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ANSWER: Metabolic syndrome and diabetes are not the same, but the two are related. When a person is diagnosed with metabolic syndrome, it means he or she has several conditions that, if left untreated, significantly raise the risk for developing diabetes. Metabolic syndrome also increases the risk for heart and blood vessel problems. Treatment for metabolic syndrome typically focuses on healthy lifestyle changes.
Although the specific definition health care providers use may vary somewhat, metabolic syndrome generally includes having three or more of the following characteristics: a large waistline, a high triglyceride level, low HDL cholesterol (also called “good” cholesterol), high blood pressure, and blood sugar that is higher than normal, but not high enough to qualify as diabetes.
High blood sugar is the hallmark sign of diabetes. When a blood sample is taken after a person fasts overnight and blood sugar measures 80 to 100 milligrams per deciliter, or mg/dL, that level is considered normal. A fasting blood sugar measurement of 126 mg/dL or higher on two separate tests is considered diabetes. The range between the two — 100 to 125 mg/dL — is referred to as prediabetes. The blood sugar level of people who have metabolic syndrome often falls into the prediabetes range.
After a diagnosis of metabolic syndrome, the first step in treatment usually involves making lifestyle changes. Many people who have metabolic syndrome are overweight. Getting to and staying at a healthy weight can make a big difference in reducing the risk of health problems associated with metabolic syndrome.
Losing weight may help lower blood pressure, blood sugar and triglyceride levels. It also can help reduce waist size. That’s important because studies have shown that carrying a lot of weight around your abdomen raises the risk of developing diabetes, heart disease and other complications of metabolic syndrome. To reduce the risk, doctors generally recommend a waistline of less than 35 inches for women and less than 40 inches for men.
Regular exercise can help with weight loss, as well as improve some of the medical concerns associated with metabolic syndrome. A good goal is 30 minutes or more every day of activity that is moderately intense, such as brisk walking, swimming or biking.
Healthy eating is a crucial component of treatment for metabolic syndrome. Encourage your mother to talk with her doctor or to a dietitian about the right diet for her situation. Two diets that are often recommended for people with metabolic syndrome include the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet. Similar to many healthy-eating plans, these diets limit unhealthy fats and focus on fruits, vegetables, fish and whole grains. Beyond weight loss, studies have shown that both diets offer important health benefits for people who have components of metabolic syndrome.
Finally, if your mother smokes, it’s very important that she stop. Smoking cigarettes can make many of the health complications of metabolic syndrome worse. It also can significantly raise the risk for other illnesses and diseases. If needed, your mother’s doctor can work with her to help her stop smoking and connect her with other resources to support her as she quits.
If lifestyle changes are not enough to control metabolic syndrome, medication also may be part of the treatment plan. Medicine to control blood pressure, manage triglycerides and lower blood sugar can be useful in treating some cases of metabolic syndrome. — Dr. Robert Rizza, Endocrinology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: I am 49 and in good health but am concerned about osteoporosis since I went through menopause at an early age (44). Are weight-bearing exercises sufficient to prevent osteoporosis, or should I also take calcium supplements? Should I have a bone density test earlier than the typical recommended age of 65?
ANSWER: Menopause does increase your risk of osteoporosis. Exercise may help lower that risk. Getting enough calcium and vitamin D can make a difference, too. Your doctor can assess your diet to see if you need supplements. To help you understand your overall risk of developing osteoporosis, an early bone density test may be useful in your situation.
Your body regularly makes new bone and breaks down old bone. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass in their mid-20s to mid-30s. The higher your peak bone mass, the more bone your body has to sustain bone health throughout the rest of your life.
Osteoporosis risk rises with age because as you get older, you lose bone faster than your body can make it. Osteoporosis occurs when the body’s creation of new bone can no longer keep up with the breakdown of old bone. Bones then become weak and brittle and can break easily. Menopause raises your risk of osteoporosis because during the first few years after menopause, women tend to lose bone density at a rapid rate.
Regular exercise may help slow bone loss. A combination of strength training exercises with weight-bearing exercises is usually best. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope or skiing — have a positive effect on the entire skeleton, and particularly benefit the bones in your legs, hips and lower spine.
Getting enough calcium and vitamin D in your diet also can help keep your bones healthy. Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. That increases to 1,200 milligrams when women turn 50 and when men turn 70. But because you have already gone through menopause, your calcium requirements may be at the higher level even though you’re still in your 40s.
Good sources of calcium include low-fat dairy products, dark green leafy vegetables, canned sardines with bones, canned salmon and soy products. Many cereals and juices are calcium-fortified. If you can’t get enough calcium in your diet, your doctor may recommend a supplement.
Vitamin D is necessary for your body to absorb calcium. Many people get all the vitamin D they need from sunlight. To make sure, your doctor can do a blood test to determine your vitamin D level. If it is too low, you may need a vitamin D supplement. At your age, the recommended daily intake of vitamin D or exposure to it via sunlight is 600 international units.
