Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
DEAR MAYO CLINIC: How soon can Alzheimer’s disease be diagnosed? What are the early symptoms to watch for?
ANSWER: There is no one test that can be used to diagnose Alzheimer’s disease. But, based on an assessment of symptoms, along with a variety of tests and exams, Alzheimer’s often can be identified in its earliest stages. Seeking medical attention as soon as Alzheimer’s symptoms become noticeable is key to a prompt diagnosis.
The most common early symptom of Alzheimer’s disease is forgetfulness. Distinguishing between memory loss that is due to aging and memory loss due to Alzheimer’s can be tricky though.
As people get older, the number of cells, or neurons, in the brain goes down. That can make it harder to learn new things or to 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 the beginning of Alzheimer’s disease.
The type of forgetfulness that is worrisome involves forgetting information that a person formerly always would 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 usually would make a priority goes unnoticed, like a doctor’s appointment. If this happens once in a while, it probably is not a problem. If a person starts to have trouble making these connections regularly, then it is 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 difficult 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.
Another early warning sign of Alzheimer’s can be a change in behavior or personality, for example, a normally outgoing person who withdraws from friends and family and refuses social engagements. Depression and other mood changes may be symptoms of early Alzheimer’s, too.
If, after reviewing a person’s symptoms, a doctor suspects Alzheimer’s, tests that assess memory and other thinking skills, judge functional abilities and identify behavior changes can be useful in determining if Alzheimer’s could be to blame. Talking with family members about a person’s cognitive skills, functional abilities and daily behaviors, and how they have changed over time is often helpful, too.
Imaging exams and laboratory tests can help show what is happening within the brain. Brain images obtained through CT, MRI or other scans may be able to show loss of brain cells or the development of proteins known to contribute to Alzheimer’s. Laboratory tests can help rule out other disorders that can cause symptoms similar to those of Alzheimer’s disease, such as a thyroid disorder or vitamin B-12 deficiency. This type of thorough evaluation often can diagnose Alzheimer’s disease in its early stages.
Timely, accurate diagnosis is important, because, once the disease has been identified, doctors may be able to offer medications to help manage Alzheimer’s symptoms and possibly slow decline in memory and other cognitive skills. Knowing they are dealing with Alzheimer’s when it’s still in its early stages also allows people with the disease, and their families, to learn about ways to cope and to take time to plan for the future. — Ronald Petersen, M.D., Ph.D., Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I was recently diagnosed with vascular Ehlers-Danlos syndrome. My doctor said there’s no cure, and that it’s genetic. What can be done to treat this? I have two young children. Should they be tested for it?
ANSWER: Although it’s true that there is no cure for Ehlers-Danlos syndrome, physical therapy often can help manage symptoms and prevent complications. Regular follow-up care and monitoring also may help catch problems that develop due to Ehlers-Danlos in the early stages, when they may be easier to treat. Because Ehlers-Danlos is an inherited disorder, it would be worthwhile to talk with a genetic counselor about genetic testing for your children.
Ehlers-Danlos syndrome often causes overly flexible joints and stretchy, fragile skin. When you have this disorder, you may be prone to dislocating joints and bruising easily. Your skin may not heal well. Vascular Ehlers-Danlos is a more severe form of the disorder that affects blood vessels. In particular, it can weaken the aorta — the large artery that carries blood away from your heart — as well as the arteries that lead to your kidneys and spleen. In some cases, vascular Ehlers-Danlos can weaken the walls of the large intestine or uterus, too.
Physical therapy often is key to managing Ehlers-Danlos syndrome. Exercises to strengthen the muscles around your joints can help to stabilize those joints. That lowers your risk of joint dislocation. A physical therapist can teach you how to do those exercises and give you suggestions for other physical activities that fit your situation.
When you have Ehlers-Danlos, there are some activities you need to limit or avoid. These include contact sports, weightlifting and other activities that increase your risk of injury and may not be appropriate for you. You also may need to limit running, step aerobics or stair climbing to decrease stress on your hips, knees and ankles.
For vascular Ehlers-Danlos, keeping blood pressure low can ease the stress on your fragile blood vessels. That reduces the risk of blood vessel injuries, such as the walls of the arteries separating — a condition known as blood vessel dissection. Lowering blood pressure also can make it less likely that your blood vessels will bulge or rupture due to weakness. In some cases, you may need to take medication to keep your blood pressure low. To monitor the health of your blood vessels over time, your doctor may recommend that you have imaging exams of your aorta and other major arteries on a regular basis.
People with Ehlers-Danlos have a chance of passing the genetic mutation for the disorder to their children. With that in mind, it is a good idea for you to consult with a genetic counselor to discuss the risks and benefits of genetic testing for your children. Prompt diagnosis of Ehlers-Danlos is crucial to ensuring the appropriate and timely medical care needed to avoid serious complications. In many cases, therefore, genetic testing is recommended for children who may have the disorder.
Because Ehlers-Danlos syndrome is uncommon, I’d encourage you to seek care from a specialist who is familiar with Ehlers-Danlos and has experience caring for people with this disorder. Also, because it can affect a number of different areas and systems in your body, it is best to receive care for Ehlers-Danlos at a health care facility that offers access to all the medical specialties you may need, such as cardiovascular diseases, vascular surgery and urology, among others. — Dr. Fadi Shamoun, Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: Three weeks ago I was diagnosed with sciatica. I didn’t have much pain initially, but it has been extremely painful the past few days — usually when I’m sitting. Would physical therapy be an option for treatment? I don’t like to take medications for pain. Are there other treatments I should try? Could surgery help?
ANSWER: Sciatica can cause significant discomfort. The good news is that time and treatment often successfully resolve this condition. In most cases, surgery is not necessary to treat sciatica.
Sciatica typically refers to pain from irritation of one of the spinal nerves in your low back. Although the source of the irritation is in your back, you feel the pain of sciatica along the affected nerve where it is located in your leg after it exits the spine, typically in the buttock and leg. Sciatica usually affects only one side of the body.
Sciatica pain is often a dull pain, but it also can be sharp and, at times, you may feel the pain travel or “shoot” down your leg. Symptoms of sciatica may include numbness, tingling or weakness along with the pain.
Sciatica develops due to a change in one of the cartilage pads in your spine, called discs. A small component of the disc pokes into the spinal canal, creating inflammation, or swelling. That, in turn, leads to inflammation of the nerve and triggers the symptoms of sciatica. Pressure on the nerve from the disc may contribute to sciatica, as well. Other less likely causes of nerve irritation include bone spurs, cysts or other lesions in the spine that grow near a nerve.
Physical therapy can be an excellent treatment option for sciatica. It often involves learning stretches to improve your flexibility, techniques for pain control and exercises to strengthen and condition the muscles that support your back. This type of physical therapy helps reduce sciatica pain and lowers your risk for future injuries. In addition to physical therapy, staying active in whatever type of physical activity you best tolerate can help ease pain and other symptoms, too.
