.
PTS affects the brachial plexus — the network of nerves that sends signals from your spine to your shoulder, arm and hand. PTS occurs when those nerves become inflamed. Typically, the inflammation causes sudden pain, followed by weakness and numbness. The severity of an attack can range from mild to severe. Some people have symptoms only in the shoulder, while other cases like yours involve the arm and hand, too.
In most cases, it is not possible to identify the cause of Parsonage-Turner syndrome. But attacks are often triggered by surgery, as well as labor and delivery in women. Influenza, high levels of stress or extreme use of a shoulder or arm also may lead to an attack of Parsonage-Turner syndrome.
A speedy and accurate diagnosis of this disorder is critical. Because they often appear after surgery, symptoms of PTS are often mistakenly blamed on a surgical injury. But where an injury is usually obvious from the time a person wakes up from surgery, PTS symptoms typically develop hours or days later.
Diagnosing PTS involves an evaluation to establish the presence and location of a patchy process consistent with nerve inflammation. This may include nerve tests such as nerve conductions and electromyography (EMG), along with imaging exams, such as magnetic resonance imaging, blood tests for alternative causes of inflammation and rarely nerve biopsies. Because PTS is rare and complex, if a primary care physician suspects it, referral to a neurologist experienced in diagnosing and managing the disorder is usually the best course of action.
If symptoms are still active when the diagnosis is made, steroid treatment may be recommended to reduce the inflammation. PTS symptoms usually fade over time. Physical therapy may be necessary to regain complete range of motion. Recovery time depends on the severity of the attack, the areas of the body affected, and how quickly treatment began.
For example, in a case with mild symptoms only affecting the shoulder that was quickly diagnosed and treated, recovery could take six months. For a more severe case that involves the shoulder, arm and hand, full recovery may take several years or more. Eventually, though, most people do recover to near-normal function after a PTS attack.
Research has shown that for some people with PTS, the disorder is the result of a problem in their genes. The genetic form of PTS is rare. But if you have recurrent attacks, if your first attack happened when you were in your 20s or younger, or if it occurred after labor and delivery, consider meeting with a genetic counselor to discuss whether you should undergo genetic testing for PTS.
For those who do have genetic PTS, some research has shown that receiving steroids during a surgical procedure or during labor and delivery can help lessen the likelihood of a PTS attack.
— Christopher J. Klein, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Number of Factors May Contribute to Urinary Tract Infection in Women
April 19, 2013
Dear Mayo Clinic:
I am a 46-year-old woman and have never had a urinary tract infection before, but think I may have one now. Do I need to be seen by a physician for treatment? What causes UTIs?
Urinary tract infection, or UTI, is generally a bacterial infection that can affect any part of the urinary tract. Up to 50 percent of women encounter UTIs during their lifetimes. When treated promptly, a UTI is typically curable. Antibiotics typically play a key role in treatment. Rarely do UTIs progress to something more serious, such as an infection of the kidney or infection of the bloodstream. Because you have not previously been diagnosed with a UTI, you should make an appointment with your doctor to discuss your symptoms.
UTIs are typically caused by bacteria that live in the colon. The most common bacterium causing a UTI is a type of Escherichia coli (E. coli). The female anatomy increases risk of UTIs, because bacteria can easily migrate from the nearby rectum or vagina to the urethra and into the bladder.
Other factors also may contribute. Sexually active women are more prone to UTIs, and sexual activity is the leading cause of UTI. Changes associated with menopause may increase susceptibility to recurrent UTIs. The loss of estrogen results in thinning of the urethral tissue and disrupts the vagina's acidity level. When this happens, there can be a shift in the vagina's balance of "good" bacteria that normally disrupt the growth of unwanted bacteria, especially E. coli.
In addition, impaired bladder emptying, urinary incontinence, obstructed urine flow due to kidney stones in the urinary tract, diabetes or immunosuppression can increase the risk of UTIs. Placement of an indwelling urinary catheter is another factor that contributes to UTI occurrence.
The majority of UTIs — also referred to as cystitis or a bladder infection — affect the bladder and urethra (lower urinary tract). Classic signs and symptoms of urinary tract infections include the frequent urge to urinate (even if going only small amounts); a burning sensation or pain when urinating; abdominal pain or pressure; cloudy, dark or bloody urine; and/or foul-smelling urine.
Most UTIs are not serious. But if infection moves upstream and affects the kidneys, additional symptoms can occur. You may feel tired, shaky, weak or even faint. Other signs and symptoms of a kidney infection include fever or 101 degrees or greater, shaking and chills, upper back and side pain, and nausea or vomiting. A suspected kidney infection warrants immediate medical care to prevent bacteria from entering the bloodstream.