A bone density test is one way to check the health of your bones. It measures how many grams of calcium and other bone minerals are in a segment of your bone. The higher the bone mineral content, the denser the bones are. The denser the bones are, the stronger they generally are and the less likely they are to break.
In women who have never broken a bone and who don’t have other osteoporosis risk factors, a bone density test to screen for osteoporosis is recommended at age 65. Because you are post-menopausal in your 40s, it’s likely you will need this test sooner even if you haven’t had a bone fracture. Depending on your level of osteoporosis risk, it could be as soon as age 50. Talk to your doctor to find out what’s best for you. — Dr. Bart Clarke, Endocrinology, Mayo Clinic, Rochester, Minn.
ANSWER: Investigational drugs are those allowed by the Food and Drug Administration (FDA) to be tested in clinical trials. Often, they are somewhere in the process of being studied for safety, effectiveness and intended use. By far, the most common way that people receive access to investigational drugs is by taking part in a clinical trial.
Your doctor may know about some clinical trials related to your specific circumstances. In addition, you or your doctor can search clinical trial databases at the National Institutes of Health (www.clinicaltrials.gov) or at the National Cancer Institute (www.cancer.gov/clinicaltrials/search).
Less commonly, people may qualify for access to an investigational drug outside of a clinical trial in what’s known as expanded access, or “compassionate use.” Expanded access is designed to allow people with serious diseases or conditions and life-threatening problems — and usually no further treatment options — access to promising investigational drugs that aren’t unreasonably risky. The drugs are not approved by the FDA and aren’t proven to be safe and effective.
However, there are a number of hurdles to clear. The drug manufacturer has to be willing and able to provide the drug. There may be numerous reasons why a drug company wouldn’t do this. If the drug is available, your doctor will need to submit an application to the FDA for review and approval. The protocol to use the investigational drug is reviewed by a review board to protect research participants. Your doctor may not agree to do this if the drug is unlikely to provide benefit, or if the drug can’t be properly administered or managed.
If you do obtain access to an investigational drug, an additional factor is cost. A drug company may or may not charge for the drug, but a health care provider is likely to charge for administering and monitoring of the drug. Insurance companies often don’t cover costs of an investigational drug. (adapted from Mayo Clinic Health Letter) — Christine Formea, Pharm.D., R.Ph.
DEAR MAYO CLINIC: How is it that children who have been vaccinated against pertussis still end up with the disease? Was the vaccination they received not effective? There are many new cases of it in our school, and adults are being told to get a booster. Is this just to protect children, or can adults get the disease as well?
ANSWER: The vaccine against pertussis, or whooping cough, is effective; however, the immunity the vaccine generates tends to weaken over time. To counter this, boosters of the pertussis vaccine are recommended for children as they get older. Adults can get pertussis, too. For the best protection again this infection, and to help keep it from spreading, adults who are regularly in close contact with young children should get a vaccine booster.
Pertussis is a highly contagious bacterial infection that causes a severe, hacking cough. The coughing spells can be followed by a high-pitched intake of breath that sounds like a “whoop” and gives the disease its name. Coughing spasms can cause extreme fatigue and vomiting. They also can make it hard to breathe. In babies, the disease is often serious because infants’ airways are small, and they may have trouble breathing in enough oxygen during these coughing spells. Severe coughing can also generate small hemorrhages in the eyes and brain.
Vaccination is the best way to prevent pertussis. Infants should be vaccinated at 2, 4 and 6 months of age. The pertussis vaccination is given in combination with tetanus and diphtheria vaccines. It’s abbreviated as DTaP for diphtheria, tetanus and pertussis. Boosters are recommended at 12 to 18 months, 4 to 6 years, and again at age 11. Pertussis booster shots are available for adults, too. They are strongly recommended for those in close contact with infants, particularly during a pertussis outbreak.
Pertussis vaccines are very safe, effective and beneficial. Before the vaccine was available, pertussis was a feared disease that killed thousands of children every year. Now, perhaps 10 to 20 pertussis deaths occur per year in the United States. Almost all of these deaths are in infants.
People of all ages can still get the disease. Since the 1980s, the number of pertussis cases has been increasing in the United States. Pertussis persists for several reasons. First, vaccinations aren’t universal. Not everyone who needs the vaccine gets it. Second, over time the vaccine’s effectiveness wanes, so adolescents and adults who don’t get a booster can develop pertussis.
Older patients typically have a milder form of the illness because they keep some immunity from their early vaccinations. Nonetheless, even those with mild pertussis are still contagious. The disease can be transmitted through germ-filled droplets propelled into the air from a cough or sneeze.
People who have pertussis are treated with a specific type of antibiotic. To prevent the illness from spreading, they need to stay home from school, day care or work until they have had five days of antibiotics. A doctor may recommend antibiotics for everyone in the household because pertussis is easily transmitted.