Though you mention that you prefer to avoid medications, newer drugs are available that can work quite well for pain caused by sciatica. They are not potentially habit-forming like narcotic drugs, or opioids, can be. Drugs like gabapentin, duloxetine, nortriptyline and pregabalin can be useful for managing severe pain or pain that makes it hard to sleep.
Corticosteroids are another treatment option. These potent anti-inflammatory drugs are delivered via an injection that places the medication just where it is needed. You have an imaging exam, such as a CT scan or an MRI, before a corticosteroid injection, so your health care provider can see where the medication should go. Imaging also is used to guide the injection as it’s being delivered to ensure safety and accuracy.
In about 90 to 95 percent of sciatica cases, the problem is successfully resolved with time and conservative, non-surgical treatments. If sciatica persists despite these treatments, though, surgery may be considered.
Although uncommon, surgery may be recommended as a first step in treatment if weakness associated with sciatica is moderate to severe, if weakness gets worse over time, if symptoms affect both legs or if you are experiencing incontinence due to sciatica. Very rarely, sciatica can lead to extensive numbness in the buttocks and pelvic floor. When that happens, prompt surgical intervention is often required.
When sciatica is the result of a disc problem — as it is in most typical cases — and surgery is required, it can be quite effective. The procedure involves removing the portion of the disc that’s affecting the nerve. This surgery usually takes about 75 minutes and requires only one day in the hospital. — Dr. Randy Shelerud, Spine Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Should all postmenopausal women take calcium supplements to prevent osteoporosis, or are there other things I can do to prevent it? Also, I know caffeine is bad for bone health, but can eating a high-protein diet also hurt my bones?
ANSWER: Calcium is crucial for long-term bone health. A calcium supplement is not always necessary, though. You may be able to get the calcium you need from your diet. Along with calcium, getting enough vitamin D and regularly engaging in weight-bearing aerobic and strengthening exercises also can protect your bones.
Your body regularly makes new bone and breaks down old bone. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass in their mid-20s to mid-30s. The higher your peak bone mass, the more bone you have to sustain bone health throughout the rest of your life.
Osteoporosis risk rises with age because as you get older, you lose bone faster than your body can make it. Osteoporosis can occur when the body’s creation of new bone can no longer keep up with the breakdown of old bone. Bones may become weak and brittle and are easily broken.
Women near the age of menopause are particularly vulnerable to bone loss. On average, in the three years around menopause — one year before the last menses and two years after it — women go through a rapid phase of bone loss, losing about 2 percent of overall bone mass each year during that time.
Getting enough calcium in your diet throughout your life can help keep your bones healthy. Women between the ages of 18 and 50 need about 1,000 milligrams of calcium a day. That increases to 1,200 milligrams when women turn 50. Good sources of calcium include low-fat dairy products, dark green leafy vegetables, canned sardines with bones, canned salmon and soy products. Many cereals and juices are also calcium-fortified.
If you can’t get enough calcium in your diet, your doctor may recommend a supplement. Don’t take a calcium supplement before checking with your doctor first. Too much calcium can lead to other health concerns, especially kidney stones.
Protein is an important part of your diet and is vital for good health. But taking in high amounts of protein every day can cause your body to lose calcium. Caffeine in large amounts may also make it hard for your body to retain calcium. If you’re concerned about the amount of protein or caffeine in your diet, talk with your doctor.
Vitamin D is necessary for your body to absorb calcium. Many people can get enough vitamin D from sunlight, but it depends on many factors and varies with the seasons. Your doctor can check a blood test to determine your vitamin D level. If it’s too low, you may need a supplement. The recommended dietary allowance of vitamin D is 600 international units daily, until age 70, when 800 international units is recommended. The upper limit of vitamin D intake is 4,000 international units a day.
Regular exercise may help slow bone loss. A combination of strength-training exercises with weight-bearing exercises is usually best. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope or skiing — have a positive effect on the entire skeleton, and particularly benefit the bones in your legs, hips and lower spine. Balance exercises such as tai chi can help reduce the risk of falls, which cause most bone fractures.
Along with the other suggestions already mentioned, to ensure the best bone health, postmenopausal women should limit alcohol to no more than one drink a day. And finally, for many health reasons, including protecting against bone loss, don’t smoke. — Dr. Robert Wermers, Endocrinology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I am a 33-year-old woman and have never had any health problems, so I don’t have a doctor that I regularly see. My husband has health issues and feels I should at least go to the doctor every year for a general exam. I don’t feel it’s necessary. How often should healthy individuals go to the doctor?
ANSWER: You don’t necessarily need to be seen on an annual basis if you’re doing well and don’t have any health concerns. It would be a good idea, however, to establish a primary health care provider for yourself. Then, make an appointment to see that provider to review the preventive screening tests and exams you need, and to decide how often you should have them done.
The specific tests that are most useful for you depend a great deal on your age, family history and health history. For example, a Pap smear to screen for cervical cancer is recommended every three years for most women in their 20s. When you reach your 30s and beyond, the recommendation for that test changes, in general, to every three to five years. Your cervical cancer screening with a Pap smear also is based largely on your previous results. If you’ve had an abnormal finding on a recent Pap smear, then you may need the test more often.
The same is true for many other preventive exams, such as mammograms, cholesterol testing and diabetes screening. Your personal medical history and family history, along with your preferences and what you value, need to be considered as you decide on the timing of these screenings. In many cases, trying to wade through the recommended schedules for these tests on your own can be confusing. In addition, the advice one organization offers about screening timetables sometimes conflicts with another’s recommendations.
That’s where a discussion with your health care provider can be particularly useful. Together you can sort out what’s appropriate for you and set a schedule of tests that fits your situation. In some cases, an annual checkup to take care of those tests and exams might make sense. In others, it may be several years between appointments, or you may need to been seen more frequently.
Establishing care with a health care provider and his or her team also allows them to touch base with you on your overall well-being and for you to build a relationship with them. That gives you an opportunity to have your team discuss life issues you may be dealing with that can have an effect on your health, such as stress, job transitions, loss, divorce or other major changes. They can talk with you about how you’re coping. They can also help you navigate those issues by offering referrals to support services and, if needed, treatment for related concerns, such as sleep problems, grief management, anxiety or depression.
Another benefit to having a primary health care provider is you can take advantage of the services they offer in addition to office visits. Many health care organizations now have secure email access that patients can use to communicate with their health care team. They also may be able to direct you to websites and other online resources that they have created or have been deemed reliable. In addition, nurses and other team members may be available to you by phone to answer questions, as well as triage more urgent health concerns
Remember, too, there’s quite a bit you can do to stay healthy in between visits to your health care provider. As much as possible, eat a healthy diet, get enough sleep, find ways to work physical activity into your daily routines, don’t smoke and enjoy life. Those lifestyle choices all have a significant and lasting impact on your long-term health. — Dr. Summer Allen, Family Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: After almost a year of having a period that is much heavier than normal, my gynecologist recommended an IUD as treatment. How does this work, and is it safe? I am 38, and I’m done having children, but don’t need contraception.
