Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
DEAR MAYO CLINIC: Is seasonal affective disorder considered depression? If so, should I be treated for it year-round even though it comes and goes?
ANSWER: Seasonal affective disorder, or SAD, is a form of depression. Year-round treatment with medication for SAD may be recommended in some cases. But research has shown that, for many people with a history of SAD, treatment with a light box beginning in early fall can be useful in preventing SAD. Medication starting at that time may be helpful, too.
SAD is a type of depression that primarily affects people during the fall and winter months. The lower levels of sunlight in the winter and fall, particularly in locations farther from the equator, can disturb your internal clock. This disruption may lead to feelings of depression. The change in seasons also can influence your body’s melatonin and serotonin — natural substances that play a role in sleep timing and mood. When combined, these factors may lead to SAD.
SAD is more than just feeling blue as the days get shorter or having the doldrums in January. Instead, it involves persistent, pervasive symptoms of depression during wintertime. Those symptoms may include feeling sad, angry or easily irritable most of the day nearly every day; lack of interest in activities you usually enjoy; difficulty concentrating; persistent tiredness; lack of energy; and, in some cases, feeling that life isn’t worth living or having suicidal thoughts.
People with SAD often feel the need to sleep considerably more than usual. SAD generally causes people to want to eat more, too, and they often gain weight. Carbohydrate cravings are common. SAD symptoms may get worse as winter progresses. By definition, the symptoms fade as daylight lengthens during springtime.
Effective treatments for SAD are available. Light box therapy is particularly useful. Light boxes mimic outdoor light by emitting a broad-spectrum ultraviolet light. The most common prescription is 30 minutes of light box use at the beginning of every morning, with the box 12 to 24 inches away. The intensity of the light box is recorded in lux, which is a measure of the amount of light you receive at a specific distance from a light source. The recommended intensity of the light typically is 10,000 lux.
Many people use light boxes while getting ready for the day, reading the paper or having breakfast. Again, starting light box therapy in early autumn may help prevent SAD from developing during the winter months.
Medication also may be part of treatment for SAD. The antidepressant medication bupropion has been approved by the U.S. Food and Drug Administration for the prevention of SAD. Other antidepressant medications may be effective, as well. These medications can be helpful for people who have a pattern of SAD and know that they are predisposed to developing it. If you’ve had SAD in the past, starting to take medication in early fall before the days get significantly shorter may prevent SAD symptoms or, if symptoms do appear, it can reduce their length and severity.
There are some self-care steps you can take all year long that may help reduce your risk of SAD, too. They include exercising regularly, maintaining healthy sleep habits and a predictable sleep/wake cycle, eating a healthy diet and limiting the amount of sugary foods you eat.
In addition, going outside on sunny days can make a difference. In the winter, when snow is on the ground, clear days can be brilliantly bright. Exposure to that natural sunlight can help ease SAD. Psychotherapy recently has been found to be effective for SAD, as well. The treatment that has shown the most success for prevention and treatment is cognitive behavioral therapy for SAD, or CBT-SAD.
If you’ve been diagnosed with SAD in the past or you suspect you have it, talk to your doctor about prevention and treatment options. Even if SAD can’t always be prevented, there are treatments available that can help you successfully manage your symptoms and make the winter months easier to take. — Dr. William Leasure, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What do you recommend for someone who has lymphedema in the leg that doesn’t respond to wraps or compression? At what point is surgery to reduce the swelling a reasonable option?
ANSWER: The mainstay of treatment for lymphedema is conservative therapy that doesn’t involve surgery. Lymphedema treatment usually starts with wraps and compression. If that doesn’t work, other nonsurgical options are available. If there’s no improvement after thorough use of conservative treatment, then it may be necessary to consider surgery.
Lymphedema affects your lymphatic system, part of your body’s immune system. Your lymphatic system circulates lymph fluid throughout your body, collecting bacteria, viruses and waste products. It carries this fluid and these substances through your lymph vessels and into the lymph nodes. The wastes then are filtered out by infection-fighting cells in the lymph nodes.
Lymphedema happens when your lymph vessels cannot adequately drain lymph fluid. That usually happens because of damage to or removal of lymph nodes from an infection, trauma, cancer treatment or surgery. When lymph fluid doesn’t drain normally, the excess fluid builds up and causes swelling, most often in an arm or leg. If it’s not promptly and properly treated, the accumulation of lymph fluid eventually can lead to solid deposits of fat and fiber in the areas affected by lymphedema. That can make the condition more difficult to treat effectively and therefore more likely to require surgery.
Compression therapy usually is the first line of treatment for lymphedema. It involves wrapping the entire arm or leg in a snug bandage or compression garment to reduce swelling and encourage the flow of lymph fluid.
If wrapping alone isn’t enough, an approach called complete decongestive therapy may be useful. That approach includes wrapping and other techniques, such as massage, exercise and skin care, to ease swelling. Your doctor also may recommend a device that puts pressure on your limb to move lymph fluid. These compression devices usually consist of a sleeve worn over the arm or leg connected to a pump that intermittently inflates to provide pressure.
If you don’t see improvement with decongestive therapy, then surgery would likely be the next step in treatment. Some of the surgical techniques used for lymphedema must be performed when the condition is still in the fluid phase, before solids are deposited in the affected area. A delay in treatment that allows solids to accumulate may require more complex surgical approaches and can make lymphedema more difficult to treat over time.
Three surgical techniques that can be used to treat lymphedema while it’s still in the fluid stage are vascularized lymph node transfer, lymphaticovenous anastomosis and lymphaticolymphatic bypass.
The first, vascularized lymph node transfer, releases scar tissue that’s blocking the lymph fluid. It also transfers a soft tissue flap from a donor into the affected area. This flap contains lymph system components. The second surgical technique, lymphaticovenous anastomosis, connects existing lymphatic vessels to tiny veins located nearby, allowing the extra lymph fluid to drain directly into the veins. The third approach, lymphaticolymphatic bypass, connects normal functioning lymphatic vessels from a donor directly to the lymphatic vessels of the affected limb.
When lymphedema progresses to the point that solids start to accumulate in the limb, other surgical procedures must be used to remove that material. Those techniques don’t address the underlying cause of lymphedema, though, so you still need compression or other therapy after that surgery. In some cases, surgery to remove the solids can be combined with one of the other surgical techniques mentioned earlier to resolve lymphedema.
The right surgical procedure for lymphedema varies depending on your individual situation. With proper diagnosis and evaluation, however, surgical techniques can be used to treat lymphedema safely and effectively in many people when combined with integrated lymphedema therapy. — Dr. Kevin Cohoon, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My father, who is 79 years old and in good health, has become quite forgetful. He seems to recognize that it’s happening, but laughs it off and chalks it up to old age. I know memory problems are common as people get older, but I’m worried. Should I have him see his doctor?
ANSWER: Although memory lapses are a normal part of aging, they can be a sign of an underlying medical problem. In older adults, memory problems are of concern when they affect information that is particularly important or familiar, when the lapses become more frequent, or when difficulty with memory interferes with daily activities. If your father’s situation falls into any of these categories, it would be a good idea for him to see his doctor.
As we grow older, our brains undergo numerous aging-related changes that can make it harder to learn new things or remember familiar words. Older adults may have difficulty coming up with names of acquaintances, for example, or they may have trouble finding reading glasses or car keys. In most cases, these memory lapses do not signal a problem.