Antibiotics work best when given early in the course of the illness. Treatment doesn’t immediately stop the cough. Pertussis is sometimes called the 100-day cough because symptoms can linger that long.
Home care includes plenty of rest and fluids. Cough medications aren’t helpful and aren’t recommended. Infants who have pertussis may need to be monitored in a hospital to make sure they can breathe on their own after a coughing spell.
The best way to fight pertussis is to keep it from developing in the first place. All infants and children — as well as adult family members and caregivers — need to be fully vaccinated against pertussis. If you’re not sure whether you need a pertussis vaccine booster, ask your doctor to check your vaccination record and make sure it is current. — Thomas Boyce, M.D., Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: What causes postpartum depression, and is it possible to have it immediately after giving birth? Are some women more likely to have postpartum depression than others, and at what point does it require treatment? My sister does not seem like herself after having her baby a month ago, but I don’t want to offend her by suggesting she get help.
ANSWER: Postpartum depression can happen from the time a baby is two weeks old, all the way through the first year of life. It is important that women who suspect they might have postpartum depression seek help as soon as possible. If you think postpartum depression may be affecting your sister, gently suggest that she talk with her health care provider about how she’s feeling.
Women at highest risk for postpartum depression are those who had depression during the pregnancy or who have a history of postpartum depression. A number of other factors can raise a woman’s risk of postpartum depression, as well, such as a complicated pregnancy or birth, an unexpected birth outcome, a high-need baby, and unrealistic expectations of motherhood. Issues that are not directly related to pregnancy or childbirth may also increase the likelihood of postpartum depression. Examples include relationship problems with a spouse, partner or another family member; financial concerns; or lack of a social support system, among others.
New mothers often feel a wide range of emotions in the days and weeks following the birth of a baby. Mood swings, crying spells, anxiety and difficulty sleeping are all typical after a baby arrives. Often called the “baby blues,” these emotional responses usually begin within the first two to three days after a baby’s delivery and may last for up to two weeks. When those symptoms last beyond two weeks — especially if they seem to get worse over time rather than better — the condition is considered postpartum depression.
No clear cause for postpartum depression has been identified. It is likely to be a combination of hormonal fluctuations, lack of sleep and the significant lifestyle changes that come with the birth of a baby.
It’s crucial that women who have postpartum depression receive treatment, especially if they are having trouble with daily activities or if they are having difficulty bonding with the new baby. Treatment usually involves discussing feelings and concerns with an obstetrics provider or mental health professional, such as a psychiatrist or psychologist who is familiar with postpartum depression. Antidepressant medication may be helpful, too. A variety of antidepressants that are safe for breastfeeding mothers are available, so the medications do not need to interfere with nursing.
Healthy lifestyle choices also can aid in recovery. Eating a healthy diet, avoiding alcohol, exercising regularly and getting enough sleep can all help improve mood and may ease some symptoms of postpartum depression. In addition, ask your health care provider if there are support groups for new moms or parenting networks in your community.
As in your situation, it can sometimes be hard for a family member or friend to raise the topic of postpartum depression with a loved one who has just given birth. But if someone you care about seems to be struggling with difficult emotions several weeks or more after a baby is born, encourage her to talk with her health care provider. Prompt treatment of postpartum depression can make a big difference for a mother and her family. — Julie Lamppa, C.N.M., A.P.R.N., Obstetrics, Mayo Clinic, Rochester, Minn.
For more information, visit Mayo Clinic's "Pregnancy and You" blog, written by Julie Lamppa, Certified Nurse Midwife.
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 during 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: 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 to prevent SAD from developing during the winter months.
Medication also may be part of treatment for SAD. The antidepressant medication bupropion is FDA approved for the prevention of SAD. Other antidepressant medications may be effective, as well. These medications can be very helpful for people who have a pattern of SAD and who 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 has recently 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. — William Leasure, M.D., Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: What causes pericardial constriction, and why does it make me swollen? Is there anything I can do to limit the swelling?
ANSWER: Pericardial constriction is a condition with a variety of possible causes, including underlying medical conditions and may even result from certain medical treatments. Swelling, or edema, is one of the most common symptoms of pericardial constriction. That’s because the condition interferes with your kidneys’ ability to work properly. Medication can often effectively reduce swelling. Rarely, in severe cases, surgery may be needed to treat pericardial constriction.
The normal pericardium is a thin, elastic sac that surrounds the heart. Under normal circumstances, it contains a small amount of fluid that helps lubricate the heart as it moves. With pericardial constriction, the sac loses its elasticity and becomes stiff. Pericardial constriction restricts the heart’s motion and makes it harder for the heart to beat effectively. The constraint on the heart limits how much blood fills into it as the heart relaxes between beats, making the heart less efficient. When less blood than usual enters the heart, less blood than usual leaves the heart on the way to the rest of the body.
