Falls are the No. 1 cause of nonfatal injuries among children up to 14 years old in the U.S., according to the National Institutes of Health. Many of these pediatric falls happen at home or on the playground.

Tom Halada, a Mayo Clinic registered nurse and pediatric trauma coordinator, says some of these injuries can be prevented.

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Each year, more than 2 million children are seen in the emergency department in the U.S. because of fall-related injuries.

"The injuries can vary widely, and it's somewhat dependent on the age range for the patient," says Halada.

Infants and toddlers often get hurt tumbling off beds and changing tables. Windows and stairs can also lead to unintentional bumps and bruises.

"One way to prevent falls around the home would be to make sure that you have properly installed safety gates for your stairs and guards for the window," explains Halada.

Bigger kids sometimes end up at the hospital because of injuries related to biking, roller-skating and other recreational activities.

"Participation in any activity, you would want to make sure that the child is wearing correct and properly sized protective equipment, such as helmet, knee pads, elbow guards, wrist guards," says Halada.

Vigilant adult supervision can help reduce falls and accidents in children.

Preventing pediatric falls

• Move furniture away from windows to prevent climbing.
• Strap babies in high chairs, swings and strollers.
• Never leave a child alone in a shopping cart.
• Keep windows locked and closed when not in use.
• Create safe play areas.
• Childproof home.
• Always supervise young children.

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According to the Centers for Disease Control and Prevention (CDC), more than 700 confirmed measles cases have been reported in at least 25 states as of mid-April — and that number continues to grow. Most cases are among people who are unvaccinated, have an unknown vaccination status or are children. The highly contagious disease can lead to serious complications and hospitalizations, and two deaths have already been confirmed.

As awareness of the measles outbreak spreads, many Americans are asking questions and reassessing their vaccination status. Now may be a good time to brush up on the basics.

Who's at risk?

Anyone can get measles, especially if they are unvaccinated. You don't even have to come face-to-face with someone who has it to be infected. Measles is one of the most contagious infectious diseases and is highly transmissible. It spreads through the air when an infected person coughs or sneezes, and it can infect others up to two hours after the sick person has left a room.

Measles symptoms and complications

Common symptoms of measles include:

• Fever
• Dry cough
• Runny nose
• Conjunctivitis (red, watery eyes)
• White spots inside the mouth
• A rash made up of large, flat spots and small raised bumps that start on the face or neck and spread down the body

Complications from measles can include pneumonia, encephalitis (brain infection), airway inflammation and diarrhea leading to dehydration. Some complications may be severe and result in death. Becoming infected during pregnancy can result in premature delivery, stillbirth, miscarriage or birth defects. Those who are at increased risk for developing complications are children under the age of 5, people over age 20, pregnant women and people with a weakened immune system.

Prevention and vaccines

Vaccination is the safest and most effective way to prevent measles. The measles, mumps, rubella (MMR) vaccine plays a vital role in safeguarding the health of patients, staff and communities.

The CDC recommends that children receive two doses of the MMR vaccine: the first dose at 12 to 15 months of age, and the second between 4 and 6 years old. In some cases, the second dose may be given earlier, based on guidance from the child's primary care clinician. Full vaccination with two doses is on average 97% effective at preventing measles illness. The combined measles, mumps, rubella, and varicella (MMRV) vaccine also provides excellent protection. Varicella is better known as chickenpox. Parents can consult with their child's physician about which vaccine is best for their child.

Measles was declared eradicated from the U.S. in 2000 through a successful vaccine program; however, according to the CDC, a decline in vaccination rates among the nation's kindergartners over the past several years has contributed to measles outbreaks.

Mayo Clinic stands behind the evidence supporting the efficacy and safety of vaccines approved by the Food and Drug Administration and the vaccination schedules outlined by the CDC.

Measles in adults  

According to the CDC, if you had the vaccine as a child or if you ever had the measles, you are protected for life and do not need a booster vaccine. If you don't have proof of immunity, you might need a vaccine. If you are unsure of your vaccination status, check with your healthcare team.

