Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
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 milligrams 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
DEAR MAYO CLINIC: What can you tell me about myofascial release therapy? Is it an effective treatment for muscle pain or tension?
ANSWER: Myofascial release often is used in physical therapy and massage practices. The technique focuses on pain believed to arise from myofascial tissues — the body’s muscle (myo) and the tough connective tissue (fascial) that wrap, connect and support your muscles. The goal is to treat pain that originates in trigger points, which are related to stiff, anchored areas within the muscles or connective tissues.
During myofascial release therapy, the therapist locates myofascial areas that feel stiff and fixed instead of elastic and movable under light manual pressure. These areas, though not always near what feels like the source of pain, are thought to restrict muscle and joint movements because of the way muscles and fascial tissues are interconnected throughout the body.
The slow, sustained manual pressure used in myofascial release therapy applies biomechanical force to stretch the tight tissue. It’s also believed to stimulate nerve messages to the brain and central nervous system. This in turn leads the brain to send messages back that result in tissue relaxation. Pressure is applied until the tightness melts away. This often reduces the pain at the tender sites, loosens restricted movement and restores musculoskeletal symmetry.
There’s some evidence that myofascial release therapy may help with low back pain, fibromyalgia, heel pain, headache, hamstring tightness and other types of pain — when used with established therapies.
If you have osteoporosis of the spine or another type of bone disease that makes you vulnerable to fracture, ask your doctor or a therapist who has training in the technique whether it’s safe for you. (adapted from Mayo Clinic Health Letter) — Dr. Peter Dorsher, Physical Medicine and Rehabilitation, Jacksonville, Florida
DEAR MAYO CLINIC: I have heard that adding flaxseed to my diet could improve my health, but I know nothing about it. What's the best way to take it?
ANSWER: Flaxseed is a nutritional powerhouse. Its health benefits come from the fact that it's high in fiber and is a rich source of a plant-based type of omega-3 fatty acid called alpha-linolenic acid. Flaxseed also contains an array of other beneficial nutrients, including soluble and insoluble fiber, antioxidant phytochemicals called lignans, and numerous other vitamins and minerals.
Flaxseed commonly is used to improve digestive health or relieve constipation, but it also may help lower total blood cholesterol and low-density lipoprotein (LDL, or "bad") cholesterol levels, which may help reduce the risk of heart disease. The connection between dietary fiber in flaxseed and digestive health is fairly obvious. But when it comes to potential heart health benefits, it’s not clear which components of flaxseed are most beneficial. It’s possible that all components are beneficial or that they may work together.
Ground flaxseed is easier to digest than whole flaxseed. Whole flaxseed may pass through your intestine undigested, which means you won't get its full nutritional benefit. Flaxseed supplements are available but usually contain only one element of flaxseed nutrition, such as the alpha-linolenic acid -rich oil, thus limiting their benefit. Flaxseed oil is also available. It has more alpha-linolenic acid than ground flaxseed, but it doesn’t contain all the nutrients of ground flaxseed.
The best way to incorporate flaxseed into your diet is by adding 1 to 4 tablespoons of ground flaxseed to your snacks and meals each day. Flaxseed has a light, nutty taste that can be added to any number of foods. Try mixing 1 tablespoon of ground flaxseed into yogurt, or hot or cold breakfast cereal. You could add 1 teaspoon to mayonnaise or mustard when making a sandwich. Or add ground flaxseed to a smoothie, pancake mix or baked goods.
Unripe and raw flaxseed can have toxins that may be harmful in high doses. Consider toasting, cooking or baking the flaxseed to destroy those toxins.
Flaxseed is available in bulk — whole or ground — at many grocery stores and health food stores. Whole seeds can be ground in a coffee grinder and then stored in an airtight container for several months. To preserve the taste and health benefits of flaxseed, keep it in the refrigerator, or freezer and grind it just before using.