Pericardial constriction can have a significant effect on your kidneys because one of the kidneys’ jobs is to remove waste and excess fluid from the blood. Low blood flow from the heart makes it hard for your kidneys to remove all the extra fluid. The kidneys also may respond to low blood flow by retaining more fluid in an attempt to increase the available blood flow.
As fluid builds up in the blood, it results in swelling, a condition sometimes referred to as edema or anasarca. When it’s left untreated, that swelling can become severe, especially in the legs and abdomen. Other common symptoms of pericardial constriction include fatigue, shortness of breath and difficulty exercising or engaging in other physical activities.
Pericardial constriction can happen for a number of reasons. Viral infections leading to inflammation of the pericardium are one of the more common causes of pericardial constriction. It can also develop as a side effect of radiation therapy or heart surgery. Less common causes include connective tissue diseases, cancer, and complications from other types of infections. Taking certain kinds of drugs can trigger pericardial constriction, although that is rare. In some cases, the cause cannot be found, a condition known as idiopathic pericardial constriction.
Doctors diagnose pericardial constriction by reviewing your medical history and performing a physical exam. Imaging exams of the heart, such as an echocardiogram, a chest X-ray, CT scan and cardiac MRI, as well as other testing, can often be helpful in diagnosing this condition.
Treatment of pericardial constriction typically focuses on controlling the symptoms and any active inflammation of the pericardium. That often involves using diuretic medications to remove excess fluid from the body and anti-inflammatory medicines to reduce inflammation of the pericardium. Anti-inflammatory medicines useful for pericardial constriction include colchicine, non-steroidal anti-inflammatory drugs, and occasionally steroids or medicines that affect the body’s immune system, such as anakinra.
If swelling persists even when you’re taking medication for it, talk to your doctor. You may need to switch to a different type of medication. If symptoms don’t improve over time with other treatments, then surgery to remove the pericardium, called pericardiectomy, may be necessary. Few people with pericardial constriction require this procedure, however. In many cases the symptoms, including swelling, can be successfully managed with medication. — Peter Pollak, M.D., Cardiovascular Diseases, Mayo Clinic, Jacksonville, Fla.
DEAR MAYO CLINIC: I am 41 and have had regular periods (every 28 days) my entire life, until recently, when I didn’t have a period for more than two months. It was then extremely heavy and lasted much longer than is typical for me. Should I be concerned? Do I need to see my doctor about this?
ANSWER: This is a very common situation for women your age. One episode of an irregular period usually isn’t cause for concern. But from this point on, keep track of your periods. If they continue to be unpredictable or unusually heavy, or if you start to have other symptoms, such as pain, hot flashes or night sweats, please make an appointment to see your health care provider for an evaluation.
Even though the average age of menopause is around 51 years, it’s not uncommon for women to experience menstrual irregularities in the decade prior to menopause, most often during their 40s. Once you notice a change in your period, it’s a good idea to start monitoring your period closely. Write down when they happen, how often they last and how heavy they are in terms of how many pads or tampons you use in a 24-hour interval.
If after four to six months your periods are still irregular, then an assessment is in order. Your primary care provider is the best place to start. He or she can do a physical exam, order any needed testing and check for possible underlying medical conditions that could be triggering your symptoms.
Two common causes of menstrual irregularity are thyroid disorders and a disorder called endometrial hyperplasia, in which the lining of the uterus thickens. Noncancerous growths of the uterus, known as uterine fibroids, may also lead to changes in your periods. Your health care provider may also check you for anemia. It’s a condition in which the body doesn’t have enough healthy red blood cells. Anemia is a common side effect of heavy menstrual blood loss.
As you monitor your cycles over the next several months, if you have very heavy bleeding that is saturating a maxi pad or tampon in one hour or less, for more than two hours, or if you have bleeding that lasts for more than 10 days, no matter how heavy it is, contact your health care provider right away. Do the same if you notice other new symptoms, such as night sweats or hot flashes.
Also, if you have factors that raise your risk for endometrial hyperplasia, including obesity, high blood pressure and diabetes, and the irregularity continues, the amount of time you monitor your condition before you call your provider is shorter. If you are at increased risk of endometrial hyperplasia and irregularity persists for two to three months, contact your provider.
Although an underlying condition can lead to menstrual irregularities, in many premenopausal women your age, period changes are a result of reproductive aging and not a sign of a medical problem. In those cases when heavy bleeding is an ongoing issue, a variety of treatments are available to manage it. Options include nonsteroidal anti-inflammatory drugs, or NSAIDs (such as ibuprofen), oral contraceptives and a hormonal intrauterine device, among others.
For now, though, chart your periods over the next several months. Note any changes you see and, if irregularities persist, talk to your health care provider. He or she can assess your condition and recommend the next steps that are appropriate for your situation. — Petra Casey, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: Every year when I get my mammogram, the results are that the breasts are too dense to see small cancers. Why should I keep getting mammograms? Should I instead ask for an ultrasound to look for cancer? Also, are self-exams still recommended? You don’t hear much about them anymore.