Treatment

There are no effective antiviral treatments for measles. Vitamin A can reduce the risk of complications from measles infection, especially among people who are vitamin A deficient. If you or your child are diagnosed with measles, your healthcare team may recommend you take vitamin A. Keep in mind that this vitamin does not prevent measles infection and taking high doses without the supervision of a healthcare professional is dangerous and can result in liver failure and death. Taking too much vitamin A during pregnancy can result in serious birth defects.

Read more about the diagnosis and treatment of measles.

What you can do now

Verify with your healthcare team that everyone in your family is up to date with their measles vaccines. This is especially important if you are planning to travel internationally or to an area in the U.S. that is affected by the outbreaks.

Be aware of the symptoms of measles, and notify your healthcare team if you suspect you may have it so that testing can be performed as soon as possible.

Related:

Researchers take rare peek into how a virus spreads in a human brain 

Resources:

Frequently Asked Questions About Measles

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DEAR MAYO CLINIC: I'll admit I tend toward negative self-talk, and I'm frequently stressed out about work, family and health concerns. I know other people have problems too, but I feel like they handle it better. What can I do to help myself and be a role model for my children?

ANSWER: Resilient people are made, not born. There isn't a gene or a personality trait for resiliency. It's a skill you can practice and strengthen, just as you would a muscle. Becoming more resilient is something you can develop at any age or phase of life.

Building resiliency

Identify three good things at the beginning or end of your day.
These don't have to be huge. For most people, positive events are in the low- to moderate-size range, like running into a friend at the store, finding a forgotten dollar in a pocket or learning that the weird noise in your car only required a quick and inexpensive fix.

What matters isn't the intensity of positive experiences; it's the frequency of recognizing them. 

This exercise helps train our brains to pay more attention to the positive. Try identifying three good things every day for two weeks, and you'll automatically begin recognizing those positive kernels.

Practice gratitude.
Ask yourself, "Who or what am I grateful for?" Once again, this is more than just big things because it's easy to forget all the small things you appreciate.

A study conducted among nuns asked them to count their blessings rather than burdens. They were divided into two groups. One kept a daily journal of their blessings; the other was the control group. Researchers found that the nuns who expressed more gratitude lived up to a decade longer than those in the control group.

To practice this resiliency skill, regularly jot down what you're grateful for or send someone a gratitude letter, email or text.

Try something different.
Your brain loves novelty and the new. Notice the new playground equipment at the park or take a different route to the store. At the store, pick up an item you've never tried before.

Spend time in nature.
Nature is full of novelty. Notice the beauty around you: what's in the sky above, the bark patterns on a tree and how light streams through clouds after a storm. Try spending five minutes outdoors and mentally noting what you see, smell, hear and feel.

Focus on what you can control.
You're stuck in traffic. There's nothing you can do about the fender bender that just happened ahead of you. Do you get all worked up? Or do you take deep breaths to tamp down the stress and evaluate the situation? Are you in danger? No. Are you going to miss a flight? Probably not. 

Is there an exit ahead you can take? Yes. Is this a tragedy or an inconvenience? Inconvenience. Will this matter 10 days from now? No.

Focus on what you can control: your reaction to the situation.

Foster relationships.
Relationships are essential to resiliency. You can connect with friends and family for different reasons. It's these people who you value and who value you. They're the ones who will be there for you when faced with the challenges of life, both large and small.

Be mindful.
Mindfulness is focusing on the moment and paying attention. But being mindful is tough. The brain is easily hijacked from the now by thoughts of the past and future and judgmental thoughts about ourselves and others.

The next time you're in a conversation and your mind starts wandering off to what you'll say in response, pull your attention back to the speaker.    

You don't need to tackle all these strategies at once. Pick one and play around with it.

Strengthening your resiliency muscle is a journey. Working on this skill throughout your life can help you grow. It's also a skill you can teach children and set them up to be more resilient as they face the ups and downs of life. — Rosean Bishop, Ph.D., Psychiatry & Psychology, Mayo Clinic Health System, Mankato, Minnesota

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Editor's note: April 16 is National Healthcare Decisions Day

DEAR MAYO CLINIC: My mom recently sat us down at the dinner table to talk about her wishes if something were to happen to her. She says we should all have advance directives made, but I feel like I'm too young to think about that. Who should have an advance directive? And what goes into it?