Like other sources of fiber, flaxseed should be taken with plenty of water or other fluids. Flaxseed shouldn't be taken at the same time as oral medications or other dietary supplements. As always, talk with your doctor before trying any dietary supplements. (adapted from Mayo Clinic Health Letter) — Katherine Zeratsky, R.D.N, L.D., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I have been on medication to treat peripheral artery disease for nearly a year, but it doesn’t seem to help the numbness and cramping in my legs. Are stents always effective in treating symptoms of peripheral artery disease, or is there a chance I’ll still have symptoms even with stents?
ANSWER: Your leg numbness and cramping could be connected to peripheral artery disease. Or they could be related to something else. Tell your doctor about your symptoms, and ask for an evaluation to confirm their source. If peripheral artery disease is the cause, look into additional treatment. That treatment could include a procedure to open the arteries, such as stenting. But other options are available, too.
Peripheral artery disease affects the arteries that supply oxygen and nutrients to your leg muscles. Peripheral artery disease happens when plaque builds up in those arteries, narrowing them and sometimes blocking them completely. When arteries are narrowed or blocked, the oxygen and nutrients in your blood can’t get to your tissues and muscles easily.
Leg cramping when you walk is a hallmark symptom of peripheral artery disease. It usually goes away within a few minutes after you stop walking. Other symptoms may include leg numbness, tightness or weakness when you walk. Atypical leg symptoms, such as leg fatigue, may be more common symptoms in peripheral artery disease than classic cramping-type symptoms.
Medication to relieve symptoms is often a first-line treatment for peripheral artery disease. For example, the drug cilostazol may be prescribed, as it improves the distance people with peripheral artery disease can walk without leg symptoms. Medication to control underlying medical conditions that can contribute to peripheral artery disease, such as high cholesterol, high blood pressure and high blood sugar, also may ease symptoms.
Lifestyle changes are an important part of peripheral artery disease treatment, too. Smoking contributes to constriction and damage of your arteries, and can make peripheral artery disease worse. If you smoke, quitting is the most important thing you can do to reduce your risk of peripheral artery disease complications. Regular exercise also is crucial. Exercise helps your body use oxygen more efficiently and conditions your muscles. Both may reduce peripheral artery disease symptoms.
If managing underlying medical conditions, taking medication to relieve peripheral artery disease symptoms and lifestyle changes aren’t enough to keep symptoms in check, then it’s time to reassess your condition. It’s possible your numbness and cramping could be the result of a different medical problem, such as a disorder related to your veins or a condition affecting your nerves. These symptoms also can be side effects of certain medications. Ask your doctor to review your current medications to see if this is a possibility for you.
If an assessment of your condition suggests peripheral artery disease is the cause of persistent leg numbness and cramping, then you may want to consider a procedure to open the arteries in your legs. The specific procedure used depends on the level, extent and type of blockage. In some cases, a stent — a small mesh framework — is placed in an artery to keep it open. A small balloon also can be inflated within an artery to reopen it and flatten the blockage against the artery wall. Another alternative is to remove the plaque using a procedure called atherectomy.
In severe cases of peripheral artery disease, your doctor may recommend a procedure to bypass the artery affected by peripheral artery disease. A graft bypass created using a blood vessel from another part of your body or using a blood vessel made of synthetic fabric can be placed in your leg. That allows the blood to flow around the blocked or narrowed artery. In many cases, artery-opening procedures reduce or eliminate peripheral artery disease symptoms. But it is possible some symptoms may linger after this treatment.
Make an appointment to talk with your doctor about your symptoms, and have them evaluated. If they are related to peripheral artery disease, it’s likely that additional treatment and lifestyle changes can help with your symptoms and, if not resolve them completely, reduce them to a point that they are manageable. — Dr. Shahyar Gharacholou, Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
DEAR MAYO CLINIC: My mother recently was diagnosed with breast cancer, and her doctor told her regular radiation wasn’t as safe as proton beam therapy for her situation. Why would this be the case? I know lots of women who have had radiation for breast cancer treatment.
ANSWER: It’s true that standard radiation therapy often is used to treat breast cancer. In some cases, however, proton beam therapy can be a better choice, particularly for women who have cancer that affects their left breast. That’s because the way proton beam therapy is delivered can prevent the dose of radiation from reaching the heart, and that lowers the risk of potential long-term side effects from treatment.
