Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
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
DEAR MAYO CLINIC: I’ve heard that some foods that are labeled as “trans fat-free” actually may contain harmful trans fats. Is this true?
ANSWER: Yes. Under labeling laws, a food can be labeled as “trans fat-free” or “containing no trans fat” if it has less than 0.5 grams of trans fats a serving.
This may seem like a minor issue, because the amount of trans fats is so small. But, think realistically of how small a true serving sometimes is. Do you always stop at a handful of crackers or a single cookie? If, for example, a type of crackers contains 0.4 grams of trans fats in a serving, and the package contains 10 servings, you still would be eating 4 grams of total trans fats if you eat the whole package.
Trans fats can increase your risk of cardiovascular disease. They raise your low-density lipoprotein (LDL) cholesterol levels and lower your high-density lipoprotein (HDL) cholesterol levels. For these reasons, dietary experts advise that you avoid consuming trans fats. The World Health Organization recommends limiting trans fats to less than 1 percent of your total calories. If you consume 2,000 calories a day, that means no more than 20 of those calories should come from trans fats. This translates to less than 2 grams a day, which can easily be found in a small amount of sweets or treats.
Trans fats are created when hydrogen is added to vegetable oils through a process called hydrogenation. These processed oils are used to improve the texture, shelf life and flavor stability of foods. Trans fats are common ingredients in commercial baked goods, such as crackers, cakes and cookies, and are often used to fry foods. Some vegetable shortenings and stick margarines contain trans fats.
To avoid trans fats, read the list of ingredients, and choose foods that do not contain partially hydrogenated oils. It’s also important to note that, since the U.S. Food and Drug Administration deemed partially hydrogenated oils no longer safe to be in foods, many manufacturers have switched to hydrogenated or saturated fats (e.g., palm oil). When the term hydrogenated appears on the label, it means the fat is saturated. Both trans fats and saturated fats increase the risk of heart disease. (adapted from Mayo Clinic Health Letter) — Katherine Zeratsky, R.D.N., L.D., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My mother, age 64, has been on a weight-loss roller coaster for years. She will stick to a strict diet for many months, sometimes losing 50 pounds or more. Then, those eating habits fade, she gains all the weight back and feels terrible about it. Right now, she’s quite overweight again and is thinking about starting another big diet. Would moderate weight-loss she can sustain long term, even if it doesn’t get her to an ideal weight, be healthier than these extremes?
ANSWER: Your mother’s pattern of weight loss and regain — weight cycling — is very common. Because she hasn’t had success keeping weight off in the past, it would be a good idea for her to use a different approach. Rather than following a strict diet, adopting healthy, ongoing lifestyle changes would be a more effective way for your mother to lose weight, improve her health and maintain her weight loss long term.
The typical approach to losing weight uses a dieter’s mentality. People follow a restrictive program that forces them to always limit what they eat. This type of strict diet often makes people feel deprived. When dietary habits are negative and restrictive, they’re likely to be temporary. Eventually, people feel they can’t keep it up any more, so they abandon their efforts and often gain back any weight they lost.
Contrary to what many people think, this cycle of losing and gaining weight does not increase a person’s risk for health problems. In addition, weight cycling does not make it more difficult to lose weight again. That said, weight cycling can be very frustrating and undermine a person’s self-confidence and self-esteem.
There is a more effective approach. First, one of the most important steps to successful weight loss is planning. Before you make any changes, set goals. Beyond sustained weight loss, do you want to feel better? Do you want to decrease health risks? Do you want to be able to be more active? If you decide on those goals first, you may find that you realize them as you make healthy lifestyle changes — even if you don’t reach a specific number on the scale. Reaching those goals may be motivating enough to help you maintain your changes.
Once you set your goals, think about lifestyle changes that can help you achieve them. You should be able to incorporate these changes into your daily life, so they become long-term habits. Try to make them specific, realistic and positive. For example, you could say, “I’m going to start walking 15 minutes a day, three days a week,” or “I’m going to eat one more serving of fruits and one more serving of vegetables each day.” As you achieve those changes, continue to build on them. It is possible to decrease calories, follow a practical and tasty dietary pattern, and feel good at the same time.
Mayo Clinic has a program based on these principles. The Mayo Clinic Diet decreases calories, but instead of taking a negative and restrictive approach, we encourage people to eat healthy, tasty food. By changing the way people eat in a positive manner — for example, they can eat as many fresh or frozen fruits and vegetables as they want — the Mayo Clinic Diet emphasizes a healthier, lower-calorie pattern of eating that is practical, enjoyable and sustainable.
Whatever approach she takes, as your mother moves forward with her weight loss, I would encourage her to think about how she can make positive lifestyle changes in diet and physical activity that will help improve her health. Beneficial lifestyle changes that can be sustained over time will lead to much more desirable and lasting weight-loss results, and an overall improved quality of life. — Dr. Donald Hensrud, Preventive Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Are recurring nosebleeds anything to worry about? I seem to have them more often lately. What’s the best way to stop a nosebleed quickly?