ANSWER: Many types of intrauterine devices, or IUDs, are available. The specific kind that has been approved by the U.S. Food and Drug Administration for treatment of heavy menses releases the hormone progestin. This type of IUD is safe and highly effective for easing periods that are heavier than normal. IUDs are not the only option for treating this condition though. Before you move forward, consider talking with your doctor about the range of treatment choices available to you.
Hormonal IUDs are small, T-shaped plastic devices placed in the uterus that release progestin over time. Typically, IUDs are used to prevent pregnancy. But, research has shown hormonal IUDs to be useful for easing heavy periods, too. That’s because they not only thicken cervical mucus to prevent sperm from reaching or fertilizing an egg, they also thin the lining of the uterus. That decreases menstrual blood flow and cramping.
One of the main benefits of using an IUD to reduce heavy periods is that, once placed, an IUD is effective for three to five years. The exact amount of time it can be left in place depends on the brand you choose. Little, if any, follow-up care is needed to manage the IUD during that time.
Side effects usually are minimal. Some women may notice headaches, acne, breast tenderness, mood changes and weight gain when they are using a hormonal IUD. There is a small risk of tearing the uterus when the IUD is placed. But, that’s rare, particularly when the procedure is performed by an experienced physician.
If you prefer not to have an IUD, or if you would like to explore other possible treatment options, there are alternatives. Some women take birth control pills to manage heavy menstrual bleeding. This also can be an effective treatment. Keep in mind, however, that taking the pill is not a good choice if you smoke. Your doctor should review your medical and family history before you start taking birth control pills to make sure you’re an appropriate candidate for them.
If, as in your situation, birth control is not needed, another option for controlling menstrual bleeding is to take a pill 10 to 12 times a month that contains only progestin. The medication reduces bleeding by correcting the hormone imbalance that usually contributes to heavy periods.
If treatment with an IUD or medication is not successful, a variety of surgical options also can be used to decrease menstrual blood flow. Most of these procedures can be done on an outpatient basis and do not require an overnight hospital stay.
Before you make a decision, it would be a good idea to take time to review all the possible treatment options with your doctor. Talk about your preferences, and discuss your medical and family background. Go over the risks and benefits of each option. That conversation can help you get a better idea of the treatment choice that’s right for you and help you find the one that best fits your situation. — Dr. Bonnie Maffi, Gynecology, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: My mother, 70, has osteoarthritis and was prescribed medication to help with the pain. What else can she do to keep it from worsening? Is physical therapy an option?
ANSWER: Osteoarthritis is a progressive disease that slowly gets worse over time. Although the process of osteoarthritis can’t be reversed, the symptoms usually can be effectively managed. Medication helps. Exercising regularly, staying at a healthy weight and lowering stress on joints makes a difference, too. For many people who have osteoarthritis, physical therapy is a useful part of their treatment plan.
Osteoarthritis happens when the protective cartilage that cushions the ends of bones in joints gradually breaks down. That leads to joint pain, tenderness and stiffness. Although osteoarthritis may damage any joint, it’s most common in the hands, knees, hips and spine.
As in your mother’s situation, medications such as acetaminophen and nonsteroidal anti-inflammatory drugs, or NSAIDs, frequently are used to control osteoarthritis. Several topical medications are available that can reduce joint pain, too. They include, among others, capsaicin cream and a gel form of the NSAID ibuprofen.
Exercising on a regular basis also helps ease osteoarthritis symptoms. This is where physical therapy may be useful. A physical therapist can work with your mother to create an individual exercise program to strengthen the muscles around her joints, increasing her range of motion and reducing pain.
Low-impact exercises, such as swimming, biking and walking, usually work well. Some people also enjoy activities such as tai chi and yoga, which combine gentle exercises and stretching with deep breathing. A physical therapist can help your mother decide on the activities that are right for her.
Staying at a healthy weight also is an important part of managing osteoarthritis. Carrying extra weight increases the stress on weight-bearing joints, such as the knees and hips. Even a small amount of weight loss can relieve some pressure and decrease pain. If she would like to lose weight, your mother can ask her health care provider for a referral to a dietitian. He or she can discuss healthy weight-loss strategies, offer suggestions for meal planning and provide your mother with nutritious recipes to get started.
To keep her symptoms from getting worse, your mother should try to avoid overusing the joints affected by osteoarthritis. A variety of assistive devices are available that can make everyday tasks less stressful on joints. For example, using a cane takes weight off a painful knee or hip. Gripping and grabbing tools make it easier to open doors and jars. Encourage your mother to ask her health care provider for information about these and other assistive devices that might be useful for her.
Some forms of alternative medicine have been suggested for osteoarthritis treatment, too. Acupuncture — a technique that involves inserting extremely thin needles through the skin at strategic points on the body — may contribute to pain control for some people. Meditation may also ease osteoarthritis symptoms in certain cases.
The nutritional supplements glucosamine and chondroitin often are touted as effective treatment for osteoarthritis. Results from studies on these nutritional supplements have been mixed though. A few have found benefits for people with osteoarthritis, but most have shown no clear effects. If your mother is interested in trying these supplements, encourage her to talk with her health care provider first. Glucosamine is not safe for people who are allergic to shellfish. Also, glucosamine and chondroitin may interact with blood thinners, such as warfarin, and cause bleeding problems.
Before she goes forward with any additional treatment, it would be a good idea for your mother to make an appointment to see her health care provider, talk about her options and discuss the benefits and risks of each. From there, they can create a comprehensive treatment plan that will help keep your mother’s osteoarthritis symptoms under control. — Dr. John Davis III, Rheumatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: If someone has been diagnosed with celiac disease but has never had any symptoms, would eating a gluten-free diet still be necessary?
ANSWER: Following a strict gluten-free diet is important for anyone who has celiac disease, even if the disorder does not trigger any symptoms. Eating gluten when you have celiac disease injures the small intestine. Over time, that injury raises the risk for developing complications related to celiac disease.
In people who have celiac disease, eating gluten — a protein found in wheat, barley and rye — sparks an immune response in the small intestine that leads to inflammation. Over time, that inflammation damages the tiny, hair-like projections, called villi, which line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. Normally, villi resemble the deep pile of a plush carpet, on a microscopic scale. The damage resulting from celiac disease makes the inner surface of the small intestine appear more like a tile floor. When that happens, the small intestine has difficulty absorbing some crucial nutrients the body needs to stay healthy and grow.
The symptoms and presentation of celiac disease can vary quite a bit from one person to another. In some cases, it may not cause noticeable symptoms right away. When symptoms do occur, they can include bloating and weight loss. Bowel changes due to celiac disease may trigger a range of gastrointestinal symptoms, from diarrhea to constipation.
Some people who have celiac disease don’t have any gastrointestinal problems. Instead, tests may reveal iron-deficiency anemia or premature bone disease. Less common symptoms of celiac disease can include an itchy, burning rash, called dermatitis herpetiformis, as well as heartburn, headaches, fatigue and joint pain, among others.