Protons are subatomic particles that combine with neutrons to form the nucleus of an atom surrounded by orbiting electrons. Radiation is energy released from atoms as an electromagnetic wave, such as X-rays, gamma rays or electrons, or as tiny particles, such as protons. For more than 120 years, radiation has been used to destroy cancer cells.
Today’s standard radiation therapy uses high-energy X-rays that travel through the body. Proton beam therapy is different. This treatment directs protons into a tumor, where their energy is released. Radiation oncologists can control the depth of penetration of the protons and where they release their energy by adjusting the energy of the protons. That allows higher doses of radiation to be more safely delivered to tumors with less risk to surrounding tissues and organs.
Proton beam therapy isn’t necessary or used for all types of cancer. But it is beneficial in the treatment of certain kinds of tumors, including brain and breast cancer, along with many pediatric cancers. The percentage of cancer patients who need proton beam therapy, rather than standard radiation therapy, is small — only about 2 to 3 percent. For those who require this treatment, the advantages can be significant.
There are several groups in particular who usually benefit most from proton beam therapy. First, proton beam therapy is well-suited for children. Radiation therapy can cause cancers, heart disease and other chronic health problems decades later in children and young adults who are cured of their cancer by radiation therapy. Proton beam therapy lowers the risk of chronic health problems, because the child’s body is exposed to a lower dose of radiation, compared to standard radiation therapy.
People with tumors close to organs that are sensitive to radiation injury ─ even with low doses of radiation ─ are the second group of ideal candidates for proton beam therapy. Some women with left-sided breast cancers fall into this category. Standard radiation therapy delivered to the left side of the chest, where the heart is located, may lead to heart problems, such as heart attacks and heart failure, among others. By using proton beam therapy, the heart doesn’t receive a dose of radiation, and that reduces the risk for heart complications later in life.
For the same reason, proton beam therapy may be recommended for treating tumors located deep within the body, when concern about damage to healthy organs and tissue may otherwise require that the standard radiation treatment dose be decreased. For example, proton beam therapy often is considered a good option for brain, head and neck, esophageal, liver, and lung cancers in adults.
If your mother has questions or concerns about proton beam therapy, encourage her to talk with her radiation oncologist. He or she can explain proton beam therapy in more detail, review your mother’s treatment plan with her, and walk her through the risks and benefits for her individual situation. — Dr. Nadia Laack, Radiation Oncology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I was recently diagnosed with chronic obstructive pulmonary disease (COPD). Why do I have different inhalers?
ANSWER: Bronchodilators commonly are prescribed for people with COPD. Bronchodilators relax the muscles around your airways so that you can breathe better. They usually come in the form of an inhaler, which allows the medicine quick access to your lungs as you breathe it in. Two of the most commonly used classes of bronchodilators are beta agonists and anticholinergics.
Some bronchodilators offer quick relief. These are called short-acting bronchodilators. They typically start working in 15 to 30 minutes, and last about four to six hours. Your doctor may prescribe a short-acting bronchodilator if your COPD is mild and you only have symptoms every once in a while. Examples of short-acting bronchodilators are albuterol (ProAir HFA, Ventolin HFA, and other brand names), levalbuterol (Xopenex) and ipratropium (Atrovent HFA).
Most long-acting bronchodilators don’t act as quickly but last longer — 12 to 24 hours or more — to relieve symptoms. Long-acting bronchodilators usually are prescribed when symptoms occur frequently. These medications act as maintenance therapy by keeping symptoms from developing in the first place. Most are not as good at providing immediate relief. Examples of long-acting bronchodilators are formoterol (Foradil, Perforomist), salmeterol (Serevent), and tiotropium (Spiriva), and there are numerous others.
If your COPD is moderate to severe, your doctor likely will recommend both types — a short-acting bronchodilator for quick relief when needed and one or more long-acting ones that you take every day to keep symptoms at bay. Consider labeling each with a marker, so you can quickly tell which is for quick relief and which is for regular treatment.