ANSWER: Kudos to your family for having those difficult conversations. Advance care planning is not just for elderly people or those with critical illnesses. We encourage everyone who is over 18 to think about completing an advance directive, which is a document that allows you to write out what your preferences are when you're getting to the end of life. 

There are usually two parts to an advance directive:

1. The healthcare surrogate form, which will allow you to write down who would help you make medical decisions if you can't make them for yourself. It usually allows you to put a first person and an alternate person as well. 
2. The second piece is a living will, which allows you to write what your wishes are at the end of life. You can indicate whether you want medical interventions that could artificially prolong your life if you have a terminal condition or are in a vegetative state. You mark yes or no.

When thinking about care are at the end of life, many people will say that quality of life for them is being able to engage and interact with family and do some of the things they love, not being on machines and tubes. Other people may say that quality of life for them is just being alive.

When you think about choosing your designated healthcare surrogate (the person who will make medical decisions for you) make sure the person knows enough about your medical condition and is aware of the available treatments and what state your condition is in. You also want to make sure this person would be comfortable making the decision you want them to make. 

Once you've completed a living will and have chosen your healthcare surrogates, make sure these people know you have chosen them, what your wishes are and where the document is. You should also give a copy of the document to your healthcare team and hospital.

In the U.S. in general, we don't do a good job at completing advance directives. Most people don't want to talk about their care at the end of life. There is a notable difference, however, in the completion of advance directives between Black people and white people, specifically older people. The medical literature suggests that African Americans are less likely to complete advance directives because of several things:

1. Culture. If the elders in the family don't want to talk about advance care planning, it oftentimes won't be discussed. 
2. Lack of information. African Americans are less likely to get information about advance care planning compared to white people. 
3. Spiritual beliefs. "If God is in control, why do I need to think about this?"
4. Mistrust. There is an understandable mistrust of the healthcare system given the injustices that have occurred in the past and are still occurring.

We often talk about the fact that we want people to complete an advance directive to ensure that their wishes are known when they are at the end of life, but in some minority communities, particularly the Black community, it's less about the individual person and more about what's best for the community or family. 

None of us really know when something serious may occur. Unfortunately, once people become critically ill, it's a difficult time to take a step back and think about their wishes, so it's good to have had these conversations before that happens. Think of it as a gift to your family members, your loved ones and your healthcare surrogates to be able to sit down with you when you're clear and levelheaded so that you can engage in conversations about what your wishes are to bring you all peace of mind. — Maisha Robinson, M.D., Neurology and Internal Medicine, Mayo Clinic, Jacksonville, Florida

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DEAR MAYO CLINIC: I catch myself constantly nagging my kids and spouse to put down their devices during dinner, in the evenings and on weekends. I feel burned out by screens by the end of the workday. How can I encourage tech-free time for my family and reduce screen time?

ANSWER: Smartphones, gaming systems and screens are everywhere. They are in our homes, bedrooms, offices, vehicles, pockets and purses. While these electronics can be helpful and entertaining, the amount of time we spend on them also can become a problem.

Consider this: When using a device, you disengage with something else. Is that something else important to you? Perhaps it's a child, a significant other, exercise, your job, chores or hobbies.

Many people feel like something is missing in life. Perhaps it's an unidentified desire to live life more fully. Reducing screen time frees up more time to connect with family and friends. Feeling connections with others can help ward off symptoms of stress, depression and anxiety. We often miss out on the fun and beauty happening around us because of screens. By being present and in the moment — perhaps by setting aside a device — you may find what you need to fill that void.

There are many wellness benefits to cutting down on screen time, including these four:

1. Improve your physical health

You know that physical activity is good for your health, but device use could reduce your exercise time. Maintaining healthy habits can be hard when you spend lots of time using screens. Benefits include:

• Preventing obesity and conditions related to excess weight. This includes conditions include type 2 diabetes and heart disease.Children who watch more TV have a greater risk of becoming overweight.
• Freeing more time for exercise and play. You can add physical activity to fill the new gaps in your schedule.
• Increasing your amount of sleep. Children who watch more TV tend to have more difficulty falling or staying asleep. They can feel tired and snack more often to make up for lost hours of sleep.
• Reducing mindless snacking which can lead to weight gain. Snacking or eating meals in front of the TV can lead to mindless eating, which can result in consuming larger portions. Eliminating distractions allows you to pay more attention to your body and its signals when you're full.

