Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
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
DEAR MAYO CLINIC: What are the best alternative treatments for chronic back and neck pain? I am not able to take pain medication. Are there any supplements that are safe and known to work?
ANSWER: Alternatives to medication for chronic pain exist. Research shows that, when they’re included in a comprehensive treatment plan, those techniques can be quite effective in lowering pain. Together, these approaches to pain management often are referred to as integrative medicine. Talk with your primary health care provider about possibilities for pain control beyond medication. If he or she is not familiar with integrative medicine, ask for a referral to a health care provider who specializes in pain management.
Chronic pain is a common problem. According to the National Institutes of Health, chronic pain affects more Americans than diabetes, heart disease and cancer combined. Chronic pain is the most common cause of disability in the U.S.
Traditionally, the first step in treating chronic pain has been medication, including strong painkillers such as opioids. But these drugs can be problematic. Not only are opioids powerful drugs, they can have serious side effects and pose a significant risk for addiction when used long term. The problems associated with using opioids for pain relief make it crucial that other strategies be considered when managing chronic pain.
In some situations when medication wasn’t a good option, surgery was recommended as the next step. Fortunately, there now are a wide range of choices available beyond medication and surgery that have been shown to be useful in easing chronic pain.
One common form of integrative medicine that’s used frequently at Mayo Clinic is acupuncture. The technique involves inserting extremely thin needles through your skin at strategic points on your body to reduce pain. How often you need this treatment depends in large part on the type and severity of your pain.
Massage therapy can help reduce pain, too. Several studies suggest massage can be effective as part of an overall strategy for managing chronic neck and back pain. Mayo Clinic has conducted more than a dozen clinical trials on massage and found it valuable for a wide variety of pain conditions. Mayo Clinic now regularly offers massage therapy to patients.
Clinical trials have shown mind-body therapies are another approach that can significantly affect chronic pain. The purpose of these treatments is to help you relax and improve the communication and connection between the state of your mind and the health of your body. Yoga, tai chi, meditation and guided imagery fall under this category.
You also asked about supplements. There are two in particular that show promise for easing pain. The first is S-adenosylmethionine, usually called SAMe. It’s been studied for its ability to reduce inflammation and relieve arthritis pain. The second is curcumin, a substance found in the spice turmeric, which also may help reduce inflammation. Initial research seems to point to a benefit in people with some forms of chronic pain who use these supplements. Be careful if you take supplements, though, and don’t start taking anything before you discuss it with your health care provider to make sure it’s right for your situation.
Although all of these treatments may help lower chronic pain, none provides a cure. Instead, they help control pain symptoms. To be most effective, they should be integrated into an overall treatment plan that includes conventional approaches to pain management, such as physical therapy, exercise and balanced nutrition. When placed in the context of this type of integrated approach, many people see significant benefits from using evidence-based alternatives to medication for chronic pain management. — Dr. Brent Bauer, Integrative Medicine and Health, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My son is 8 and wets the bed a few times each week. We have tried a variety of things to help prevent it from happening, including stopping beverages two hours before bedtime and using a mattress pad with a bed-wetting alarm. Should we take him to see a specialist? Don’t kids usually outgrow bed-wetting by this age?
ANSWER: Bed-wetting is common in children your son’s age, especially boys. Most of those children outgrow bed-wetting without any medical care by the time they reach adolescence. If he’s not having any other urinary associated problems, such as accidents during the day or urinary tract infections, it’s not necessary to take your son to see a doctor. If you notice other medical problems that could be connected to the bed-wetting, however, then an appointment with your son’s primary health care provider would be a good idea.
Toilet training is a complicated process. The sequence of events that must happen in both the brain and the bladder, and the connection between the two, for a child’s body to regulate bladder function effectively during the day and at night can take several years.
Many children have no trouble staying dry during the day and yet have persistent nighttime wetting. It’s not clear why some children have problems with bladder control at night, while others do not. But bed-wetting tends to be more common in children who are heavy sleepers.
There is nothing a child can or cannot do to prevent bed-wetting, and you should never punish a child when it happens. The techniques you’re using to try to curb bed-wetting — limiting liquids before bedtime and using a bed-wetting alarm — may help and are reasonable steps to take. Just be patient as you work with your son, and try not to become discouraged if the problem doesn’t stop. It usually takes time. For example, with a bed-wetting alarm, it often takes at least two weeks to see any response and up to 12 weeks to enjoy completely dry nights.
If you notice any of the following symptoms, contact your son’s health care provider: unusual straining during urination, a small or narrow stream of urine, dribbling after urination, cloudy or pink urine, bloodstains on underpants or nightclothes, redness or a rash in the genital area, or daytime as well as nighttime wetting. Also, talk to his health care provider if your son is having pain or a burning sensation when he urinates. These symptoms could signal a urinary tract infection, or a bladder or kidney problem. In some cases, accidents during the day as well as at night may be an early sign of diabetes, although that is uncommon.
If your son hides wet underwear or bedding to conceal wetting, or if he seems particularly stressed about it, talk to his health care provider about ways you may be able to help your son feel less anxious about bed-wetting.
Rarely, prescription medication may be used to control bed-wetting. Medications are available that can slow nighttime urine production, calm the bladder or change a child’s sleeping and waking pattern. These medications do not cure bed-wetting. When a child stops taking them, the bed-wetting typically comes back.
Keep in mind that most children eventually outgrown bed-wetting. Often, all that is needed is time, support, understanding and patience. — Dr. Patricio Gargollo, Pediatric Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I often get leg cramps and am wondering if I should get screened for peripheral artery disease, since my father had it. Are there other symptoms of peripheral artery disease I should be looking for?
ANSWER: Peripheral artery disease, or PAD, affects the arteries that supply oxygen and nutrients to the leg muscles. Leg cramping when you walk is one of its symptoms. The medical term for this is intermittent claudication. It usually goes away within a few minutes after you stop walking. A family history of peripheral artery disease can increase your risk for developing this disease, so it would be a good idea to see your health care provider and get tested for it.
Peripheral artery disease happens when plaque builds up in your 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. The rate at which the plaque builds up and symptoms begin is different for every person.
