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