Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
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
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