Symptoms of peripheral artery disease often include tightness, cramping, weakness or numbness in the calf, thigh or buttocks when you walk. These symptoms can sometimes lead to leg weakness and falls. Other symptoms may include a cold feeling in your lower leg or foot; sores on your toes, feet or legs that won’t heal; a change in the color of your legs; hair loss or slower hair growth on your feet and legs; slow toenail growth; shiny skin on your legs; no pulse or a weak pulse in your legs or feet; and, in men, erectile dysfunction.
Your health care provider can diagnose peripheral artery disease using a test called the ankle-brachial index. It measures the blood pressure in your legs and compares it to the blood pressure in your arm. In people who don’t have peripheral artery disease, blood pressure in the legs is higher or equal to the one in the arm. People with peripheral artery disease have a much lower blood pressure in their legs.
People with PAD have a higher risk of heart attack or stroke. Effective treatment of peripheral artery disease often includes a combination of lifestyle changes and medication. In some cases, a procedure to open the arteries is necessary.
One of the best things you can do if you have peripheral artery disease is start walking on a regular basis. Walk for 30 minutes a day, at least four or five days a week. If that’s too much initially due to leg pain, then walk until, or just past, the maximum leg discomfort you can tolerate. Try to go a little farther every day, until you’re up to 30 minutes. The exercise will improve your heart and blood vessel health by improving oxygen delivery to your muscles, thereby helping your muscles work better and longer. Walking also promotes the growth of new blood vessels.
High cholesterol is a contributing factor to peripheral artery disease, and getting cholesterol under control is critical to successful peripheral artery disease treatment. Depending on your situation, you may need a statin medication to lower the level of cholesterol in your blood. Eating a healthy diet and maintaining a healthy weight can help lower cholesterol, too.
Other medical conditions that can worsen peripheral artery disease include uncontrolled diabetes and high blood pressure. If you have either of those conditions, talk to your health care provider about a treatment plan.
Finally, if you have peripheral artery disease and smoke, you need to stop. 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. If you’re having trouble quitting on your own, ask your health care provider about smoking cessation options, including medications to help you quit. — Dr. Fadi Shamoun, Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
DEAR MAYO CLINIC: I was diagnosed with an acoustic neuroma last year. My doctor says I likely won't need treatment. But I know others who have had the same condition and had surgery to remove the tumor. Why would I not need any treatment?
ANSWER: An acoustic neuroma, more accurately called a vestibular schwannoma, is a benign tumor that grows on the balance and hearing nerves. These nerves twine together to form the vestibulocochlear nerve, which runs from your inner ear to your brain. Hearing loss due to an acoustic neuroma often occurs predominantly on one side only. For many years, doctors thought surgical removal was the best treatment. Then, in the mid-1980s, stereotactic radiosurgery, such as Gamma knife radiosurgery, was shown to be safe and effective. Increasingly, doctors are concluding that, in some cases, no treatment may be just as good as or better than active intervention in the long run.
An acoustic neuroma arises from the cells (Schwann cells) that make up the insulation surrounding the vestibulocochlear nerve. What causes these cells to overgrow and form a tumor isn’t certain, but it may be related to sporadic genetic defects. Acoustic neuromas are uncommon and usually are diagnosed between ages 30 and 60. In rare cases, the overgrowth may be caused by an inherited disorder, called neurofibromatosis type 2.
Most acoustic neuromas grow very slowly, although the growth rate is different for each person and may vary from year to year. Some acoustic neuromas stop growing, and a few even spontaneously get smaller. The tumor doesn’t invade the brain but may push against it as it enlarges.
Signs and symptoms typically include loss of hearing in one ear, ringing in the ear (tinnitus) and unsteadiness while walking. Occasionally, facial numbness or tingling may occur. Rarely, large tumors may press on your brainstem, threatening vital functions. A tumor can prevent the normal flow of fluid between your brain and spinal cord so that fluid builds up in your head — a condition caused hydrocephalus.
Diagnosis can be a challenge because early signs and symptoms may be attributed to more familiar causes, such as aging or noise exposure. If an acoustic neuroma is suspected, such as when a hearing test reveals loss predominantly in one ear, the next step is to undergo imaging — typically an MRI — to look for evidence of a tumor on the vestibulocochlear nerve. Increasingly, acoustic neuromas are being discovered as incidental findings when people undergo an MRI scan for unrelated reasons, such as chronic headache, multiple sclerosis or even during surveillance imaging for another unrelated tumor.
Treatment varies depending on the size and growth of the acoustic neuroma, symptoms, and your personal preferences. Options include:
- Monitoring — If you have a small acoustic neuroma that isn’t growing or is growing slowly and causes few or no signs or symptoms, your doctor may decide to monitor it. It sounds like this is what your doctor has recommended for your situation. Recent studies indicate that more than half of small tumors don’t grow after diagnosis, and a small percentage even shrink. Monitoring involves regular imaging and hearing tests, usually every six to 12 months. The main risk of monitoring is tumor growth and progressive hearing loss.
- Stereotactic radiosurgery — This approach may be used if the acoustic neuroma is growing or causing signs and symptoms. In this procedure, doctors deliver a highly precise, single dose of radiation to the tumor. The procedure’s success rate at stopping tumor growth is usually greater than 90 percent. Although the risk is small, stereotactic radiosurgery can damage nearby balance, hearing and facial nerves, worsening symptoms or creating new ones.
- Open surgery — Surgical removal typically is recommended when the tumor is large or growing rapidly. This involves removing the tumor through the inner ear or through a window in your skull. If it can be removed without injuring the nerves, your hearing may be preserved. Surgery risks include nerve damage and worsening of symptoms. In general, the larger the tumor, the greater the chances of your hearing, balance and facial nerves being affected. Other complications may include a persistent headache.
Research is ongoing to compare the three treatment strategies. But, based on long-term data, there appears to be surprisingly little difference in outcome no matter which treatment is chosen for smaller tumors. Talk to your doctor to make sure you are being monitored appropriately for your situation. (adapted from Mayo Clinic Health Letter) — Dr. Michael Link, Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I am finally ready to quit smoking for good. Is it better to quit smoking abruptly or gradually taper off tobacco use?
ANSWER: Congratulations on taking that first step: deciding to quit smoking. Smokers and tobacco users are more likely to develop disease and die earlier than people who don't use tobacco. Because nicotine is highly addictive, it may take more than one try to quit. But it is possible. Thinking about how to go about quitting is important, and there are a number of resources available to help you quit.
While quitting either abruptly or gradually can work, quitting abruptly may work better, according to a recent study published in the Annals of Internal Medicine.
The study involved about 700 smokers randomly assigned to either quit tobacco use abruptly with the aid of nicotine replacement patches or gradually reduce tobacco use with the aid of nicotine patches and a two-week structured cigarette reduction program. Behavioral counseling was provided leading up to the quit day for both groups.
After four weeks, 49 percent of the abrupt quit group and 39 percent of the gradual reduction group remained tobacco-free. At six months, 22 percent of the abrupt quit group and 15.5 percent of the gradual reduction group remained tobacco-free.
It’s not entirely clear why this gap exists. It may be that the taper for the gradual reduction group was too sudden or the tapering schedule may have made it more difficult to initiate the quit date.
One thing is known: The best way to quit smoking is with the aid of one of several nicotine replacement products and behavioral counseling. Stopping smoking with no help — gradually or suddenly — isn’t as likely to help you quit.
In addition, each time a person tries to stop, the likelihood for success increases. If you’ve tried to stop smoking but failed, don’t give up. You’re more likely to succeed with repeated attempts, and behavioral counseling and medications to help.
Every state has a telephone quit line that you can access by calling 1-800-QUIT-NOW (800-784-8669 toll-free). Or go online to becomeanex.org or smokefree.gov, where you'll find more information and support to help you stop smoking for good. (adapted from Mayo Clinic Health Letter) — Dr. Jon Ebbert, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m flying to a family reunion this winter, and my doctor suggests I take supplemental oxygen with me on the airplane because I have chronic obstructive pulmonary disease (COPD). I don’t normally use supplemental oxygen, so why would I need it on an airplane?
ANSWER: People who have COPD or diseases that can cause low oxygen levels may need in-flight oxygen supplementation even if they don’t use oxygen at home.
As a plane takes off and gains altitude, surrounding air pressure — the weight of the atmosphere pressing against the earth — decreases. Pressurized cabins limit the decrease considerably but not entirely. Federal regulations require cabin pressure altitude to be below 8,000 feet above sea level. This pressure level is manageable for most people, but is still about the same as being a quarter to a third of the way up Mount Everest. If you have lung disease, this could cause problems.
Low air pressure decreases the rate at which oxygen is absorbed into your bloodstream. If you already have low oxygen levels on the ground, as is often the case with COPD, even a small decrease in oxygen flow can have an effect. Any increase in your body’s demand for oxygen — for something as simple as getting up and walking to the bathroom, for example — can elevate that effect, potentially leaving you with breathing problems on the plane.
Commercial airlines have varying requirements for bringing oxygen on a plane, so check with your airline. Also, flights within other countries may have different rules. Most airlines require notification at least 48 hours before the flight and longer for international flights. You’ll likely need written documentation of your need for oxygen from your doctor.
Some airlines provide in-flight supplemental oxygen systems. You also can rent a battery-powered portable oxygen concentrator to bring with you, which means you have it during layovers and when you arrive at your destination. Portable oxygen concentrators must be approved by the Federal Aviation Administration for domestic flights, and the International Civil Aviation Organization for international flights.
Give yourself enough time, preferably weeks or even months ahead, to confirm you have everything you need and answer any questions you might have. If you bring a portable oxygen concentrator, be sure you bring enough batteries to comfortably last more than the length of the trip, in case there are unanticipated delays. (adapted from Mayo Clinic Health Letter) — Dr. Clayton T. Cowl, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I have hypothyroidism and take medication for it. When researching online, I read that I should avoid kale and spinach. Is this true? I enjoy a kale or spinach smoothie almost daily and don’t want to give that up. Are there other foods I should avoid because of hypothyroidism?
ANSWER: Although you may find many claims about foods you should and shouldn’t eat to ensure thyroid health, in general there are no specific foods you must avoid if you have hypothyroidism — including kale and spinach. Eating a healthy, balanced diet and carefully taking your medication as prescribed by your health care provider will go a long way toward effectively managing hypothyroidism.
Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. Hypothyroidism, sometimes called underactive thyroid, is a condition in which your thyroid gland doesn’t produce enough of certain important hormones.
The hormones that the thyroid gland makes — triiodothyronine, or T3, and thyroxine, or T4 — have a large impact on your health, affecting all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.
When your thyroid doesn’t make enough T3 and T4, the result is hypothyroidism. In most cases, hypothyroidism can be treated safely and effectively with the synthetic thyroid hormone levothyroxine, which replaces your body’s natural T3 and T4.
Concern surrounding the impact of spinach, kale and other similar vegetables — including broccoli, broccoli rabe, turnips, Brussels sprouts, Chinese cabbage and cauliflower — on thyroid health is due to the effect they can have on the thyroid’s ability to absorb iodine. Having enough iodine in your diet is crucial for thyroid health because your thyroid gland needs iodine to make T3 and T4.
It’s true that eating a lot of these vegetables could limit your thyroid’s uptake of iodine. The amount you would need to eat to have that effect, however, is very large — much larger than most people would ever normally eat and certainly far more than would be included in a daily smoothie.
In addition, the effect of these vegetables is on the thyroid gland itself. That means for someone like you whose thyroid gland isn’t working properly, and who is taking thyroid hormone replacement medication, even if you ate these vegetables in large amounts, there wouldn’t be any impact on the amount of thyroid hormone in your body.
It is worthwhile to note, though, some foods, dietary supplements and medications may interfere with your body’s ability to process thyroid hormone replacement. For example, it can be hard for your body to absorb the medication if you take your tablets with meals that are high in fiber.
To help ensure that your body absorbs the medication properly, follow your health care provider’s directions on how to take it — typically on an empty stomach.
Also, to avoid problems with absorption, don’t take your thyroid hormone medication with foods that contain walnuts, soybean flour or cottonseed meal. Don’t take it at the same time as you take an iron supplement or a multivitamin that contains iron. It’s also important to avoid taking it with calcium supplements or antacids that contain aluminum or magnesium. Some ulcer medications and some cholesterol-lowering drugs also can interfere with thyroid hormone replacement. To avoid potential problems, eat these foods or use these products several hours before or after you take your thyroid medication.
If you’re concerned about your diet or about how other medications you take could have an effect on your thyroid medication, review your current medication list with your health care provider. A consult with a dietitian also can be useful if you have questions or concerns about what to include in a healthy, balanced diet. — Dr. John Morris III, Endocrinology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I started working a night shift six months ago, and I just can’t get enough sleep. I’m having a hard time staying asleep during the day. Most days, I get five hours of sleep or less. What can I do to get more sleep? I’m worried that lack of sleep is going to affect my health.
ANSWER: Trying to sleep during the day rather than at night can be difficult. As you’ve found out, humans naturally are wired to be awake during the day and sleep at night. But there are steps you can take to help your body adjust and get the sleep you need.
Your body has an internal sleep-wake rhythm. In most people, that rhythm generally fits a 24-hour cycle. Because of your sleep-wake rhythm, you get sleepy at certain times of the day and become more alert at other times. The main influence on this rhythm is exposure to external light.
Shift work often presents sleep problems because the timing is a mismatch between your body’s biological sleep-wake cycle and the schedule required by your job. When you have to work, your internal rhythm wants you to sleep. When you are done working and you want to sleep, your body thinks it’s time to be awake.
To help your body get enough sleep, first, stay consistent. Go to bed and get up at the same time each day, including on your days off. This will allow your body to adapt to your schedule. Changing your sleep schedule when you don’t work makes it much more difficult for your body to adjust, making it less likely you will get the sleep you need over time.
When you go to work, surround yourself with plenty of bright light. If you drink caffeine, do it early in your shift. If the sun starts to rise during your commute home, wear dark sunglasses to dim the external light. As soon as you arrive home, go to bed. If you delay, it will be more difficult to get to sleep.
Set up your bedroom environment to help you sleep. Keep it dark, covering the windows with room-darkening shades or curtains to block out any external light. Wearing a sleep mask over your eyes also may be useful. Adjust the temperature in your room so it is cool and comfortable.
Your surroundings should be quiet. If other family members are home when you sleep, ask them to respect your need to rest. If possible, sleep in a room located away from family areas that can get noisy. Unplug or turn off phones and other electronic devices so you are not disturbed.
Leading a healthy, active lifestyle also can promote healthy sleep. Eat a well-balanced diet. Keep alcohol to a minimum. Although alcohol can make it easier to fall asleep faster, it makes it harder to stay asleep. Exercise regularly.
Most adults need seven to eight hours of sleep every 24 hours. Few people can function well on five hours or less. Without enough sleep, your health may suffer. You probably already know that lack of sleep can lead to fatigue, irritability and difficulty concentrating. But, over time, people who don’t get the sleep they need also may be at higher risk for other health problems, including high blood pressure, heart disease and diabetes.
If you try these tips consistently for two weeks and still have problems getting enough sleep, talk to your doctor. He or she may be able to give you additional suggestions for steps you can take to adjust your body’s sleep-wake rhythm. — Dr. Meghna Mansukhani, Sleep Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Why do hearing aids work for some people but not others?
ANSWER: The type of hearing loss you have and how severe it is can impact how well a hearing aid works for you. A variety of hearing aids are available, so if the first one you try isn’t helpful, ask your audiologist to recommend another. For people who have hearing loss that does not benefit from hearing aids, another device called a cochlear implant may be a useful alternative.
Your ear has three areas: the outer, middle and inner ear. When you hear, sound waves pass through the outer ear and cause vibrations at the eardrum, which are transmitted through the three small bones of the middle ear to the fluid-filled inner ear. The inner ear is a snail-shaped structure called the cochlea.
Within the cochlea are thousands of tiny hair cells that help translate the sound vibrations into electrical signals that are sent to your brain through your auditory nerve. The vibrations of different sounds affect these tiny hair cells in different ways, causing different signals to be sent to your brain. That’s how you distinguish one sound from another.
In most people who develop hearing loss, the hair cells in the cochlea are damaged or missing, usually as a result of aging or exposure to loud noise, or due to genetic reasons. That means the signals can’t be transmitted efficiently to the brain.Hearing aids don’t replace or regenerate the hair cells that have been damaged, so they can’t completely restore normal hearing. They can improve your ability to hear by amplifying sound, helping you hear the sounds you’ve had trouble hearing. But even when the sound level increases with a hearing aid, you still may notice some hearing loss.
Most hearing aids are digital and can be programmed individually to analyze and adjust sound based on your specific hearing loss, listening needs and the level of the sounds around you. Although hearing aids can be programmed to amplify certain sounds, they cannot eliminate all background noise.
Hearing aids vary significantly in price, size and features. Some fit completely inside your ear canal. Some are placed in the outer portion of your ear. Others hook over the top of your ear and sit behind it. Your audiologist can review your options and help you choose which one might be best for your needs.
It can take time to adjust to a new hearing aid and decide if it’s right for you. That’s why you have a trial period for hearing aids. During the trial period, you work closely with your audiologist to determine what is best for your hearing health needs. If you have concerns, don’t hesitate to tell your audiologist. He or she may be able to adjust your hearing aid or offer a different type of hearing aid that suits you better.
If your hearing loss is severe and cannot be managed with hearing aids, a cochlear implant could be another treatment option if it’s medically appropriate for you. The device works by bypassing the hair cells in your inner ear that don’t work and giving the brain the ability to perceive sound once again. A cochlear implant includes an external processor that fits behind your ear and an internal receiver implanted under the skin behind your ear.
For most people with mild to moderate hearing loss, though, hearing aids can offer significant improvement in hearing. Working with your audiologist, it’s likely you will be able to find a hearing aid that fits your needs. — Dr. Gayla Poling, Audiology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I had some heart trouble earlier this year and have not yet gotten a flu shot. Is it safe for someone like me, who has heart issues, to get the vaccine?
ANSWER: In almost all cases, the answer is yes. Unless you have a specific reason for not getting a flu (influenza) shot — such as an allergy — the flu shot is very safe, even if you have heart disease.
In fact, heart disease increases the risk of complications if you get influenza, and, so, in your case, the flu vaccine would be strongly recommended. Influenza, or the flu, is a known risk factor for cardiovascular events such as heart attack and stroke, which sometimes can cause death. The flu also can worsen heart failure or other conditions that can stress the cardiovascular system, such as diabetes or asthma.
It’s not entirely clear how the flu triggers cardiovascular problems. It may make artery-clogging plaques more unstable and vulnerable to rupture. It may lower oxygen levels and make the heart work harder. It may directly injure heart cells. Or it may simply put too much stress on a more frail body.
The flu shot reduces the risk of getting the flu. Even if you get the flu after receiving a flu shot, you’ll probably have a less severe case of the flu.
A recent review of research suggests that getting the flu vaccine may reduce the risk of a heart attack. The review found that older adults who got the flu vaccine reduced their risk of heart attack over the next eight months by about 36 percent. Among older adults with pre-existing heart disease, getting a flu shot reduced heart attack risk by over half. (adapted from Mayo Clinic Health Letter) — Dr. Priya Sampathkumar, Infectious Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m 61 and have noticed my hearing is not what it used to be. Do I need to see my doctor, or is it OK to wait until I think I need hearing aids?
ANSWER: Don’t wait. Make an appointment to have your hearing evaluated now. Most health care providers recommend a baseline hearing check at 50 and then regularly scheduled follow-up assessments after that based on your individual needs.
Hearing loss that occurs gradually with age is common. About 25 percent of people in the U.S. between 55 and 64 have some hearing loss. For those older than 65, that number is closer to 50 percent.
In many people, hearing loss is related to the aging process, along with persistent exposure to loud noises over time. Genetics may play a role in some cases, too. Other factors, such as excessive earwax, can temporarily prevent your ears from conducting sounds as well as they should and may add to hearing problems.
Most types of hearing loss cannot be reversed. That doesn’t mean, however, that you simply have to put up with not being able to hear. There are effective management options that can help improve your hearing and make it easier for you to interact with the people around you.
To identify the extent and cause of hearing loss, you need a comprehensive hearing evaluation. That usually involves your health care provider first doing a physical exam of your ears to see if factors such as earwax, inflammation or problems with the structure of your ears may be contributing to hearing loss. He or she may ask you questions about your medical history and any communication difficulties you’ve had.
If that points to possible hearing loss, your health care provider likely will recommend a more thorough hearing evaluation with an audiologist. For that, you sit in a soundproof room, wear earphones and hear sounds directed to one ear at a time. During the evaluation, a range of sounds in various tones are presented, and you indicate each time you hear the sound. Each tone is repeated at faint levels to find the softest you can hear. The responses are recorded on a graph known as an audiogram. You also may be asked to sit quietly as additional tests are performed to evaluate the function of your ears.
If your hearing assessment reveals hearing loss, your audiologist can talk with you about the management options that fit your situation, as well as any additional follow-up needed. A variety of hearing aids are available that can make sounds stronger and easier to hear. For more severe hearing loss, a cochlear implant may be an option. Unlike a hearing aid that amplifies sound and directs it into your ear, a cochlear implant compensates for parts of your inner ear that may not be working.
Even if you don’t have hearing loss now, a hearing assessment at this time is useful. If you experience hearing loss over time, your health care provider can look at the results of this baseline test to see how your hearing has changed.
No matter what the outcome of your evaluation, take steps to protect your hearing. Remember, the louder the sound, the less time you should be around it. When you wear headphones, keep the volume safe. With headphones on, you should still be able to hear someone talking to you in a normal voice an arm’s length away. Wear hearing protection when you’re around noisy tools, equipment or firearms.
Talk with your health care provider about how often you need your hearing checked. Many factors can impact your hearing health care. For example, people who frequently work around, or are exposed to, loud noise may need hearing tests more often. — Gayla Poling, Ph.D., Audiology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Is it easy to determine a direct cause of erectile dysfunction? My husband is 51 and refuses to see his doctor even though I know it’s bothering him. Does erectile dysfunction ever go away on its own, or is treatment always necessary?
ANSWER: Finding the specific cause of erectile dysfunction isn’t always simple. A number of underlying medical conditions can trigger erectile dysfunction, and other factors such as stress, depression or anxiety can make it worse. But it’s important to have erectile dysfunction evaluated. It could be an early warning sign of other potential health problems. And erectile dysfunction is unlikely to resolve without some treatment or lifestyle changes. Your husband definitely should see his health care provider about erectile dysfunction.
Erectile dysfunction is the inability to get or keep an erection firm enough for sex. It’s a common problem. Studies of men 40 to 70 have found that about 52 percent have some degree of erectile dysfunction.
Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect self-confidence and contribute to relationship problems. Perhaps most important, though, problems getting or keeping an erection can be a sign of an underlying health condition that needs treatment, such as vascular disease, which can lead to a heart attack or stroke.
The reason for the connection between erectile dysfunction and conditions such as heart disease often stems from problems with the inner lining of blood vessels, called the endothelium, and smooth muscle. Endothelial dysfunction causes inadequate blood supply to the heart and impaired blood flow to the penis. It also contributes to the development of plaque buildup in the arteries, which is a risk factor for heart disease called atherosclerosis.
Erectile dysfunction doesn’t always signal an underlying heart problem. However, research suggests that the earlier a man experiences erectile dysfunction that is not due to psychological factors, the more likely he is to have hidden — sometimes called occult — endothelial dysfunction, and the more likely he is to experience something like a heart attack in the future.
Many of the health problems associated with heart disease and stroke also are associated with erectile dysfunction, including high blood pressure, high cholesterol and diabetes. Your husband should see his health care provider to be screened for these and other similar conditions as a first step in identifying the possible cause of erectile dysfunction.
If an underlying medical condition is found, treatment for it may help resolve erectile dysfunction. In some cases, lifestyle changes also can be helpful in combating erectile dysfunction, as well as lowering the risk for other health concerns.
For example, several studies have demonstrated the benefits of exercise on improving erectile function. One study found that when men increased their level of exercise to 120 minutes or more a week of cardiovascular activity, such as running, biking, swimming or jogging, it had an effect nearly as strong as taking an erectile dysfunction medication. Quitting smoking, losing excess weight and eating a healthy diet all can have a positive effect, too.
In men who have no other health concerns and in whom a specific cause of erectile dysfunction cannot be identified, medication such as sildenafil, tadalafil, vardenafil or avanafil, often can treat erectile dysfunction successfully. These medications enhance the effects of nitric oxide — a natural chemical in the body that relaxes muscles in the penis, increasing blood flow. When these medications no longer are effective, other erectile dysfunction treatments are available.
Encourage your husband to make an appointment to see his health care provider. Evaluating and treating erectile dysfunction is important not only for his sexual health, but also it may benefit his long-term health overall. — Dr. Landon Trost, Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What’s the difference between almond milk and regular milk? When I was drinking regular milk, I was getting calcium oxalate kidney stones every couple of years; however, when I stopped dairy, the kidney stones stopped. I’m hesitant to start dairy again, so am wondering if drinking almond milk will make a difference.
ANSWER: It sounds like your concern about milk and other dairy products is that their calcium may spur the development of more kidney stones. In fact, people who’ve had calcium oxalate kidney stones do need a certain amount of calcium in their diets. And, although almond milk and other plant-based milks, such as soy milk, contain calcium, they also contain oxalate. People with a history of calcium oxalate stones often are cautioned to avoid oxalate-rich foods. Cow’s milk doesn’t have oxalate, and it does have the calcium you need, so it is a good choice for you.
Kidney stones made of calcium oxalate form when urine contains more of these substances than the fluid in the urine can dilute. When that happens, the calcium and oxalate form crystals. At the same time, the urine may lack substances that prevent the crystals from sticking together, creating an ideal environment for kidney stones to form.
It may seem to make sense that when calcium and oxalate make up the kidney stones, then avoiding both should help. But calcium is a critical part of your diet. Your body needs it, not only to keep your bones healthy, but also to help regulate your blood pressure and aid in muscle function. Oxalate is a naturally occurring substance found in many foods. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Your liver also produces oxalate.
A key for preventing growth of calcium oxalate stones is to get the right amount of calcium. A typical recommendation is to have 1,000 to 1,200 milligrams of calcium every day. If you have calcium-rich foods or beverages at each meal, you lower the amount of oxalate absorbed into your bloodstream, reducing your risk of new kidney stones.
For the best stone prevention, calcium should come from food and not calcium pills. When you consider good sources of calcium, dairy products are high on the list. Check the Nutrition Facts label to find out how much calcium is in these and other beverages and foods.
In addition to getting the right amount of calcium, there are other changes you can make to reduce your risk of calcium oxalate kidney stones. For example, it’s important to drink plenty of water and other fluids. Drink about 8 to 10 ounces of liquid each hour you’re awake. The easiest way to know whether you’re drinking enough fluids is to look at your urine. It should be almost clear.
You also may need to cut down on foods that are rich in oxalate. Unfortunately, oxalate content is not listed on food labels. The highest amounts of oxalate are found in certain fruits, vegetables and other plant foods, such as nuts. Meats, eggs, dairy products, white rice and pasta are generally low in oxalate. If your health care provider recommends you limit oxalate-rich foods, consider meeting with a dietitian to evaluate your diet.
Sugar and sodium can raise the risk of developing kidney stones, so limiting both in your diet also will help. Finally, too much meat, chicken or fish can increase the likelihood of kidney stones. Limit these foods to no more than 3 ounces at your midday meal and 3 ounces at your evening meal.
For more information on diet changes that can lower your risk for kidney stones, talk to your health care provider or a dietitian. He or she can help guide your dietary choices to reduce your risk of stones while still getting the nutrition you need. — Katherine Zeratsky, R.D.N., L.D., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’ve always been told FluMist is just as effective as the flu shot for kids, so why isn’t the mist available this year? Does that mean the shot is not likely to be very effective either?
ANSWER: The Centers for Disease Control and Prevention recommends a yearly flu vaccine for all children 6 months and older. Mayo Clinic strongly endorses that recommendation. Depending on your child’s age and health, you typically can choose between a flu shot and the nasal spray form of the flu vaccine. However, this year, only the flu shot is recommended because the spray has been relatively ineffective in recent flu seasons.
Influenza, usually called the flu, is a viral infection that affects the respiratory system. It’s not the same as what people often refer to as “stomach flu,” which causes diarrhea and vomiting. Common symptoms of the flu include a fever higher than 100.4 degrees Fahrenheit, muscle aches, headache, a cough, a sore throat and fatigue.
Influenza often goes away on its own without any lasting problems. But, sometimes, influenza can be life-threatening. People at higher risk of developing serious complications from the flu include children younger than 5 years old, adults older than 65, pregnant women and people with weak immune systems.
Even if you’re not in one of those categories, though, you still need a flu shot. While the flu may not cause lasting problems for you, you can spread it easily to others who may not fare as well. The best defense against influenza is getting the flu vaccine every year.
In the past, multiple studies showed that the nasal spray flu vaccine worked as well as, and sometimes better than, the injectable form of the vaccine. But newer research has found that, during the last two flu seasons, the mist hasn’t provided much, if any, protection against the flu virus. In contrast, the flu shot provided a high level of protection.
Based on those findings, the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that, during this flu season, children 6 months and older get the flu vaccine by injection only.
If your child has a lot of anxiety about shots, ask your health care provider if a spray coolant or a vibrating ice pack can be applied to the skin to numb it before the vaccine is given. That can make the injection less painful and may reduce the fear associated with getting the vaccine as a shot.
To give your child the most protection from the flu, it’s best to get the flu vaccine as soon as it becomes available and before disease outbreaks occur in your area. It takes up to two weeks after vaccination for a person to be fully protected from the flu.
If your child is younger than 9 years old and is getting the vaccine for the first time, he or she needs two doses, given at least four weeks apart. Children who needs two doses but only receive one may have little or no protection from the flu. If your child has had two or more total doses of the flu vaccine during past seasons, then one dose is enough this season. Or if your child is now 9 years old or older, one dose also is enough. Yearly flu vaccines also are recommended for all adults.
To protect yourself, your children and the people around you most effectively, get your flu vaccine as soon as it becomes available to you. — Dr. Robert M. Jacobson, Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What happens when a Maisonneuve fracture involving the tearing of all of the ligaments is not surgically repaired? What are the long-term effects of not treating the injury?
ANSWER: For this kind of complex ankle and leg injury, surgery often is necessary to stabilize the ankle joint and allow for proper healing. If a Maisonneuve fracture isn’t treated, the result can be long-term ankle instability and early-onset arthritis.
A Maisonneuve fracture is the result of two injuries that happen at the same time. The first is typically a very high break or fracture in the fibula — the smaller of the two bones between your ankle and your knee. The second is an ankle sprain — an injury that stretches or tears the tough bands of tissue, called ligaments, that help hold the bones of the ankle joint in place.
Maisonneuve fractures are most common in athletes who participate in sports such as skiing, gymnastics or dancing, where there is a risk of falling with the foot and leg hitting the ground at an awkward angle while they are rotating.
Symptoms of a Maisonneuve fracture include those you’d have with an ankle sprain, such as ankle pain, swelling, bruising and restricted range of motion. Symptoms also include ankle instability and pain higher in the leg at the site of the fibula fracture.
Diagnosing a Maisonneuve fracture can be challenging because it requires identifying several injuries. When health care providers suspect a Maisonneuve fracture, full-length X-rays of the fibula and the tibia (your other lower leg bone) are taken. Ankle joint, or mortise, X-rays are done, as well, to assess the joint damage and see if the bones in the joint are out of alignment.
X-rays taken while you aren’t bearing weight on your ankle may not reveal the full extent of a Maisonneuve fracture. Therefore, your health care provider may recommend that additional X-rays be taken while you put weight on your ankle. These images, also called stress films, can further assess possible damage to the ligaments in the ankle and evaluate the status of the ankle joint. In some cases, an MRI is used to assess the ankle joint, too.
If the images show a Maisonneuve fracture, but the bones of the ankle joint are still in their proper place, or just slightly out of alignment, and the stress films show only minor ankle instability, then surgery may not be necessary. In such cases, using crutches, along with a brace, cast or splint as the ankle and leg heal, followed by physical therapy to regain your range of motion, may be sufficient treatment.
When a Maisonneuve fracture involves significant ligament injury such as you describe, however, surgery is almost always required to stabilize the ankle joint and allow for proper healing. Depending on the specifics of the injury, your surgeon may place screws or other devices to hold the ankle joint in place while the ligaments heal. Screws may be removed when healing is complete, but that’s determined on a case-by-case basis.
Standard postoperative recovery typically includes keeping weight off the affected ankle for 6 to 12 weeks. Following this, physical therapy may be used to regain flexibility, strength and balance. The goal is for the patient to be able to return to full activity and to regain the function he or she had prior to the injury.
If the ankle joint is not positioned properly during the healing process, the joint may be at risk for developing arthritis. Eventually, that can lead to chronic ankle pain, tenderness, stiffness and loss of flexibility.
To ensure the long-term health of the ankle joint following this injury, it is important to have a Maisonneuve fracture thoroughly assessed, properly diagnosed and promptly treated. — Dr. William Cross III, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: At my last mammogram, I asked my doctor if I could be tested for the breast cancer gene. She didn’t think it was necessary even though I have an aunt who had breast cancer. How do doctors decide who should be tested? Why shouldn’t all women be tested?
ANSWER: Genetic testing for the gene mutations associated with breast cancer, called BRCA1 and BRCA2, is offered to people who are likely to have inherited one of the mutations, based on their personal and family medical history. There are other newer genetic tests that may be available, too, depending on a person’s family cancer history.
BRCA gene mutations are uncommon. Affecting only about one percent of the population, they are responsible for approximately 5 to 10 percent of breast cancers. Because of their rarity, testing everyone for them isn’t necessary or recommended. If you’re concerned you might have one of these mutations, ask your doctor to help you assess your overall risk.
The first step in determining the possibility of a BRCA mutation is gathering a comprehensive family history. Your doctor would want to know if anyone in your family has had breast cancer or other types of cancer. If you have a first-degree relative with the disease — a parent, sibling or child — that has more of an impact on your risk than other relatives who have breast cancer, such as aunts or cousins. If you have a male relative with breast cancer, that could raise your risk more significantly, too.
The age a relative was diagnosed with cancer also makes a difference. People who have a BRCA gene mutation tend to develop breast cancer at a younger age than people who do not. If someone in your family had breast cancer before 50, that may increase the possibility a genetic mutation could be involved.
Typically, a family with BRCA will show a pattern of breast cancer that affects multiple family members over several generations diagnosed with breast cancer at young ages. But other cancer diagnoses should be reviewed, too. Ovarian, pancreatic or prostate cancer at a young age also could point to a hereditary predisposition to breast cancer.
If your family history suggests the possibility of a BRCA gene mutation, consider meeting with a genetic counselor before you make any decisions about testing. A genetic counselor can use your family history to calculate the family’s risk of hereditary breast cancer more specifically. He or she can help you fully understand the pros and cons of genetic testing. A genetic counselor also can offer guidance on the ideal individuals in the family to be tested first.
If genetic testing is recommended for you, you decide to have it done, and you learn that you do have a BRCA gene mutation, your risk for breast cancer would be much higher than normal. In women without BRCA, the odds of getting breast cancer are 1 in 8. For people with a BRCA mutation, lifetime risk for breast cancer ranges from 50 to 80 percent. With that in mind, women who carry the mutation should be referred to a breast health specialist or breast center to determine how often they should be screened for breast cancer and review possible medical and surgical treatment options that are available to them, based on their individual circumstances.
Keep in mind that, for most people, the likelihood of having a BRCA gene mutation is low ― even when a family member has had breast cancer. The vast majority of breast cancers are not inherited. It is important, however, for all women to be screened for breast cancer regularly. How often you need breast cancer screening tests should be based on your personal medical history, family history and preferences. Talk to your doctor about the schedule that best fits your needs. — Dr. Sandhya Pruthi, Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I recently read about a study that showed women should not have their ovaries removed before menopause because of the increased risk of developing chronic conditions such as heart disease, lung disease and depression. I had my ovaries removed at age 44 when I had a hysterectomy and am now 55. Are there things I can do to prevent the other conditions mentioned in the study?
ANSWER: For women who have their ovaries removed before 45 and before they reach menopause naturally (usually around 51 in the U.S.), menopausal hormone therapy, or MHT, often is recommended to prevent the negative effects of early estrogen loss.
At 55, though, MHT likely would not be useful for you to prevent chronic disease. There are, however, a variety of lifestyle changes that could lower your risk of chronic disease. Depending on your medical history, other steps may be helpful, too. It would be worthwhile to make an appointment with your primary health care provider to review your health risks and discuss how you might reduce them.
The study you mention, led by a Mayo Clinic research team and published this fall, found that women who had both ovaries removed before age 46 experienced a significantly elevated risk of multiple chronic health conditions, including depression, high cholesterol, heart disease, arthritis, asthma, chronic obstructive pulmonary disease and osteoporosis.
Removing both ovaries — a procedure called bilateral oophorectomy — triggers menopause in women who have not already gone through it. Along with menopause comes a significant drop in the amount of estrogen in a woman’s body.
The study results showed that, in younger women, the premature loss of estrogen caused by an oophorectomy may affect a series of aging mechanisms at the cellular and tissue level across the whole body that can lead to diseases in multiple systems and organs. That means the effects of oophorectomy in premenopausal women are much broader and more severe than previously documented. With these findings in mind, the researchers involved in the study recommend the practice of removing the ovaries to prevent ovarian cancer be discontinued in premenopausal women who are not at high risk of cancer.
For women who go through menopause before 45, several options are available to help lower the risk of chronic disease. Multiple medical societies, including the North American Menopause Society and the International Menopause Society, recommend that women who go through menopause before 45, either naturally or as the result of medical treatment, take MHT at least until 51 — unless there is a clear reason not to do so. MHT can help prevent the potential adverse, long-term health consequences of losing estrogen too soon.
Because you are past 51, there is no evidence that MHT will help prevent chronic disease in your situation, although it can be useful in managing menopause symptoms such as hot flashes, night sweats and sleep problems.
If you want to reduce your risk of chronic disease in midlife and beyond, though, there are many things that you can do. Heart disease is still the No. 1 killer of women, so lowering your risk factors for heart disease is key. Lifestyle factors, such as maintaining a healthy weight, eating a healthy diet, exercising regularly and stopping smoking, are all crucial for long-term health.
Having a discussion with your primary health care provider is a good idea, too. He or she can review your situation, including your personal and family health history, so any treatment you may need can be personalized for you, and you can understand and modify your risks for future disease. — Dr. Stephanie Faubion, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I was diagnosed with benign prostatic hypertrophy last year, and my doctor said at the time that there was no need for immediate treatment. Is it OK to wait to see a doctor again until symptoms appear, or would that be too late? Does treatment for it mean I will need surgery?
ANSWER: When benign prostatic hypertrophy, or BPH, doesn’t cause any symptoms, it’s fine to postpone treatment. If you begin to notice urinary symptoms, though, talk to your doctor. Typically, treatment is based on how bothersome symptoms are and how much they affect your daily activities. Surgery may be necessary to treat BPH in some cases, but medication generally is used first and is often effective in successfully managing this condition.
BPH is enlargement of the prostate gland that’s not related to cancer. It’s a common condition in men as they age. BPH may cause symptoms such as a frequent or urgent need to urinate, difficulty starting urination, weak urine stream, a stream that stops and starts, increased urination at night, or inability to empty the bladder completely.
BPH tends to progress over time as the prostate grows larger. Not everyone diagnosed with BPH develops symptoms, though, and the size of the prostate is not necessarily linked to specific symptoms. For example, some men with only slightly enlarged prostates may have significant symptoms, while other men with substantially enlarged prostates have only minor urinary symptoms. In some cases of BPH, symptoms eventually stabilize and may even improve over time.
Treatment for BPH is focused on managing symptoms, so delaying treatment until symptoms appear won’t negatively affect the outcome of that treatment. Some men with only mild symptoms opt not to have any treatment.
Self-care steps, such as limiting beverages in the evening, scheduling regular bathroom breaks throughout the day, limiting alcohol and caffeine, exercising regularly and eating a healthy diet, can be useful in controlling mild BPH. If symptoms begin to interfere with your daily routines, it’s likely your doctor will recommend treatment for BPH.
Medication is the most common treatment for mild to moderate BPH. Your doctor may prescribe a drug from a class of medications called alpha blockers. They relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Another group of medications, called 5-alpha reductase inhibitors, can be used to shrink your prostate by preventing hormonal changes that cause prostate growth. In some cases, taking an alpha blocker and a 5-alpha reductase inhibitor at the same time can be helpful if those medications alone aren’t effective.
If BPH symptoms become severe, or if medication is not enough to manage your symptoms, a surgical procedure may be recommended. A variety of procedures can be used to treat BPH. Most of them involve removing or destroying excess prostate tissue.
Possible side effects from prostate surgery depend on the type of procedure you have. In general, complications may include temporary difficulty with urination, urinary tract infection, bleeding, semen flowing backward into the bladder instead of out through the penis during ejaculation, erectile dysfunction, and, very rarely, loss of bladder control.
At this time, however, you don’t need to make any treatment decisions. Monitor your condition, and if you begin to notice any urinary symptoms, talk to your doctor. The two of you can then decide how best to manage BPH going forward. — Dr. Todd Igel, Urology, Mayo Clinic, Jacksonville, Florida