The type of forgetfulness that is worrisome involves forgetting information that a person formerly would always have remembered. For example, a favorite social event gets missed, like a tee time for a weekly golf game. Or, a calendar item that an individual would usually make a priority, such as a doctor’s appointment, goes unnoticed. If this happens once in a while, it probably isn’t a problem. If a person starts to have trouble making these connections regularly, then it’s time to see a doctor.
A medical evaluation also is in order if memory lapses lead to problems in a person’s day-to-day life or if someone begins to have trouble with mental tasks. Examples include becoming overwhelmed or confused when faced with decisions, having a hard time driving, getting irritated or upset when mental concentration is required to complete a task, getting lost on the way to a familiar location, or having trouble following step-by-step instructions.
If your father goes to his doctor, an evaluation likely would include a review of his medical history and a physical exam. In addition, tests that measure cognitive function — attention, memory, language and spatial skills, among others — may be part of the assessment. In some cases, a neurological evaluation and brain scans also may be useful. The doctor may want to talk with you or other family members about your perspective on your father’s cognitive skills, functional abilities and daily behaviors, and how they have changed over time.
The purpose of this evaluation would be to screen for signs and symptoms of dementia. The doctor also will rule out reversible causes of memory loss. Keep in mind that dementia isn’t a specific disease; it’s a clinical syndrome. That means it’s a term used to describe a group of symptoms, such as memory loss, difficulty reasoning, inability to learn or remember new information, personality changes or inappropriate behavior, that affect a person’s intellectual and social abilities enough to make it hard to perform daily activities.
Dementia has a variety of possible causes, including progressive disorders such as Alzheimer’s disease and dementia with Lewy bodies. Other conditions also can mimic the symptoms of dementia, such as depression, thyroid abnormalities, infections, immune disorders and nutritional deficiencies, among many others. Prompt evaluation of a symptom such as persistent forgetfulness that could point to dementia is important for early diagnosis and identifying management strategies.
It is possible, too, that your father’s memory lapses may be just what he thinks they are: a normal part of aging. If they seem to be problematic, though, encourage him to see his doctor. A thorough assessment should be able to identify if there is a need for concern. — Dr. Ericka Tung, Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m 47 years old and have been a smoker since I was 15. I’ve tried to quit more times than I can count. My wife says I should try nicotine replacement. But that doesn’t make sense to me. I want to be done with cigarettes and nicotine. How will putting more nicotine in my body help me kick this addiction?
ANSWER: When you’re trying to get rid of a cigarette habit that’s rooted in nicotine addiction, it may seem odd to look to nicotine for help. But nicotine replacement products are safe and effective aids for people trying to stop smoking. Particularly when paired with other smoking cessation techniques, nicotine replacement often serves as a bridge to a tobacco-free life.
The nicotine in cigarettes is highly addictive. Nicotine is what hooks you on smoking and keeps you smoking. However, nicotine is not the component in cigarettes that puts your health at risk. The real danger is tobacco.
Tobacco and tobacco smoke contain chemicals that cause lung cancer, as well as cancers of the mouth, throat, esophagus and larynx. Using tobacco can lead to other serious health problems, too, such as emphysema and chronic bronchitis. Two-thirds of all tobacco users eventually die of a tobacco-related illness. The sooner you stop putting tobacco into your body, the better off you will be.
Nicotine replacement products give you nicotine without tobacco. That helps relieve the withdrawal symptoms and cravings you may have if you try to quit smoking cigarettes without nicotine replacement. For many, going from tobacco to nicotine replacement is a critical and important step to a tobacco-free lifestyle.
Nicotine replacement doesn’t reinforce a cigarette habit the way tobacco does. You don’t get as much nicotine with nicotine replacement as you do with tobacco products, and nicotine replacement makes it significantly less likely that you will return to tobacco. Not using nicotine replacement reduces your chances of breaking free from tobacco.
A range of nicotine replacement products are available without a prescription. You can buy nicotine gum, patches and lozenges at most pharmacies and drug stores. Nicotine nasal spray and inhalers are available by prescription only.
Although nicotine replacement can be useful as you quit smoking, breaking a smoking habit is still hard, especially if you try to do it on your own. The best way to quit is to seek help from your doctor or a counselor trained as a tobacco treatment specialist. He or she can help you decide on the overall approach that’s best for you.
For example, along with nicotine replacement, other prescription medications may be helpful. Bupropion can help control nicotine cravings. Varenicline can reduce the pleasurable effects of smoking and lessen nicotine withdrawal symptoms.
Most health care providers also recommend behavioral therapy in addition to medication. Behavioral therapy often involves replacing old behaviors with new routines that aren’t associated with smoking.
For example, avoid places where you usually smoke. Instead, when you go out, visit places where smoking isn’t allowed. Try to spend time with people who don’t smoke or also want to stop smoking. Make it inconvenient to smoke by getting rid of your cigarettes. Chew gum while you drive, or take new routes to your usual destinations to keep your attention focused on your environment and away from smoking. If you usually have a cigarette with a cup of coffee or alcohol, drink water, soda or tea instead.
Nicotine replacement can be an integral step on the path to life without tobacco. But, to give yourself the best chance to stop smoking for good, seek help from a medical professional familiar with tobacco treatment. The effort will be well worth it, as the health benefits of not smoking are substantial, and they start accumulating almost immediately after you quit. — Dr. Jon Ebbert, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’ve been a runner since high school but was diagnosed with deep vein thrombosis (DVT) during my first pregnancy, so stopped running for a few months. I am now nine weeks pregnant with my second baby and continue to run for exercise, but I’m worried I’ll develop DVT again. Should I be concerned?
ANSWER: Because you experienced a previous episode of DVT during a prior pregnancy, you are at an increased risk for DVT recurrence during the current pregnancy. Doctors typically recommend that women in your situation receive medication to help prevent blood clots throughout pregnancy. You do not necessarily need to stop running during pregnancy, but it would be a good idea to talk with your doctor to decide what’s best for your individual circumstances.
DVT happens when a blood clot forms in a vein typically located deep within the leg or pelvis. Clots can be caused by anything that prevents blood from circulating normally, as well as from the increased tendency to clot that accompanies pregnancy — a condition known as a hypercoagulable state. DVT is serious, because, if a clot in the leg or pelvis breaks free and travels to your lungs, it can be a life-threatening emergency (pulmonary embolus).
A variety of factors can increase your risk for DVT, including pregnancy. That’s because, when you are pregnant, the pressure in the veins in your pelvis and legs increases. Other factors that can increase DVT risk include a family history of DVT, certain genetic disorders (thrombophilias), obesity, immobility, surgery, hospitalization for a medical illness, a trauma or fracture, and certain medications.
For women who have had a previous pregnancy-related DVT or those who have had a DVT associated with the hormone estrogen, taking an anticoagulant medication during pregnancy can help prevent future blood clots. To reduce the risk of a DVT most effectively, the typical recommendation is to take an anticoagulant during all subsequent pregnancies and for six weeks after a baby is born. The amount and the specific type of anticoagulant medication you need depend on a number of factors, including your weight, medical history and overall risk for developing another DVT.
Although taking an anticoagulant can lower your risk of another DVT significantly, it can’t eliminate the risk completely. To keep your risk as low as possible, take your anticoagulation medication exactly as prescribed. Lactation is permissible with most anticoagulants.