2. Free up time to have fun playing and exploring

Exploring and learning about the world is an integral part of life. Children are naturally curious, but adults can explore too. Instead of spending time on devices, you and your family can try new activities. Go for a bike ride, take a walk, visit a park, check out the museum or explore a local nature trail. Activities that don't involve screens can be as exciting as what is on them. Try coloring, reading, crafting or other activities that use your imagination. Decreasing screen time allows more time for play and creative activities.

3. Make social connections

Connecting with others is crucial for us to feel cared for. Children look to their caregivers for this sense of belonging; adults may find it within their families and friends. Devices can damage these relationships.

When parents engage with a screen, children may feel they need to compete for attention. When you set down your device, you are more emotionally available and can help strengthen the family bond.

One study found that children who went without electronic devices for five days were better at recognizing facial emotions and reading nonverbal cues than those who lived life as usual. Less screen time can result in better face-to-face social skills. Having a TV on, even as background noise, will direct your focus to it rather than what is happening around you.

4. Boost your mood

Putting down your phone and going outside or doing an enjoyable activity can be a mood booster. It can make you feel more accomplished and improve your well-being. Depression and anxiety can cause a person to withdraw and isolate themselves from others. Engaging in social activities helps you connect with others and reduce symptoms of these conditions. Children who spend more time looking at a screen are more likely to have behavioral problems and divided attention; decreasing screen time can improve their focus. Violence in media may cause kids to feel anxious and depressed and lead them to think that violence is an acceptable way to deal with problems.

While technology is a great tool, it also can hinder your wellness and make you feel disconnected from those around you. Taking a break from devices frees up more time to be active and enjoy time with loved ones. Why not give it a try? — Mysoon Ayuob, M.D., Family Medicine, Mayo Clinic Health System, Faribault, Minnesota

Related post:

• Mayo Clinic Minute: How staring at screens can affect your vision
  
  

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In the U.S., it’s estimated that 4.5 million adults are diagnosed with chronic liver disease. It develops over time and may be caused by a number of conditions including, hepatitis, genetics, alcohol overuse or cancer. Chronic liver disease is different than acute liver disease, which can come on quickly and may be the result of an injury or a virus.

Regardless of the cause, Dr. Bashar Aqel, a Mayo Clinic transplant hepatologist, says when the liver can no longer function, a life-saving transplant may be needed.

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The liver is the largest internal organ of the body. It is essential for metabolism, digesting food and ridding the body of toxic substances. Liver failure can happen quickly, or over time.

"Once liver disease advances, the only way we can reverse the process and give the patient their life back is by replacing the liver, " says Dr. Aqel.

When patients become a candidate for a liver transplant, they are added to a waitlist. Unfortunately, there are more people waiting for a liver than there are available organs.

"As the patient is waiting on the list, they usually are anxiously waiting for that call when a donor becomes available. And that's what we call the deceased donor liver transplantation."

Another option is a living liver transplant. It's a major surgery where a person donates two-thirds of his or her liver. Donors needs to go through an extensive evaluation to make sure they can donate safely.

"A healthy liver is able to regenerate, and you will be surprised to know that with living donor liver transplantation, both segments of the liver will grow back to almost the normal size within 90 days after transplantation."

Being a living organ donor may not be an option for everyone, but there are ways to people can sign up to be an organ donor. It can be as easy as checking a box on your driver's license.

"Donating your organs is really donating the gift of life to people who are in urgent need for organ transplantation," Dr. Aqel says.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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For Anthony Maita, 'Buddy' is not just any other dog.

"He's the best thing that's ever happened to me," says Anthony.

It's no wonder, considering Buddy was right by Anthony's side during one of the most challenging times of his life — when Anthony began having epileptic seizures.

Watch: When seizures don't stop: Anthony's battle against drug-resistant epilepsy

Journalists: Broadcast-quality video (2:38) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"I started having the seizures, noticeable seizures, and from there, it just started getting worse and worse," recalls Anthony.

