Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
DEAR MAYO CLINIC: I have heard different recommendations from different sources regarding vitamin D. One doctor told my husband that everyone living in the Northern Hemisphere should take a vitamin D supplement every day, even in the summer. What do you recommend?
ANSWER: Understanding how much vitamin D you need can be confusing because there are different recommendations about how much vitamin D adults should get. Using the recommendations that fall on the low end, many adults don’t get the amount of vitamin D they should. Because few foods contain vitamin D naturally, eating foods fortified with vitamin D and taking a supplement may be beneficial.
Vitamin D is important because it helps your body sustain normal levels of calcium and phosphorus. Because it works as a key that allows your body to absorb calcium, vitamin D plays a critical role in forming and maintaining healthy bones. It also helps keep your muscles, nerves and immune system healthy.
Research suggests that consistently getting enough vitamin D can significantly lower the risk for the bone-thinning disease osteoporosis. Low vitamin D also is associated with falls, multiple sclerosis, rheumatoid arthritis, chronic pain, diabetes, high blood pressure, cardiovascular disease and some cancers. However, an association does not mean low vitamin D causes these conditions, or that taking a vitamin D supplement will adequately prevent or treat them.
Vitamin D is found in some foods, such as egg yolks, cheese, cod liver oil, beef liver and fatty fish like tuna, salmon, sardines, herring and mackerel. But the amount of vitamin D in these foods is quite small. In the U.S., many people get the bulk of their dietary vitamin D from foods that are fortified with it, including milk, cereals and some brands of yogurt and orange juice.
In general, even with fortified foods, diet usually doesn’t provide enough vitamin D. And certain health conditions that affect the gastrointestinal tract may decrease the absorption of vitamin D and predispose to low vitamin D blood levels. You also can get vitamin D through direct exposure to sunlight, although the amount of sun you need to get enough vitamin D can vary greatly.
For people in northern climates or those who spend most of their time indoors, adequate exposure to sunlight can be hard to get. Also, if you regularly wear sunscreen with a sun protection factor higher than eight — a wise move to protect your skin from cancer — or if you have a darker skin tone, you may not be absorbing vitamin D, even when you are out in the sunshine.
Recommendations for how much daily vitamin D adults need through diet have changed over the years. Currently, different recommendations exist. The Institute of Medicine has placed the recommended dietary allowance, or RDA, for vitamin D at 600 international units (IU) per day for young adults and 800 IU per day for adults older than 70. Other experts suggest that adults’ vitamin D needs are much higher. For example, the Endocrine Society recommends up to 1,500 to 2,000 IU of vitamin D daily for adults.
Mayo Clinic recommends that adults get at least the RDA of 600 IU. However, 1,000 to 2,000 IU per day of vitamin D from a supplement is generally safe, should help people achieve an adequate blood level of vitamin D, and may have additional health benefits. While there are no guidelines for checking your vitamin D blood level, it may be prudent in people with osteoporosis or certain other health conditions. Discuss with your health care provider if it may be beneficial to check your vitamin D level.
If you have ongoing health concerns or a chronic health condition, talk to your health care provider before you begin taking any dietary supplement, including vitamin D. He or she can help you decide if supplements are appropriate for your situation. — Dr. Donald Hensrud, Preventive Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Is it true that women have different symptoms of a heart attack than men? If so, why does this happen, and what are the symptoms in women?
ANSWER: Heart attack symptoms in women can be similar to those in men, but there are some crucial differences. Women’s symptoms tend to be more subtle and may be more ambiguous. Along with being able to recognize possible heart attack symptoms, as a woman, it’s also important to understand your own personal risk factors for heart disease and to get help right away if you suspect a heart attack.
Although it may not be the first disorder that comes to mind when you think of women’s health issues, heart disease is the leading cause of death in both women and men in the U.S. And a 2016 research study found that women die more often than men from heart disease.
With those sobering statistics in mind, the importance of knowing what to look for when it comes to a heart attack can’t be overstated. Many are familiar with the hallmark symptoms of a heart attack: crushing chest pain, pain radiating down one arm, nausea and vomiting. Women who have a heart attack may experience all of these symptoms. But they are often less obvious than when they happen in men.
For example, chest pain is a common heart attack symptom in women, but it’s often not the predominant symptom or the only symptom. Women’s chest pain usually is not as severe as men’s chest pain. Often the chest pain may be accompanied by other symptoms, such as shortness of breath, fatigue and nausea. In addition, the pain may not be just in the chest, but in the back, shoulder or neck, too.
There’s no clear explanation for why heart attack symptoms appear differently in women than they do in men. A few factors may play a role. In women, heart disease tends to affect the smaller cardiac vessels more often than in men. Tight artery blockages are not as common in women as in men. Women’s vessels sometimes are smaller, and the vessel walls often are stiffer in women. But whether these factors are the underlying cause of the variation in symptoms between men and women is not well-understood.
What is known is that many of the risk factors for heart disease are the same for women and men. Diabetes, smoking, high blood pressure, high cholesterol, being overweight, lack of regular physical activity, and an unhealthy diet all raise the risk for heart disease. It’s important to note, too, that some of these factors play a bigger role in the development of heart disease in women. A woman who smokes is at greater risk for heart disease than a man who smokes, as is a woman who has diabetes.
There also are some specific risk factors that affect only females. Women who have high blood pressure during pregnancy — a condition called preeclampsia — are at increased risk later in life for heart disease. After menopause, when estrogen levels drop, the rate of heart disease in women goes up dramatically.
Take time to talk with your health care provider about your individual risks for heart disease. Review your personal and family medical history, so you can better understand your risk overall. If you think you might be having a heart attack — even if the symptoms seem vague — don’t ignore them, and don’t wait. Get emergency help right away. Don’t drive yourself to the hospital. Call 911. — Dr. Rekha Mankad, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What is familial hypercholesterolemia? Is that just another way of talking about high cholesterol? How is it diagnosed?
ANSWER: Familial hypercholesterolemia is not the same as a typical case of high cholesterol. Familial hypercholesterolemia is an inherited condition that affects the way the body processes cholesterol. It results in high cholesterol in the blood and significantly raises the risk of a heart attack or stroke. Familial hypercholesterolemia can be detected with a genetic test. Once it’s identified, it often can be effectively treated.
Cholesterol is a waxy substance that’s found in the fats in blood. While the body needs some cholesterol to build healthy cells, having too much cholesterol can cause health problems. In people who have familial hypercholesterolemia, a defective gene prevents the body from removing from the blood low-density lipoprotein cholesterol — known as LDL (sometimes referred to as the “bad” cholesterol). Because of the extra cholesterol, plaque builds up in the arteries, causing them to narrow and increasing the likelihood of a heart attack or a stroke.
The gene mutation that causes familial hypercholesterolemia is passed from parent to child. Children with familial hypercholesterolemia inherit a defective copy of the gene from one parent. In most cases, they have one affected gene and one normal gene. In rare cases, a person inherits an affected copy of the gene from both parents. That leads to a much more severe form of the disease.
Familial hypercholesterolemia is a relatively common genetic condition. About 5 percent of the general population has high cholesterol as defined by LDL cholesterol greater than 190 milligrams per deciliter of blood. Of that group, about 5 to 7 percent have familial hypercholesterolemia.
Familial hypercholesterolemia can be serious and life-threatening. It typically does not cause any symptoms. If left untreated, it can lead to sudden cardiac death due to a heart attack, often before the age of 50. Because of the potentially devastating nature of this disease, it’s crucial that it is identified and treated early. Unfortunately, many people with familial hypercholesterolemia don’t know they have it. Current estimates are that only about 10 percent of those affected by the disease have been diagnosed.