In general, regular exercise can help lower your risk of blood clots by enhancing blood flow and circulation throughout your body. Sitting for long periods of time limits blood flow and makes it more likely that a blood clot may form in one of your veins. For that reason, staying active during pregnancy is important, especially for patients with a history of DVT. Anecdotal recommendations include getting up and moving every one to two hours to promote blood circulation.
If you would like to keep running, discuss it with your obstetrician. He or she can help you decide on an appropriate level of activity for your situation. Even if running isn’t the best choice, it’s very likely you can participate in other activities that won’t increase your DVT risk and will help you stay fit and healthy throughout your pregnancy. — Dr. Carl Rose, OB-GYN, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m a 56-year-old man without any health problems. Recently, I’ve noticed I don’t have the energy for physical activities that I used to. Working in the yard, riding my bike and even just doing jobs around the house all wear me out much faster now than even five years ago. My sex drive is lower, too. I see ads all the time for testosterone therapy and what a difference it can make for men my age. Should I give it a try? Is it safe?
ANSWER: Recent research shows that testosterone therapy can be useful in some cases, but it’s not right for all men. To see if it could be helpful for you, start by making an appointment with your doctor to have your testosterone level checked.
Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s bone density, fat distribution, muscle strength and mass, red blood cell production, sex drive and sperm production. For most men, testosterone peaks during adolescence and early adulthood. Then, as men get older, testosterone levels gradually fall.
If testosterone drops below a certain level, it can cause symptoms. Fatigue and low sexual interest are common. Some men also see changes in beard and body hair growth. Muscle wasting and a decrease in muscle strength can be a result of low testosterone, too.
Your doctor can use a blood test to check your testosterone level. Even if your testosterone level is found to be low, though, testosterone therapy is not automatically the answer. It’s also important to determine any potential causes or associated conditions of low testosterone before moving forward with treatment.
In some cases, medical conditions can contribute to low testosterone, including thyroid problems, obesity, obstructive sleep apnea, depression and excessive alcohol use. Some medications may cause testosterone levels to drop, as well.
As part of your evaluation, your doctor should review your current medications and check for underlying medical problems that could be contributing to your symptoms. If your testosterone is low and a medical condition is identified, treatment for that disorder may be all you need to bring your testosterone level back into the normal range. A change in medications also could make a difference.
If low testosterone isn’t due to medication or a medical problem, then taking prescription testosterone replacement may be beneficial. Numerous studies have found that testosterone may be helpful for men experiencing symptoms as a result of low testosterone. In many cases, however, the effects are modest. In men with normal levels of testosterone, taking prescription testosterone generally has no effect for most symptoms.
In addition to easing symptoms of low testosterone, prescription testosterone may have other benefits, including reducing fat mass, improving lean muscle mass, strengthening bones and improving insulin sensitivity.
Taking prescription testosterone does have risks. It may cause production of more red blood cells (a condition known as polycythemia); increase prostate-specific antigen, or PSA, in the blood; enlarge breasts; or reduce sperm production. Testosterone therapy does not cause cancer, including prostate cancer. If your doctor recommends that you take testosterone, you need regular blood tests to make sure the prescribed dose is correct, as too much testosterone potentially can lead to other medical problems.
Although most studies suggest that testosterone therapy does not increase the risk of heart attacks or stroke, and that it may even be protective in some cases, there is not enough information to prove its safety conclusively among elderly men with cardiovascular risk factors.
To see if testosterone therapy may be right for you, make an appointment to see your doctor and assess your symptoms. He or she can do a thorough evaluation and help you decide what, if any, treatment you may need. — Landon Trost, M.D., Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I rarely use table salt anymore when cooking. Instead, I like to use sea salt. But I've noticed that a lot of sea salts don’t contain iodine. Do I need iodized salt, or are there sources of iodine other than salt that are likely giving me all of the iodine I need?
ANSWER: For most people, iodized salt is probably the easiest way to maintain sufficient iodine intake. Iodine is an important nutrient that your thyroid needs to produce certain hormones. Not getting enough iodine in your diet can lead to problems such as an enlarged thyroid gland (goiter) and an abnormally low level of thyroid hormones (hypothyroidism).
Iodine is a trace element present in the earth. Distributed variably around the world due to the effects of the ice age, iodine has accumulated primarily in coastal areas. The most common dietary sources of iodine are seaweed, fish and dairy products. Inland areas have fewer natural sources of iodine. In the U.S., areas where iodine deficiency was common in the early 1900s —the Great Lakes, Appalachians and Northwest — were known as the “goiter belt.” Researchers from these areas encouraged the U.S. to adopt table salt iodization as an inexpensive, yet universal, way of providing iodine supplementation. Although salt iodization never was made mandatory, estimates are that more than 90 percent of U.S. households today have access to iodized salt.
Other sources of dietary iodine include eggs, enriched grain products and plant foods grown in iodine-rich soils. Unfortified sea salt contains only a small amount of iodine.
Still, it’s hard to determine precisely how much iodized salt contributes to an individual’s iodine levels. Iodized salt in the U.S. contains 45 micrograms of iodine per gram of salt. The recommended daily intake for adults is 150 micrograms, which can be obtained from about one-half to three-quarters of a teaspoon of table salt. Testing of the general population indicates that most Americans consume sufficient levels of iodine through their diets. Pregnant women and nursing mothers are the only groups in the U.S. that are advised to take a daily iodine supplement, usually as part of a prenatal vitamin.
Depending on where you live and how much seafood you eat, you may not want to substitute all of your table salt with sea salt. However, that shouldn’t stop you from using sea salt when you want that particular flavor. Be cautious with the amount, however, as all salt is high in sodium. (adapted from Mayo Clinic Health Letter) — Katherine Zeratsky, R.D.N., L.D., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I went through menopause a few years ago and didn’t have any of the usual signs or symptoms. But, lately, I'm finding that my vaginal area is extremely dry, and sex is becoming uncomfortable ─ even with a lubricant. Are there other options?
ANSWER: Your situation is common. Menopause can trigger a wide variety of symptoms, but not everyone has all of them, and different symptoms of menopause tend to develop at different times. Vaginal dryness often doesn’t appear until a year or two after the last menstrual cycle. You have several options, in addition to a lubricant, that can ease your discomfort.
When you go through menopause, your body experiences a significant drop in the amount of the hormone estrogen it makes. The loss of estrogen can lead to a number of symptoms that affect the urinary tract and genital area.
Those symptoms may include burning with urination, an increase in urinary frequency, an urgent need to urinate, incontinence associated with urgency, increased risk for urinary tract infections, and vaginal dryness, itching or burning. In addition to being drier after menopause, vaginal tissues often become thinner and less elastic. Because of these changes, sex may not only be uncomfortable, it may be painful. Together, all of these symptoms are known as genitourinary syndrome of menopause, or GSM.
According to the North American Menopause Society, up to 45 percent of women have symptoms of GSM after menopause, including painful sex due to vaginal dryness. Less than a quarter of those women go to their medical providers to try to do something about it. But, help is available.
You mention that you use a vaginal lubricant. That over-the-counter product is designed to be applied before sexual activity to make sex more comfortable and pleasurable. When a lubricant is not enough, consider using a vaginal moisturizer, too. This product is also available without a prescription at most drug stores and pharmacies. You apply it once every two or three days to maintain vaginal moisture.