It began after Anthony graduated from high school. He was making plans for his future and looking forward to attending college. That's when the seizures began.

Initially, the seizures were mild but quickly became more severe. "The experience (seizure) is like a loss of time, like a blank spot in your memory — like you're waking up without any recollection of what happened," says Anthony.

"The seizures were several times a week. His lips would be blue. His mouth would be blue," says Patricia Maita, Anthony's mother. "It so hard to see your child go through that and feel so helpless."

Doctors tried to manage Anthony's seizures with medication, but nothing worked. Eventually Anthony was diagnosed with drug-resistant epilepsy, or DRE.

In search of hope, Anthony's family turned to Mayo Clinic in Arizona.

"Up to a third of patients who develop epilepsy during their life will become resistant to medication," explains Jonathon J. Parker, M.D., Ph.D., a neurosurgeon at Mayo Clinic who specializes in treating the most serious and complex cases of epilepsy, including DRE.

"These patients have tried at least two medications, and they're still having seizures. At that point, we know the chances of seizure freedom unfortunately become very low, and that's when we start looking at other options," says Dr. Parker.

A battle for millions worldwide

Anthony is one of approximately 50 million people worldwide diagnosed with epilepsy. It is one of the most common neurological disorders globally. It is characterized by recurrent unprovoked seizures caused by abnormal electrical activity in the brain.

Of those diagnosed with epilepsy, approximately 30%, or 15 million people, are considered medication-resistant. Uncontrolled seizures often rob many people of their ability to live and function independently.

While it is rare, seizures can lead to sudden unexplained death in epilepsy, or SUDEP. "We know that more frequent seizures mean the patient is at higher risk of SUDEP, so that's why we are very aggressive about treating epilepsy with all the tools we have available," says Dr. Parker.

Current treatment options for patients with DRE include surgical procedures such as brain resection to remove a portion of the brain tissue responsible for generating seizures. A less invasive procedure involves laser ablation therapy that pinpoints and destroys abnormal brain tissue. While often effective, these surgical approaches carry the risk of possible side effects, such as memory impairment, motor deficits and speech difficulties. 

Neuromodulation is another surgical approach that uses electrical or magnetic stimulation to interrupt abnormal neural activity without removing brain tissue.

Unlocking new hope for patients

Now, a growing number of scientists across the globe are part of an innovative trend in research, investigating novel ways to treat DRE. It involves the use of regenerative medicine as a "reparative" approach to help the brain heal. 

Dr. Parker is the lead investigator of the first-in-human clinical trial at Mayo Clinic which studies the use of implanted specialized inhibitory brain cells as a potential reparative treatment for DRE. Dr. Parker's clinical trial is underway in Arizona.

Mayo Clinic in Arizona is one of 29 sites nationwide participating in the inhibitory brain cell implant clinical trial for patients with focal epilepsy, where seizures originate in a specific region of the brain. 

Anthony became Mayo Clinic's first patient to undergo the investigational brain cell implant. 

"We use a very minimally invasive technique where we inject the inhibitory cells through a pencil eraser-sized incision in the back of the head. Our hope is that, over time, these cells become part of the brain and help repair the neural circuitry, and reduce or prevent seizures without the side effects," says Dr. Parker. The cells are implanted in a one-time, single-dose procedure.

"Honestly, it was pretty easy," says Anthony. "I had no trouble with it." Anthony was discharged from the hospital the next day.

Doctors say it is still too early to determine whether the brain cell implant was effective, but they are hopeful.

"Anthony has been doing great since the procedure," says Dr. Amy Z. Crepeau, a neurologist at Mayo Clinic. "We have a great deal of optimism in regard to the potential of this brain cell therapy. Developing a safe and effective, minimally invasive treatment that does not carry the possible negative side effects could be a game changer in treating patients with DRE and improving their quality of life."

Tabitha's life-long struggle to control seizures

Tabitha Wilson lives in fear, never knowing when or where the next seizure will strike.

The Florida resident was diagnosed with epilepsy at the age of 2. She was placed on medication that adequately managed her seizures — until the week before her high school graduation. 

"I was 17 years old sitting in history class when the seizure happened," recalls Tabitha. "They had to load me up in an ambulance in front of the whole school."