Identifying who should be tested for familial hypercholesterolemia can be difficult, and there is some disagreement among researchers and physicians regarding screening guidelines. What everyone agrees on, though, is that when a person is diagnosed with familial hypercholesterolemia, all of the members of that individual’s family should be tested for the familial hypercholesterolemia gene mutation, too, particularly first-degree relatives — children, parents and siblings.
Diagnosing familial hypercholesterolemia involves a cholesterol check, called a lipid panel or a lipid profile, as well as a genetic test. As is common at most health care facilities, Mayo Clinic strongly recommends that patients meet with a genetic counselor before undergoing any genetic testing. The counselor can explain what the test involves and what it means, as well as the possible implications of the test results.
Once familial hypercholesterolemia has been diagnosed, treatment typically includes taking medication to lower LDL cholesterol. Adopting positive lifestyle choices, such as eating a low-fat diet, exercising and maintaining a healthy body weight, is always a good way to help ensure heart health and is recommended for people who have familial hypercholesterolemia. In most cases, though, lifestyle changes alone aren’t enough to lower LDL cholesterol to healthy levels in people who have familial hypercholesterolemia.
If you are concerned about the possibility of familial hypercholesterolemia in your family, especially if you have a family member who experienced a heart attack or stroke before age 50, talk to your health care provider about your risk factors for the condition and whether you should be tested for it. — Dr. Iftikhar Kullo, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Why does it seem that suicide tends to run in families? Does it have anything to do with genetics?
ANSWER: The association between genetics and suicide is complicated. Research has shown that there is a genetic component to suicide. But it is only one of many factors that may raise an individual’s risk. And even if someone is at high risk for suicide, that doesn’t predict whether or not an individual will actually act on suicidal thoughts.
Genetic research, including studies involving twins, has revealed that many psychiatric conditions, including having suicidal tendencies, are influenced by genetics. While studies demonstrate that specific genes, such as one called the BDNF Met allele, can increase risk for suicide, it’s more likely that a range of genes affect connections and pathways within the brain, and impact suicide risk.
Complicating matters further, a process called epigenetics also comes into play when considering the effect of genes on suicide. This process controls when certain genes are turned on or off as a person grows and develops, and it can be influenced by what happens in a person’s environment.
For example, if someone goes through a difficult event as a child, that experience could have an impact on how or when a gene is activated within that person’s brain. Researchers speculate that negative experiences influencing epigenetics in a person who has a family history of suicide could further compound that person’s suicide risk.
In addition, it is known that 90 percent of people who die by suicide have a psychiatric illness at the time of death. Mood disorders, psychotic disorders, certain personality disorders and substance use disorders can increase suicide risk substantially. Each of those disorders has a genetic component, too.
It’s important to understand, however, that an increased risk of suicide does not predict who will commit suicide. For some people — even those whose genetics may seem to predispose them to a higher suicide risk — the thought of suicide doesn’t enter their minds. For others, suicide quickly may become a focus of their thoughts.
For those whose thoughts do turn to suicide, the way they arrive at suicidal thoughts may be a well-imprinted and familiar pathway. Psychotherapeutic treatment can help examine the process they go through to get to that point and find ways to interrupt the process.
Genetics, family history and environment all matter when it comes to the risk of suicide. But knowing risk factors is not a substitute for a thorough assessment of an individual’s situation and the process he or she takes to arrive at suicidal thoughts.
If you or a loved one are concerned about your risk for suicide, or if you’ve had suicidal thoughts, talk to a mental health professional. To help you find ways to break the cycle that leads to suicidal thoughts, he or she can work with you to treat any psychiatric illness that may be present and help you understand the process you’re going through when you turn to the possibility of suicide.
If you are in a suicide crisis or emotional distress, the National Suicide Prevention Lifeline provides free, confidential emotional support 24/7 at 1-800-273-8255 (toll-free). — Dr. Brian Palmer, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My 6-month–old son was born with an undescended testicle. His pediatrician said we should consider having it surgically repaired in the next few months, but I have read that treatment isn’t always necessary. Would it be reasonable to wait until he’s a bit older to see if it changes on its own? What are the risks of waiting?
ANSWER: In many cases, an undescended testicle moves into the proper position on its own within the first few months after birth. If it hasn’t done so by the time a baby is 4 to 6 months old, though, it’s unlikely that the problem will correct itself. Leaving the condition untreated eventually may lead to problems such as infertility and could raise the risk for testicular cancer. Fortunately, surgery to move an undescended testicle to the right location is a simple procedure, and recovery is usually minimal.
As a male fetus develops, the testicles form within the abdomen. During the last several months of in utero development, the testicles gradually descend from the abdomen through a passageway in the groin, called the inguinal canal, into the scrotum.
When a baby boy has an undescended testicle, the process of the testicle moving into the scrotum stops or is delayed. The reason that happens is not clear. It’s possible that a combination of genetics, the mother’s health and environmental factors may disrupt the hormones, physical changes and nerve activity that have an impact on the testicles’ development.
An undescended testicle often is detected when the baby is examined shortly after birth. For the first several months, monitoring the condition is all that’s needed. Many times, the testicle moves into place during those early months.
If, as in your son’s situation, the testicle has not moved in six months, then treatment usually is recommended. It’s important to correct an undescended testicle as soon as possible, because, for testicles to develop and work normally, they need to be slightly cooler than normal body temperature. The scrotum provides this cooler environment.
If an undescended testicle is not corrected, over time it could lead to low sperm count, poor sperm quality and decreased fertility due to abnormal development of the testicle. Men who've had an undescended testicle also have an increased risk of testicular cancer. Surgically correcting an undescended testicle can decrease that risk, but it doesn’t eliminate the risk completely.
Treatment often involves surgery with a procedure called an orchiopexy. During this procedure, a surgeon carefully manipulates the testicle into the scrotum and stitches it into place. In many cases, the surgery can be performed using minimally invasive techniques. An overnight hospital stay usually isn’t required, and you can bring your son home the same day. Recovery typically takes only a few days.
After surgery, your son will need regular follow-up appointments to make sure the testicle stays in place and check that it is developing and functioning properly. Those appointments may include a physical exam; an imaging test, such as an ultrasound; and a blood test to check the hormone levels in your son’s body. In general, the surgery is effective, with more than 90 percent of cases requiring no additional treatment.
Now would be a good time to ask your son’s pediatrician to refer him to a pediatric urologist for treatment. In many cases, the surgery is recommended between 6 and 12 months of age. Research suggests that the sooner an undescended testicle is corrected, the lower the risks for complications later. The pediatric urologist can work with you to decide on the approach and timing of treatment that are right for your son. — Dr. Patricio Gargollo, Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What causes cellulitis, and how is it treated?
ANSWER: Cellulitis is a bacterial infection that typically affects the deeper layers of your skin and the layer of fat just beneath. It’s quite common, especially among middle-aged and older adults. Most often, cellulitis occurs when a crack or cut in your skin allows bacteria to get inside and multiply.
Cellulitis can range from mild to severe. Most cases are treated effectively with antibiotics. Prompt treatment is key. If severe, or when left untreated, cellulitis can spread to your lymph nodes, bloodstream and deeper tissues, rapidly becoming life-threatening.
Cellulitis usually develops in the lower legs, although it can occur in any area with skin. The surface skin area appears red and swollen, and is typically painful and warm to the touch. Over time, the untreated area of redness expands.