When celiac disease doesn’t cause symptoms, following a gluten-free diet may seem like an unnecessary challenge. But it is critical for everyone with celiac disease to eliminate gluten from the foods they eat. If that doesn’t happen, celiac disease can result in serious complications.
For example, when the small intestine cannot absorb enough calcium and vitamin D, it may lead to softening of the bone in children and a loss of bone density in adults. Over time, a range of other problems also may develop as a result of the body not getting the nutrients it needs — from skin rashes and difficulty absorbing lactose to infertility and nerve damage. People with celiac disease who don’t maintain a gluten-free diet also have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
Eating a diet without gluten may seem daunting at first, but you don’t have to manage it alone. For help planning a healthy gluten-free diet, consult with a registered dietitian who is familiar with celiac disease. He or she can give you an overview of gluten-free foods, show you which foods to avoid, and help you learn to recognize ingredients on nutrition labels that contain gluten. A dietitian also can offer gluten-free meal ideas and recipes.
Fortunately, gluten-free products are becoming more popular and easier to find, including gluten-free breads, pastas and baked goods. If you have trouble locating gluten-free items at your local bakery or grocery store, check online. Many companies now ship these products across the country.
Once gluten is removed from the diet, inflammation in the small intestine generally begins to lessen. Complete healing and regrowth of the villi may take several months to several years, so maintaining a gluten-free diet is vital for intestinal healing. — Dr. Amy Oxentenko, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What is considered “low” for the diastolic number in a blood pressure reading? What would a low reading mean? If the systolic number is within normal range, what can be done to alter the diastolic number?
ANSWER: A blood pressure reading has two numbers, given in millimeters of mercury. The first, or upper, number measures the pressure in your arteries when your heart beats. That’s systolic pressure. The second, or lower, number measures the pressure in your arteries between beats. That’s the diastolic pressure.
In general, diastolic blood pressure is considered to be low if it is 60 millimeters of mercury or less. Normal blood pressure varies from one person to another though. If your diastolic blood pressure is consistently below 60 millimeters of mercury, but you aren’t experiencing any problems from it, you may not need to do anything. Noticeable symptoms of low blood pressure generally include dizziness, lightheadedness or fainting. If you’re having these or other symptoms that could be related to low blood pressure, more investigation may be required to uncover the possible cause and provide appropriate treatment.
In some cases, medications can cause low diastolic blood pressure. In particular, medications intended to lower blood pressure, called anti-hypertensives, may go too far in the other direction, reducing blood pressure beyond a healthy level. These anti-hypertensives include diuretics (sometimes called water pills), alpha blockers and beta blockers. Other medications also may lead to low blood pressure, such as drugs for Parkinson’s disease, certain types of antidepressants, and the drug sildenafil, particularly in combination with heart medication (e.g., nitroglycerine).
An underlying medical condition could trigger low blood pressure, as well. For example, heart problems, such as extremely low heart rate, heart valve problems and heart failure, may cause low blood pressure, because they prevent the body from being able to circulate enough blood. Endocrine disorders, such as adrenal insufficiency, also can trigger low blood pressure.
Other conditions, including dehydration, blood loss, severe infection and a severe allergic reaction, can lead to low blood pressure. But, these disorders usually cause a sudden, dramatic drop in pressure, rather than a sustained low blood pressure reading over time.
Another possible cause for low diastolic blood pressure is extremely stiff arteries. Very often, around 55 to 60 years of age, arteries begin to lose some of their flexibility. That can increase systolic blood pressure and cause discordantly low diastolic blood pressure. In some cases, however, stiff arteries could be a symptom of vascular disease.
When your diastolic blood pressure is consistently below normal, it may need to be evaluated. In young healthy people who do not take medications or have any symptoms, no treatment may be needed. But, it’s still a good idea to talk to your doctor about it. If you do take medications, ask your doctor to review your current medication list to see if they could be contributing to low blood pressure.
If your doctor suspects that an underlying disorder could be the source of the problem, then additional tests may be necessary. It also would be worthwhile to talk with your doctor about managing any vascular risk factors you may have that can be changed, such as smoking, high cholesterol, diabetes and obesity. When a medical condition leads to low diastolic blood pressure, successfully treating that problem may eliminate the low blood pressure, too. — Dr. Sandra Herrmann, Nephrology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My grandson is 11 and already has high cholesterol. He does not eat a lot of junk food and plays many sports, but we do have high cholesterol in our family. Could this be hereditary, and, if so, is it common to show up in such a young person?
ANSWER: High cholesterol certainly can be genetic, and it may show up at an early age in some people. Although your grandson can’t do anything about his genetics, he can make lifestyle choices to help manage his cholesterol. If that isn’t enough, then medication to help control cholesterol may be an option, too.
Cholesterol is a waxy substance found within the fats, or lipids, in blood. Cholesterol is carried through the blood attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different kinds of cholesterol. They are based on what type of cholesterol the lipoprotein carries. Low-density lipoprotein, or LDL, is sometimes called bad cholesterol. It transports cholesterol particles throughout the body. LDL cholesterol builds up on the walls of the arteries, making them hard and narrow. High-density lipoprotein, or HDL, is considered good cholesterol. It picks up excess cholesterol and takes it back to the liver.
While the body needs some cholesterol to build healthy cells, having too much cholesterol can raise a person’s risk for heart disease. High cholesterol, particularly high levels of LDL, can lead to the development of fatty deposits in blood vessels. Eventually, these deposits can make it hard for blood to flow through the arteries. When that happens, the heart may not get as much oxygen-rich blood as it needs. That raises the risk of a heart attack. If blood flow to the brain is reduced, that can cause a stroke.
High cholesterol does have a tendency to run in families, and genetics play a role in a person’s risk for developing high cholesterol. For example, genetic makeup may keep cells from effectively removing LDL cholesterol from the blood or cause the liver to produce too much cholesterol.
When a young person, such as your grandson, has high cholesterol, the first steps to help control cholesterol usually involve lifestyle changes. Getting regular exercise and staying at a healthy weight both can go a long way to managing cholesterol levels. It sounds like your grandson is already active in sports. He should continue those activities, with a goal of getting at least 30 minutes of exercise a day. He also should limit the amount of time he spends in front of computers, tablets, televisions and phones.
Eating a healthy diet is also important for cholesterol control. Working with a dietitian can be very useful for families who have children dealing with high cholesterol. A dietitian can assess your grandson’s eating habits and recommend changes, such as avoiding processed foods that contain large amounts of saturated fats and sugars, for example. The dietitian also can offer ideas for healthy food choices and recipes for the entire family.
In some cases, lifestyle changes may not be enough to keep cholesterol in check, and medication is necessary to bring cholesterol down to a healthy level. It is important to lower high cholesterol in children, because, if left untreated, high cholesterol eventually can lead to narrowed and hardened arteries, increasing the risk of serious health problems later in life. — Dr. Aida Lteif, Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What is better for sun protection: a chemical sunscreen or a physical sunscreen? Is it really necessary for me to wear sunscreen even if I work in an office all day?