Some people with COPD are prone to frequent exacerbations, or flare-ups, of symptoms, which may require the use of antibiotics or steroids, or both. A number of medications help reduce the risk of exacerbations, including both classes of long-acting bronchodilators, as well as inhaled corticosteroids, an antibiotic (azithromycin), and roflumilast (Daliresp).
If you have frequent exacerbations despite daily use of a long-acting bronchodilator, talk to your doctor. A combination with additional medicines may work better for you. (adapted from Mayo Clinic Health Letter) — Dr. Paul Scanlon, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’ve heard that having sleep apnea can increase your blood pressure. What if you don’t sleep well but don’t have sleep apnea. Does that raise your blood pressure, too?
ANSWER: Research suggests that sleeping five hours or less a night can, over time, increase your risk of developing — or worsening — high blood pressure. Sleeping between five and six hours a night also may increase high blood pressure risk. This can occur with or without obstructive sleep apnea, a sleep disorder in which you repeatedly stop and start breathing during sleep.
In one Mayo research study, study participants were restricted to four hours of sleep each night for nine nights. The same participants got nine hours of sleep each night during a second study visit. When they slept four hours, study participants had an average systolic blood pressure reading (top number) during the night that was 10 millimeters of mercury (mm Hg) higher than during the nine-hour sleep phase. In addition, the usual blood pressure dip that occurs at night wasn't as pronounced when they were sleep deprived.
It’s not fully understood why this occurs, but it’s thought that sleep helps regulate stress hormones and helps your nervous system to remain healthy. Over time, lack of sleep could hurt your body’s ability to regulate stress hormones, leading to high blood pressure.
Nearly everyone has a bad night or two of sleep now and then, but if you’re consistently getting less than six hours of sleep, talk to your doctor about ways to improve your rest. Not only is poor sleep linked to elevated blood pressure, it also can have a big impact on your enjoyment of life and has been associated with other health risks, such as obesity, diabetes, depression, risk of accidents or falls, and even premature death. (adapted from Mayo Clinic Health Letter) — Dr. Naima Covassin, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: If opioids are such a problem in our country, why are they used so often to treat pain? Aren’t there other effective options for controlling pain that aren’t as risky?
ANSWER: Pain is a common medical problem, and opioids are often used to combat it because they can be very effective at relieving pain for a short period of time. However, you are correct that taking opioids poses significant risks, including addiction and overdose. Alternatives to opioids are available, and it’s wise for people who need pain relief to seriously consider using non-opioid options when possible.
Opioids are powerful painkillers. Commonly prescribed opioid medications include oxycodone, morphine, hydromorphone, oxymorphone, hydrocodone, fentanyl, meperidine, codeine and methadone.
These medications are often used in hospitals to combat pain after surgery or to ease pain after a traumatic injury. Opioids also can be the most effective treatment for severe ongoing pain, such as pain caused by cancer. But other uses of opioids are increasing, too. Estimates are that 50 million Americans suffer from chronic pain. Many turn to opioid painkillers for relief. Opioid prescriptions for chronic noncancer pain have doubled in the last decade.
In cases of serious cancer pain, the likelihood of becoming addicted to opioids over time is low. In many other situations, however, addiction to and overdose of opioids is a very real concern. Overdosing on opioids triggers low blood pressure, a slow rate of breathing and the potential for breathing to stop, as well as the possibility of a coma. Opioid overdose has a significant risk of death. In fact, according to the Centers for Disease Control and Prevention, more people in the U.S. have fatal overdoses related to opioid use than compared to overdoses of heroin and cocaine combined.
In addition to these risks, using opioids for more than a short period of time needs to be viewed with caution because little evidence is available to support its effectiveness over time for noncancer pain. People with chronic pain who take opioids typically need higher doses over time to achieve the same level of pain control, leading to an increased risk of dependence, addiction, overdose and reduced quality of life. Some research also has shown that long-term opioid use may actually make people more sensitive to pain — a condition called opioid-induced hyperalgesia.