Certain factors can put you at greater risk of cellulitis, including:
- Wounds, cuts or incisions
Any opening in the skin — from a small scratch or an insect bite to an ulcer or a recent surgery — can provide an entryway for bacteria.
- Skin condition
Conditions such as athlete’s foot, dermatitis and eczema can cause the skin to break or crack, and increase your chance of developing cellulitis. Shingles can cause broken blisters that are vulnerable to infection. Itching leads to scratching, and scratching introduces bacteria to deeper layers.
Skin can become swollen because of damage to your veins (edema) or the lymphatic system (lymphedema) or following surgery. Stretched, swollen skin can crack, creating an entry point for bacteria.
- Previous episodes
Having had cellulitis in the past increases your chances of having it again.
- Peripheral neuropathy
Decreased sensation and an inability to feel an injury can increase the risk of cellulitis.
- Other illnesses
Certain conditions such as diabetes or cancer can make you more prone to infection because of poor circulation or a weakened immune system. With diabetes, keeping blood sugars in control can reduce the risk of nerve or blood vessel diseases, as well as severity of cellulitis.
If you develop signs or symptoms of cellulitis, see your doctor as soon as possible. If symptoms are worsening or you also have a fever or chills, seek emergency care, because the infection may be severe or spreading rapidly.
To make a diagnosis, your health care provider likely will review your medical history and perform an exam to look for skin features that suggest cellulitis. If signs such as redness and swelling are developing on both legs, the cause is usually something other than cellulitis. Sometimes blood tests or imaging are necessary to rule out other conditions, including a blood clot in a leg vein (deep-vein thrombosis), a reaction to a drug or a skin irritant, lymphedema, or an infected joint. For simple, uncomplicated cellulitis, however, additional testing isn’t required.
Cellulitis usually improves with antibiotic treatment in combination with local cares (elevation and compression) that reduce swelling. Decreased swelling improves blood supply and circulation, getting the antibiotic to the infection and making the antibiotic more effective. Also, cool compresses can relieve discomfort.
Typically, antibiotics are taken for five to 14 days, depending on the severity and location of the infection and response to treatment. Most people start to feel better within two or three days of starting treatment; however, it is recommended that patients complete the entire course of antibiotic prescribed to ensure the infection resolves and the bacteria are eliminated.
Treating underlying conditions that make you more vulnerable to cellulitis, such as edema, eczema and diabetes, is also helpful in clearing up the present infection and preventing a recurrence.
More serious infections may require hospitalization for administration of antibiotics via IV and close monitoring for complications and improvement. While complications are rare, they can be serious and life-threatening. Sometimes, severe cellulitis can cause the surrounding tissue to die. Rarely, bacteria can enter the bloodstream, spreading the infection to distant parts of the body.
If you have recurring episodes of cellulitis, your doctor may recommend taking a long-term course of preventive antibiotics to keep the infection at bay. It also may help to visit with a dermatologist or an infectious disease specialist to look for other causes of your symptoms. (adapted from Mayo Clinic Health Letter) — Dr. Marcia O’Brien, Family Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: After a recent mammogram, my doctor suggested an additional test. She recommended molecular breast imaging, but, when I got to the appointment, I was scheduled for 3-D imaging. What is the difference between the two? Is one more accurate than the other at detecting breast cancer?
ANSWER: Both molecular breast imaging and a 3-D mammogram, also called tomosynthesis, can help doctors see inside the breast more clearly than they can with standard mammography. But the two tests are different in the way they image the breasts.
Tomosynthesis is an anatomic test. That means cancer is seen based on changes in how the breast anatomy looks. Getting a tomosynthesis feels the same as getting a standard mammogram. Your breast is compressed, and X-rays pass through the breast to make pictures of your breast tissue.
However, rather than an image that is formed from pictures taken from top to bottom and side to side, like a conventional, two-dimensional mammogram, a 3-D mammogram takes multiple thin pictures of the breast. With the 3-D approach, the breast tissue can be analyzed layer by layer. This reduces overlapping tissue, which is a common reason women are brought back for extra pictures after a standard screening mammogram.
Research shows tomosynthesis can detect more breast cancers than standard mammography. It’s useful for women with dense breast tissue, because the thin pictures can make a cancer easier to see through the dense breast tissue.
Molecular breast imaging also has been shown to be valuable for women with dense breast tissue. Molecular breast imaging, when combined with a standard mammogram, detects more breast cancers in women with dense breast tissue than a mammogram alone.
But molecular breast imaging is different than a 3-D mammogram, because it is a functional test ─ not an anatomic test. That means the pictures it creates show differences in tissue activity. Tissue with more active cells, like cancers, light up, or appear brighter, than less active, normal tissue on molecular breast imaging.
Before a molecular breast imaging test starts, you get a small injection of a radioactive tracer into a vein in your arm. The tracer contains a substance that's quickly absorbed by fast-growing cells in the breast, such as cancer cells. Then, a special camera is used to examine the breast. Molecular breast imaging takes about 40 minutes for most women. During the test, your breast is placed in light compression — just enough to hold the breast in place.
When doctors talk about cancers detected by an imaging test, the number is based on how many cancers are found in 1,000 women screened. Molecular breast imaging finds about eight additional cancers per 1,000 women screened, compared to standard mammography. That’s about a 270 percent increase in cancer detection. Tomosynthesis, or 3-D imaging, finds about one to two additional cancers per 1,000 women screened versus a standard mammogram. That’s about a 30 percent increase in cancer detection. Although molecular breast imaging and 3-D mammography have not been compared directly in a controlled study, the numbers suggest that molecular breast imaging detects more breast cancers than 3-D mammography.
But that is not to say that every woman with dense breast tissue must have molecular breast imaging or tomosynthesis. Additional tests can be necessary after either exam, which may not show cancer and be a false alarm. A woman must weigh the chance of needing additional testing and possibly a biopsy that could be normal or benign (not cancer) versus the benefit of possibly finding a cancer not seen on a two-dimensional mammogram.
If you’re unsure of the breast imaging test that would be best for you, discuss the options with your doctor. Together, you can decide on the additional tests that are most appropriate for your situation. — Dr. Katie Hunt, Radiology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m 45 years old, and I just started wearing glasses a few years ago. I usually go to my eye doctor once a year for a checkup. During those exams, in addition to checking my vision, my doctor looks for signs of glaucoma. What is glaucoma? Who’s most likely to get it?
ANSWER: Glaucoma, which is a group of serious eye disorders that damage the optic nerve, is the leading cause of preventable blindness in the developed world. Because it rarely causes symptoms in its early stages, regular eye exams that include checking for glaucoma are important. A variety of factors can raise your risk for glaucoma, including age and having a family history of the disease.
Your optic nerve is a bundle of nerve fibers that goes from the back of your eyeball to your brain. It serves as the communication cable between the two, allowing you to see. In most cases of glaucoma, the optic nerve is damaged by a rise in pressure within the eye. The elevated pressure usually is due to a blockage of the eye’s drainage channels, preventing fluid that is constantly produced in the eye to flow out of it. As the nerve deteriorates, blind spots develop in your vision. If left untreated, glaucoma leads to blindness.
In its early stages, glaucoma usually doesn’t have any symptoms. Typically, it is not until the late stages of the disease — after significant damage already has been done — that people who have glaucoma begin to notice eye problems, such as loss of peripheral vision. That’s why it’s crucial to get regular eye exams that include looking at the appearance of the optic nerve through a microscope, as well as a measure of the pressure within your eye. If your doctor suspects glaucoma, he or she may recommend other tests, too.