ANSWER: Both chemical and physical sunscreens offer effective sun protection when applied correctly. Physical sunscreens usually are less expensive than chemical sunscreens. Given that they also are hypoallergenic, physical sunscreens may be a safer choice for some people who have sensitive skin. It is a good idea to wear sunscreen every day even if you work indoors.
Sunscreen protects your skin from the sun’s ultraviolet, or UV, light. There are two types of UV light that can harm your skin: UVA and UVB. UVA is the long wavelength of light that penetrates to the deep layers of skin. UVA leads to skin damage over time that can prematurely age your skin, causing wrinkling and age spots. UVB is the shorter wavelength of light that penetrates the surface of the skin and causes sunburn. The best sunscreens offer protection from all UV light. These are labeled as “broad-spectrum” or “full-spectrum” sunscreens.
Physical sunscreen literally blocks UV light from reaching your skin by either reflecting the light or absorbing it. These products contain zinc oxide or titanium dioxide. Some people don’t like to use physical sunscreen, because it remains visible on the skin after you apply it. It also can be hard to wash off. However, physical sunscreen provides significant, lasting protection from UVA and UVB light. It also tends to be less irritating to the skin than chemical sunscreens. That can be particularly beneficial for younger children and individuals who have sensitive skin.
Chemical sunscreens work by absorbing the UV light and causing it to undergo a chemical reaction that prevents it from damaging your skin. Many chemical sunscreens are available.
As you choose sunscreen, check its sun protection factor, or SPF. This number gauges how well a sunscreen blocks UVB rays. Experts agree that an SPF factor of 15 is the minimum needed to prevent skin damage from UVB. Sunscreens with SPFs higher than 50 provide only a small increase in UVB protection, compared to SPF 30 or SPF 50. That means high SPF sunscreens, such as SPF 100, may not be worth the added expense you pay for them when compared to the protection they offer.
The key to getting the full amount of SPF protection from sunscreen is applying it generously and frequently. Most people simply do not apply enough. For example, about two tablespoons of sunscreen, or about enough to fill a shot glass, is only enough for your face, your neck and the back of your hands. Apply sunscreen generously to the rest of your exposed skin as well. Reapply sunscreen at least every two hours, or more often if you’ve been sweating or swimming. A sunscreen may be water-resistant, but no sunscreen is waterproof.
To best protect your skin from UV light, wear sunscreen every day, even if you spend much of your time indoors. For the days you spend in your office, using a cosmetic product that contains sunscreen, such as moisturizer or aftershave, is all you need. When you spend more time outdoors, however, use a stronger form of sunscreen and reapply it at least every two hours.
Keep in mind, too, that you need sunscreen anytime you’re outside, even if the sun isn’t shining. UV light penetrates through the clouds, and it reflects off water, snow and other surfaces. When reflected, the rays become stronger, making sunscreen important year-round. — Dr. Dawn Davis, Dermatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I typically drink three or four cans of diet soda each day, and my doctor told me it may be the cause of my high blood pressure. But, I’ve been drinking this much soda for years and have never had any issues. Why would it suddenly affect my blood pressure?
ANSWER: It’s unlikely that the diet soda you drink is causing your high blood pressure. A number of studies have examined this topic, and there is no evidence to suggest a link between regularly drinking diet soda and an increase in blood pressure. In fact, some research findings seem to suggest the opposite. Diet soda actually may contribute to lowering blood pressure.
A variety of artificial sweeteners are available on the market. All of them are judged to be safe for general use. The three artificial sweeteners primarily used in soft drinks and diet sodas are stevia, sucralose and aspartame. Stevia, a natural product, has been shown to possibly lower blood pressure in people who have high blood pressure. Sucralose, which has almost the same molecular structure as table sugar, does not have much, if any, effect on blood pressure.
The bulk of diet sodas are made with aspartame. Aspartame does not appear to cause high blood pressure either. For example, in one study looking at a possible connection between the two, rats were fed either sugary foods or large doses of aspartame. The results showed that blood pressure went down in the group that consumed the artificial sweetener.
The most telling study, though, was done in humans. It tested blood pressure in four groups of overweight participants. Each group drank one liter of either regular soda with sugar, diet soda, milk or water every day for six months. Blood pressure in those who consumed the diet soda and the milk came down by 10 to 15 percent, compared to those who drank sugared soda.
As you are considering the amount of diet soda you drink each day, it is worthwhile to note that some population studies, called epidemiologic research, show a relationship between the regular use of diet soda and obesity. These studies also show a relationship between diet soda consumption and metabolic syndrome, and an increase in cardiovascular disorders. However, these are associations only. Some nonmedical literature you see may interpret those findings to mean that diet soda somehow causes these medical conditions. But, this type of research does not pinpoint the cause of the disorders. It only identifies factors that may be related to them.
Although changing your diet soda habit may not have an effect on your blood pressure, other lifestyle changes can make a difference. For example, eat a healthy diet that is low in salt and has plenty of fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Exercise regularly, and get to, and stay at, a healthy weight. If you drink alcohol, do so in moderation. For women of all ages and men older than 65, that means no more than one alcoholic drink a day. Men 65 and younger should have no more than two drinks a day. Manage stress in healthy ways. Don’t smoke.
All of those steps can help control blood pressure. But, sometimes lifestyle changes alone aren’t enough, and medication is necessary to keep blood pressure at a healthy level. Talk with your doctor about the blood pressure treatment options that are right for you. — Dr. Irvin Cohen, Nephrology, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: What would cause someone to become lactose-intolerant later in life? I’m in my 40s and have never had an issue with dairy, but, now, I can’t seem to have it without problems. Do I need to see a doctor to be tested for allergies, or should I just avoid dairy?
ANSWER: Lactose intolerance isn’t a true allergy, and it can develop at any age. In some people, lactose intolerance may be triggered by another medical condition, such as Crohn’s disease. In others, it develops without a specific underlying cause. It would be a good idea to have your condition evaluated by your doctor to confirm that what you’re dealing with truly is lactose intolerance.
Lactose intolerance results from a problem with the carbohydrate lactose, a type of sugar found in dairy products. When you eat or drink dairy products, enzymes in your small intestine digest lactose, so the body can make energy. In people with lactose intolerance, a certain enzyme, called lactase, is missing from the body. When those people eat dairy products, the body has no way to break down the lactose. This leads to fermentation of the sugar in the intestines and triggers symptoms, such as diarrhea, nausea, abdominal cramps, bloating and gas.
Sometimes, lactose intolerance develops when the small intestine’s production of lactase decreases after an illness, injury or surgery involving the small intestine. This is called secondary lactose intolerance. Among the diseases associated with this kind of lactose intolerance are celiac disease, bacterial overgrowth and Crohn’s disease. Treatment of the underlying disorder may restore lactase levels and improve symptoms.