If you use a moisturizer and a lubricant, but sex is still uncomfortable or painful, make an appointment to talk to your medical provider about prescription therapies for vaginal dryness. He or she may recommend treatment with low-dose vaginal estrogen. It comes in several forms, including a cream you apply twice a week, tablets placed into the vagina twice a week, and a ring that’s inserted in the vagina and replaced every three months.
Another option is an oral medication called ospemifene. It’s a selective estrogen receptor modulator, or SERM, that’s approved for treating painful intercourse associated with GSM. While this medication is an option for most women, it isn’t recommended for women who have breast cancer or are at high risk of developing breast cancer. Your medical provider can help you find a treatment for vaginal dryness based on your symptoms and personal preferences, as well as your medical and family history.
Your medical provider also can talk with you about any other menopause symptoms you may have and discuss ways to ease those, as well. Hormone therapy, which remains the most effective treatment for hot flashes and night sweats related to menopause, is appropriate for many women. Its use depends on your age, how long it’s been since menopause began, and your personal health history, among other factors. In a conversation with your medical provider, you can sort through what’s best for you. — Dr. Stephanie Faubion, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Does Botox work on deep forehead wrinkles, or do you have to catch them early for it to make a big difference? Is long-term use safe? What happens if I have the injections regularly for a few years, but then quit? Will my forehead look worse than if I had never gotten Botox?
ANSWER: All forms of Botox injections approved by the U.S. Food and Drug Administration for forehead wrinkles are intended for people 65 and younger. Beyond that, the medication may not be as effective as it is for younger individuals. Botox is safe to use long term, and you can stop using it at any time without your skin looking worse than it did before you started Botox. When used for cosmetic purposes, medical insurance does not cover Botox treatments.
Botox injections use forms of botulinum toxin to paralyze muscle activity temporarily. This toxin is produced by the bacterium that causes botulism, a type of food poisoning. Botox injections are popular for reducing the appearance of facial wrinkles. The injections are used to treat other medical conditions, too, such as repetitive neck spasms, excessive sweating, overactive bladder and lazy eye. The injections also may help prevent chronic migraines in some people.
Botulinum toxin injections block certain chemical signals from nerves, mostly signals that cause muscles to contract. This temporarily relaxes the facial muscles that underlie and cause wrinkles, including forehead furrows. Studies show that people who receive the most benefit from the injections are 65 and younger.
That is not to say, however, that people older than 65 can’t or shouldn’t use Botox. But, it is important to recognize that the results may not be as effective as in a younger population. For older adults to achieve the same results as younger patients, Botox should be used in combination with facial fillers injected into the skin to soften wrinkles.
For Botox injections, your health care provider uses a thin needle to inject tiny amounts of botulinum toxin into your skin. The number of injections you need will vary, depending on a variety of factors, including the size of the area being treated. Botulinum toxin injections usually begin working a few days after treatment. The effect may last up to three months or longer. To maintain the benefits of Botox, you need regular follow-up injections.
Botox has been shown to be safe for both short- and long-term use. Data for treatment of wrinkles with Botox only go back about 15 years. However, Botox for wrinkles uses a much smaller dose than patients receive for other conditions, such as muscle spasticity. Significant safety concerns have not been identified in people who receive larger doses of Botox for those other problems ─ further supporting its safety.
To ensure your safety, you should only receive Botox under the care of an experienced health care provider, such as a board-certified dermatologist, plastic surgeon, eye plastic surgeon or otolaryngologist who has personally examined you. These subspecialists have the most expertise to minimize complications and treat them if a complication occurs. Botox can be dangerous if it's given incorrectly. Although uncommon, Botox injections can produce side effects, including pain, swelling or bruising at the injection site, headache, flu-like symptoms, and eye dryness or excessive tearing, among others.
If you decide to stop using Botox, your forehead wrinkles will go back to the way they looked before you started the injections. Your face will not become more wrinkled as a result of Botox. Muscle strength and movement in your forehead also will return to normal when you discontinue Botox use. — Alina Bridges, D.O., Dermatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Six months ago I was diagnosed with a groin hernia. At the time, my doctor said that eventually I'll need surgery, but it doesn't bother me, so I have not been back. Is surgery always necessary, or do some hernias go away on their own? Is it dangerous to ignore it?
ANSWER: Abdominal hernias are common and not necessarily dangerous. But, a hernia doesn’t usually get better on its own. In rare circumstances, it can lead to life-threatening complications. Consequently, surgery is usually recommended for a hernia that’s painful or becoming larger.
An abdominal hernia occurs when part of an organ or tissue bulges through a weak spot in the wall of muscle that surrounds your abdomen. Some hernias don’t cause any symptoms, and people might not even know they have one until their doctor discovers it during a routine medical exam. More often, it's common that patients can see and feel the bulge created by the hernia. The bulge is usually more obvious when you’re standing upright or straining. You might feel pain, weakness or pressure in the affected area.
There are two different types of groin hernias: inguinal and femoral. Inguinal hernias are some of the most common hernias, occurring more often in men. The weak spot is in the inguinal canal. In men, this is where the spermatic cord exits the abdomen and enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place. Often, an inguinal hernia is present at birth — especially for boys — but it may develop later in life due to factors such as aging muscles, strenuous activity or chronic coughing.
Femoral hernias are far less common and are more often seen in older women. They form along the canal that carries the principal blood vessels (femoral artery and vein) into the thigh. This hernia usually produces a bulge that’s slightly lower than an inguinal hernia.
Even though your hernia isn’t causing any symptoms, it's important that you have it regularly evaluated by your doctor. He or she will want to keep an eye on it and reassess the situation ─ even if it becomes just slightly uncomfortable. Some people wear a supportive belt or undergarment to hold the hernia in, but this isn’t a long-term solution.
Fatty tissue in the abdomen is usually the first tissue to exit the hernia. This is beneficial, because it plugs the hole. Problems arise when part of an organ ─ typically the intestine ─ pushes through the weakened muscle and becomes trapped on the outside (incarcerated). You can tell when this happens, because the hernia can’t be returned into the abdomen by application of gentle pressure. It typically causes constant discomfort.
An incarcerated abdominal hernia may prevent passage of contents through the intestine (bowel obstruction). The hernia also may be cut off from the body’s blood supply ─ a risk that increases with age. This can lead to gangrene, a life-threatening condition requiring immediate surgical attention. See your doctor promptly if you can’t push the hernia back in with gentle pressure, or you experience increased pain, nausea, fever, swelling or darkening of the skin over the hernia.
The best treatment for bothersome abdominal hernias is an operation to push back the protruding organ or tissue into the abdomen and reinforce the weakened muscles. Sometimes, this involves placing a synthetic or biological mesh against the weakened area to help with reinforcement.
Some evidence suggests that laparoscopic surgery, which involves inserting surgical instruments through several small incisions, results in quicker recovery. But, conventional open surgery may be appropriate with hernias that are larger or more difficult to treat. If you require surgery to fix the hernia, your doctor will be able to help you determine which type is best for your specific situation. (adapted from Mayo Clinic Health Letter) — Kristi Harold, M.D., General Surgery, Mayo Clinic, Phoenix
DEAR MAYO CLINIC: Is it true that plantar fasciitis sometimes can be treated with ultrasonic energy? How does that work?