ANSWER: Most people experience a nosebleed at one time or another. They tend to happen more often in younger children and older adults. Bleeding often results from a cold, a sinus infection, dry air, a scab being dislodged or use of certain medications, such as nasal steroids. Occasional nosebleeds are nothing to worry about and are not dangerous. But, you may want to talk with your doctor if they are becoming regular and are bothersome.
Most nosebleeds are easily treated with a few simple steps. First of all, make sure you sit up. This decreases the pressure in the veins of your nose, which slows the flow of blood. Leaning slightly forward will help you avoid swallowing blood. Very gently, blow your nose once or twice to remove any clotted blood. Next, pinch the front, soft part of your nose with your thumb and index finger, and breathe through your mouth. Do this for about five minutes. Pressure should stop the flow of blood. Repeat for 10 minutes, if needed.
To keep the bleeding from starting again, don’t pick or blow your nose for a few days, and don’t strain or bend down for several hours. Seek prompt medical care if the bleeding resulted from a head injury or accident, or if it doesn’t stop after 30 minutes.
To help prevent future nosebleeds, keep the interior lining of your nose moist. Regularly apply petroleum jelly inside your nose using a cotton swab up to three times each day. Saline nasal spray also can help moisten dry nasal membranes. Using a humidifier to moisten the air in your home can be helpful, as well.
If you have reoccurring nosebleeds, talk to your doctor about steps you can take to avoid them. Your doctor may want to take a closer look at your nasal passages or refer you to an ear, nose and throat specialist. If you are on a blood thinner, your doctor may recommend adjusting the dose. (adapted from Mayo Clinic Health Letter) — Dr. Paul Takahashi, Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What causes BPPV, and is there a treatment for it?
ANSWER: Benign paroxysmal positional vertigo, or BPPV, is one of the most common causes of vertigo (dizziness). BPPV is characterized by sudden bursts of vertigo that are caused by head movements, such as sitting up or tilting your head. What leads to the development of BPPV isn’t known, but it’s more common in older adults.
Once you develop BPPV, the bursts of dizziness typically occur after you change the position of your head, such as when you roll over in bed. BPPV also may cause nausea and possibly vomiting, with a feeling of lingering fatigue, queasiness or a feeling of imbalance. Without treatment, these symptoms may last for as little as one day to as long as weeks or months. Fortunately, with proper diagnosis, a simple procedure may be all it takes to treat BPPV.
Your sense of balance relies on a finely tuned system that coordinates sensory information (from nerves throughout your body) and visual information to help you determine the position of your body relative to your surroundings.
BPPV is a result of tiny crystals in your inner ear being out of place. The crystals make you sensitive to gravity and help you to keep your balance. Normally, a jelly-like membrane in your ear keeps the crystals where they belong. If the ear is damaged — often by a blow to the head — the crystals can shift to another part of the ear. When they are out of place, the crystals make you sensitive to movement and position changes that normally don’t affect you, sparking vertigo.
Since there are numerous causes of imbalance and dizziness — and more than one cause may occur at the same time — proper diagnosis is critical to effective treatment. With BPPV, the primary diagnostic test is called the Dix-Hallpike test. During the test, you are placed in the position that usually causes your vertigo. Then, your doctor checks for involuntary, jerking eye movements (nystagmus) that are associated with BPPV. The test may be done in different ways to determine which side is causing the problem.
Treatment for BPPV can be done in your doctor’s office, or with an audiologist or certain physical therapists. The treatment includes a series of body movements that reposition the crystals in your inner ear, where they no longer cause symptoms. Two procedures used are the canalith repositioning procedure and the Lempert roll. With canalith repositioning, just one time through the procedure is often enough to correct BPPV. However, it may be necessary to perform the procedure up to several times with brief breaks between before BPPV is eliminated. Your doctor will be able to detect treatment completion when there’s no sign of nystagmus in your eyes. After the treatment, you’ll likely be advised to keep your head upright for the rest of the day.
Although the canalith repositioning procedure is highly effective, BPPV can linger or return. This is more likely to happen in older adults. If this happens, you may be taught how to do the canalith repositioning procedure on your own at home.
If dizziness persistently lingers or continues to return, a visit to a specialist, such as an audiologist or vestibular therapist, may be warranted. A specialized evaluation can determine if BPPV is being treated properly or if other factors affecting balance may be in play.
Some people continue to have symptoms of impaired imbalance and dizziness after BPPV has been resolved. In these cases, working with a physical therapist specializing in vestibular and balance rehabilitation can help you decrease dizziness symptoms and regain balance. (adapted from Mayo Clinic Health Letter) — Dr. Neil Shepard, Audiology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: After undergoing gastric bypass surgery last year, having a glass of wine affects me much more than it used to. Is this typical?