More common than secondary lactose intolerance is primary lactose intolerance. People who develop primary lactose intolerance start life making normal levels of lactase — a necessity for infants, who get all their nutrition from milk. As children replace milk with other foods, lactase production normally decreases. It stays high enough, though, to digest the amount of dairy in a typical adult diet. In primary lactose intolerance, lactase production declines below normal at some point for reasons that are unclear. The low amount of lactase then makes milk products difficult to digest and leads to lactose intolerance symptoms.
Your doctor can confirm a diagnosis of lactose intolerance with a clinical test. One that’s often used is a lactose tolerance test. It assesses your body’s reaction to a dose of lactose. After you consume a drink containing lactose, a sample of your blood is taken to measure glucose levels. If your glucose level does not rise, it means your body isn’t properly digesting and absorbing the lactose.
Alternatively, another test called the hydrogen breath test may be used. This test also requires you to consume a drink that contains high levels of lactose. Your doctor next measures the amount of hydrogen in your breath. Normally, very little hydrogen is detectable. However, if your body doesn’t digest the lactose, the fermentation reaction in your colon releases hydrogen and other gases. Your intestines absorb those gases, and you exhale them. Larger-than-normal amounts of hydrogen measured during this test are a sign that your body isn’t fully digesting and absorbing lactose.
If you have lactose intolerance, there isn’t a way to cure it. The most effective way for people with lactose intolerance to get relief from symptoms is to lower the amount of dairy products they eat. You may be able to use dairy products that have reduced levels of lactose or are lactose-free. Some people who have lactose intolerance benefit from taking lactase enzyme supplements, as well.
If test results do not point to lactose intolerance, your doctor may recommend additional tests to check for another condition that could be causing your symptoms, such as a milk allergy, intestinal disorders or other problems within your digestive tract. — Dr. Rohit Divekar, Allergic Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My husband frequently gets cold sores. Most of the time, it seems they are due to stress. We’ve been together for two years. I’ve never had cold sores, and I’d like to avoid ever getting them. I always assumed we should just avoid kissing until the cold sore is gone, but I recently heard that even touching can spread the virus as long as it’s visible. Is this true? Also, are there things he can do to keep from getting cold sores so often?
ANSWER: The virus that causes cold sores usually is spread to other people through saliva. So, your inclination to avoid kissing while your husband has a cold sore is a wise move. But, it’s also true that some active virus is present at the site of a cold sore. That means any direct contact with the sore could spread the virus. There are a number of steps your husband can take to reduce the chance of spreading the virus that causes the sores and lower his risk for developing cold sores frequently.
Cold sores are tiny, fluid-filled blisters on and around the lips. The blisters often are grouped together. After the blisters break, a crust forms over the resulting sore. Cold sores typically heal within one week without leaving a scar.
The medical term for cold sores is herpes simplex labialis. You also may hear them referred to as fever blisters. The sores usually are caused by a herpes simplex virus, HSV-1. Most people who get this virus are first infected during childhood, and the initial infection typically produces few symptoms.
Once HSV-1 is in a person’s body, however, it doesn’t go away. Instead, it remains dormant in the nerve cells of the skin. Over time, the virus can reactivate and cause other cold sores to appear. Cold sores that come back in otherwise healthy people are thought to be triggered by stress, fatigue and sunlight.
To keep the virus from spreading, your husband should be careful to avoid kissing and other skin-to-skin contact with you and with anyone else while he has a cold sore. He also should keep his personal items, such as towels and lip balm, separate from other people in your household during the time he has a sore. Do not share utensils, cups or other dishes either.
As in your husband’s situation, stress is a common trigger for recurrent cold sores. Sunshine exposure also may lead to cold sores in many people who have had them before. Regularly using a lip balm with a broad-spectrum sunscreen may help reduce his number of cold sore outbreaks.
Cold sores generally clear up on their own without medical treatment. But, if your husband continues to get them regularly, he may want to talk with his doctor about medications that are available for cold sores. Several kinds of prescription oral medication can be used to speed the healing of cold sores. They don’t have an effect on the transmission of the virus to other people, though. For individuals who often develop cold sores, or for those at risk of serious complications from the sores, a daily dose of an antiviral medication may be useful to help prevent frequent outbreaks. — Dr. Jason Sluzevich, Dermatology, Mayo Clinic, Jacksonville, Florida
DEAR MAYO CLINIC: Every few months, I develop hemorrhoids that are quite painful, but, after a few days, they seem to go away on their own. Is there a way to avoid getting them altogether? Do I need to see my doctor the next time the hemorrhoids return?
ANSWER: Hemorrhoids are quite common, and they often follow the pattern you describe. Making some lifestyle changes may lower your chances of developing hemorrhoids. But, if those changes aren’t enough to keep them from coming back, and the hemorrhoids cause you considerable discomfort, then consider making an appointment with your doctor for an evaluation to see if treatment may be necessary.
Hemorrhoidal cushions are part of the body’s natural anatomy in the anal canal. They help keep stool in and control continence. The problem with hemorrhoids develops when veins in those cushions become swollen and bulge. Hemorrhoids can occur inside the rectum. Those are called internal hemorrhoids. Or, they can happen under the skin around the anus. Those are called external hemorrhoids. Internal hemorrhoids don’t cause any pain and usually don’t require treatment unless they start to bleed. External hemorrhoids are the ones that typically lead to the pain and discomfort people often associate with hemorrhoids.
Hemorrhoids develop due to increased pressure on the pelvic floor. That pressure often comes from straining during bowel movements and sitting for long periods of time on the toilet. It also may be a result of chronic constipation or diarrhea, obesity or pregnancy. External hemorrhoids tend to occur in the pattern you mention, developing over a three- to four-day period and then slowly going away.
One of the key factors in preventing hemorrhoids is being able to pass stool regularly without straining. There are a number of lifestyle changes you can try to help make that happen. They include exercising regularly, eating a healthy diet that is high in fiber, drinking plenty of fluids, and avoiding sitting for long periods of time.
When painful external hemorrhoids develop, self-care steps usually can relieve the discomfort. Over-the-counter creams, ointments, suppositories or pads designed to treat hemorrhoids contain ingredients such as witch hazel or hydrocortisone that can lessen pain and itching. These products are often effective, but don't use them for more than a week at a time. If used too often or for too long, they may cause side effects, such as a skin rash, inflammation or skin thinning.
Soaking in a warm bath or a sitz bath with plain water 10 to 15 minutes, two or three times a day may reduce hemorrhoid swelling. Ice packs or cold compresses also can ease swelling and pain. Over-the-counter pain relievers, such as ibuprofen, aspirin or acetaminophen, may help relieve some discomfort, too.
If hemorrhoids last more than a week despite home remedies, or if they cause pain and discomfort, then it’s time to make an appointment with your doctor. You also should see your doctor if you’re experiencing painless rectal bleeding, so he or she can rule out other more serious conditions. If your symptoms are due to hemorrhoids, your doctor may recommend removing the hemorrhoids surgically. A variety of techniques can be used to accomplish this. Most of them can be done in your doctor’s office and do not require an overnight hospital stay.