ANSWER: Increased breast density can make interpreting mammograms difficult. Even if your breasts are dense, however, Mayo Clinic recommends an annual mammogram starting at age 40. Some women who are at a high risk for breast cancer may need to start screening earlier. Depending on your situation, your doctor may recommend additional screening tests, too. Breast self-exams are no longer formally recommended, but it is important for you to be familiar with your breasts’ typical appearance.
Breast tissue that is not dense contains fat and appears dark on a mammogram. Dense breast tissue is composed of milk glands, milk ducts and supportive breast tissue. Dense tissue appears white on a mammogram. There are four levels of breast density: fatty, scattered fibroglandular, heterogeneously dense and extremely dense. If you have heterogeneously or extremely dense breasts your breasts are considered “dense.” Some states require the level of breast density to be documented on your mammogram report.
Because both dense tissue and cancer appear white on mammogram images, a high level of breast density can obscure cancer on a mammogram. Mammograms, however, are still very useful for detecting breast changes that could indicate cancer, even in women who have dense breast tissue. Mammograms remain one of the most important tools in the fight against breast cancer. Studies of women in their 40s and 50s have shown that screening mammograms decrease breast cancer deaths by 15 to 20 percent.
Along with your annual mammogram, talk with your doctor about your individual breast cancer risk. Women with dense breasts may benefit from supplemental imaging, such as 3D digital breast tomosynthesis or molecular breast imaging. Women with a high risk for breast cancer may benefit from breast MRI.
Be mindful that there is a downside to some supplemental screening tests. The test could find an abnormality that requires further investigation which ultimately turns out benign, therefore subjecting you to the risk of an unnecessary medical procedure. Also, your insurance may not cover the cost of some supplemental screening studies, leaving you with an out-of-pocket expense. And finally, at this time research remains inconclusive about whether supplemental breast imaging reduces the rate of breast cancer deaths overall.
Some health care facilities do use handheld ultrasound testing to scan the whole breast. However, consistent, high-quality handheld ultrasound examinations of the entire breast are difficult to perform. Mayo Clinic does not use ultrasound as a supplemental screening tool to scan the entire breast for cancer. Mayo Clinic does use diagnostic ultrasound to investigate specific areas of the breast that look or feel abnormal or appear abnormal on a mammogram image.
In addition to screening exams, breast self-awareness can be key to catching breast cancer early. The breast self-exams that used to be routinely recommended are no longer used as part of breast cancer screening. That’s because research hasn’t shown a clear benefit. Still, you should be aware of the general appearance and feel of your breasts.
If you notice any of the following changes, report them to your doctor right away: a breast lump; a change in the texture of your breast tissue; breast skin changes, such as dimpling or redness; a change in the position of a nipple; change in breast symmetry; or discharge from a nipple.
For the best breast care, talk with your doctor about your cancer screening options. Together, you and your doctor can decide based on your individual risk factors what specific breast cancer screening tests are right for you. — Dawn Mussallem, D.O., Diagnostic Breast Specialist at The Robert and Monica Jacoby Center for Breast Health, Hematology/Oncology, Mayo Clinic, Jacksonville, Fla.
DEAR MAYO CLINIC: How do doctors determine whether or not chemotherapy or surgery is appropriate for treating pancreatic cancer? Why do some people with a late-stage diagnosis have treatment, while others are told treatment will not help their situation?
ANSWER: The treatment plan for each individual with pancreatic cancer is unique to that person’s situation and the stage of the disease when it is diagnosed. But where in the past many people were advised that no treatment was available when cancer had spread outside the pancreas, today improved chemotherapy offers new treatment possibilities for this difficult cancer.
Pancreatic cancer is uncommon compared to other kinds of cancer, such as lung, colorectal and breast cancer. Symptoms of pancreatic cancer are relatively nonspecific and can include abdominal or back pain, weight loss, new onset or worsening diabetes, and jaundice or yellowing of the skin. Smoking is the only known significant risk factor, and although a small fraction of patients have a genetic predisposition, the majority of causes are unknown. The lifetime risk of developing the disease for people in the general population is about 1 percent. Unfortunately for those who do get it, pancreatic cancer is one of the hardest kinds of cancer to successfully treat. The five-year survival rate now is just over 7 percent. [...]
DEAR MAYO CLINIC: I have heard that taking coenzyme Q10 is good for people who take statins. There are so many commercials and ads about it. But is it really necessary to take this supplement? How do I know if I need it? And is liquid better than pill form? How much do I take?
ANSWER: Although a coenzyme Q10 supplement may be helpful for some people who take a statin medication, no research studies have confirmed that it has benefits for everyone who takes statins. For most people, a diet rich in fruits, vegetables, nuts and fish is enough to keep their coenzyme Q10 at a healthy level, and a supplement is not necessary.