In general, a comprehensive eye exam is recommended once every two to four years for people 40 to 54 and every one to three years for those 55 to 64 ─ even if you have no problems with your eyes or vision. After 65, you should have a comprehensive eye exam every one to two years. Depending on your risk factors, these exams may need to be more or less frequent.
Two of the most significant risk factors for glaucoma are age and family history. People older than 60 develop glaucoma much more frequently than younger individuals. And the disease tends to run in families. If you have a close relative who’s been diagnosed with glaucoma, make sure your eye doctor is aware of that.
Other risk factors for glaucoma may include having high or low blood pressure, as well as other medical conditions such as diabetes, heart disease and hypothyroidism. However, in most people, glaucoma is not associated with other diseases. A severe eye injury can put you at risk for glaucoma, as can certain types of eye surgery and being nearsighted or farsighted.
Ethnic background also appears to impact a person’s risk of developing glaucoma. African-Americans who are older than 40 have a much higher risk for developing glaucoma than Caucasians. African-Americans also are more likely to suffer permanent blindness as a result of glaucoma. People of Asian descent also have an increased risk of developing certain types of glaucoma.
Most glaucomas cannot be prevented, but regular eye exams can catch this condition early. Although there’s no way to reverse damage that’s been done to the optic nerve, treatment to lower pressure in the eye can prevent or slow vision loss due to glaucoma. Review any possible risk factors you may have for glaucoma with your eye doctor. Based on that, he or she can recommend an exam schedule that’s right for you. — Dr. Arthur Sit, Ophthalmology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My eyes have gotten drier as I’ve gotten older, and I’ve tried eye drops for relief. But some eye drops feel irritating, and others seem to have a rather thick consistency. What options do I have?
ANSWER: Dry eyes occur when your tears — a mixture of water, fatty oils and mucus — aren't able to provide enough lubrication for your eyes. This can happen because your eyes don't make enough tears or if your tears are poor quality. Aging is a common cause of dry eyes, but certain medical conditions and some medications also can result in dry eyes.
Some people with dry eyes find relief without buying any special treatments or eye drops. One option is to apply warm compresses to the eyes. You can use a warm washcloth or a heated beaded mask, and apply to the eyes for 10 minutes. Then, gently wash your eyelashes and eyelids using watered-down mild shampoo.
By unplugging any plugged oil gland pores on the eyelid margins, oil from the eyelid can freely glide over the surface of your eye to form a protective layer — much like a sheen of oil sometimes can be seen in parking lot puddles after rain. This can take a few days to benefit you, and it keeps your tears from evaporating so quickly.
If warm compresses and lid scrubs don’t work, you may consider using eye drops. Avoid eye drops that state they will reduce redness, as prolonged use of this type of eye drops can cause irritation. Instead, use artificial tears. Some contain preservatives to prolong shelf life, but these can cause eye irritation if used more than four times a day. For more frequent use, try preservative-free eye drops. These come in packages of multiple single-use vials. After you use a vial, you throw it away.
Lubricating eye ointments have a thicker consistency. They coat your eyes, providing longer-lasting relief from dry eyes. Since these products can blur your vision temporarily, they are best used just before bedtime.
If nonprescription eye drops aren’t helping, talk to your eye doctor. Sometimes, an underlying problem, such as Sjögren’s syndrome or rosacea, may need to be treated first. If a medication you take for another condition is causing your dry eyes, your doctor can discuss whether changing your prescription might help.
If an inflammation on the surface of your eyes is causing your dry eyes, it may be possible to control it with prescription eye drops that contain the immune-suppressing medication cyclosporine (Restasis). This medication may require several months of regular use before symptoms improve.
The U.S. Food and Drug Administration recently approved a new kind of eye drop solution, lifitegrast (Xiidra), which may work a little faster than cyclosporine. Lifitegrast also works to decrease surface inflammation, although in a different way than cyclosporine.
Other options that may provide relief from dry eyes are available, as well. Examples include tear duct plugs to keep tears from draining out, dissolvable eye inserts, other medications and select procedures to help increase moisture in your eyes. Sometimes, even special types of eyewear may help reduce dryness from outside air.
Talk with your doctor to determine the cause of your dry eyes. He or she can recommend a treatment that is right for your situation. (adapted from Mayo Clinic Health Letter) — Dr. Thelma Barnes, Ophthalmology, Mayo Clinic, Phoenix
DEAR MAYO CLINIC: At what age does obsessive-compulsive disorder typically become noticeable in children? My 7-year-old recently has become very focused on having things straight (e.g., blankets, toy cars and papers) and checking to make sure his stuffed animals are lined up a certain way before he goes to sleep. He even gets up to check them multiple times. Is this typical of a kid his age, or should I have him evaluated?
ANSWER: The behaviors you’re seeing in your son could be appropriate forms of play for a child his age. It’s possible, however, that they might point to obsessive-compulsive disorder, or OCD, if he feels driven to do them, or if doing these routines interferes with his daily activities or causes significant distress. If that’s the case, an evaluation for OCD may be in order.
OCD is a condition characterized by a pattern of unreasonable thoughts and fears (obsessions) that lead people to do repetitive behaviors (compulsions). People with OCD may try to ignore or stop the obsessions, but that only increases their distress and anxiety. They then feel driven to perform compulsive acts to try to ease the stress. Despite efforts to ignore or get rid of the bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior, and the cycle of OCD continues.
OCD can start at any age and has been known to affect very young children, even those under 5. Most often, though, OCD in children begins around 10, usually a little earlier for boys and a little later for girls.
The behaviors you mention — lining up toys and other items, arranging them in certain ways, making sure they’re straight — are not, in themselves, problematic. In the same way, following a certain routine around bedtime is good for children and can help them feel secure. So the fact that your son is engaging in these activities isn’t out of the ordinary.
These activities could be signs of an underlying problem, such as OCD, if your son doesn’t enjoy doing them, but believes he won’t feel good unless he does, or if he gets very upset if he cannot do them. In addition, if your son feels compelled to do these activities to the point that they get in the way of other activities or routines, that may signal a problem, too.
For example, if he has difficulty leaving for school in the morning if he hasn’t first straightened his blankets and papers just so, or if he becomes very upset if his attempts to arrange his animals are interrupted by a request to do something else (like come to dinner), then it may be time for an evaluation with his primary health care provider or a mental health professional.
If your son is diagnosed with OCD, the first treatment should be a type of psychotherapy called exposure and response prevention. It involves gradual exposure to a fear and learning to cope with the anxiety that fear triggers. For a child with OCD, that means breaking the rules the child has set, such as straightening, rearranging and double-checking, and learning that those routines aren’t needed in order to feel OK.
Keep in mind as you consider whether or not to have your son evaluated for OCD that it is the feelings his behaviors produce in addition to the behaviors themselves that must be examined. If he simply likes lining up his stuffed animals and straightening his things, and that doesn’t cause disruption or undue stress in your household, you can feel confident just letting him continue to enjoy these activities. — Dr. Stephen Whiteside, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m 26 years old, and my partner and I would like to have a baby within the next year. Are there things I can do now, before I get pregnant, that will make it more likely our baby will be healthy?
ANSWER: You’re wise to be thinking about this now. There are lifestyle steps you can take before you conceive that can increase the chances of having a healthy baby. It’s also a good idea to meet with your health care provider to review your health history, discuss any medical conditions you have and review factors that could potentially raise your baby’s risk for a birth defect.