Incorporating changes into your exercise and diet routines now may help you avoid hemorrhoids in the future. If they do come back, try the self-care steps listed above. In most cases, no further treatment will be needed. But, if hemorrhoids continue to cause significant pain, see your doctor. — Dr. John Pemberton, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m a 62-year-old man with no health problems. At my last checkup, my doctor recommended that I be tested for hepatitis C, even though I don’t have any symptoms. Is this really necessary?
ANSWER: It is important for people in your age group to be tested for hepatitis C. Studies have shown that Americans born between 1945 and 1965 are five times more likely than other individuals to be infected with the virus. Most people who have hepatitis C do not show symptoms, so the Centers for Disease Control and Prevention (CDC) recommends that anyone who falls in the high-risk age range get tested.
Hepatitis C is caused by a virus that attacks the liver. Its effects can be serious and long-lasting. If left untreated, hepatitis C can cause liver damage, scarring of the liver tissues — a condition known as cirrhosis — and, eventually, even death. Hepatitis C is a leading cause of liver cancer and the No. 1 reason for liver transplants.
In about 60 to 80 percent of adults who become infected with hepatitis C, the virus lingers in the body. But, in most cases, it’s impossible to tell it is there without testing. As people with hepatitis C age, the virus slowly damages the liver over time. Many people with hepatitis C don’t know they have the infection until liver problems show up. That’s often decades after the initial infection. It’s estimated that if everyone in the recommended age group is tested for hepatitis C, it could prevent more than 120,000 deaths from liver disease.
The hepatitis C virus is spread from contact with contaminated blood. The reason for the higher hepatitis C infection rate in baby boomers is not entirely clear. It may be linked to the fact that, before 1992, blood screening tests for hepatitis were not as reliable as they are now. So, it was possible to get the virus through a blood transfusion or an organ transplant without knowing it.
Some people may have become infected with hepatitis C by sharing contaminated needles when injecting drugs. This can happen even if a person comes in contact with an infected needle only once. In many people, it is not possible to know how they became infected. No matter what the source of a hepatitis C infection, it is critical that it be detected.
Blood tests are available that can identify the hepatitis C virus. When the virus is found, it may be necessary to take a small sample of liver tissue — a procedure called a liver biopsy — or have other tests done to determine the severity of liver damage. Results of these tests can help guide treatment decisions.
Hepatitis C infection is treated with antiviral medications that can clear the virus from the body. Usually, a combination of these medications is taken over several weeks to several months. Twelve weeks after the treatment is completed, another blood test is done to check for hepatitis C. If the virus is still present, a second round of treatment may be recommended. In the vast majority of cases, no further treatment is necessary beyond that.
I strongly encourage you to be tested for hepatitis C. For everyone born between 1945 and 1965, as well as anyone else who may be at high risk for other reasons, being tested for this virus is a crucial step in ensuring long-term health. — Dr. Stacey Rizza, Infectious Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My 13-year-old daughter has become very moody, which I realize is normal for this age. But, I’m concerned she may be depressed. What is the difference between typical teen behavior and depression in teenagers? Are there certain things I should watch for that could be signs of depression?
ANSWER: Variation in mood is normal. People’s moods usually are related to their thoughts about the events happening around them, along with events in their recent past. Teens’ reactions to those events may seem extreme. But, that doesn’t necessarily signal an underlying problem, such as depression. However, there are specific symptoms of depression to watch for. If you see signs of depression in your daughter, ask her about them, and, if you are concerned, make an appointment for her to see a health care provider for an evaluation as soon as possible.
It’s not unusual for teens’ moods to shift quickly and for their emotional responses to be strong. That’s due, in part, to the developmental changes in brain activity and to the fluctuations in hormones that happen in an adolescent’s body. These changes also can contribute to teens having heightened or exaggerated interpretations of what’s going on around them. All this can combine to make a teen’s emotions seem volatile or unpredictable. Although that can be unsettling to the adults who care about them, for many teens, rapid and intense mood changes are often a normal part of their development.
In some cases, though, emotion and mood can signal depression. If sadness, irritability, anger or other difficult emotions are persistent and do not seem to ease over several weeks, that may be cause for concern. If your daughter cries frequently for no clear reason, if she expresses feelings of hopelessness or worthlessness, or if she feels overwhelming guilt or fixates on what she perceives to be past failures, those are all possible symptoms of depression. That’s particularly true if the way she’s feeling makes it hard for her to do normal daily routines, such as get up on time, go to school or finish homework.
Other symptoms of depression in teens may include loss of interest in activities they usually enjoy, sleep and appetite changes, lack of energy, problems concentrating or making decisions, neglecting their appearance, and use of alcohol or drugs. Some teens who are depressed also may express negative views of themselves and the future. They may harm themselves or have thoughts of death or suicide.
If you suspect your daughter is dealing with more than the normal ups and downs of being a teen, talk to her. Share with her that you are concerned, and ask how she is feeling. If you believe she may be thinking about suicide, ask her, “Are you thinking of killing yourself?” Some parents avoid this question because they fear it might put the idea of suicide in a child’s mind when it wasn’t there before. That’s not the case. Teens know about suicide. If they are thinking about it for themselves, they want someone to ask them about it.
Even if she doesn’t want to hurt herself, a teen whose behavior goes beyond the typical mood swings of adolescence needs help. If your daughter has symptoms of depression, take her to see her health care provider or a mental health professional who can assess her situation and offer guidance. That provider also can help connect you and your daughter with other support services, such as local counseling resources and support groups, if necessary.
For more information about teen depression, go to Mayo Clinic’s YouTube channel (http://www.youtube.com/user/mayoclinic), and watch the four-minute video, “Preventing Teen Suicide.” The National Suicide Prevention Lifeline is also available for teens who may be thinking about hurting themselves: 1-800-273-8255 (toll-free). Details about this important resource are online at http://www.suicidepreventionlifeline.org. — Dr. Jarrod Leffler, Child and Adolescent Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Is there a link between traumatic brain injury, or TBI, and depression? Would the treatment for depression in someone with a TBI be different than treatment for depression without this sort of injury?
ANSWER: Quite a bit of research has been done on this topic. The results clearly show that when people without any prior mental health concerns or history of depression suffer a traumatic brain injury, their risk for depression increases significantly. Some studies suggest that the risk for developing depression following a traumatic brain injury may be two to five times higher than in the rest of the population.
For people with a traumatic brain injury who are diagnosed with depression, treatment for depression needs to be integrated into an overall rehabilitation treatment plan. If it’s not, successful long-term recovery from a traumatic brain injury may be difficult.
A traumatic brain injury happens when damage to a person’s head or body from an outside force — such as a fall, a vehicle collision or a sports injury — leads to problems with brain functions. A TBI can cause a wide variety of physical symptoms, such as headaches, seizures, weakness, numbness and loss of coordination, to name just a few. These injuries also frequently trigger cognitive or mental symptoms, including confusion, frequent mood changes, memory loss, and difficulty with reasoning or learning.