Coenzyme Q10 is a substance the body makes naturally. Every cell in the body needs coenzyme Q10 to help generate energy. When you take a statin medication to lower your cholesterol, it may lower the amount of coenzyme Q10 in your cells and in your bloodstream, too. That’s because the mechanism in your body that makes cholesterol also makes coenzyme Q10.
Some researchers have suggested that low levels of coenzyme Q10 can lead to the muscle aches that can be associated with statin use. With that in mind, coenzyme Q10 supplements have sometimes been recommended for people who take statins.
However, results from the research studies that have looked at giving people on statins coenzyme Q10 supplements have not been definitive. When participants in the studies know that they are getting coenzyme Q10, results often show that they experience fewer muscle aches. When the studies are double-blind — meaning neither the patient nor the doctor know if the medication they are getting is a statin or a sugar pill — then a coenzyme Q10 supplement has never been shown to be helpful in reducing muscle aches.
If you are worried that your coenzyme Q10 level is low, you can have it checked with a blood test at your doctor’s office. If it is lower than normal, then you may first want to consider making changes to your diet. For most people, eating at least five fruits and vegetables a day, fish two to three times a week, and nuts two to three times a week keeps their coenzyme Q10 level normal, even if they are taking a statin.
If your coenzyme Q10 level stays low after you have incorporated these foods into your diet, then taking a supplement may be appropriate. Coenzyme Q10 supplements are available over-the-counter at most pharmacies. You may see them under the names “ubiquinone” or “ubiquinol.” Ubiquinol tends to be better absorbed than ubiquinone, and the ideal dose is typically 200 mg once per day. Most of the time, ubiquinol is sold in a gel-based or liquid-based capsule.
Before you take any type of supplement, though, talk to your doctor to make sure it is appropriate for you. Just because you are on a statin does not necessarily mean you should take a coenzyme Q10 supplement. Also, if you are experiencing side effects, such as muscle aches, that seem to be associated with your statin use, bring that to your doctor’s attention, as well. In some cases, changing the dose or switching to a different type of statin can successfully ease those side effects. — Stephen Kopecky, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: I’ve heard that nonprescription decongestants can have significant side effects. Is this true?
ANSWER: While many people rely on nasal decongestants to help ease symptoms of a cold or flu, these medications can sometimes cause more harm than good, especially if taken repeatedly. Examples of commonly used decongestants include phenylephrine and pseudoephedrine. Often, these ingredients are included in multi-symptom cold and flu preparations, such as Maximum Strength Mucinex D, Robitussin Multi-Symptom Cold, and Tylenol Sinus Congestion & Pain.
Taking a decongestant can temporarily ease congestion, but it can also create a slight increase in your blood pressure. If you already have high blood pressure, especially if it’s not controlled, this may be a concern. Decongestants also can interfere with the effectiveness of certain blood pressure medications. If you’re on blood pressure medication, check with your doctor or pharmacist before taking a nasal decongestant.
Extended-release decongestants may be less likely to raise blood pressure than the immediate-release kind but can still cause problems. People who have conditions such as diabetes, benign prostatic hyperplasia (BPH), ischemic heart problems, thyroid disorders, glaucoma and seizures generally should avoid using nasal decongestants.
In addition, using nonprescription decongestant nasal sprays (Afrin, Dristan, others) for more than three or four days can cause even worse nasal congestion once the decongestant wears off (rebound rhinitis). All too often, people think their colds are getting worse, so they increase their use of nasal spray, leading to a downward spiral of medication use and worsening congestion. Other occasional side effects of nasal sprays may include nosebleeds, agitation and insomnia.
Thankfully, symptoms usually last no more than a week and a half. If you have continued congestion, it may be time to visit your doctor to explore treatment options that may be more effective. (adapted from Mayo Clinic Health Letter) — Lisa Buss Preszler, Pharm.D., R.Ph., Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minn.
ANSWER: There are several things you can do to help heal the skin on your heels. Cracked heels usually develop when the skin around the rim of the heel is dry and thickened and increased pressure applied to the fat pad under the heel causes the skin to split. To prevent this, moisturize often. Moisturizers provide a seal over your skin to keep water from escaping and your skin from drying out. Try rubbing your heels with a thick moisturizer, such as Eucerin or Cetaphil, several times a day. Some moisturizers contain keratolytic agents — such as urea, salicylic acid or alpha hydroxy acid — that help soften and exfoliate the skin, but they may cause slight stinging or irritation.
Foot soaks — in warm, plain or soapy water for about 20 minutes — may be helpful. Follow up with a loofah or foot scrubber, then coat your heels with a petrolatum-based ointment, such as Vaseline or Aquaphor. You might want to use petrolatum-based moisturizers before you go to bed, as they can feel a bit greasy. Slipping on a pair of socks over your moisturized feet may help lock in moisture overnight.
If these measures don’t help, or if your heels become swollen or inflamed, talk to your doctor or a dermatologist. You may need a prescription ointment with stronger moisturizers or a steroid cream to relieve inflammation. Bandages or a special tissue glue can protect and hold the edges of the cracks together so that they can heal. Wearing supportive shoes and losing excess weight also may help relieve pressure on your feet.