Birth defects affect 1 in every 33 babies born in the U.S. each year. Birth defects range from mild to severe and can affect almost any part of the body. Some defects, such as Down syndrome, are triggered by problems in a baby’s chromosomes. But, in most cases, the exact cause of birth defects, such as heart problems, vision and hearing issues, and disorders of the spine and brain, cannot be pinpointed. That said, there are things you can do to help reduce the risk of birth defects.
First, take a daily multivitamin that contains at least 400 micrograms of folic acid. Folic acid helps prevent defects, such as spina bifida, which affects the neural tube — the structure in an embryo that eventually develops into a baby’s brain and spinal cord. Taking folic acid before and during pregnancy reduces the risk for neural tube defects.
Second, schedule a preconception appointment with your health care provider. He or she can review your individual health history, as well as your family history, to identify possible areas of concern.
For example, diabetes and high blood pressure can impact pregnancy, as can the medication you take to control those disorders. Your health care provider can make adjustments before you get pregnant to ensure that the medications you take are safe for a developing fetus. At the appointment, you also can review your immunization record and make plans to get missing vaccinations before you get pregnant.
Your sexual health can impact the health of your child, as well. It is important to have regular screening for sexually transmitted infections. This also can occur at the preconception appointment with your health care provider. Infections such as genital herpes, syphilis and cytomegalovirus can cause birth defects that may include brain and spine abnormalities, cerebral palsy, hearing and vision impairments, and prematurity.
Your health care provider can talk with you about any birth defects that have affected your family, or your partner’s family, as well as genetic disorders that could be hereditary. If you have a family history of birth defects or genetic disorders, he or she may recommend you talk with a genetic counselor to gather more information and consider genetic testing.
In addition to taking folic acid and getting ready for your pregnancy by consulting with your health care provider, you can make some lifestyle choices that can help foster a healthy pregnancy.
Avoid alcohol, illicit drugs and smoking. If you smoke, stop now. Smoking during pregnancy has been linked with many health problems, including problems with the placenta, low birth weight, premature birth, miscarriage, stillbirth, and cleft lip or palate. Also, fetal alcohol spectrum is a preventable birth defect if you don’t drink alcohol during pregnancy. If you’d like help with these issues, talk with your health care provider.
If you are overweight or obese, take steps to get to a healthier weight before you become pregnant, as obesity also increases the risks of certain birth defects. Talk with your health care provider about an exercise and nutrition program to meet and maintain your goals before and during pregnancy.
As you get ready to become pregnant, try to be as healthy as possible overall. Take your multivitamin every day. Eat a healthy diet. Exercise regularly. Avoid smoking, alcohol and drug use. Get any medical conditions you have under control. If you have questions or concerns along the way, talk with your health care provider. He or she can offer assistance and guidance during this exciting time. — Deborah Miller, APRN, C.N.P., OB-GYN, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What is postural tachycardia syndrome, and how is it diagnosed? Can it be treated, or do you just have to live with it?
ANSWER: A diagnosis of postural tachycardia syndrome, commonly known as POTS, typically is based on symptoms, along with the results of an assessment called a tilt table test. Although there’s no cure for postural tachycardia syndrome, often it can be managed effectively with lifestyle changes and medication. And fortunately, teenagers — the group most often affected by POTS — usually outgrow the disorder by the time they reach their 20s.
Postural tachycardia syndrome affects the autonomic nervous system, which controls involuntary body functions such as heart rate and blood pressure. In postural tachycardia syndrome, the nerves that regulate blood flow are out of balance, so enough blood doesn’t go to the right place at the right time. The result is a variety of symptoms, including an overly rapid heartbeat when shifting from lying down to standing up.
A person’s heart rate is usually about 70 to 80 beats per minute when resting. Normally, the heart rate increases by 10 to 15 beats per minute when standing up, and then it settles down again. For people with postural tachycardia syndrome, the heart rate goes up considerably higher when they stand, often increasing 30 to 50 beats per minute or more. This can lead to lightheadedness, dizziness and fainting.
Other postural tachycardia syndrome symptoms may include chronic fatigue; headaches or other types of chronic pain; and digestive problems, such as nausea and cramping. These symptoms may vary considerably from one person to another. If symptoms seem to be pointing to postural tachycardia syndrome, the diagnosis usually is confirmed using a tilt table test.
For a tilt table test, you begin by lying flat on a table. Straps are put around your body to hold you in place. After about 30 minutes of lying flat, the table is quickly tilted to raise your body to a head-up position — simulating a change in position from lying down to standing up. Then, your heart rate and blood pressure are monitored for about 10 minutes. In people who have postural tachycardia syndrome, the heart rate goes up by more than 30 beats per minute when tilted up (40 beats per minute or more for teenagers). Blood pressure remains steady or changes only slightly.
Postural tachycardia syndrome begins in the teenage or early adulthood years. Although postural tachycardia syndrome is a chronic condition, about 80 percent of patients grow out of it. Until that happens, treatment can ease postural tachycardia syndrome symptoms.
In people who have postural tachycardia syndrome, the blood vessels are too relaxed. Extra fluid is needed to fill up the vessels, allowing blood to flow properly. Drinking extra fluids alone isn’t enough. Increased salt intake is also necessary to hold fluid in the blood vessels. It’s also important for people with postural tachycardia syndrome to avoid caffeine and alcohol.
Exercise is critical. Engaging in daily, moderate, aerobic exercise — biking, rowing or swimming, for example — not only improves fitness and increases energy levels, but also works to retrain the autonomic nervous system to regulate blood flow correctly. Wearing garments that mildly compress the thighs and abdomen also can encourage proper blood flow and reduce postural tachycardia syndrome symptoms.
A variety of medications are available to treat postural tachycardia syndrome. But they are generally not effective if the strategies of fluid, salt, compression and exercise are not also in place.
Because postural tachycardia syndrome is a complicated disorder that can show up in a variety of ways, those with postural tachycardia syndrome may need to use several different treatment options. At times, it can be challenging to find a treatment regime that successfully controls all postural tachycardia syndrome symptoms. If you don’t respond well to initial treatment, it’s important to continue medical care and work with a provider familiar with postural tachycardia syndrome who can customize care to your individual needs. — Dr. Jeremy Cutsforth-Gregory, Neurology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: How do doctors decide on the best treatment for kidney stones? When I had a calcium stone, my doctor gave me medication and told me to drink plenty of water until it passed. When my mother had one, she went through a procedure to break up the stone. Why the difference? Also, what makes these stones so painful?
ANSWER: Treatment for kidney stones depends on a stone’s size, type and location. As in your case, extra fluids and medication may be all that’s needed for some small stones. Other treatment may be necessary when a stone is larger. The pain associated with kidney stones usually is the result of spasms triggered by a stone stuck in the ureter, coupled with pressure in the kidney from urine backup.
Kidney stones form from minerals and acid salts. About 85 percent of kidney stones are calcium-based, typically calcium oxalate. Less common are uric acid stones, struvite stones and cystine stones. Doctors use blood and urine tests to find out what kind of stones are present. If you have passed a stone, a laboratory analysis also can reveal the makeup of the stone.
Many uric acid and cystine stones can be dissolved by taking medication and drinking extra fluids. Calcium-based stones are different, because they don’t dissolve. You have to get them to pass through your urinary system or have them removed.
Drinking extra water can help flush out the urinary system, making it easier for a small stone to pass. Medication to relax the muscles in your ureter — the tube that connects your kidney to your bladder — also can help a stone pass more quickly and with less pain.