ANSWER: Yes. The treatment you are referring to is called percutaneous ultrasonic fasciotomy, which uses ultrasound technology to treat plantar fasciitis and other soft tissue problems. The treatment is showing promising results in patients who have not gotten relief from standard therapies for persistent plantar fasciitis.
Plantar fasciitis is a common foot problem that involves the thick band of tissue (plantar fascia) connecting the heel bone to the toes. The purpose of the plantar fascia is to support the arch of the foot and act as a shock absorber when you walk, run, jump or otherwise use your feet. If the strain on the plantar fascia becomes too great, small tears can develop in the tissue. Those tears can lead to inflammation and pain. In some cases, these microtears fail to heal properly, leading to degenerative changes, scarring and abnormal blood vessel growth within the tissue.
Plantar fasciitis has many possible causes, including certain types of exercise that put a lot of stress on the feet, such as jogging. Excess weight also can contribute to plantar fasciitis, particularly in overweight people who have been sedentary and then begin an exercise program. In addition, thin-soled or loose shoes, high-heeled shoes, and shoes without enough arch support or flexible padding to absorb shock can increase strain on the plantar fascia, leading to plantar fasciitis. Age also is a factor. As you age, tendons and fascia lose some flexibility and are less able to absorb impact.
To treat plantar fasciitis effectively, the extra stress on the plantar fascia must be relieved, so the tears can heal. For most people, these small tears can be treated successfully with physical therapy and special equipment that gives the foot extra support. A cortisone or other injection also may be considered.
But, for some, this isn’t enough, and finding a solution to the chronic pain and loss of function due to plantar fasciitis can be frustrating. Open surgery to remove the damaged tissue is an option, but recovery often is prolonged, and recurring pain is common.
Fortunately, a minimally invasive treatment is available for patients with plantar fasciitis who otherwise have not found relief. Percutaneous ultrasonic fasciotomy uses the Tenex Health TX tissue removal (debridement) system, which Mayo Clinic doctors helped develop. The procedure, which can be done in a doctor’s office, can be used on elbows, shoulders or other places where tendinopathy (irritation in the tendons) may develop, as well.
Here’s how it works. Before the procedure, imaging tests — such as ultrasound or MRI — are done to determine the location and extent of the degenerated tissue. Once the specially trained physician has a clear picture of what’s going on, her or she numbs the skin over the area and makes a small incision ─ just large enough to insert a needle-like probe.
The physician then inserts the probe into the opening, guided by ultrasound imaging. The probe’s oscillating tip produces ultrasonic energy, which breaks down the damaged tissue directly ahead of it. At the same time, a built-in inflow-outflow fluid system simultaneously irrigates and sucks up the broken down, or emulsified, tissue. Once all of the degenerated tissue is cleared away, the probe is removed, and the incision is closed with adhesive skin tape and a pressure bandage. The whole procedure takes only a few minutes, and complications are few.
After the procedure, patients must rest the area for several days and may need crutches or a walking boot to relieve pressure on the foot. But, they usually can get back to their regular routine within a week to 10 days, although it might take several months before returning to the activity that prompted the plantar fasciitis. Improvement continues as the tissue heals. Some people may benefit from additional physical therapy.
The procedure may not be appropriate for patients who have a complete tear in the fascia, but those with plantar fasciitis that hasn’t responded to initial treatment should talk to their doctor about all of their treatment options, including ultrasonic fasciotomy. — Jay Smith, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What causes prostatitis, and how is it diagnosed? Is it treatable?
ANSWER: Prostatitis — a general term that encompasses a group of conditions characterized by swelling or inflammation of the prostate gland — generally isn’t life threatening. Although it’s less well-known than other prostate health concerns, such as prostate enlargement or prostate cancer, about 2 million American men visit their doctors for it each year. Some forms of prostatitis can be challenging to diagnose and treat.
The prostate is a walnut-sized gland located directly below the bladder in men. One of its main jobs is to produce fluid (semen) that nourishes and transports sperm. Irritation or inflammation of the prostate gland can occur for a number of reasons. Sometimes, bacteria-laden urine leaks from the urethra into the prostate, causing an infection. Use of a catheter or other instrument also can introduce infectious agents. In many cases of prostatitis, however, no clear cause can be found. It’s possible, though not proven, that other factors, such as trauma, increased pressure on the prostate, an overactive immune system or even excessive stress, can contribute to prostate irritation.
Prostatitis can cause a variety of symptoms, including a frequent and urgent need to urinate and painful or burning sensations while urinating. This often is accompanied by pelvic, groin or low back pain. If you experience any of these symptoms, see your doctor promptly to avoid complications, such as spread of the infection.
There are four types of prostatitis — two of which are caused by bacteria. Acute bacterial prostatitis usually comes on suddenly and can cause fever and chills in addition to pain and urinary symptoms. Chronic bacterial prostatitis also is caused by bacteria, but signs and symptoms typically develop more slowly and are less severe. Sometimes, it occurs as a complication of acute bacterial prostatitis that hasn’t been adequately treated.
Chronic pelvic pain syndrome (chronic prostatitis) symptoms are a lot like chronic bacterial prostatitis, but without the fever. In addition, tests show no sign of bacteria in the urine or in fluid from the prostate gland. In some cases, white blood cells found in a urine sample may signal the presence of inflammation. Although this is the most common form of prostatitis, it’s also the most challenging to diagnose and treat, because the cause is so uncertain.
Finally, asymptomatic inflammatory prostatitis doesn’t cause any symptoms and usually is found during an examination done for another reason. For example, prostatitis may increase the level of prostate-specific antigen (PSA) in your blood, which may be detected during a PSA screening test for prostate cancer. Asymptomatic prostatitis often doesn’t require treatment. But, if you need a repeat PSA test, your doctor may recommend a course of antibiotics first to clear the prostatitis.
To diagnose prostatitis, a urine sample may be collected to check for an infection. Unless the cause is clearly bacterial, prostatitis generally is diagnosed by feeling the prostate gland. To do this, your doctor inserts a gloved finger into your rectum and feels the outside wall of the gland. An inflamed prostate usually feels enlarged and tender. In some cases, a second urine sample may be collected after massaging the prostate, which forces fluid into the urethra. This fluid then can be examined for bacteria.
If neither bacteria nor white blood cells are found, your doctor may recommend further testing to rule out other conditions that may be causing your symptoms.
Prostatitis caused by bacteria can be treated with antibiotics. The length of treatment varies, depending on the type of prostatitis. While acute bacterial prostatitis usually can be treated with a four- to six-week course of antibiotics, chronic bacterial prostatitis is often more resistant to antibiotics and can take six to 12 weeks before the infection is cured. In some cases, a daily low-dose antibiotic may be needed indefinitely.
If you’re having difficulty urinating, your doctor may prescribe an alpha blocker to help relax the muscles connected to the bladder and prostate. Nonprescription pain relievers can help relieve pain and discomfort. Other therapies might include sitting and soaking in a warm bath (sitz bath), biofeedback (which can teach you how to control your bodily responses to certain stimuli), and physical therapy exercises. Acupuncture also may help prostatitis symptoms. (adapted from Mayo Clinic Health Letter) — Erik Castle, M.D., Urology, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: Are there any special health benefits to fermented foods?