ANSWER: Yes. In fact, the effects of alcohol are nearly doubled in people who have had gastric bypass surgery, compared with those who haven’t had the procedure.
Gastric bypass — one of the most common types of bariatric surgery in the U.S. — helps you reduce your food intake by creating a small gastric pouch. Before the surgery, food enters your stomach and passes into the small intestine. After surgery, most of the stomach and the first part of your small intestine (duodenum) are bypassed, and a digestive route directs food into the middle section of your small intestine (jejunum). This helps you lose weight by limiting the amount of calories you can consume and absorb.
But, this direct route to your small intestine also allows your body to absorb alcohol more readily — and much faster. Your gastric pouch is unable to break down alcohol as effectively as your old stomach would have. In addition, your body weight is likely much lower than it was before your surgery, meaning you get a higher dose of alcohol per pound.
Several studies compared blood alcohol concentrations in women who’d undergone gastric bypass with those who hadn’t had the surgery. The studies showed that, for women who’d had the operation, blood alcohol concentrations peaked sooner and at approximately double the level of those who hadn’t had the operation. Women who’d had the procedure also felt much more inebriated for longer.
To answer your question, increased sensitivity to alcohol is real. For you, having two drinks is the equivalent of having four drinks, at which point you’re likely well above the legal limit. It’s an important limitation to keep in mind for your safety and the safety of others. (adapted from Mayo Clinic Health Letter) — Dr. Meera Shah, Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Our 3-month-old is on formula and gets really fussy sometimes after she eats. It seems like she’s in pain. When we give her the over-the-counter gas drops, it usually seems to make her feel better. Are there any risks from giving her the gas drops every day? Is there anything else we should be doing for her?
ANSWER: You and your baby are not alone. Fussiness is common and can be a normal part of infant behavior. In general, there’s no harm in giving your baby gas drops if they seem to help. It’s likely her frequent fussiness will fade over time without additional treatment.
Over-the-counter gas drops usually contain simethicone, a medicine designed to relieve painful symptoms associated with having too much gas in the stomach and intestines. Simethicone is generally a safe medication for babies. It could cause loose stools, but that is uncommon. The typical dose for simethicone is 20 milligrams, up to four times a day. It is safe to use every day. If gas drops make your baby feel better, you can continue using them.
When you choose gas drops, however, check the ingredient information, and avoid drops that contain sodium benzoate or benzoic acid. These substances can be harmful to babies in large quantities. Fortunately, they are not included in most gas drops intended for infants.
As in your case, gas drops may be useful for infant fussiness. To date, though, research studies have not found simethicone to be very effective at relieving infant colic. Though your question doesn’t mention colic, it’s possible that some of your baby’s fussiness might be related to that condition, rather than feeding.
Infant colic is defined as a baby crying for more than three hours a day, more than three days a week, for a period of three weeks or longer in an otherwise healthy infant. This crying occurs for no apparent reason, despite the baby being well-fed and in a clean diaper. The amount of daily crying usually increases after birth, reaching a peak around six weeks, before gradually starting to improve. Although colic can be quite distressing for babies and their parents, it usually doesn’t require medical care.
In some cases of colic or other frequent fussiness, parents worry that their baby might not be on the right formula. Usually, healthy babies do well on standard infant formulas. Some formulas are marketed to ease fussiness and spit up. There is little evidence that they are helpful or necessary in most cases. The nutrition in these formulas is similar to standard formulas, and both are safe for babies. Of course, breast-fed babies can be fussy, too, and moms sometimes wonder if making personal dietary changes might be helpful. However, evidence is limited regarding avoidance of any particular foods.
There has been some new research indicating that probiotics could be helpful for infant colic. Unfortunately, other studies have shown mixed results, so more research is needed. Probiotics are not routinely recommended for fussiness, but some parents try them anyway. I would recommend talking to your baby’s health care provider if this is something you would like to consider.
Sometimes, babies may swallow extra air during feedings, leading to discomfort afterward. To help avoid this, feed the baby in a more upright position, and pause regularly for burping. Experimenting with various nipples or bottles may be helpful, as every baby is different. Moving the baby’s legs in a bicycling motion sometimes can help, too. Giving your baby a warm bath or lightly rubbing her stomach when she seems uncomfortable also can be soothing.
In many cases, colic and other forms of fussiness slowly disappear with time and can be managed with self-care. You should visit your baby’s health care provider if you have concerns about her growth or weight gain. An evaluation is also a good idea if your baby seems to be constipated. Although they typically are not medical emergencies, if you notice blood in your baby’s stool, if she is vomiting, or if she has prolonged or excessive crying that is different than usual, seek prompt medical care. — Dr. Kara Fine, Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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