A range of alternatives to opioid medications exists for managing chronic pain. They include other pain-relieving medications that don’t contain opioids, such as acetaminophen, naproxen sodium and nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen.
Physical and occupational therapy, stress management, relaxation techniques, acupuncture and biofeedback all have been shown to have a positive effect on chronic pain, too. Incorporating cognitive behavioral therapy, in which a therapist works with patients to learn more effective, positive ways to cope with chronic pain, also has been shown to be useful in dealing with pain.
Many health care organizations, including Mayo Clinic, offer pain rehabilitation programs that help people taper off opioid pain medications while learning about these and other pain-management techniques.
Non-opioid approaches to managing chronic pain not only eliminate the risks of addiction and overdose, in many cases, they also offer more effective pain relief that lasts longer and allows people to maintain a higher quality of life than is possible with ongoing opioid use. — Dr. W. Michael Hooten, Pain Clinic, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I was diagnosed with diabetes a few months ago, and I am concerned about peripheral neuropathy in my feet. Is there anything I can do to prevent this?
ANSWER: Peripheral neuropathy is a common problem that can happen as a result of diabetes. But it isn’t inevitable. To help prevent peripheral neuropathy, closely follow your health care provider’s instructions for managing your diabetes and make healthy lifestyle choices.
Peripheral neuropathy happens when nerves in your feet or hands — your peripheral nerves — become damaged. Diabetes may lead to peripheral neuropathy because excess sugar in the blood can injure the walls of the tiny blood vessels, called capillaries, which deliver blood to the nerves. That injury hampers the capillaries’ ability to carry sufficient amounts of blood. Without proper nourishment, the peripheral nerves lose their ability to function properly.
Although peripheral neuropathy can affect both the hands and the feet, for people with diabetes, it’s more common in the feet. It usually involves a slow progression of numbness, prickling or tingling in the feet that may then spread into the legs. Some people with peripheral neuropathy also feel a sharp, jabbing, throbbing, freezing or burning pain, and their feet may be extremely sensitive to touch.
The best thing you can do to help prevent peripheral neuropathy is keep your blood sugar under control. Monitor your blood sugar regularly, and take your diabetes medications exactly as directed by your health care provider.
Exercising regularly also can help control your blood sugar and help prevent peripheral neuropathy. Try to make physical activity part of your daily routine. Thirty minutes of moderate exercise, such as brisk walking, on most days of the week is recommended. A combination of exercises — aerobic exercises, such as walking, biking or swimming on most days, combined with resistance training, such as weightlifting or yoga twice a week — often helps control blood sugar more effectively than either type of exercise alone.
A healthy diet is important, too. Eat plenty of fruits, vegetables, whole grains and legumes each day, and limit the amount of food you eat that contains saturated fat. If you have questions about your diet, talk to your health care provider, or consider meeting with a dietitian who specializes in working with people who have diabetes.
Exercise and diet also can help if you need to lose weight. If you’re overweight, getting to and staying at a healthy body weight can lower your blood sugar significantly, thus reducing your risk of peripheral neuropathy.
If you smoke, stop. Smoking can affect your blood circulation and raise your risk of developing peripheral neuropathy. If you're having trouble quitting on your own, ask your health care provider about smoking cessation options, including medications to help you quit.
Because peripheral neuropathy can sometimes begin slowly with just numbness in the feet, it’s important that you are vigilant about foot care. Check your feet daily for any cuts or other injuries. Left unchecked, a small injury can turn into a major infection. To avoid foot damage, be careful when you trim your toenails, wear shoes that fit properly and don’t go barefoot.
If you notice any foot injuries or sores on your feet that do not heal, make an appointment with your health care provider to have them checked as soon as possible. Also, talk to your health care provider right away if you notice any foot numbness or pain. Early diagnosis and treatment of peripheral neuropathy offer the best chance for controlling its symptoms and preventing further damage to your nerves. — Dr. Elizabeth Cozine, Family Medicine, Mayo Clinic Health System, Zumbrota, Minnesota
DEAR MAYO CLINIC: I am 58 and considering becoming a vegetarian. I know it will be important to make sure I get enough protein, but are there other nutrients I should focus on, as well?