ANSWER: The jury’s still out. In recent years, claims of possible health benefits of fermented dairy or plant foods, such as yogurt, kefir, aged cheese, tempeh, miso, sauerkraut and many others, have gained the spotlight.
The digestive tract is loaded with beneficial bacteria. Likewise, live, active bacteria make fermented foods possible. These bacteria, known as probiotics, are where the potential health benefits in fermented food may be.
While it sounds promising, the evidence is more suggestive than proved. Some evidence supports select probiotic use for certain bowel disorders. Research is ongoing to understand how probiotics may influence other areas of health, including obesity and regulation of the immune system.
To gain benefits, it’s generally thought that a daily probiotic dose of around 10 billion colony-forming units (CFU) of certain bacteria strains is needed. However, fermented foods are all over the map in terms of the dose and type of beneficial bacteria. Some fermented foods contain supplemental probiotics to achieve a consistently high dose. Others might contain only moderate or low levels of live cultures — or no live cultures at all.
Fermented foods can be a part of a healthy diet and may provide health benefits that other foods can’t. But, it’s hard to say exactly what you’re getting from a fermented food in terms of bacterial type or dose. Therefore, it’s difficult to know what you can expect in terms of probiotic benefits. In addition, a fermented product with live active cultures also may contain high levels of saturated fat, salt or added sugars. (adapted from Mayo Clinic Health Letter) — John K. DiBaise, M.D., Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: Six months ago, after becoming pregnant for the first time, I had a miscarriage at 12 weeks. My husband and I want to become pregnant again, but we’re worried about another miscarriage. Are there things I can do to prevent it this time? I’m 27 years old, and I don’t have any health problems.
ANSWER: Having a miscarriage can be shocking, stressful and sad. It’s understandable that you want to do everything you can to avoid going through it again. Although there are some steps you may be able to take to lower your risk of another miscarriage, in most cases, a miscarriage isn’t related to anything a pregnant woman did or did not do. The majority of miscarriages are due to chromosomal abnormalities that happen for no clear reason. Many women who have a miscarriage go on to have normal pregnancies and deliver healthy babies.
In general, a miscarriage is defined as the loss of a pregnancy before 20 weeks gestation. Because it is not a topic that receives much attention, miscarriage tends to be more common than people might think. Doctors estimate that up to 25 percent of all recognized pregnancies end in miscarriage.
Most miscarriages happen because the fetus isn’t developing normally. Problems with the baby’s genes or chromosomes are usually the result of errors that occur by chance as the embryo divides and grows. They typically aren’t due to an inherited disorder, and usually aren’t caused by a mother’s behavior or health.
That said, there are a few risk factors that can raise the chances of having a miscarriage. Among the most significant is advanced maternal age. This one doesn’t apply to you right now, and it won’t for some time. Women older than 35 have a higher risk of miscarriage than do younger women. At 35, the risk of miscarriage is about 20 percent risk. At 40, it goes up to about 40 percent. At 45, it’s about 80 percent.
Another risk factor that doesn’t sound like it fits your situation is having certain medical conditions. Some disorders that may raise the risk of a miscarriage include uncontrolled diabetes, high blood pressure, thyroid disease, infections, hormonal problems and problems with the uterus or cervix.
When it comes to lifestyle choices you can control, it is important to avoid smoking, drinking alcohol or using illegal drugs when you are pregnant. Not only do these activities raise your risk for a miscarriage, they endanger the health of your baby throughout pregnancy. If you are on prescription medication, ask your doctor if it’s safe to continue taking that medication during pregnancy.
Staying at a healthy weight before you become pregnant and throughout your pregnancy may also help ensure your baby’s health. Being underweight or overweight appears to be linked to an increased risk of miscarriage, as well as other health concerns during pregnancy. For example, women who are significantly overweight are more likely to develop gestational diabetes.
None of the following activities cause miscarriage: lifting, straining, having sex or exercising.
If you have questions or concerns about becoming pregnant again, talk to your health care provider. He or she can review your health and family history, talk with you about risk factors and discuss any preconception care that could be helpful.
As you go forward, please keep in mind that, in almost all cases, miscarriages are beyond a mother’s control. If you become pregnant again, unless an underlying medical condition is identified that needs special care, you shouldn’t need to do anything differently. Get regular prenatal care and focus on taking care of yourself and your baby. — Dr. Yvonne Butler Tobah, Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: Earlier this spring, I developed pain in my wrist and on the inside of my elbow after a long weekend of golf. I iced the area for a few days, but the pain is still there when I move a certain way or try to lift anything heavy. Is it possible that I tore something in my elbow while golfing? At what point should I see a doctor?
ANSWER: The condition you’re describing sounds like golfer’s elbow. It’s a common injury typically associated with overuse, and isn’t limited to golfers. Self-care measures often are enough to take care of the problem. But, because you still have symptoms after icing it for several days, it would be a good idea to see your health care provider for an evaluation. He or she can then determine if you need additional treatment.
The medical term for golfer’s elbow is medial epicondylitis. It happens when muscles and tendons that control flexing of your wrist and fingers are damaged, often by too much stress or repeated stress due to forceful wrist and finger motions. Golfers may develop this condition when they repeatedly hit the ball incorrectly or use improper swing techniques.
In many cases, golfer’s elbow requires only self-care at home. Rest from golf and other repetitive wrist and hand activities. Ice the painful area for 15 to 20 minutes at a time, three to four times a day, for several days. Take an over-the-counter nonsteroidal anti-inflammatory drug, such as ibuprofen or naproxen sodium.
When those measures aren’t enough to relieve the pain, then it’s time to see your health care provider. He or she may recommend that you wear a type of brace called a counter-force brace on the painful arm. That can reduce strain on your muscles and tendons. Your provider also may refer you to a physical or occupational therapy program that can teach you techniques to help ease your symptoms, as well as stretching and strengthening exercises. In the majority of cases, no further evaluation or treatment is needed beyond that point.
If pain is persistent, though, imaging tests may be necessary to assess the injury. A musculoskeletal ultrasound study or MRI can be used to evaluate if there’s a tear in one of your muscles or tendons.
Additional treatment may include corticosteroid injections. Although they can help ease pain for a while, in general, these injections are not effective long-term. Another newer treatment is platelet-rich plasma injections. The goal of this approach is to help heal tendon damage and promote the growth of new, healthy tissue.
When pain lasts despite other treatments, more invasive approaches may be necessary. One option is called ultrasonic percutaneous tenotomy, or TENEX. In this procedure, under ultrasound guidance, a doctor inserts a needle into the damaged portion of the tendon. Ultrasonic energy vibrates the needle so swiftly that the damaged tissue liquefies and is suctioned away. If symptoms don’t improve after thorough use of other treatments, then surgery may be an option to remove the damaged tissue.
Once your symptoms go away, take steps to prevent golfer’s elbow from returning. Use weight training to strengthen your forearm muscles, and do stretching exercises before you go golfing to help avoid injuries. If you use older golfing irons, consider upgrading to lighter graphite clubs to reduce stress and strain on your wrists.
Don’t play through pain. If you notice discomfort in your elbow or forearm, take a break. Finally, work on your golf form and swing. If you play frequently, ask a golf instructor to evaluate your form and correct any improper habits. Repeating a swing that has poor mechanics puts you at higher risk for another injury. — Dr. Bryan Ganter, Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Ariz.