Kidney stones often can be quite painful. There are several reasons for that. First, the ureter is small and inflexible, so it can’t stretch to accommodate a stone. Second, when a stone gets into the ureter, the ureter reacts by clamping down on the stone in an attempt to squeeze it out. Those spasms can lead to significant pain. Third, if the stone is blocking the ureter, urine backs up into the kidney, causing pressure within the kidney.
People often describe kidney stone pain as flank pain that starts under the rib cage and goes down toward the testicles in men or the labia in women. To ease pain, health care providers often recommend over-the-counter pain relievers for those who are waiting for a kidney stone to pass. Sometimes, narcotics also are prescribed.
Stones that are too large to pass through the urinary tract on their own or stones that are causing other problems, such as bleeding, kidney damage or urinary tract infections, usually require more invasive treatment.
One procedure that can break up a kidney stone is called extracorporeal shock wave lithotripsy, or ESWL. It uses sound waves to create strong vibrations that break the stones into tiny pieces. Those pieces then pass out of the body in urine.
Another option to remove a stone in the ureter or kidney is a procedure in which a thin, lighted tube, called a ureteroscope, equipped with a camera is passed through the urethra and bladder to the ureter. Once the stone is located, special tools can snare the stone or break it into pieces that pass in the urine.
If a stone is particularly large, minimally invasive surgery may be necessary. A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone using small telescopes and instruments inserted through a small half-inch incision in the back.
Because you have a history of kidney stones, if you haven’t already done so, talk with your health care provider about strategies you can use to help prevent stones in the future. In many cases, dietary changes, an increase in fluids and, sometimes, medication can help reduce the risk of kidney stones. — Dr. David E. Patterson, Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: How is thyroid cancer treated? Does it always require taking out the thyroid? When is iodine treatment used, and how does that work?
ANSWER: Treatment for thyroid cancer usually involves removing all or part of the thyroid gland. In cases where thyroid cancer is advanced or aggressive, radioactive iodine treatment may be recommended after surgery to destroy any cancer cells that couldn’t be removed during surgery. For very small papillary thyroid cancers (less than 1 centimeter in diameter and completely confined to the thyroid on ultrasound examination), it may be reasonable to avoid surgery and monitor them periodically without treatment. This is termed “surveillance” and requires annual imaging of the thyroid with high-quality ultrasound. These small thyroid cancers are low risk for progression, especially in persons over 60.
The thyroid is a butterfly-shaped gland located in the midline of your neck, about halfway between your Adam’s apple and your breastbone. Your thyroid gland produces two main hormones: thyroxine, or T4, and triiodothyronine, or T3.
Thyroid hormones impact many cells within your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, affect the working of your nervous system, and influence your heart rate. Your thyroid gland also produces calcitonin, a hormone that helps regulate the amount of calcium in your blood.
Thyroid cancer is not common in the U.S. When it is found, though, most cases can be cured. Surgery to remove all or most of the thyroid — a procedure called a thyroidectomy — is often the first step in treatment.
Thyroidectomy typically involves making an incision in the center of the neck to access the thyroid gland directly. In addition to removing the thyroid, the surgeon may remove lymph nodes near the thyroid gland if the cancer is known or suspected to be spreading outside the thyroid. Then, those lymph nodes will be checked for cancer cells. An ultrasound exam of the neck before surgery can help doctors determine if lymph node removal is necessary.
When thyroid cancer is found in its earliest stage, and the cancer is very small, it may only be necessary to remove one side, or lobe, of the thyroid, and leave the rest in place. In that situation, the thyroid still can function and produce hormones.
When the entire thyroid is removed, lifelong thyroid hormone therapy is required to replace the thyroid's natural hormones and regulate the body's metabolism. In addition to supplying the missing hormone the thyroid normally makes, this medication also suppresses the pituitary gland’s production of thyroid-stimulating hormone, or TSH. That’s useful, because there’s a possibility that high TSH levels could foster the growth of any remaining cancer cells.
If thyroid cancer is found in its later stages, if it’s a more aggressive form of cancer, or if it is cancer that has come back after earlier treatment, then radioactive iodine therapy may be recommended after the thyroid has been removed.
Radioactive iodine comes in a capsule or liquid that’s swallowed. The therapy works because thyroid cells naturally absorb iodine. So when the medicine is taken up by any remaining thyroid cells or thyroid cancer, the radioactivity destroys those cells. Because the thyroid is the primary site where iodine is absorbed by the body, there’s a low risk of harming other cells with this treatment. Afterward, the radioactive iodine leaves the body through urine.
If thyroid cancer is not cured with a combination of surgery and radioactive iodine therapy, then chemotherapy, external radiation therapy or other treatment may be necessary. Fortunately, surgery cures most cases of thyroid cancer, and the long-term outlook after the procedure is usually excellent. — Dr. John Morris III, Endocrinology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What causes hip dysplasia in adults, and can it be treated without a total hip replacement?
ANSWER: Hip dysplasia is a condition in which the top portion of the thigh bone doesn't fit properly in the socket portion of the hip joint — either because it is out of place or it is not the correct shape. In many cases, this condition is present at birth. Some people may not be diagnosed during childhood, however, and only when symptoms appear later is the problem identified. Although some adults with hip dysplasia need surgery to correct the problem, total hip replacement isn’t always necessary.
The hip is a large ball-and-socket joint. The ball portion of the joint is the top of the thigh bone. It’s called the femoral head. It fits into the socket portion of the joint, called the acetabulum, which is part of the pelvis. Between the two is a layer of smooth cartilage that allows the joint to glide easily when it moves. Ligaments, tendons and muscle stabilize the hip joint and keep it in place.
Before birth, the ball and socket of the hip must fit together properly, because they act as molds for each other during fetal development. If the ball isn't seated firmly into the socket, the socket will not form fully around the ball, and the socket will be too shallow. In some cases, during the final month of pregnancy, the space within the womb can become so crowded that the ball of the hip joint moves out of its correct position, which results in a shallow socket. This happens more frequently in large babies and those in the breech position before birth.Hip dysplasia also can make the joint more likely to develop osteoarthritis. Osteoarthritis wears away the cartilage on both the ball and the socket, leading to joint pain, stiffness and a loss of flexibility.
When hip dysplasia is diagnosed in adults, surgery may be required to prevent further damage to the hip joint. If an adequate amount of cartilage still exists between the ball and socket, realignment surgery on the existing joint often is recommended to fix the problem. This usually involves reshaping or repositioning the hip socket, so the femoral head fits into it better, providing more stability and decreasing wear and tear on the joint.
Several surgical techniques can be used to correct hip dysplasia while preserving the existing hip joint. One of the more common is a procedure called periacetabular osteotomy, in which the socket is cut free from the pelvis and then repositioned so that it matches up properly with the ball. Total hip replacement surgery usually is required when there is no longer enough cartilage between the ball and socket for the joint to move smoothly. — Dr. Robert Trousdale, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What’s the difference between Lewy body dementia and Alzheimer’s? How is Lewy body dementia diagnosed?
ANSWER: Doctors diagnose Lewy body dementia based on the range of symptoms a person shows. Generally, a Lewy body dementia diagnosis requires an ongoing decline in thinking skills, along with two of the following: visual hallucinations, Parkinsonism or fluctuating alertness. In addition, people who have Lewy body dementia also may experience a sleep condition known as REM sleep behavior disorder, in which people act out their dreams while they sleep. They also may have instability in their blood pressure and heart rate, and the body may have difficulty controlling body temperature and sweating.