Because the damage that a moderate to severe TBI can cause is far-reaching, most people who have a significant brain injury require comprehensive rehabilitation that includes physical, social and cognitive therapies. The overall goal is to improve their ability to function, so they can perform daily tasks and take part in activities they enjoy.
Therapy may begin in the hospital and continue at an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The specific type of rehabilitation and how long treatment lasts depends on the severity of the brain injury and what part of the brain was injured.
Making progress in rehabilitation can be especially challenging when a TBI is complicated by undiagnosed depression. That’s why it is so important for health care providers to thoroughly screen people with a TBI for depression and to watch for signs of depression during the rehabilitation process.
Common symptoms of depression include, among others, persistent feelings of sadness, emptiness or hopelessness; frequent tearfulness, anger, irritability or frustration; loss of interest or pleasure in activities a person usually enjoys; sleep problems; significant fatigue or lack of energy; changes in appetite; feelings of worthlessness or guilt; difficulty concentrating; problems with thinking and memory; and recurrent thoughts of death or suicide. Identifying symptoms of depression in someone who has a TBI can be tricky, because some depression symptoms may be mistaken for symptoms caused by the brain injury.
When depression is diagnosed along with a traumatic brain injury, treatment may include antidepressant medication and behavioral therapy — treatment options similar to those recommended for people with depression who are not dealing with a TBI. But, treatment for depression needs to be carefully integrated into the overall TBI treatment plan, so recovery from the brain injury and depression can move forward together.
It is also worthwhile to note that TBI is not the only medical condition that can raise a person’s risk for developing depression. For example, cardiovascular disease, stroke and heart attack all can play a role in the onset of depression. If left untreated, depression often can lead to poor outcomes from these health problems, along with a decrease in a person’s quality of life overall.
If you or a loved one has experienced a TBI or another significant health concern, and you see symptoms of depression, do not ignore them. Talk to your health care provider or a mental health professional right away. Help and effective treatments for depression are available. — Dr. Craig Sawchuk, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What is the best way to treat acne scars that are a few years old? How effective and safe are treatments?
ANSWER: A variety of treatments can be used to help reduce the appearance of acne scars. To be most effective, the inflammatory phase of acne that includes active pimple formation and redness needs to be resolved before treatment for scarring begins.
Moderate to severe cases of acne can result in scars that cause discoloration and indentations in the skin. In most cases, acne scars do improve over time without treatment. That’s particularly true of discoloration. Indentations may be more stubborn and less prone to disappearing on their own.
For lasting skin color changes, creams that contain a bleaching agent can help fade discoloration. These products are available without a prescription at many drug stores and pharmacies for you to use at home. It’s also important to consistently use sunscreen with an SPF of 30 or higher on your face and any other areas of scarring to protect your skin and minimize contrast in skin color.
For scarring that leaves skin indentations, you have a number of options. Dermatologists are trained in procedures that work to smooth the skin, which is the goal of these treatments. For example, laser resurfacing can help improve skin tone and appearance. For this procedure, a dermatologist uses a laser to damage the collagen beneath your skin and stimulate the growth of new, healthier collagen. Other energy-based procedures, such as pulsed light sources and radiofrequency devices, also can be used to help make scars less noticeable.
In some cases, soft tissue fillers, such as collagen or fat, can be injected under the skin or into indented scars to fill them out. Injections of botulinum toxin, or Botox, also may be used around acnes scars to relax the skin, reduce puckering and improve the skin’s overall appearance. Both of these techniques need to be repeated occasionally to maintain their results.
For more severe scarring, your dermatologist may recommend a chemical peel or dermabrasion. These procedures involve removing the top layer of skin to eliminate surface scars and make deeper scars less apparent. Healing and recovery after these techniques can take several weeks or more.
Surgery may be useful in some cases of acne scarring, too. Using a minor surgical procedure called punch excision, a dermatologist cuts out individual acne scars and repairs the wound with stitches or a skin graft. Another technique called subcision involves inserting needles under the skin to loosen fibers below a scar to help improve its appearance.
All of these approaches have been approved for treating acne scars, but each of them comes with the potential for side effects. Before you decide on any treatment, review the possible side effects with your dermatologist. If you have any questions, don’t hesitate to ask.
Not all of these treatments work the same way for everyone. Some people may see better results with one approach than others do. In addition, acne scars may require a combination of treatments to reduce or eliminate them. To determine the best plan for you, make an appointment to talk with a dermatologist about the range of treatment options that are available. He or she can review the risks and benefits of each, and help you decide what’s appropriate for your situation. — Dr. Jennifer Hand, Dermatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My daughter is 3 and has had two urinary tract infections in the last six months. Is this common in kids? What can we do to prevent a future infection, and does this mean she will always be more susceptible?
ANSWER: Urinary tract infections, often called UTIs, are usually thought of as an adult problem. Although they aren’t particularly common in children, kids can get UTIs, too. There are some steps you can take to help prevent UTIs in your daughter. Most of the time, having one or two UTIs as a child doesn’t raise the risk for having more in the future.
A UTI is an infection in any part of the urinary system — the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. (That’s the tube that carries urine from your bladder out of your body.) During the first year of life, boys get UTIs more often than girls. Beyond the first year, UTIs are more common in girls.
UTIs typically develop when bacteria get into the urinary tract through the urethra and begin to multiply in the bladder. That can happen as a result of not wiping properly after a child goes to the bathroom. Holding urine for prolonged periods or constipation can also increase the risk of UTIs. In a 3-year-old child, toilet training can make it more likely that these issues will occur.
UTIs in this age group typically present with symptoms that may include a strong, persistent urge to urinate; a burning or painful sensation when urinating; passing frequent, small amounts of urine; or cloudy, red, pink or strong-smelling urine. Young children may not be able to pinpoint or articulate their symptoms, but they usually can tell that it hurts when they go to the bathroom. If a child has been successfully toilet trained, and then starts to have frequent accidents, that could also signal the presence of a UTI.
In some cases, a UTI may lead to pelvic pain, especially in the center of the pelvis and around the area of the pubic bone. Some children also may develop a fever with a UTI. Although uncommon, the presence of a fever, back pain or vomiting may signal a more serious infection that is affecting the kidneys and the bladder.
Treatment for UTIs in children usually involves taking an antibiotic medication. Symptoms often go away within several days of treatment, but to ensure that the infection is completely eliminated, it’s important to give your child the full course of antibiotics, as prescribed.
Among children who have a UTI, about one-third will get another infection later in life. Only about 10 percent will get a third infection. Especially when UTIs are severe or when they keep happening, your child’s doctor may order an ultrasound or other imaging tests to see if any anatomic abnormalities could be increasing his or her risk of developing UTIs.
To help prevent future UTIs, encourage your daughter to wipe from front to back after using the bathroom. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra. Also, remind her to go to the bathroom regularly — about once every two to three hours — so she is not holding in urine for long periods of time. If she has constipation, make sure to treat it aggressively with dietary changes and, if necessary, medication. — Dr. Brian Lynch, Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota