Liza Torborg @lizatorborg
Activity by Liza Torborg @lizatorborg
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
DEAR MAYO CLINIC: My grandmother, who is 82, has no major health issues, but she’s become rather weak and frail over the past several years, and her balance isn’t very good. Several weeks ago, she fell in her bathroom. Although her injuries were minor, my family is worried. Is there something we can do to help keep her from falling again?
ANSWER: You’re wise to be concerned about your grandmother’s safety. Falls are the leading cause of injuries for older Americans. Falls not only threaten seniors’ safety, but also their independence.
Having a conversation with your grandmother is a worthwhile place to begin. She may fear falling, which can decrease her mobility within the home and participation in her community. And even though your grandmother doesn’t have any significant health concerns, it still would be a good idea for her to visit her doctor. It’s possible that her weakness and loss of balance could signal an underlying medical condition.
A physical exam and a discussion with her doctor about her overall health could reveal specific fall risk factors or a need for health care services, such as physical therapy. A physical therapist can recommend exercises that would be helpful to her. Even gentle, low-impact activities can improve strength, balance, endurance, flexibility and coordination. A physical therapist also can determine if a walker or cane could provide safer mobility.
Your grandmother’s doctor also should review any medications she’s taking to make sure those medications don’t have side effects that might contribute to a risk of falling. Review calcium and vitamin D requirements for optimum bone health. Annual vision and hearing checks are important, as well.
To help your grandmother prevent another fall, take a close look at the environment within her home to ensure that it’s safe. Taking basic steps to make a home safer can go a long way toward lowering the risk of falls. That includes eliminating tripping hazards by removing boxes, newspapers, electrical cords and phone cords from walkways. Take coffee tables, magazine racks, plant stands and coat racks out of high-traffic areas. Secure loose rugs with double-faced tape or a slip-resistant backing — or simply remove the rugs. Repair any loose floorboards or carpeting. Store clothing, dishes, food and other frequently used items within easy reach.
Lighting within the home also can make a big difference. Along with keeping her home well-lit during the day, your grandmother could put nightlights in her bedroom, bathroom and hallways, and place a lamp close to her bed. You may want to consider installing glow-in-the-dark or illuminated light switches, so they are easy to find in low light. Pathways to those switches should be clear of tripping hazards.
Because you mention that weakness and balance are issues for your grandmother, make sure her home is well-suited for easy mobility. For example, there should be handrails on both sides of the stairways and nonslip treads on steps made of wood or other slick surfaces.
The bathroom can be a particularly risky area, but making a few adjustments can help. A raised toilet seat or a toilet with armrests can make it easier to get up and down without losing balance. In the shower or tub, installing nonslip mats, grab bars, a sturdy plastic seat and a handheld shower nozzle to use while sitting down can make it less likely your grandmother will slip and fall while bathing.
Many communities now have fall prevention programs specifically designed to help seniors reduce their risk of falling. Often offered as group classes, these programs usually focus on education, exercise, balance and fitness. It sounds like your grandmother could benefit from such a program. To find out if there is one in your area, ask your grandmother’s doctor, or contact your local Area Agency on Aging for more information. — Connie Bogard, P.T., Ph.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My sister, who is 56, recently was diagnosed with early-stage endometrial cancer. I’m wondering if this kind of cancer runs in families. Could I be at risk for it, too? Are there other things that can raise a woman’s risk for endometrial cancer? Are there any screening tests available for it?
ANSWER: An increased risk for endometrial cancer can run in families in some cases, but it’s rare. More commonly, this kind of cancer is linked to risk factors such as obesity, age and having other underlying medical conditions. At this time, no screening test is available for endometrial cancer. Researchers are, however, studying a test that could help detect this type of cancer in its earliest stages.
Endometrial cancer begins in the uterus, within the layer of cells that form the uterine lining, called the endometrium. You may sometimes hear endometrial cancer referred to as uterine cancer.
As in your sister’s case, endometrial cancer often is found when it’s still at an early stage. That’s because the most common symptom, abnormal vaginal bleeding, usually prompts a woman to see her doctor. If endometrial cancer is discovered early, surgically removing the uterus typically offers a cure.
Endometrial cancer on its own is not a disease you inherit. However, a genetic disorder known as Lynch syndrome that is passed down through families has been shown to increase the risk of developing endometrial cancer, as well as other cancers of the colon, stomach, kidney, small intestine, liver and sweat glands. If you’re concerned about a family history of these kinds of cancers, discuss it with your doctor to see if genetic testing might be appropriate.
In most cases, though, factors other than family history play a larger role in raising a person’s risk for endometrial cancer. Some of the most significant include medical conditions that change the balance of the hormones estrogen and progesterone in your body. Examples of such conditions include obesity, polycystic ovary syndrome and diabetes. Fluctuations in the balance of these hormones cause changes in the endometrium. Having high blood pressure or high cholesterol can raise your risk for endometrial cancer, too.
Women who have never been pregnant, those who started menstruation at an early age or who go through menopause at a later age, and women who have had hormone therapy for the treatment of breast cancer all are at an increased risk for endometrial cancer. Age is a factor, as well. Endometrial cancer most often affects women after they have gone through menopause.
Right now, there isn’t a noninvasive way to check for endometrial cancer. When symptoms appear, a sample of the endometrial tissue has to be surgically removed and examined, or biopsied, to determine whether a woman has endometrial cancer.
But a clinical trial is underway at Mayo Clinic that’s studying the effectiveness of collecting and examining samples of uterine fluid via a tampon for diagnosing endometrial cancer. The study currently has more than 1,000 participants. If the results show promise, it may offer a new, less invasive way to identify this cancer quickly.
If you are worried about endometrial cancer or if you notice any abnormal vaginal bleeding — such as bleeding after menopause, bleeding between periods or unusual blood-tinged discharge — make an appointment to see your doctor to have it evaluated. In most cases, when endometrial cancer is caught early, it is a highly treatable disease. — Dr. Jamie Bakkum-Gamez, Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I just turned 30 and recently was diagnosed with Hashimoto’s thyroiditis. I’m wondering about whether it can be cured or if I will have to take medication for the rest of my life. I’ve read the Autoimmune Protocol (AIP) diet may help. Is this true? Do you have any suggestions for managing symptoms?
ANSWER: Hashimoto’s thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto’s thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto’s, but a specific diet alone is unlikely to reverse the changes caused by the disease.
Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. The hormones that the thyroid gland makes — triiodothyronine (T3) and thyroxine (T4) — affect 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.
Hashimoto’s thyroiditis develops when your body’s immune system mistakenly attacks your thyroid. It’s not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It’s possible that a genetic predisposition also may be involved in the development of this autoimmune disorder.
A chronic condition that develops over time, Hashimoto’s thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness.
If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms.
You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren’t natural to the human body, and they potentially can cause health problems. The American Thyroid Association’s hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism.
Although hormone replacement therapy is effective at controlling symptoms of Hashimoto’s thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year.
If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it’s possible those symptoms could be a result of something other than Hashimoto’s thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy.
A healthy lifestyle that includes eating well, getting plenty of sleep, exercising regularly and limiting stress can benefit your immune system, and could contribute to an improvement in your immune health. However, there’s no evidence that following one diet in particular is an effective treatment for autoimmune disorders such as Hashimoto’s thyroiditis. If you have questions about diet or other lifestyle choices you can make to improve your health when you have Hashimoto’s, please talk to your doctor. — Dr. Victor Bernet, Endocrinology, Mayo Clinic, Jacksonville, Florida
DEAR MAYO CLINIC: I’m 72 and have worn hearing aids for about a decade. Over the past several years, my hearing seems to be getting worse. Although I’ve tried several different kinds of hearing aids, I can’t hear well with them anymore. A friend suggested I ask my doctor about a cochlear implant. I thought those were just for people who are deaf. Could a cochlear implant help someone like me? How does it work?
ANSWER: It’s possible that a cochlear implant could be a good alternative to hearing aids in your situation. When they were introduced in the 1980s, it’s true that cochlear implants mainly were used for people who had complete hearing loss. Today, however, they often are used to help people who have more advanced hearing loss that cannot be corrected with hearing aids.
Your ear has three areas: the outer, middle and inner ear. Sound waves pass through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones of the middle ear transmit the vibrations as they travel to the inner ear. Within the inner ear, the vibrations pass through fluid in a snail-shaped structure, called the cochlea.
Attached to nerve cells in the cochlea are thousands of tiny hairs that help translate sound vibrations into electrical signals that are sent to your brain through your auditory nerve. The vibrations of different sounds affect these tiny hairs in different ways, causing the nerve cells to send different signals to your brain. That's how you distinguish one sound from another.
In most people who develop hearing loss, the hairs in the cochlea are damaged or missing, usually as a result of aging and exposure to loud noise, or for genetic reasons. That means the electrical signals can’t be transmitted efficiently to the brain, and the result is hearing loss. A cochlear implant bypasses hair cells that don’t work anymore and gives the brain the ability to perceive sound once again.
The implant has two main pieces: an external processor that fits behind your ear and an internal receiver implanted under the skin behind your ear. The processor captures and processes sound signals and then sends those signals to the receiver. The receiver sends the signals to tiny electrodes that are placed directly into the cochlea when the device is implanted. Those signals are received by the auditory nerve and directed to your brain. Your brain interprets those signals as sounds. All of the parts of a cochlear implant are small, and the processor that fits behind your ear looks somewhat similar to a hearing aid. Because of the small size of these devices, they are relatively inconspicuous, particularly in people with long hair.
Cochlear implantation requires a relatively short outpatient surgical procedure. A small incision is made behind the ear to insert the device. Most people experience little discomfort from the surgery, and its overall risk is low. The device usually is turned on several weeks following surgery. After the device is turned on, you will be able to hear; however, hearing improvement continues for six months to a year after surgery.
Cochlear implants are a well-established technology. At first, physicians and researchers only recommended them for people who had total hearing loss. Over the years, though, research has shown that cochlear implants can be useful for people who still have some hearing. They can be particularly helpful for people who have difficulty understanding speech in everyday listening situations, despite using good hearing aids.
Talk to your doctor or a medical professional who specializes in hearing loss to find out if you would be a good candidate for a cochlear implant. The great majority of people who receive a cochlear implant find that they are able to communicate better with the people around them and more fully participate in conversations and other daily activities that require the ability to hear clearly. — Dr. Matthew Carlson, Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My daughter was diagnosed with breast cancer at 54 and had surgery to remove one breast. Her surgeon told her that it wasn’t necessary to remove both breasts, because she was not at high risk for developing cancer on the other side. How can that be true? Isn’t a recurrence likely if she still has breast tissue on the other side?
ANSWER: The fact that your daughter developed cancer in one breast doesn’t mean she is at high risk to develop cancer in the other breast. Her risk of developing a new cancer in the breast that remains after surgery is lower than most people think (around 0.2 to 0.6 percent per year). And the risk that the breast cancer will come back in a different part of her body is not changed, whether or not her healthy breast is removed.
The technical term for this procedure — surgically removing a healthy breast in a woman with breast cancer — is called a contralateral prophylactic mastectomy, or CPM. Many women diagnosed with breast cancer opt to have CPM, because they believe it just makes sense to remove both breasts when cancer is detected in one.
Research has found, though, that for women with an average risk of breast cancer, CPM doesn’t prolong life, nor does it change the risk of cancer coming back. In fact, for this group, studies show that, even though they have cancer in one breast, the risk of cancer developing in the other breast is still relatively low. For these reasons, the American Society of Breast Surgeons recently recommended against CPM for average-risk women with cancer in one breast.
Generally speaking, a woman is considered to be at average risk for breast cancer if she does not have a strong family history of the disease; does not have a gene that predisposes her to developing breast cancer, such as BRCA1 or BRCA2; and does not have a history of radiation therapy to the chest wall at a young age. If your daughter had any of these, it’s likely her breast cancer risk would be considered high, and a CPM may be recommended.
Part of the reason for recommending against CPM in average-risk women is that the procedure itself comes with risks of its own. When you have CPM, the risks of bleeding and infection due to surgery are double what they would be if you had a mastectomy only on one side. That’s because there are two surgical sites, rather than one. Given the lack of survival benefit or improvement in cancer outcomes with CPM in average-risk women, undergoing surgery and exposing yourself to those surgical risks may not be worth it.
Of course, other factors beyond future cancer risk can come into play when deciding whether to have CPM. For example, when women have a mastectomy on one side and opt for breast reconstruction, breast symmetry may be a consideration. Some women prefer to have both breasts removed and reconstructed during the same surgical procedure, so the appearance of their breasts is similar. That is certainly a valid topic to discuss with your surgeon if you’re considering CPM. There are alternatives for the other breast to achieve symmetry, including breast reduction or breast augmentation, that preserve breast sensation.
The bottom line is that women who are considering CPM should have a detailed conversation with their surgeons about what they want to achieve with the surgery. If the goal is to prolong survival or lower future cancer risk, then CPM may not be the right choice. But that is not to say no one who falls in the average-risk category should ever have the procedure. Just make sure that going through with CPM can realistically meet your long-term objectives. — Dr. Judy C. Boughey, Surgery, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Is seasonal affective disorder considered depression? If so, should I be treated for it year-round even though it comes and goes?
ANSWER: Seasonal affective disorder, or SAD, is a form of depression. Year-round treatment with medication for SAD may be recommended in some cases. But research has shown that, for many people with a history of SAD, treatment with a light box beginning in early fall can be useful in preventing SAD. Medication starting at that time may be helpful, too.
SAD is a type of depression that primarily affects people during the fall and winter months. The lower levels of sunlight in the winter and fall, particularly in locations farther from the equator, can disturb your internal clock. This disruption may lead to feelings of depression. The change in seasons also can influence your body’s melatonin and serotonin — natural substances that play a role in sleep timing and mood. When combined, these factors may lead to SAD.
SAD is more than just feeling blue as the days get shorter or having the doldrums in January. Instead, it involves persistent, pervasive symptoms of depression during wintertime. Those symptoms may include feeling sad, angry or easily irritable most of the day nearly every day; lack of interest in activities you usually enjoy; difficulty concentrating; persistent tiredness; lack of energy; and, in some cases, feeling that life isn’t worth living or having suicidal thoughts.
People with SAD often feel the need to sleep considerably more than usual. SAD generally causes people to want to eat more, too, and they often gain weight. Carbohydrate cravings are common. SAD symptoms may get worse as winter progresses. By definition, the symptoms fade as daylight lengthens during springtime.
Effective treatments for SAD are available. Light box therapy is particularly useful. Light boxes mimic outdoor light by emitting a broad-spectrum ultraviolet light. The most common prescription is 30 minutes of light box use at the beginning of every morning, with the box 12 to 24 inches away. The intensity of the light box is recorded in lux, which is a measure of the amount of light you receive at a specific distance from a light source. The recommended intensity of the light typically is 10,000 lux.
Many people use light boxes while getting ready for the day, reading the paper or having breakfast. Again, starting light box therapy in early autumn may help prevent SAD from developing during the winter months.
Medication also may be part of treatment for SAD. The antidepressant medication bupropion has been approved by the U.S. Food and Drug Administration for the prevention of SAD. Other antidepressant medications may be effective, as well. These medications can be helpful for people who have a pattern of SAD and know that they are predisposed to developing it. If you’ve had SAD in the past, starting to take medication in early fall before the days get significantly shorter may prevent SAD symptoms or, if symptoms do appear, it can reduce their length and severity.
There are some self-care steps you can take all year long that may help reduce your risk of SAD, too. They include exercising regularly, maintaining healthy sleep habits and a predictable sleep/wake cycle, eating a healthy diet and limiting the amount of sugary foods you eat.
In addition, going outside on sunny days can make a difference. In the winter, when snow is on the ground, clear days can be brilliantly bright. Exposure to that natural sunlight can help ease SAD. Psychotherapy recently has been found to be effective for SAD, as well. The treatment that has shown the most success for prevention and treatment is cognitive behavioral therapy for SAD, or CBT-SAD.
If you’ve been diagnosed with SAD in the past or you suspect you have it, talk to your doctor about prevention and treatment options. Even if SAD can’t always be prevented, there are treatments available that can help you successfully manage your symptoms and make the winter months easier to take. — Dr. William Leasure, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: What do you recommend for someone who has lymphedema in the leg that doesn’t respond to wraps or compression? At what point is surgery to reduce the swelling a reasonable option?
ANSWER: The mainstay of treatment for lymphedema is conservative therapy that doesn’t involve surgery. Lymphedema treatment usually starts with wraps and compression. If that doesn’t work, other nonsurgical options are available. If there’s no improvement after thorough use of conservative treatment, then it may be necessary to consider surgery.
Lymphedema affects your lymphatic system, part of your body’s immune system. Your lymphatic system circulates lymph fluid throughout your body, collecting bacteria, viruses and waste products. It carries this fluid and these substances through your lymph vessels and into the lymph nodes. The wastes then are filtered out by infection-fighting cells in the lymph nodes.
Lymphedema happens when your lymph vessels cannot adequately drain lymph fluid. That usually happens because of damage to or removal of lymph nodes from an infection, trauma, cancer treatment or surgery. When lymph fluid doesn’t drain normally, the excess fluid builds up and causes swelling, most often in an arm or leg. If it’s not promptly and properly treated, the accumulation of lymph fluid eventually can lead to solid deposits of fat and fiber in the areas affected by lymphedema. That can make the condition more difficult to treat effectively and therefore more likely to require surgery.
Compression therapy usually is the first line of treatment for lymphedema. It involves wrapping the entire arm or leg in a snug bandage or compression garment to reduce swelling and encourage the flow of lymph fluid.
If wrapping alone isn’t enough, an approach called complete decongestive therapy may be useful. That approach includes wrapping and other techniques, such as massage, exercise and skin care, to ease swelling. Your doctor also may recommend a device that puts pressure on your limb to move lymph fluid. These compression devices usually consist of a sleeve worn over the arm or leg connected to a pump that intermittently inflates to provide pressure.
If you don’t see improvement with decongestive therapy, then surgery would likely be the next step in treatment. Some of the surgical techniques used for lymphedema must be performed when the condition is still in the fluid phase, before solids are deposited in the affected area. A delay in treatment that allows solids to accumulate may require more complex surgical approaches and can make lymphedema more difficult to treat over time.
Three surgical techniques that can be used to treat lymphedema while it’s still in the fluid stage are vascularized lymph node transfer, lymphaticovenous anastomosis and lymphaticolymphatic bypass.
The first, vascularized lymph node transfer, releases scar tissue that’s blocking the lymph fluid. It also transfers a soft tissue flap from a donor into the affected area. This flap contains lymph system components. The second surgical technique, lymphaticovenous anastomosis, connects existing lymphatic vessels to tiny veins located nearby, allowing the extra lymph fluid to drain directly into the veins. The third approach, lymphaticolymphatic bypass, connects normal functioning lymphatic vessels from a donor directly to the lymphatic vessels of the affected limb.
When lymphedema progresses to the point that solids start to accumulate in the limb, other surgical procedures must be used to remove that material. Those techniques don’t address the underlying cause of lymphedema, though, so you still need compression or other therapy after that surgery. In some cases, surgery to remove the solids can be combined with one of the other surgical techniques mentioned earlier to resolve lymphedema.
The right surgical procedure for lymphedema varies depending on your individual situation. With proper diagnosis and evaluation, however, surgical techniques can be used to treat lymphedema safely and effectively in many people when combined with integrated lymphedema therapy. — Dr. Kevin Cohoon, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: My father, who is 79 years old and in good health, has become quite forgetful. He seems to recognize that it’s happening, but laughs it off and chalks it up to old age. I know memory problems are common as people get older, but I’m worried. Should I have him see his doctor?
ANSWER: Although memory lapses are a normal part of aging, they can be a sign of an underlying medical problem. In older adults, memory problems are of concern when they affect information that is particularly important or familiar, when the lapses become more frequent, or when difficulty with memory interferes with daily activities. If your father’s situation falls into any of these categories, it would be a good idea for him to see his doctor.
As we grow older, our brains undergo numerous aging-related changes that can make it harder to learn new things or remember familiar words. Older adults may have difficulty coming up with names of acquaintances, for example, or they may have trouble finding reading glasses or car keys. In most cases, these memory lapses do not signal a problem.
The type of forgetfulness that is worrisome involves forgetting information that a person formerly would always have remembered. For example, a favorite social event gets missed, like a tee time for a weekly golf game. Or, a calendar item that an individual would usually make a priority, such as a doctor’s appointment, goes unnoticed. If this happens once in a while, it probably isn’t a problem. If a person starts to have trouble making these connections regularly, then it’s time to see a doctor.
A medical evaluation also is in order if memory lapses lead to problems in a person’s day-to-day life or if someone begins to have trouble with mental tasks. Examples include becoming overwhelmed or confused when faced with decisions, having a hard time driving, getting irritated or upset when mental concentration is required to complete a task, getting lost on the way to a familiar location, or having trouble following step-by-step instructions.
If your father goes to his doctor, an evaluation likely would include a review of his medical history and a physical exam. In addition, tests that measure cognitive function — attention, memory, language and spatial skills, among others — may be part of the assessment. In some cases, a neurological evaluation and brain scans also may be useful. The doctor may want to talk with you or other family members about your perspective on your father’s cognitive skills, functional abilities and daily behaviors, and how they have changed over time.
The purpose of this evaluation would be to screen for signs and symptoms of dementia. The doctor also will rule out reversible causes of memory loss. Keep in mind that dementia isn’t a specific disease; it’s a clinical syndrome. That means it’s a term used to describe a group of symptoms, such as memory loss, difficulty reasoning, inability to learn or remember new information, personality changes or inappropriate behavior, that affect a person’s intellectual and social abilities enough to make it hard to perform daily activities.
Dementia has a variety of possible causes, including progressive disorders such as Alzheimer’s disease and dementia with Lewy bodies. Other conditions also can mimic the symptoms of dementia, such as depression, thyroid abnormalities, infections, immune disorders and nutritional deficiencies, among many others. Prompt evaluation of a symptom such as persistent forgetfulness that could point to dementia is important for early diagnosis and identifying management strategies.
It is possible, too, that your father’s memory lapses may be just what he thinks they are: a normal part of aging. If they seem to be problematic, though, encourage him to see his doctor. A thorough assessment should be able to identify if there is a need for concern. — Dr. Ericka Tung, Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m 47 years old and have been a smoker since I was 15. I’ve tried to quit more times than I can count. My wife says I should try nicotine replacement. But that doesn’t make sense to me. I want to be done with cigarettes and nicotine. How will putting more nicotine in my body help me kick this addiction?
ANSWER: When you’re trying to get rid of a cigarette habit that’s rooted in nicotine addiction, it may seem odd to look to nicotine for help. But nicotine replacement products are safe and effective aids for people trying to stop smoking. Particularly when paired with other smoking cessation techniques, nicotine replacement often serves as a bridge to a tobacco-free life.
The nicotine in cigarettes is highly addictive. Nicotine is what hooks you on smoking and keeps you smoking. However, nicotine is not the component in cigarettes that puts your health at risk. The real danger is tobacco.
Tobacco and tobacco smoke contain chemicals that cause lung cancer, as well as cancers of the mouth, throat, esophagus and larynx. Using tobacco can lead to other serious health problems, too, such as emphysema and chronic bronchitis. Two-thirds of all tobacco users eventually die of a tobacco-related illness. The sooner you stop putting tobacco into your body, the better off you will be.
Nicotine replacement products give you nicotine without tobacco. That helps relieve the withdrawal symptoms and cravings you may have if you try to quit smoking cigarettes without nicotine replacement. For many, going from tobacco to nicotine replacement is a critical and important step to a tobacco-free lifestyle.
Nicotine replacement doesn’t reinforce a cigarette habit the way tobacco does. You don’t get as much nicotine with nicotine replacement as you do with tobacco products, and nicotine replacement makes it significantly less likely that you will return to tobacco. Not using nicotine replacement reduces your chances of breaking free from tobacco.
A range of nicotine replacement products are available without a prescription. You can buy nicotine gum, patches and lozenges at most pharmacies and drug stores. Nicotine nasal spray and inhalers are available by prescription only.
Although nicotine replacement can be useful as you quit smoking, breaking a smoking habit is still hard, especially if you try to do it on your own. The best way to quit is to seek help from your doctor or a counselor trained as a tobacco treatment specialist. He or she can help you decide on the overall approach that’s best for you.
For example, along with nicotine replacement, other prescription medications may be helpful. Bupropion can help control nicotine cravings. Varenicline can reduce the pleasurable effects of smoking and lessen nicotine withdrawal symptoms.
Most health care providers also recommend behavioral therapy in addition to medication. Behavioral therapy often involves replacing old behaviors with new routines that aren’t associated with smoking.
For example, avoid places where you usually smoke. Instead, when you go out, visit places where smoking isn’t allowed. Try to spend time with people who don’t smoke or also want to stop smoking. Make it inconvenient to smoke by getting rid of your cigarettes. Chew gum while you drive, or take new routes to your usual destinations to keep your attention focused on your environment and away from smoking. If you usually have a cigarette with a cup of coffee or alcohol, drink water, soda or tea instead.
Nicotine replacement can be an integral step on the path to life without tobacco. But, to give yourself the best chance to stop smoking for good, seek help from a medical professional familiar with tobacco treatment. The effort will be well worth it, as the health benefits of not smoking are substantial, and they start accumulating almost immediately after you quit. — Dr. Jon Ebbert, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’ve been a runner since high school but was diagnosed with deep vein thrombosis (DVT) during my first pregnancy, so stopped running for a few months. I am now nine weeks pregnant with my second baby and continue to run for exercise, but I’m worried I’ll develop DVT again. Should I be concerned?
ANSWER: Because you experienced a previous episode of DVT during a prior pregnancy, you are at an increased risk for DVT recurrence during the current pregnancy. Doctors typically recommend that women in your situation receive medication to help prevent blood clots throughout pregnancy. You do not necessarily need to stop running during pregnancy, but it would be a good idea to talk with your doctor to decide what’s best for your individual circumstances.
DVT happens when a blood clot forms in a vein typically located deep within the leg or pelvis. Clots can be caused by anything that prevents blood from circulating normally, as well as from the increased tendency to clot that accompanies pregnancy — a condition known as a hypercoagulable state. DVT is serious, because, if a clot in the leg or pelvis breaks free and travels to your lungs, it can be a life-threatening emergency (pulmonary embolus).
A variety of factors can increase your risk for DVT, including pregnancy. That’s because, when you are pregnant, the pressure in the veins in your pelvis and legs increases. Other factors that can increase DVT risk include a family history of DVT, certain genetic disorders (thrombophilias), obesity, immobility, surgery, hospitalization for a medical illness, a trauma or fracture, and certain medications.
For women who have had a previous pregnancy-related DVT or those who have had a DVT associated with the hormone estrogen, taking an anticoagulant medication during pregnancy can help prevent future blood clots. To reduce the risk of a DVT most effectively, the typical recommendation is to take an anticoagulant during all subsequent pregnancies and for six weeks after a baby is born. The amount and the specific type of anticoagulant medication you need depend on a number of factors, including your weight, medical history and overall risk for developing another DVT.
Although taking an anticoagulant can lower your risk of another DVT significantly, it can’t eliminate the risk completely. To keep your risk as low as possible, take your anticoagulation medication exactly as prescribed. Lactation is permissible with most anticoagulants.
In general, regular exercise can help lower your risk of blood clots by enhancing blood flow and circulation throughout your body. Sitting for long periods of time limits blood flow and makes it more likely that a blood clot may form in one of your veins. For that reason, staying active during pregnancy is important, especially for patients with a history of DVT. Anecdotal recommendations include getting up and moving every one to two hours to promote blood circulation.
If you would like to keep running, discuss it with your obstetrician. He or she can help you decide on an appropriate level of activity for your situation. Even if running isn’t the best choice, it’s very likely you can participate in other activities that won’t increase your DVT risk and will help you stay fit and healthy throughout your pregnancy. — Dr. Carl Rose, OB-GYN, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I’m a 56-year-old man without any health problems. Recently, I’ve noticed I don’t have the energy for physical activities that I used to. Working in the yard, riding my bike and even just doing jobs around the house all wear me out much faster now than even five years ago. My sex drive is lower, too. I see ads all the time for testosterone therapy and what a difference it can make for men my age. Should I give it a try? Is it safe?
ANSWER: Recent research shows that testosterone therapy can be useful in some cases, but it’s not right for all men. To see if it could be helpful for you, start by making an appointment with your doctor to have your testosterone level checked.
Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s bone density, fat distribution, muscle strength and mass, red blood cell production, sex drive and sperm production. For most men, testosterone peaks during adolescence and early adulthood. Then, as men get older, testosterone levels gradually fall.
If testosterone drops below a certain level, it can cause symptoms. Fatigue and low sexual interest are common. Some men also see changes in beard and body hair growth. Muscle wasting and a decrease in muscle strength can be a result of low testosterone, too.
Your doctor can use a blood test to check your testosterone level. Even if your testosterone level is found to be low, though, testosterone therapy is not automatically the answer. It’s also important to determine any potential causes or associated conditions of low testosterone before moving forward with treatment.
In some cases, medical conditions can contribute to low testosterone, including thyroid problems, obesity, obstructive sleep apnea, depression and excessive alcohol use. Some medications may cause testosterone levels to drop, as well.
As part of your evaluation, your doctor should review your current medications and check for underlying medical problems that could be contributing to your symptoms. If your testosterone is low and a medical condition is identified, treatment for that disorder may be all you need to bring your testosterone level back into the normal range. A change in medications also could make a difference.
If low testosterone isn’t due to medication or a medical problem, then taking prescription testosterone replacement may be beneficial. Numerous studies have found that testosterone may be helpful for men experiencing symptoms as a result of low testosterone. In many cases, however, the effects are modest. In men with normal levels of testosterone, taking prescription testosterone generally has no effect for most symptoms.
In addition to easing symptoms of low testosterone, prescription testosterone may have other benefits, including reducing fat mass, improving lean muscle mass, strengthening bones and improving insulin sensitivity.
Taking prescription testosterone does have risks. It may cause production of more red blood cells (a condition known as polycythemia); increase prostate-specific antigen, or PSA, in the blood; enlarge breasts; or reduce sperm production. Testosterone therapy does not cause cancer, including prostate cancer. If your doctor recommends that you take testosterone, you need regular blood tests to make sure the prescribed dose is correct, as too much testosterone potentially can lead to other medical problems.
Although most studies suggest that testosterone therapy does not increase the risk of heart attacks or stroke, and that it may even be protective in some cases, there is not enough information to prove its safety conclusively among elderly men with cardiovascular risk factors.
To see if testosterone therapy may be right for you, make an appointment to see your doctor and assess your symptoms. He or she can do a thorough evaluation and help you decide what, if any, treatment you may need. — Landon Trost, M.D., Urology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I rarely use table salt anymore when cooking. Instead, I like to use sea salt. But I've noticed that a lot of sea salts don’t contain iodine. Do I need iodized salt, or are there sources of iodine other than salt that are likely giving me all of the iodine I need?
ANSWER: For most people, iodized salt is probably the easiest way to maintain sufficient iodine intake. Iodine is an important nutrient that your thyroid needs to produce certain hormones. Not getting enough iodine in your diet can lead to problems such as an enlarged thyroid gland (goiter) and an abnormally low level of thyroid hormones (hypothyroidism).
Iodine is a trace element present in the earth. Distributed variably around the world due to the effects of the ice age, iodine has accumulated primarily in coastal areas. The most common dietary sources of iodine are seaweed, fish and dairy products. Inland areas have fewer natural sources of iodine. In the U.S., areas where iodine deficiency was common in the early 1900s —the Great Lakes, Appalachians and Northwest — were known as the “goiter belt.” Researchers from these areas encouraged the U.S. to adopt table salt iodization as an inexpensive, yet universal, way of providing iodine supplementation. Although salt iodization never was made mandatory, estimates are that more than 90 percent of U.S. households today have access to iodized salt.
Other sources of dietary iodine include eggs, enriched grain products and plant foods grown in iodine-rich soils. Unfortified sea salt contains only a small amount of iodine.
Still, it’s hard to determine precisely how much iodized salt contributes to an individual’s iodine levels. Iodized salt in the U.S. contains 45 micrograms of iodine per gram of salt. The recommended daily intake for adults is 150 micrograms, which can be obtained from about one-half to three-quarters of a teaspoon of table salt. Testing of the general population indicates that most Americans consume sufficient levels of iodine through their diets. Pregnant women and nursing mothers are the only groups in the U.S. that are advised to take a daily iodine supplement, usually as part of a prenatal vitamin.
Depending on where you live and how much seafood you eat, you may not want to substitute all of your table salt with sea salt. However, that shouldn’t stop you from using sea salt when you want that particular flavor. Be cautious with the amount, however, as all salt is high in sodium. (adapted from Mayo Clinic Health Letter) — Katherine Zeratsky, R.D.N., L.D., Endocrinology/Nutrition, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: I went through menopause a few years ago and didn’t have any of the usual signs or symptoms. But, lately, I'm finding that my vaginal area is extremely dry, and sex is becoming uncomfortable ─ even with a lubricant. Are there other options?
ANSWER: Your situation is common. Menopause can trigger a wide variety of symptoms, but not everyone has all of them, and different symptoms of menopause tend to develop at different times. Vaginal dryness often doesn’t appear until a year or two after the last menstrual cycle. You have several options, in addition to a lubricant, that can ease your discomfort.
When you go through menopause, your body experiences a significant drop in the amount of the hormone estrogen it makes. The loss of estrogen can lead to a number of symptoms that affect the urinary tract and genital area.
Those symptoms may include burning with urination, an increase in urinary frequency, an urgent need to urinate, incontinence associated with urgency, increased risk for urinary tract infections, and vaginal dryness, itching or burning. In addition to being drier after menopause, vaginal tissues often become thinner and less elastic. Because of these changes, sex may not only be uncomfortable, it may be painful. Together, all of these symptoms are known as genitourinary syndrome of menopause, or GSM.
According to the North American Menopause Society, up to 45 percent of women have symptoms of GSM after menopause, including painful sex due to vaginal dryness. Less than a quarter of those women go to their medical providers to try to do something about it. But, help is available.
You mention that you use a vaginal lubricant. That over-the-counter product is designed to be applied before sexual activity to make sex more comfortable and pleasurable. When a lubricant is not enough, consider using a vaginal moisturizer, too. This product is also available without a prescription at most drug stores and pharmacies. You apply it once every two or three days to maintain vaginal moisture.
If you use a moisturizer and a lubricant, but sex is still uncomfortable or painful, make an appointment to talk to your medical provider about prescription therapies for vaginal dryness. He or she may recommend treatment with low-dose vaginal estrogen. It comes in several forms, including a cream you apply twice a week, tablets placed into the vagina twice a week, and a ring that’s inserted in the vagina and replaced every three months.
Another option is an oral medication called ospemifene. It’s a selective estrogen receptor modulator, or SERM, that’s approved for treating painful intercourse associated with GSM. While this medication is an option for most women, it isn’t recommended for women who have breast cancer or are at high risk of developing breast cancer. Your medical provider can help you find a treatment for vaginal dryness based on your symptoms and personal preferences, as well as your medical and family history.
Your medical provider also can talk with you about any other menopause symptoms you may have and discuss ways to ease those, as well. Hormone therapy, which remains the most effective treatment for hot flashes and night sweats related to menopause, is appropriate for many women. Its use depends on your age, how long it’s been since menopause began, and your personal health history, among other factors. In a conversation with your medical provider, you can sort through what’s best for you. — Dr. Stephanie Faubion, Women’s Health Clinic, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Does Botox work on deep forehead wrinkles, or do you have to catch them early for it to make a big difference? Is long-term use safe? What happens if I have the injections regularly for a few years, but then quit? Will my forehead look worse than if I had never gotten Botox?
ANSWER: All forms of Botox injections approved by the U.S. Food and Drug Administration for forehead wrinkles are intended for people 65 and younger. Beyond that, the medication may not be as effective as it is for younger individuals. Botox is safe to use long term, and you can stop using it at any time without your skin looking worse than it did before you started Botox. When used for cosmetic purposes, medical insurance does not cover Botox treatments.
Botox injections use forms of botulinum toxin to paralyze muscle activity temporarily. This toxin is produced by the bacterium that causes botulism, a type of food poisoning. Botox injections are popular for reducing the appearance of facial wrinkles. The injections are used to treat other medical conditions, too, such as repetitive neck spasms, excessive sweating, overactive bladder and lazy eye. The injections also may help prevent chronic migraines in some people.
Botulinum toxin injections block certain chemical signals from nerves, mostly signals that cause muscles to contract. This temporarily relaxes the facial muscles that underlie and cause wrinkles, including forehead furrows. Studies show that people who receive the most benefit from the injections are 65 and younger.
That is not to say, however, that people older than 65 can’t or shouldn’t use Botox. But, it is important to recognize that the results may not be as effective as in a younger population. For older adults to achieve the same results as younger patients, Botox should be used in combination with facial fillers injected into the skin to soften wrinkles.
For Botox injections, your health care provider uses a thin needle to inject tiny amounts of botulinum toxin into your skin. The number of injections you need will vary, depending on a variety of factors, including the size of the area being treated. Botulinum toxin injections usually begin working a few days after treatment. The effect may last up to three months or longer. To maintain the benefits of Botox, you need regular follow-up injections.
Botox has been shown to be safe for both short- and long-term use. Data for treatment of wrinkles with Botox only go back about 15 years. However, Botox for wrinkles uses a much smaller dose than patients receive for other conditions, such as muscle spasticity. Significant safety concerns have not been identified in people who receive larger doses of Botox for those other problems ─ further supporting its safety.
To ensure your safety, you should only receive Botox under the care of an experienced health care provider, such as a board-certified dermatologist, plastic surgeon, eye plastic surgeon or otolaryngologist who has personally examined you. These subspecialists have the most expertise to minimize complications and treat them if a complication occurs. Botox can be dangerous if it's given incorrectly. Although uncommon, Botox injections can produce side effects, including pain, swelling or bruising at the injection site, headache, flu-like symptoms, and eye dryness or excessive tearing, among others.
If you decide to stop using Botox, your forehead wrinkles will go back to the way they looked before you started the injections. Your face will not become more wrinkled as a result of Botox. Muscle strength and movement in your forehead also will return to normal when you discontinue Botox use. — Alina Bridges, D.O., Dermatology, Mayo Clinic, Rochester, Minnesota
DEAR MAYO CLINIC: Six months ago I was diagnosed with a groin hernia. At the time, my doctor said that eventually I'll need surgery, but it doesn't bother me, so I have not been back. Is surgery always necessary, or do some hernias go away on their own? Is it dangerous to ignore it?
ANSWER: Abdominal hernias are common and not necessarily dangerous. But, a hernia doesn’t usually get better on its own. In rare circumstances, it can lead to life-threatening complications. Consequently, surgery is usually recommended for a hernia that’s painful or becoming larger.
An abdominal hernia occurs when part of an organ or tissue bulges through a weak spot in the wall of muscle that surrounds your abdomen. Some hernias don’t cause any symptoms, and people might not even know they have one until their doctor discovers it during a routine medical exam. More often, it's common that patients can see and feel the bulge created by the hernia. The bulge is usually more obvious when you’re standing upright or straining. You might feel pain, weakness or pressure in the affected area.
There are two different types of groin hernias: inguinal and femoral. Inguinal hernias are some of the most common hernias, occurring more often in men. The weak spot is in the inguinal canal. In men, this is where the spermatic cord exits the abdomen and enters the scrotum. In women, the inguinal canal carries a ligament that helps hold the uterus in place. Often, an inguinal hernia is present at birth — especially for boys — but it may develop later in life due to factors such as aging muscles, strenuous activity or chronic coughing.
Femoral hernias are far less common and are more often seen in older women. They form along the canal that carries the principal blood vessels (femoral artery and vein) into the thigh. This hernia usually produces a bulge that’s slightly lower than an inguinal hernia.
Even though your hernia isn’t causing any symptoms, it's important that you have it regularly evaluated by your doctor. He or she will want to keep an eye on it and reassess the situation ─ even if it becomes just slightly uncomfortable. Some people wear a supportive belt or undergarment to hold the hernia in, but this isn’t a long-term solution.
Fatty tissue in the abdomen is usually the first tissue to exit the hernia. This is beneficial, because it plugs the hole. Problems arise when part of an organ ─ typically the intestine ─ pushes through the weakened muscle and becomes trapped on the outside (incarcerated). You can tell when this happens, because the hernia can’t be returned into the abdomen by application of gentle pressure. It typically causes constant discomfort.
An incarcerated abdominal hernia may prevent passage of contents through the intestine (bowel obstruction). The hernia also may be cut off from the body’s blood supply ─ a risk that increases with age. This can lead to gangrene, a life-threatening condition requiring immediate surgical attention. See your doctor promptly if you can’t push the hernia back in with gentle pressure, or you experience increased pain, nausea, fever, swelling or darkening of the skin over the hernia.
The best treatment for bothersome abdominal hernias is an operation to push back the protruding organ or tissue into the abdomen and reinforce the weakened muscles. Sometimes, this involves placing a synthetic or biological mesh against the weakened area to help with reinforcement.
Some evidence suggests that laparoscopic surgery, which involves inserting surgical instruments through several small incisions, results in quicker recovery. But, conventional open surgery may be appropriate with hernias that are larger or more difficult to treat. If you require surgery to fix the hernia, your doctor will be able to help you determine which type is best for your specific situation. (adapted from Mayo Clinic Health Letter) — Kristi Harold, M.D., General Surgery, Mayo Clinic, Phoenix