A brain disease that gets worse over time, Lewy body dementia is caused by an abnormal protein, called synuclein, which is deposited in certain nerve cells and nerve processes. These deposits are called Lewy bodies — named after the physician who first identified them. In Lewy body dementia, Lewy bodies are found in the deep structures of the brain that control movement, as well as in the middle and outer structures involved in emotion, behavior, judgment and awareness.
Many patients with Lewy body dementia also have overlapping Alzheimer’s disease. About half of Lewy body dementia patients have significant Alzheimer’s disease, as well. Thus, it is not surprising that those diagnosed with Lewy body dementia have symptoms associated with Alzheimer disease, such as memory loss and naming difficulty. However, when doctors who have expertise and experience with the disease make a Lewy body dementia diagnosis, that diagnosis is often correct — as confirmed later during an autopsy. An accurate diagnosis is important, because Lewy body dementia responds differently than Alzheimer’s disease to commonly prescribed dementia medications.
Lewy body dementia usually progresses gradually over several years, but the way it progresses can vary significantly from person to person. For example, Lewy body dementia may begin with signs of dementia, and Parkinsonism appears later. Or the disease may start with movement difficulties, and signs of dementia don’t emerge for some time. Most people with Lewy body dementia experience the onset of Parkinsonism and dementia within one year. As Lewy body dementia progresses, all symptoms usually become more severe.
Hallucinations occur early in Lewy body dementia but only after about four years in Alzheimer’s disease. If a person acts out dreams, that is strong evidence that he or she has synuclein protein in the brain. This protein is found only in Lewy body dementia, Parkinson’s disease and a rare disease called multiple system atrophy. Acting out one’s dreams is a feature in all of these diseases.
Lewy body dementia is a complex disease, and it can be difficult to control. Currently, there’s no cure. But, when treatment is carefully managed, symptoms may be reduced, so they have less effect on a person’s daily functioning and quality of life.
Some people diagnosed with Lewy body dementia respond positively to medications called cholinesterase inhibitors. They boost the level of a chemical messenger in the brain called acetylcholine that’s important for memory and other cognitive functions. These drugs may help improve alertness and reduce hallucinations and signs of dementia.
Other medications are available to help decrease the Parkinsonism, hallucinations and other Lewy body dementia symptoms. These medications must be closely monitored by a health care provider. In people who have Lewy body dementia, medications to improve motor function may make symptoms such as hallucinations worse, and medications used to combat dementia may increase Parkinsonism.
Because Lewy body dementia treatment needs to be managed skillfully to obtain the most effective results, people who have this disease should be monitored by a physician with expertise and experience with Lewy body dementia ─ usually a neurologist or a neuropsychiatrist. — Dr. Neill Graff-Radford, Neurology, Mayo Clinic, Jacksonville, Florida
DEAR MAYO CLINIC: Our newborn was diagnosed with a problem in one of his kidneys called hydronephrosis, and we were told he eventually may need surgery. What caused this? How will the condition affect him in the future?
ANSWER: Hydronephrosis is a condition in which urine stays in the kidney instead of flowing out of it. That causes the kidney to swell. A range of medical conditions can lead to hydronephrosis. Treatment often depends on the underlying cause. Although surgery is sometimes needed, in many cases hydronephrosis resolves on its own as a child grows, and surgery is not necessary.
Essentially, hydronephrosis can be boiled down to a problem of urine flow. Normally, urine goes from the kidney to the tube that drains the kidney, called the ureter, to the bladder and then out of the body. In certain cases, however, urine backs up or remains inside the kidney or in the ureter. It’s in these cases that hydronephrosis develops.
One common reason for hydronephrosis is a partial blockage in the urinary tract. These blockages often form where the kidney meets the ureter, at a point called the ureteropelvic junction. Less commonly, they may occur where the ureter meets the bladder at what's called the ureterovesical junction.
Another frequent cause of hydronephrosis is a condition called vesicoureteral reflux. This happens when urine flows backward through the ureter from the bladder up into the kidney. Normally, the ureter is a one-way street. Urine flowing the wrong way makes it difficult for the kidney to empty properly and causes the kidney to swell.
Other less common causes of hydronephrosis in children include kidney stones, a tumor in the abdomen or pelvis, and problems with nerves that lead to the bladder.
When hydronephrosis is found in a fetus during pregnancy, an evaluation of the kidneys and the bladder often can be done using imaging exams while the baby is still in utero. This gives doctors a better idea of how the condition may need to be managed after birth.
When the baby is born, more tests are done to identify the source of the problem. The tests usually consist of an ultrasound of the kidneys and bladder, along with another test called a voiding cystourethrogram. These tests of the urinary tract allow doctors to examine the kidneys, bladder and ureters carefully. Depending on the results from these two tests, further imaging may be necessary.
In cases of mild and sometimes even moderate hydronephrosis without reflux, surgery typically is not needed. The hydronephrosis tends to improve on its own over time. If this is the case for your child, his doctor may recommend antibiotics to lower the risk of urinary tract infections.
When hydronephrosis makes it hard for the kidney to function — as can happen in more severe cases or in cases that involve reflux — surgery may be recommended to eliminate the blockage or correct the reflux.
If left untreated, hydronephrosis eventually can lead to permanent kidney damage. Rarely, it can cause kidney failure. In most cases, however, this condition does resolve successfully. In the meantime, because hydronephrosis typically affects only one kidney, the other kidney can do the work for both.
As you consider your options going forward, it’s best to do so in consultation with a board-certified pediatric urologist. He or she can help you decide the tests needed to determine the source of the hydronephrosis and, based on that, the best approach to treatment for your child. — Dr. Patricio Gargollo, Pediactric Urologist, Mayo Clinic Children's Center, Rochester, Minnesota.
DEAR MAYO CLINIC: I’m 15 weeks pregnant and have had horrible morning sickness from the beginning of the pregnancy. I’ve lost weight and worry that will affect the baby's health. I didn't experience any morning sickness with my first pregnancy. Is this normal? What can I do to get back to eating while feeling nauseated all the time?
ANSWER: Nausea and vomiting during pregnancy — whether it happens only in the morning or lasts all day — can make you feel bad. It also can be worrisome, especially when it causes weight loss. For most pregnant women, though, morning sickness doesn’t pose a health threat. And it usually goes away as a pregnancy progresses. In the meantime, there are steps you can take to ease morning sickness.
Morning sickness is most common during the first trimester, but it can linger throughout pregnancy. Exactly what causes morning sickness is unknown. It’s likely related to the hormones hCG and estrogen, which are high during pregnancy. As in your situation, it’s not unusual to have different levels of nausea with each pregnancy.
Women who have significant morning sickness often lose weight early in pregnancy. Only in rare circumstances does this cause problems. The nausea usually subsides over time. As that happens, most women are able to catch up and gain a healthy amount of weight by the end of the pregnancy.
Although morning sickness is hard to prevent, you may be able to make it less bothersome. Nausea tends to be worse when your stomach is completely full or empty. So rather than eating three large meals a day, eat smaller amounts more often. You can eat whatever foods appeal to you and don’t cause nausea. Some women find snacking on soda crackers or dry toast can quell feelings of queasiness. Ginger also can help. Try ginger ale, ginger tea or ginger lollipops.
Drink plenty of fluids throughout the day, but don't drink too much at one time. Some women find drinking beverages with a meal makes nausea worse. If so, take in solid foods and liquids separately to see if that helps.
The smell of certain foods, especially during cooking, can be a problem. Avoid those foods if you are preparing meals, and ask someone to help make meals if cooking triggers nausea.
Pay attention to when and how you take your prenatal vitamins. Taking them in the morning can sometimes makes nausea worse. If that's the case for you, try taking them in the evening instead. Taking your vitamins with food also may help. If those changes don’t make a difference, try a vitamin that has low iron or is iron-free until you feel better.
Acupressure and acupuncture seem to reduce morning sickness for some women. Acupuncture involves inserting very fine needles into the skin at strategic points on the body. Acupressure wristbands are available without a prescription in most pharmacies.
If nausea continues, your doctor may suggest over-the-counter medications. Anti-nausea medications and medications to reduce acid production can be useful. A combination of doxylamine succinate, a sleep aid, and vitamin B6 may be recommended to decrease symptoms. If that doesn't work, a prescription medication may help.
A small percentage of women develop serious nausea and vomiting during pregnancy called hyperemesis gravidarum. Women with this disorder often become dehydrated and lose weight. If it isn't treated quickly, hyperemesis gravidarum may require hospitalization. Rarely, it can lead to premature birth or low birth weight.
If you notice symptoms in addition to nausea, such as lightheadedness, dizziness, faintness, a fast heartbeat, or inability to keep food or fluids down for more than 12 hours, contact your health care provider. You may need additional evaluation or treatment.
Keep in mind that, although it’s certainly not a pleasant part of pregnancy, for most women, morning sickness resolves with a combination of self-care and time, and without any lasting problems. — Julie Lamppa, APRN, CNM, OB-GYN, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My dad recently went to the emergency room with terrible chest pain and sweating, and was concerned he was having a heart attack. He was kept overnight for monitoring, but doctors said his heart was fine and that his symptoms were probably due to heartburn. Should I suggest he have more tests to determine if it’s something more serious? Are there things he can do to avoid having another episode like this?
ANSWER: In a situation like this, it’s important for your father to have a follow-up appointment with his primary care physician to confirm the underlying cause of his symptoms. The physician can do a more thorough evaluation, and refer him for more tests and a consultation with a cardiologist, if needed.
Heartburn, a burning sensation under the breastbone, is a symptom of gastroesophageal reflux disease, or GERD. It happens when stomach acid backs up into the esophagus — the tube that carries food from your mouth to your stomach. Although a burning sensation in the chest is common with GERD, its symptoms can vary widely. In some cases, GERD may feel like a dull ache or pressure in the chest, or, if it’s severe, GERD can lead to crushing chest pain. A heart attack, heart disease and other cardiac concerns can trigger similar symptoms.
Distinguishing the difference between the symptoms of GERD and those that could be related to a heart condition can be difficult. That’s because the nerves that lead to the heart and those that lead to the esophagus are located close to one another, so determining exactly where symptoms come from can be a challenge.
With that in mind, it’s important to confirm that chest pain is not heart-related. So, even if results of heart tests such as an electrocardiogram look fine in the emergency care setting, a more comprehensive evaluation still is needed. In many cases, that assessment includes a stress test to see how well the heart works during physical activity. Based on the severity of his symptoms and your father’s medical history, his physician can determine if he needs to see a cardiologist for additional testing.
It is possible that another condition unrelated to GERD or a heart condition could be causing your father’s symptoms, such as gallstones. In most cases, however, chest pain comes from a cardiac concern or GERD.
If the follow-up assessment shows that your father’s symptoms are due to GERD, there are a number of steps he can take to help prevent symptoms in the future. Overeating or eating a large meal and then lying down are the two most common heartburn triggers. Eating smaller meals and not eating two to three hours before going to bed often can reduce symptoms. Avoiding high-fat foods, spicy foods and citrus juices can be helpful, too. Many people who experience heartburn also find that reducing alcohol, caffeine and nicotine may decrease the frequency of symptoms.
Typically, GERD does not require treatment from a health care provider. Over-the-counter antacid medications are often enough to decrease symptoms, along with lifestyle changes. Some symptoms, however, should prompt a medical appointment, including food sticking in the esophagus, dark or bloody stools, unexplained weight loss or bouts of heartburn that happen more than two or three times a week.
The bottom line is that your father needs further evaluation to make sure he doesn’t have a heart condition. GERD can be managed, and nobody dies from it. But untreated heart problems can be fatal. It’s imperative your father have a formal cardiac evaluation at this time. — Dr. Jeffrey Alexander, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: After six months of chemotherapy, I developed autonomic neuropathy. I have been done with chemotherapy for a few months, but the neuropathy has not gone away. Is there a chance it could be permanent?
ANSWER: Autonomic neuropathy can be a rare side effect of certain chemotherapy drugs. Because it is rare, and because there are many causes of autonomic neuropathy, your doctor should evaluate you to ensure that there is not another cause for your symptoms.
Peripheral neuropathy that leads to numbness, tingling and pain in the hands and feet is much more commonly associated with chemotherapy medications than autonomic neuropathy. When peripheral neuropathy develops as a result of chemotherapy, symptoms typically fade away within several months of the end of treatment. But it can sometimes take longer than that. Although it’s uncommon, in some cases peripheral neuropathy caused by chemotherapy can last for years, or it may be permanent. Treatment is available to help manage symptoms.
While some chemotherapy drugs may cause neuropathy, others do not. Even with the drugs known potentially to be toxic to nerves, only about 30 percent of patients who receive them will develop peripheral neuropathy due to treatment. Risk of developing neuropathy, however, is one of the main reasons for limiting the amount of chemotherapy a person is given.
Although less common than peripheral neuropathy, autonomic neuropathy can develop as a result of chemotherapy, too. It occurs when the nerves that control involuntary bodily functions are damaged. The nerve damage interferes with the messages sent between your brain and other parts of the autonomic nervous system, such as your heart, blood vessels and sweat glands.
Autonomic neuropathy can affect your blood pressure, your body’s ability to control its temperature, digestion, bladder function and sexual function. The specific symptoms a person has with this disorder depend on the nerves that are damaged.
Some people with autonomic neuropathy may have lightheadedness when they stand. They may experience exercise intolerance — a condition in which your heart rate does not adjust properly in response to an increase in your activity level.
People who have autonomic neuropathy also may develop altered sweating patterns or burning pain in their hands or feet. They may have difficulty emptying their bladder or experience urinary incontinence. Sexual difficulties, including problems achieving or maintaining an erection or ejaculation problems in men, and vaginal dryness, low libido and difficulty reaching orgasm in women, can be a result of autonomic neuropathy.
Changes in digestive function due to autonomic neuropathy can lead to symptoms such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.
In people who experience autonomic neuropathy due to chemotherapy, the symptoms usually develop gradually during the course of treatment. Symptoms may continue to get worse for several weeks after all the chemotherapy is completed. In many cases, the symptoms start to improve after that, although it can take several months or more for them to disappear completely.
Treatment can help control your symptoms. The specific treatment you need is based on the parts of your body most affected by autonomic neuropathy. Medication often can be useful in managing symptoms. Lifestyle changes, such as exercise, modifying your diet and increasing fluid intake, can help, too.
Stay in touch with your doctor, and make sure he or she knows you still are dealing with autonomic neuropathy symptoms. If symptoms persist, it may be worthwhile to consult with a neurologist to confirm the diagnosis and discuss the possibility of additional treatment options. — Dr. Sarah Berini, Neurology, Mayo Clinic, Rochester, Minnesota