DEAR MAYO CLINIC: I’m a 25-year-old woman, and I recently tore my ACL playing basketball. My doctor says I don’t need surgery and recommends physical rehabilitation instead. Can rehab completely fix the problem, so I can stay active? I love playing basketball and skiing. I don’t want to give them up, but I don’t want to wreck my knee either.
ANSWER: Surgery isn’t always necessary to treat an anterior cruciate ligament (ACL) tear. Physical rehabilitation can strengthen the muscles around the joint and, in some cases, allow a return to physical activity. But, that’s usually true only if your activity does not involve aggressive cut and pivot movements, or jumping and high impact. The activities you mention, however, raise your risk for knee instability if you choose not to have your ACL repaired surgically.
Ligaments are strong bands of tissue that connect one bone to another. Your ACL is one of two ligaments that cross in the middle of the knee and connect your thighbone, or femur, to your shinbone, or tibia. The ACL helps to keep your knee joint stable
When the ACL is torn, it usually causes knee pain and swelling. After an ACL injury, you also may feel instability in the knee or feel that the knee is "giving way" when you turn quickly or pivot. Often, a “pop” is heard or felt. ACL injuries frequently happen as a result of suddenly stopping, changing directions or pivoting. Sports that put you at risk of an ACL injury include basketball, singles tennis, football, volleyball and soccer. Downhill skiing also puts you at risk, because the length of a ski, combined with the rigidity of ski boots, places considerable force on your knee.
The purpose of treatment for an ACL injury is to reduce pain and swelling, restore normal knee movement, strengthen the muscles around the joint and allow a return to activity. For some people, this can be achieved with physical rehabilitation alone. If one of the menisci — the cushioning cartilage in the knee joint — is also torn, however, that can increase knee instability, making surgery the best option. It is worthwhile to note, too, that an ACL tear raises your risk of developing arthritis in your knee joint later in life. Studies show that risk to be similar whether or not you have surgical reconstruction.
Rehabilitation often involves working with a physical therapist to learn exercises that strengthen your leg muscles, as well as the muscles in your hips, pelvis and lower abdomen. Increasing muscle strength helps stabilize your knee joint, making it less susceptible to further injury.
To lower your risk of another ACL tear, a physical therapist should assess your movement patterns when you jump, land, pivot and change directions. Often, this will include a video analysis of how you land from a jump. Improving your movement patterns with corrective exercises can go a long way toward protecting against ACL injuries.
As you go back to your activities, having the proper gear also can help lower your risk of injury. Wear appropriate footwear when you play basketball. When you go downhill skiing, adjust your bindings correctly, so your skis will release when you fall. Some people wear a knee brace after an ACL injury, especially if they have not had surgical reconstruction. Research has shown, however, that wearing a brace does not appear to prevent or reduce the risk of an ACL injury.
If you continue to have episodes of knee instability despite physical rehabilitation or if you want to return to activities that place your knee at higher risk for further injury, consider ACL reconstruction surgery. Because a torn ACL can't be sewn back together, surgery involves replacing the torn ligament with a piece of tissue (i.e., a portion of your patellar or hamstring tendons) called a graft.
Talk to your doctor and your physical therapist about your sports and activity desires after your ACL injury. They can help you create a treatment plan that fits your goals and gives you the best odds for a safe return to activity. — Dr. Edward Laskowski, Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Years ago, after going through infertility testing, my doctor told me someone would love a bone marrow transplant from me because I have an overactive immune system. Why does that make someone a good candidate? I am now 53 and am wondering if I’m too old to donate bone marrow. If not, how do I find out where I can go in my area to become a donor?
ANSWER: Thank you for your interest in becoming a bone marrow donor. Bone marrow donation can save lives, and there’s always a need for people willing to donate. Although age is sometimes a factor, the most important criteria for being a donor is to have the stem cells in your bone marrow match those of the recipient. To be considered as a donor, you can join the registry of potential bone marrow donors that’s maintained by the National Marrow Donor Program.
People who need a bone marrow transplant often have blood disorders or diseases that affect the immune system, such as leukemia, lymphoma or severe anemia. A transplant may be necessary for people with these conditions because their bone marrow may not be able to make enough healthy stem cells, or because bone marrow may not be able to regrow sufficiently following chemotherapy or radiation therapy. A bone marrow transplant can help make the blood cells the body needs, lowering the risk of life-threatening infections, anemia and bleeding.
Although the procedure is called a bone marrow transplant, it's actually the blood-forming stem cells within bone marrow that benefit the transplant recipient. Bone marrow stem cells can develop into red blood cells that carry oxygen to the body, platelets that help blood clot or white blood cells that help fight infection.
It's often best for people in need of bone marrow transplants to receive their own stem cells, if possible. This process usually is safer for the recipient. But in some cases, a person's bone marrow may be too diseased to be used for a transplant. In those situations, it's necessary to use stem cells from a donor instead.
Current research shows that bone marrow donations from people between the ages of 18 and 44 lead to more successful transplants. Because of that, most physicians will select a donor under the age of 45, when possible. However, people are allowed to be donors until the age of 60, and there is particular need for donors from minority populations and those from multiple ethnic or racial backgrounds.
I’m not aware of data supporting the theory that having a history of infertility means you have a stronger immune system and, as a result, would be a better bone marrow donor. In fact, if a potential donor had children, that would make a transplant physician less likely to select that person as a donor. Medical research has shown bone marrow transplant recipients with donors who have had children are at higher risk for a transplant complication called chronic graft versus host disease.
To be considered as a bone marrow donor, visit the National Marrow Donor Program’s website, bethematch.org. There you can learn more and join the bone marrow donor registry. You should note that potential donors between the ages of 45 and 60 are asked to provide payment to cover the cost to join the registry.
Fortunately, the donor’s stem cells repopulate well, so, theoretically, a person could donate more than once. There can be pain after bone marrow donation, but it usually does not interfere with work or school. Peripheral blood donation (blood stem cells collected directly from the blood) requires receiving growth factor drugs and collection on an apheresis machine.
Joining the registry to become a potential bone marrow donor is commendable. As a donor, you have the opportunity to save a person’s life. Although your chances of being chosen are lower due to the reasons outlined above, if you are chosen as a bone marrow donor, you will potentially be someone’s cure. — Dr. Dennis Gastineau, Hematology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: My daughter is 15 and lifts weights regularly to stay in shape. Lately, she’s complained about stretch marks on her legs as a result of weight lifting. She doesn’t like how they look, but I’m more concerned that she is doing too much. Is weight training healthy for girls who are still growing? How much is too much?
ANSWER: Muscle strengthening activities, such as lifting weights, can be beneficial for teens. But, weight lifting is not the only way to increase strength. Encourage your daughter to consider varying her workouts to include other kinds of strength training. That may reduce the risk of unwanted side effects, such as stretch marks, that can come from doing just one activity. Also, muscle strengthening shouldn’t be the only activity a teen uses to stay in shape. It needs to be part of an overall fitness program that includes aerobic activity, as well.
In general, a safe and effective workout routine for teens involves strength training three times a week on nonconsecutive days. Your daughter can change up her activities throughout the week and still continue to build strength.
For example, with some activities, she can use her own body weight for resistance — a technique called body weight training. Examples include exercises such as rope or tree climbing, swinging on bars or other playground equipment, games such as tug-of-war, pushups, squats, lunges, abdominal crunches, pullups or step-ups.
Another option is to work muscles using resistance tubing. A lightweight, portable, inexpensive strength-training tool, the tubing provides resistance when stretched. Resistance tubing can be used to strengthen almost any muscle group.
When your daughter lifts weights, they can be free weights or part of weight machines. It’s important that a trained professional supervise weightlifting to ensure teens use proper technique and lift the appropriate amount of weight.
Overall, strength training is safe for teens. The rate of injuries is low, with the most common injuries related to inadequate supervision or instruction, using improper technique, or trying to lift too much weight. In the past, there was some concern that muscle strengthening may have a negative impact on a teen’s growth, but recent studies have found that growth is not affected by strength training.
To reduce the risk of injury, it’s best to do a 10- to 15-minute warmup of light aerobic exercise before strength training. Stretching is not necessarily needed before strengthening; however, stretching can be performed afterward with at least 30 seconds of stretch per muscle group.
In addition to increased strength, teens can gain a variety of benefits from regular strength training, such as better physical endurance, enhanced self-esteem and higher self-confidence. Teens who engage in regular strength training often see improvement in their cholesterol levels, blood pressure, blood sugar and body weight. Research has found they tend to perform better in school, and they have lower levels of depression and anxiety than other teens. Muscle strengthening also contributes to building bone strength. That’s important for teens, because 95 percent of a person’s bone mass is accumulated by the end of the teenage years.
To achieve overall fitness, aerobic activity should be part of your daughter’s routine. High-impact aerobic activity also provides the added benefit of building bone strength in teens. A good goal for teens is at least one hour of moderate to vigorous physical activity every day, with at least three days a week of aerobic activity at a vigorous level.
Moderate aerobic exercise includes brisk walking; games that require catching and throwing, such as baseball and softball; and active recreation, such as canoeing, hiking, skateboarding or inline skating. Examples of vigorous aerobic exercise are jumping rope; running; cross-country skiing; games that involve running and chasing, such as flag football or tag; and sports such as soccer, hockey, basketball, swimming and tennis. — Bradford Landry, D.O., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: A few months ago my 12-year-old daughter and I were on a flight that had significant turbulence, which was really upsetting for her. Since then, she has had nightmares about the flight and has told me almost daily that she will never fly again. We have a wedding coming up that will require us to fly, and she insists that she will not go. What can I say to her that will help calm her fears? Should I have her evaluated by a psychologist?
ANSWER: Your daughter’s situation is not unusual. It’s common for children to develop fears, particularly in response to an unsettling experience. There are a number of steps you can take at home to help her better understand and become more familiar with what she fears. As that happens, it’s likely her fear will become less overwhelming and, even if it doesn’t go away completely, she may be able to manage it more effectively.
First, as you work with your daughter to help her manage her fear of flying, remain calm and encouraging. Keep all your interactions about this topic warm and supportive. Let her know you care about her and you want to help her.
Second, reassure her that what she’s going through is normal. Everyone is afraid of something. There’s nothing wrong with being scared going into a situation that frightened you in the past. It’s perfectly reasonable to be afraid of flying when you had a bad experience on a plane. But, that doesn’t mean you have to avoid the situation. In fact, avoidance may make it worse. There are ways to lessen our fears.
One good way to help manage fear is to get more information about what’s causing it. To help your daughter do this, provide her with basic information about the overall safety of flying. Use reliable sources that she can read or refer to on her own. Don’t simply say, “Flying is safe. Don’t worry about it.” Unless you are a pilot or an aviation expert, your word probably is not enough to reassure her at this time. Also, educate her about what turbulence is and what causes it. Understanding why something happens can make it more predictable and understandable. And, that makes it less scary.
Next, help your daughter become less anxious when she thinks about flying by facing her fears, rather than avoiding them. Try to find videos that show turbulence. Watch them by yourself first to make sure they are appropriate for your daughter to see. Then, show them to her. Watch them with her over and over again until they get boring. This type of exposure to a fear-producing situation in a safe environment gradually can reduce anxiety about the situation overall.
You can take the same approach to your daughter’s nightmares. Ask her to tell you in detail about her disturbing dreams. Then, have her write down everything she can remember about those dreams. Review the details, and talk with her about her dreams until they no longer elicit a fearful response.
By examining and better understanding what’s making her afraid, you are helping your daughter see that she can manage her fear. It might not take away her fear of flying completely, and she may still feel uncomfortable about getting on a plane, but, by going through these steps with her, you help her reduce the power fear has over her.
If you try these techniques and your daughter still remains extremely fearful of flying, consider making an appointment for her with a psychologist who has experience working with children and adolescents dealing with anxiety. — Stephen Whiteside, Ph.D., Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: A little more than two years ago, I was diagnosed with vulvar lichen sclerosus. My doctor prescribed a topical cream, which I still use once or twice each week. I have never been back for a recheck, but I recently read that I should be getting a regular exam, because this condition might cause vulvar cancer. How often do you recommend that I see my doctor?
ANSWER: Thank you for your question. Given it is a chronic condition, most women who have vulvar lichen sclerosus need long-term treatment. At this time, the evidence is not clear whether lichen sclerosus actually raises the risk for vulvar cancer, though there may be a small chance that cancer could develop. Therefore, you should have follow-up evaluations regularly, as recommended by your doctor. As long as your symptoms are well-controlled with the cream you are using, a checkup with your primary health care provider every six to 12 months likely will be enough to monitor your condition properly.
Lichen sclerosus can appear anywhere on the body. It is most common on the skin of the vulva, foreskin of the penis and skin around the anus. Vulvar lichen sclerosus causes light-colored, itchy patches of skin on the vulva. At first, these patches of skin may look shiny and smooth. The patches then may become wrinkled and thin. The thin skin can tear, bruise or bleed easily, causing significant discomfort. In time, the skin also may become scarred. The scarring can lead to pain during sex, as well as pain or difficulty when you urinate or have a bowel movement.
Anyone at any age can get lichen sclerosus, but postmenopausal women are affected most often. The cause of this condition is not well-understood. It may be connected to hormone changes in the body. It also might be an autoimmune disorder, where the body’s immune system attacks its own healthy organs or tissue. It’s important to remember that lichen sclerosus is not caused by a virus, and it’s not a sexually transmitted disease. It isn’t contagious and can’t be passed from one person to another.
The most common treatment for lichen sclerosus is a prescription of corticosteroid cream. It often stops the itching and discomfort, and prevents scarring. When first using the corticosteroid cream, it typically needs to be applied to the affected areas of skin every day for several weeks. Once symptoms are under control, many women need to continue using corticosteroid cream two or three times a week long-term to keep their symptoms from coming back. In most cases, no other treatment is required.
At this time, the connection between vulvar lichen sclerosus and vulvar cancer is not clearly understood. Some research studies seem to show there may be a small chance that skin affected by lichen sclerosus could be at higher risk for developing cancer. Results from other studies, however, have not found the same correlation.
It is important to see your health care provider on a regular basis so he or she can confirm that the treatment for lichen sclerosus is working. Your health care provider also can check for side effects from the treatment and watch for any new skin changes that may require further evaluation. Follow-up exams generally are recommended every six to 12 months. Contact your doctor to decide on a follow-up schedule that’s appropriate for your situation. — Dr. Beatriz Stamps, Gynecology, Mayo Clinic, Scottsdale, Arizona