To confirm that you have a UTI, your doctor may check a sample of your urine for white blood cells, red blood cells or bacteria. A urine culture— which involves growing bacteria from your urine sample — is done less frequently. A urine culture can help identify which bacterium is causing the infection and what medication best targets that organism. If you've had a new sexual partner in the last few months, let your doctor know. In that case, your doctor may also check for sexually transmitted diseases.
In general, women who have a previous history of UTIs and are experiencing some of the classic symptoms (frequent, urgent or painful urination) can contact their physician for a prescription for antibiotics without needing to be seen in the doctor's office.
There are steps you can take to reduce your risk of future urinary tract infections. Drink plenty of liquids, especially water, to dilute your urine and flush bacteria from your urinary tract before an infection can begin. After urinating and after a bowel movement, wipe front to back to help prevent bacteria in the anal region from spreading to the vagina and urethra. Finally, empty your bladder soon after intercourse, and avoid using potentially irritating feminine products, such as deodorant sprays or powders, in the genital area.
— Paul Takahashi, M.D., Primary Care Internal Medicine, Mayo Clinic, Rochester, Minn.
Pay Close Attention to Symptoms to Determine if Cause is Sinus Infection or Allergies
April 12, 2013
Dear Mayo Clinic:
I have long suffered from allergies. But there have been times when I haven't been sure if my symptoms are really from my allergies or may be caused by a sinus infection instead. How can I tell the difference?
Allergies and sinus infections are often mistaken for one another. But they are two separate conditions. By paying close attention to the specific symptoms you have, you can usually identify which one is more likely to be causing the problem.
A sinus infection, also called sinusitis, affects the cavities around your nasal passages. The infection causes your sinuses to become inflamed and swollen. The swelling makes it hard for your sinuses to drain, and mucus builds up. You become congested and have trouble breathing through your nose. Sinusitis often causes thick yellow or green nasal discharge. A sore throat, cough or headache, as well as pressure or tenderness around your eyes, cheeks, nose or forehead, may also accompany sinusitis.
In most cases, viruses cause sinusitis. These viral infections usually go away on their own within a week to 10 days. Self-care measures such as extra rest and fluids along with over-the-counter pain relievers and decongestants can help. When sinusitis is caused by bacteria, the infection may not require treatment, either. But if it is persistent or severe, then antibiotics — such as amoxicillin, doxycycline and others — may be used to treat the infection.
Allergies can produce many of the same cold-like symptoms as a sinus infection, including sinus pressure, a runny nose and congestion. But the condition itself, called allergic rhinitis, is different. It is caused by an allergic response to allergens, such as pollen, dust mites or pet dander. This reaction happens when your immune system releases chemicals, such as histamine, into your bloodstream. These immune system chemicals lead to your allergy symptoms.
One of the key ways to tell if you are experiencing allergic rhinitis is if you have itchy, watery eyes along with your other symptoms. Itchiness is rarely a symptom of a sinus infection. Another way to tell the difference is if you have very thick yellow or green nasal discharge. That is more likely a symptom of a sinus infection.
If you have seasonal allergies triggered by pollen or spores, then the timing of your symptoms may help you decide if they are likely caused by allergies. For example, tree pollen is most common in the spring. Grass pollen is common in late spring and early summer, while ragweed pollen is prevalent in the fall. Mold and fungi spores are usually more plentiful in warm-weather months. The seasons for these allergens may be different, though, depending on the region of the country where you live.
Over-the-counter medications, such as antihistamines, can be quite effective in relieving allergy symptoms. If you are regularly bothered by allergies, ask your doctor if a prescription nasal corticosteroid may be right for you. These nasal sprays help prevent and treat nasal inflammation and congestion, while antihistamines treat the itching and runny nose that allergies can cause.
Nasal corticosteroids can be particularly helpful if you have seasonal allergies and use them just as the allergy symptoms begin. That's because when the season first starts, you need a lot of the allergen to cause symptoms. But as symptoms progress, lower amounts of allergen produce more symptoms. By starting the medication early, you might be able to diminish this effect and reduce your symptoms throughout the entire allergy season.
If you suspect your nasal congestion and other symptoms are the result of sinus problems rather than allergies, you may just need to be patient, take care of yourself and use over-the-counter medications as needed until the infection clears. However, if symptoms last for more than two weeks, or if they are severe, make an appointment to see your doctor.
— Juan Guarderas, M.D., Otorhinolaryngology and Allergy, Mayo Clinic, Jacksonville, Fla.
Until Past Menopause, Birth Control Necessary to Prevent Unwanted Pregnancy
March 29, 2013
Dear Mayo Clinic:
I am 44 and would like to discontinue taking birth control pills. Do I need to use another form of contraception if I want to avoid getting pregnant? At what point is it safe to assume that won't happen?
Many women wonder if they need birth control once they are in their 40s. Some actually stop using contraception, believing that they do not need it. That belief is not accurate. Until you are past menopause, birth control is necessary if you do not want to get pregnant.
Menopause is defined as the absence of your menstrual period for 12 months in a row. The average age of menopause in the United States is 51. Ninety-five percent of women go through menopause by age 56.
Contraceptives that use hormones, such as birth control pills, are safe and effective for women of all ages, as long as they do not have risk factors such as smoking or high blood pressure. When used long-term, hormonal contraceptives lower the risk for ovarian cancer and endometrial cancer, a type of cancer that begins in the uterus.
Hormonal contraceptives offer added benefits to women in the years leading up to menopause — a transition known as perimenopause. They can control the hot flashes and night sweats common in up to 80 percent of these women, and reduce heavy bleeding. They also help keep periods regular.
If your desire to stop birth control pills is due to the inconvenience of taking a pill every day, there are hormonal contraceptives that do not require daily attention. One is an implant placed under the skin of the upper arm. Another is a hormonal intrauterine device, or IUD, inserted into the uterus.
Both release a low dose of progestin, a form of the female hormone progesterone. They are very effective in preventing pregnancy. Less than 1 out of 100 women who use these hormonal contraceptives for one year will get pregnant. The implant works for up to three years. The IUD works for up to five years.
One drawback to hormonal contraceptives is that it can be hard to tell when menopause occurs. With these birth control options, you continue to have some bleeding each month, even if you are not ovulating. You may switch to a contraceptive that does not have hormones to see if you have reached menopause. Or, an easier alternative may be to continue hormonal birth control until age 56.
Birth control choices that do not contain hormones include barrier methods, such as condoms, diaphragms, cervical caps, sterilization procedures and natural family planning. A nonhormonal copper IUD is available, too. Although very effective for birth control for up to 10 years, it does not regulate periods or prevent hot flashes.
You should also understand your options for emergency contraception. Emergency contraception is not meant to be used in place of routine birth control. But it is an option if your method of birth control fails, you miss a birth control pill or you have unprotected sex.
In the U.S., emergency contraception is available in pill form and as an IUD. One type of pill which contains progestin can be used up to three days after unprotected sex, while another containing ulipristal can be used up to five days after. The IUD form must be inserted within five days after unprotected sex. These contraceptives do not end a pregnancy that has implanted. Instead, they delay or prevent ovulation.
As you consider birth control options, I strongly recommend you talk with your health care provider. He or she can review the alternatives with you, discuss the benefits and risks of each, and help you make an informed decision about the one that best fits your situation.
— Petra Casey, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.
Treatment for Restless Legs Syndrome Focuses on Relieving the Symptoms
March 1, 2013
Dear Mayo Clinic:
Is restless legs syndrome hereditary? Is there an effective treatment, or does a diagnosis of RLS mean I will have it for life?
Restless legs syndrome, or RLS, is not always hereditary. But it does run in some families, and several genetic links have been found for RLS. While restless legs syndrome is most often a chronic condition, treatment is available that often can effectively control its symptoms.
Restless legs syndrome is a condition characterized by an unpleasant or uncomfortable urge to move your legs. Some people describe it as a crawling, pulling or burning sensation in their thighs, calves or feet. The sensation is temporarily relieved when you get up and move around, especially by walking, or when you shift or stretch your legs. RLS symptoms typically begin after you have been sitting or lying down for some time. Symptoms also tend to get worse in the evenings and at night, and are less bothersome during the day.
In many cases of RLS, the cause is unknown. But RLS appears to be hereditary in about half the people who have it. Several specific gene variations have been associated with this disorder. Familial RLS symptoms often begin earlier in life — usually before age 40 — than they do in forms of the disease that are not hereditary.
In some cases, RLS may be related to another underlying medical condition. For example, some people with symptoms of RLS are found to have iron deficiency. In these situations, taking iron supplements may eliminate symptoms of restless legs syndrome.
Treatment for RLS usually focuses on relieving the symptoms. A variety of simple steps you can take at home may help. Taking a warm bath, massaging your legs, applying warm or cool packs, and trying relaxation techniques, such as yoga or meditation, can all be useful in calming RLS. Exercising at a moderate level on a regular basis and establishing good sleep habits can help, too. For some people, caffeine, alcohol and tobacco can trigger RLS symptoms or make them worse. You may want to try cutting back on these substances to see if your symptoms lessen.
If lifestyle changes are not enough, your doctor may prescribe medication to reduce leg restlessness. Medications that have been shown to be helpful for RLS include several that affect a chemical in your brain called dopamine. Dopamine's job is to send messages from your brain to your body that control muscle movement. Researchers suspect that RLS may be linked to an imbalance in dopamine.
Using drugs that stimulate dopamine receptors in the brain, such as ropinirole, pramipexole or rotigotine, can help control RLS symptoms. Side effects of dopamine medications, however, may include nausea, sedation or, rarely, certain compulsive behaviors such as shopping or gambling. Caution and long-term follow-up for the use of these mediations is necessary.
Certain medications used to treat painful nerve conditions and epilepsy, such as gabapentin, also may effectively treat RLS. Other prescription drugs, including opioid analgesics, muscle relaxants and sleep medications, are sometimes used to help combat RLS symptoms as well.
Be aware that certain medications can make RLS symptoms worse, including some antidepressants and anti-nausea drugs. Review with your doctor a list of the medications you are currently taking. Your doctor may recommend substitutes, as needed, to help manage RLS.
If restless legs syndrome disrupts your daily life or hurts your overall quality of life, consider seeking specialty care. A sleep medicine physician or a neurologist can evaluate your condition and work with you to create a treatment plan that fits your situation.
— Erik St Louis, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Treatment for Rib Fracture Limited, but First Rule out Other Underlying Injuries
March 1, 2013
Dear Mayo Clinic:
My husband, 71, slipped on the stairs and now has a painful area on his rib cage. He has fractured a rib before and says there is no way to treat it, so he has not gone to the doctor. Is it true that nothing can be done? Does he need to see a doctor?
It is true that usually not much can be done for a fractured rib that isn't moved out of normal position and alignment (displaced). Treatment for a rib fracture is usually limited to providing adequate pain control, avoiding strenuous activities and letting it heal. But your husband should be seen by a doctor to rule out other underlying injuries.
Rib fractures are one of the most common types of fracture in older adults. In one study that looked at causes of rib fracture in older adults, about 25 percent of fractures were caused by major trauma, such as a car accident. These account for the most severe injuries, where multiple ribs are fractured, and when fractured bone ends are displaced. Displaced bones can cause many life-threatening complications, and emergency care is appropriate in most cases of major trauma and for anyone with three or more fractured or displaced ribs.
But most causes of rib fracture don't occur as a result of major trauma. In the same study, one-third of the rib fracture causes were due to moderate trauma, such as falling from a standing height. And for about 40 percent of the fractures in the study, there was no identifiable trauma that caused the fracture, which means that nontraumatic events — such as the repeated stress of a coughing spell or swinging a golf club — may have caused it. This may be more likely to occur in someone with weakened bones due to osteoporosis. A tiny percentage of fractures had a direct pathological cause, such as a cancer that had spread to rib bones.
Rib fractures that are the result of mild to moderate trauma or repeated stress on the bone are usually less severe initially, but can be very painful. Pain often occurs when you take a deep breath. It's often possible to isolate a spot on the bone that hurts to the touch or that hurts when you bend or twist.
Serious complications requiring prompt medical intervention — such as lung bruising and swelling, bleeding into or around the lungs, or a collapsed lung — can occur after rib fracture due to minor to moderate trauma. Such complications may require insertion of a chest tube or other surgery, blood transfusion, and artificial ventilation. Emergency care may be necessary if the injured person has lightheadedness, shortness of breath or significant chest pain, particularly if it's worsening.
Even if a suspected fractured rib doesn't require emergency care, it's still important to see a primary care physician for diagnosis and possible treatment.
Controlling pain of a rib fracture is critical so that you can breathe deeply and cough. When pain prevents you from doing this, the risk of developing pneumonia rises. In fact, pneumonia is the most prevalent and serious complication of rib fractures in older adults, occurring in roughly 30 to 35 percent of adults age 65 and older.
Pain control may include nonprescription drugs such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). If these aren't enough, your husband's doctor may prescribe stronger medications. For severe fractures, regional anesthesia may be considered.
Most nondisplaced rib fractures heal within six weeks. Although pain will gradually subside over this time, your husband will likely experience some pain flare-ups because it's hard to totally avoid movement of the healing rib. In some cases, application of a prescribed trunk support, for limited periods, may help to decrease the pain. I recommend he see his doctor, who can rule out any underlying issues and help with pain control. Many people return to their daily activities in less than six weeks.
— Mehrsheed Sinaki, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.