If you have other skin conditions, such as psoriasis or eczema, you’ll want to consult with your doctor as well, as this may affect treatment. If you have diabetes, it’s especially important to take good care of your feet. Cracked heels that are left untreated may lead to infection and ulcers. (adapted from Mayo Clinic Health Letter) — Lawrence E. Gibson, M.D., Dermatology, Mayo Clinic, Rochester, Minn.
DEAR MAYO CLINIC: I’ve heard many times that handwashing is the best way to prevent illness. But how often is it enough? I have small children, and I want to keep them as healthy as possible. Is hand sanitizer a good alternative to soap and water?
ANSWER: You’re correct that frequent handwashing is one of the best ways to avoid getting sick and to keep from spreading any illness you may have to someone else. There’s no magic number for how often you should wash. Just try to make sure your hands are consistently clean. Soap and water always work well. But if you don’t have access to a sink, hand sanitizer is a good choice, too.
Bacteria, viruses and other germs surround us every day and live in the same environments we do. As you touch objects, surfaces and other people, germs can be transferred to your hands. When you then touch your eyes, your nose or your mouth, the germs can get inside your body and potentially make you sick. Cleaning your hands gets rids of the germs, lowering your risk for illness. [...]
ANSWER: Chest pain or shortness of breath that happens with exertion could be symptoms of a number of medical conditions — even when the results of a stress test appear normal. The two most common stress tests are echocardiogram (or echo) stress tests and nuclear stress tests.
An echocardiogram uses sound waves to make up images of the heart beating and pumping blood. For an echo stress, you walk on a treadmill to increase your heart rate, or you may be given medication that increases your heart rate. As your heart rate rises, the health care team monitors you to see if the heart muscle is pumping as strongly as it should.
If there is significant blockage in a blood vessel that leads to the heart ― a coronary artery ― the part of the heart muscle supplied by that vessel won’t pump as vigorously as the other parts of the heart muscle around it. The stress echo images look at how the heart is pumping at rest compared to after the stress portion of the test. If the heart function is normal at rest but doesn’t pump as strongly after the stress portion, this can also be a sign of underlying coronary artery disease.
Echo images done at rest show how strong the heart is pumping and if there is evidence of a previous heart attack. Additionally, echo images can provide information about the heart valves, the lining around the heart, and if there is high blood pressure in the lungs, a condition called pulmonary hypertension. The echo can also show how efficient your heart is pumping blood around the body (the ejection fraction). Some individuals have symptoms of shortness of breath due to congestive heart failure. An echo will show if the heart function is impaired due to a weakened pump (heart failure with reduced ejection fraction) or a stiffened pump (heart failure with preserved ejection fraction).
If your doctor suspects you have coronary artery disease, the other common type of stress test is called a nuclear stress test. Nuclear stress tests also can be done either while on a treadmill or with medication to stimulate the heart. The test looks at the blood flow to the heart and overall heart function. If there was a significant blockage in a blood vessel to the heart, blood wouldn’t be able to travel as well downstream to the heart muscle, and on the nuclear images we would see the affected part of the heart muscle shows reduced blood flow compared to neighboring parts.
Nuclear stress tests provide information about the blood flow to the heart. If there is an area in the heart that shows reduced blood flow compared to the surrounding heart muscle, it’s usually a sign of a critical blockage in a coronary artery. The nuclear stress test also provides information about overall heart function, however doesn’t provide information about the heart valves or lining around the heart (pericardium) the way an echo does.
An echo or nuclear stress test may not reveal certain conditions, such as microvascular angina. That happens when cholesterol builds up in the smallest blood vessels that supply the heart. Nuclear and echo stress tests don’t assess for changes in those tiny vessels. Some women may have coronary artery vasospasm — a muscle spasm affecting the thin muscular layer of the coronary arteries. This condition can cause chest discomfort with a normal stress test result.
A normal stress test result only shows that there is not a significant coronary artery blockage. A smaller blockage could be present that isn’t picked up by the stress test. Being attentive to risk factors for heart disease (such as high cholesterol, family history, diabetes, tobacco use and high blood pressure) is still important even when a stress test is normal.
It’s possible, too, that the cause of chest pain or shortness of breath isn’t related to the heart. It could be a lung disorder, such as a blood clot to the lungs, known as a pulmonary embolism. Additionally, other causes of chest discomfort include spasm of the esophagus, diseases of the aorta, gastroesophageal reflux disease, musculoskeletal pain, fast heart rhythm abnormalities and costochondritis. Other causes of shortness of breath include underlying lung disease such as COPD, asthma and deconditioning.
Finally, no test is 100 percent accurate. A stress test can be wrong for a variety of reasons. For example, a nuclear stress test may be inaccurate if someone has severe blockages in all three main coronary arteries. The test looks for differences in blood flow between areas of the heart. If the entire heart has reduced blood flow, no one area of the heart will look abnormal compared to the rest.
If you’re having chest pain or shortness of breath following a normal stress test, continue to seek medical evaluation. Work with your doctor to keep investigating until the source of the symptoms is identified. — Amy Pollak, M.D., Cardiovascular Diseases, Mayo Clinic, Jacksonville, Fla.
DEAR MAYO CLINIC: I’ve had persistent headaches for about six months. Medication sometimes helps, but not always, and the pain just keeps coming back. My doctor checked to see if another medical problem could be causing the headaches, but she didn’t find anything. She now recommends I see a pain management specialist. What can they offer other than more medication? I’m missing a lot of work, and I’m afraid I’ll never get this under control.
ANSWER: Chronic pain such as yours can be debilitating and, as you’ve seen, pain relievers aren’t always the solution. A specialist in pain management can assess your situation, give you alternative treatment options, and help you find ways to cope with the chronic headaches, so you can get back to living your life the way you want.
As in your situation, when no underlying condition is found that’s causing chronic headaches, then treatment focuses on lowering the frequency and severity of the headaches, as well as reducing the disruption they cause in your daily life. One of the best ways to identify the type of headache you have, along with examining specific headache therapies, may be to consider seeing a headache specialist such as a neurologist. [...]
DEAR MAYO CLINIC: I am a 49-year-old man with a strong family history of coronary artery disease. Although I used to compete in triathlons, I just don’t have that kind of stamina anymore, and I become short of breath pretty easily. Should this be cause for concern? I also don’t have much time to exercise, so I run five or six miles just once or twice per week. Would another type of exercise be better for someone in my situation?
ANSWER: With a family history like yours, along with what sounds like a loss of exercise capacity, it would be a good idea to see a cardiologist and have your situation evaluated. Testing may be able to show if you have any heart issues that need to be addressed. A cardiologist can also assess your exercise routines and other lifestyle issues that could have an impact on your heart health.
Coronary artery disease happens when the major blood vessels that lead to your heart — your coronary arteries — become damaged or diseased, often due to a buildup of cholesterol-containing deposits, known as plaque, or inflammation. [...]
DEAR MAYO CLINIC: I’m 62 years old and am having difficulty keeping healthy weight on due to GERD and reflux. I am really confused about what foods and beverages I should avoid, and what foods will not make my reflux act up. What do you recommend mature adults who have this condition avoid, and what healthy food are best for my situation?
ANSWER: In the past, doctors recommended quite a few dietary restrictions for people who had gastroesophageal reflux disease, or GERD. But more recent recommendations advise against such restrictive diets. In fact, eliminating the wide range of foods that could be associated with reflux is no longer the norm. Instead, we now suggest only avoiding foods that you know make your symptoms worse. In addition, maintaining a healthy weight is important because being overweight has been shown to increase reflux.
Acid reflux happens when stomach acid flows back up into your esophagus — the tube that connects your throat to your stomach. Occasional acid reflux is very common. Almost everyone experiences it from time to time. Acid reflux starts to become a problem when it happens frequently or if it involves large amounts of acid. [...]
DEAR MAYO CLINIC: I am 80 years old and had prostate cancer treatment several years ago. I later had several urine blockages requiring catheters, and doctors finally decided on a suprapubic catheter, which has functioned as expected for three years. Would it be possible for me to have the catheter removed and return to a normal manner of urinating? I am otherwise in good health and am wondering what complications may arise with such a procedure.
ANSWER: When a suprapubic catheter is needed long-term, returning to normal urination usually isn’t feasible. In some cases, however, it may be possible. Working with your urologist, you can see if it might be an option in your situation. If not, and if you would still like to get rid of the catheter tube, other alternatives are available.
A urinary catheter is a small plastic tube that drains urine from the bladder. A suprapubic catheter is a type of urinary catheter placed into the bladder through a small hole in the abdomen. The tube carries the urine outside of the body and is connected to a drainage bag that collects the urine. [...]
DEAR MAYO CLINIC: I am 79 years old. Lately I have had trouble sleeping, and I would like to try a sleeping pill. Are they safe for someone my age?
ANSWER: An inability to sleep can be exhausting and frustrating. It saps your energy and goes hand in hand with problems such as depression, chronic pain, susceptibility to illness, high blood pressure and increased risk of accidents. Sleeping pills can at times be an effective component of sleep therapy. However, they need to be used cautiously, especially among older adults.
Often, the inability to get to sleep or stay asleep is a symptom of an underlying disease or condition contributing to poor sleep. This can include chronic pain, coughing, heart problems, difficulty breathing, digestive problems, acid reflux, thyroid problems and sleep disorders such as obstructive sleep apnea or leg movement disorders. Alcohol or medications such as certain antidepressants, caffeine, decongestants, asthma drugs or pain medications also can contribute to insomnia. Because of this, it’s important that you first have a thorough medical evaluation. [...]