ANSWER: Following a vegetarian diet is a healthy way of eating. Multiple studies have linked vegetarian diets to a reduced incidence of chronic disease and cancer. Excluding meat or animal products makes a diet healthier, but there are other factors to consider.
As with all dietary patterns, it’s important not to rely too heavily on processed foods, which can be high in calories, sugar, fat and sodium. Vegetarians have an advantage in that they usually eat more fruits, vegetables and whole grains than people who consume meat.
The key to a healthy vegetarian diet, as with all diets, is to include a variety of foods. No single food can provide all the nutrients your body needs. It’s especially important for older adults to be aware of their nutritional needs, since aging can increase the risk of nutritional deficiencies. Talk with your doctor or a registered dietitian about developing a healthy vegetarian eating plan that meets your needs. In general, though, pay attention to these nutrients:
- Calcium and vitamin D — Calcium helps maintain strong bones and prevent fractures, which is especially important as you age. Milk and dairy foods are highest in calcium. However, dark green vegetables are good plant sources when eaten in sufficient quantities. Calcium-enriched and fortified products, including juices and cereals, are other options. Vitamin D also plays an important role in bone health, immune function and in the reduction of inflammation. Vitamin D is added to milk, some brands of soy and rice milk, and some cereals. If you don’t eat enough fortified foods and have limited sun exposure, you may need a vitamin D supplement derived from plants. Of note is that research studies suggest a high intake of vegetables and fruits is associated with increased bone mineral density, which is probably due to mechanisms other than calcium or vitamin D.
- Vitamin B-12 — Vitamin B-12 is necessary to produce red blood cells and prevent anemia. Dairy and eggs are good sources, if you include these in your diet. Older adults tend to have more difficulty absorbing vitamin B-12 from food and may want to consider fortified foods or vitamin supplements to make up for any deficiencies. This is especially true for those on a vegan diet, which excludes dairy products.
- Protein — Protein helps maintain healthy skin, bones, muscles and organs. Eggs and dairy products are good sources, and you don’t need to eat large amounts to meet your protein needs. You can get sufficient protein from plant-based foods (e.g., soy products, legumes, lentils, seeds, nuts and whole grains) if you eat a variety throughout the day.
- Omega-3 fatty acids — Omega-3 fatty acids are important for heart health. Diets that don’t include fish and eggs are generally low in active forms of omega-3 fatty acids. Canola oil, soy oil, walnuts, ground flaxseed and soybeans are good sources of a plant-based form of omega-3s called alpha-linolenic acid. However, conversion of alpha-linolenic acid to the omega-3 types that are best for heart health is much less efficient.
- Iron and zinc — Iron is a crucial component of red blood cells. Dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables, and dried fruit are good sources of iron. Because iron isn’t as easily absorbed from plant sources, the recommended intake of iron for vegetarians is almost double that of nonvegetarians. To help your body absorb iron, eat foods rich in vitamin C (e.g., strawberries, citrus fruits or tomatoes) at the same time as you’re eating iron-containing foods. As with iron, zinc isn’t as easily absorbed from plant sources as it is from animal products. Cheese is a good option if you eat dairy. Plant sources of zinc include whole grains, soy products, legumes, nuts and wheat germ.
- Iodine — Iodine is a component in thyroid hormones, which help regulate metabolism, growth and function of key organs. Plant-based diets are typically low in iodine. However, just one-fourth of a teaspoon of iodized salt a day provides a significant amount of iodine.
With just a little planning, a vegetarian diet can easily provide you with all of the nutrition you need and likely will improve your health. If you need a good starting point for additional information, including recipes, visit Vegetarian Nutrition — a website created by the Academy of Nutrition and Dietetics. (adapted from Mayo Clinic Health Letter) — Dr. Donald Hensrud, Healthy Living Program, Mayo Clinic, Rochester, Minnesota