Tabitha tried new types of medications, but the seizures only got worse.

"I fell down a flight of stairs, burned myself while cooking. I've completely blacked out and don't know where I am or who you are," says Tabitha. She was eventually diagnosed with drug-resistant epilepsy.

Tabitha underwent three brain surgeries to treat her DRE. Still, the seizures continued.

"I'll have good days and bad days. Some days, I'll have two, three, four seizures, back-to-back," says Tabitha.

Her uncontrolled seizures have robbed Tabitha of the ability to live independently. "I can't drive. I can't cook. I can't go swimming alone. I can't take a bath, only a shower and if someone is home with me," says Tabitha.

Watch: Tabitha Wilson shares what it's like to live with drug-resistant epilepsy.

Tabitha turned to Mayo Clinic in Florida where she learned about a clinical trial also investigating the potential of regenerative medicine as a possible treatment for DRE.

Dr. Sanjeet S. Grewal, director of stereotactic and functional neurosurgery at Mayo Clinic, is leading a team of researchers studying the use of implanted stem cells in conjunction with deep brain stimulation for patients like Tabitha.

Deep brain stimulation is one of the most recent FDA-approved methods of neuromodulation therapy for epilepsy. Studies show that patients who undergo deep brain stimulation experience median seizure reduction up to 70% after five years. However, Dr. Grewal says it is uncommon for patients to become seizure-free. 

"Unfortunately, neuromodulation doesn't give us the seizure freedom we want, and that's why we are trying to combine deep brain stimulation with stem cell therapy to see if we can increase the efficacy of neuromodulation," he says. 

Tabitha became the first patient to undergo the investigational treatment. Dr. Grewal says she is also the first person in the world to undergo surgery for deep brain stimulation and receive stem cell therapy in the thalamus in her brain as a potential treatment for DRE. 

Watch: Dr. Sanjeet Grewal, neurosurgeon, explains how Mayo researchers are leading a new trend in research for treating patients with drug-resistant epilepsy.

The clinical trial involves the use of mesenchymal stem cells, a type of adult stem cell that has anti-inflammatory properties. MSCs may also support tissue repair and healing. Further scientific research is needed to confirm their therapeutic potential in the field of regenerative medicine.

The MSCs used in the clinical trial are derived from fat tissue and created at the Human Cell Therapy Laboratory at Mayo Clinic in Jacksonville, Florida under the leadership of Abba Zubair, M.D., Ph.D., a pioneer in cell therapy.

Dr. Zubair's research teams have developed a cost-effective method of producing MSCs for use in potential treatments for conditions such as stroke.

Dr. Zubair has also led innovative research, including sending stem cells to the International Space Station to investigate how microgravity impacts their growth.

"My mission is to discover ways to address problems that patients have been struggling with and find a solution for them.
I believe the future is bright. "

Dr. Abba Zubair, Pioneer in Cell therapy, Mayo Clinic in Florida

Dr. Zubair has several research projects scheduled to launch into space in 2025.

"MSCs are what we call multipotent, meaning they can differentiate into different cell types based on where they're placed. If they are placed near blood vessels, they can become blood vessel types. If they're placed by heart cells, they can become heart cell types," explains Dr. Grewal.

The hope is the MSCs eventually become neural or brain cell types and interact in the part of the brain where the seizures occur. "It's called paracrine signaling, where they're releasing signals to the brain tissue around them and interacting in a way to try to repair that tissue."

Since undergoing the procedure, there has been an improvement in Tabitha's seizure management. However, Dr. Grewal says it is too early to know whether this is due to the deep brain stimulation, stem cells or both. 

Drs. Grewal and Parker say there is still a long road ahead to determine whether these cell therapies are proven safe and effective for patients with DRE. But they agree each day brings them one step closer to a potential treatment or cure for patients like Tabitha and Anthony.

"We've thought about this for generations, we just didn't have these technologies to enable it. Now we do," says Dr. Grewal. "So, whether it's wound healing, neurodegeneration, epilepsy or stroke, there are so many different studies going on investigating the potential of regenerative or reparative therapies."

Related articles

• Mayo Clinic researchers lead transformative shift toward neurorestorative treatment strategies for most severe forms of epilepsy
• Epilepsy Treatment
• Minimally invasive epilepsy treatment
• Mayo Clinic Minute: Demystifying epilepsy
• Epilepsy Surgery
• Laser ablation surgery helps treat young man’s epilepsy

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On a Saturday evening in September of 2024, Mae Helgeson arrived at Mayo Clinic in Rochester, her small body reeling from the trauma of a life-threatening accident. Although she was intubated and sedated, it didn't take long for the care team to learn what made this little girl special. 

"I distinctly remember meeting her parents — you just immediately felt warmth and love," says Dr. Brenda Schiltz, a physician in Rochester's pediatric intensive care unit (PICU). "I could so clearly understand who Mae was through them."

At age 11, Mae was both an old soul and a spirited child. "She was a petite thing with huge energy," says her mom, Julie Helgeson. "She was a deeply feeling person."

Mae thrived on being outside, photographing birds on her family's property, her favorite field guide in tow. Mae loved to draw. She was learning to play the ukulele. Her passions began to bloom once the family started homeschooling, allowing Mae to learn in her ideal environment — among the trees.

It was obvious to everyone who met the family that they were tight-knit. "You could tell they knew that girl in and out," says Claire Shea, a nurse who cared for Mae early in her stay.

From the beginning, the team focused on incorporating all the things that mattered to Mae. While this is the goal for every patient, the family's well-defined sense of their daughter enabled the PICU staff to honor her in unique ways.

"I often ask parents to tell me about their child. Is there anything you think is important or that I should know about your family?" says Paige Dighton, one of the Child Life specialists who partnered with Mae's family. "This allows them to share the special things — those unique qualities that make them a family. You learn more than just what's in their chart."

What her parents shared influenced everything from the small details — like the hand-colored paper birds the nurses hung in her room — to the most impactful moments — like how Mae would spend her final hours. 

"They held Mae's hopes and dreams alongside the decisions they were making," says Dighton.

Those decisions were the hardest ones her parents have ever faced.

A musical pause

Several days after her arrival, caring for Mae meant providing a moment of reprieve through music.

When her dad, Matt, stopped Maureen Howell in the hallway of the PICU, he shared how much his daughter loved music and invited her to visit. As a music therapist on the Child Life team — usually with a guitar or guitalele strung across her back — Howell was eager to offer whatever support they wanted.    

The hours she spent in that hospital room would prove to be deeply memorable.

"Before my visit, they had gotten some difficult news from neurology," recalls Howell, "There was a weight — a heaviness — in the room."

Part of her role is to adapt her offerings, which range from therapeutic songwriting to guided imagery for pain relief, to meet the needs of the patient. That meant getting to know Mae and her family first.

"We're not just treating and healing physical needs," explains Jennifer Rodemeyer, manager of the Child Life program in Rochester. "We're also treating and healing the emotional needs of families," making care like Howell's so important.

Family photos and Mae's brothers' artwork decorated the hospital room, giving Howell an immediate sense of their connectedness. A few days earlier, Shea — one of the nurses who'd been there the first night — had decorated Mae's orthopedic boots with Sharpie to highlight her favorite things, from art to trees to tacos, while the nurses' vibrant paper birds had transformed the room into a nature scene.  

"We don't just think about the medical things going on in a patient's room," says Shea. "There's a lot of power in seeing them as a person, hearing the stories and bringing that in." Beyond creating a comfortable space for the family, this can help new members of the care team, like Howell, know how to connect.

As she talked with Mae's parents, they shared videos of their daughter playing the ukulele, welcoming Howell into their world. When she asked if she could sing for them, others in the room quietly departed.

It almost felt like time stood still as she strummed song after song, giving Mae's parents the opportunity to simply hold their girl and grieve.

"They were just lying in bed with her — singing along with me at times, crying, just kind of blocking out everything else that was happening," Howell says. "They just took that time to be together."

From "Over the Rainbow" to "Yellow" by Coldplay, Howell adapted her playlist — and in some cases, the song's lyrics — to offer as soothing an experience as possible for Mae's parents.

At a couple points, Julie noticed Matt glancing at her, silently asking if she needed a break. "I was like, 'No, stay,'" says Julie. She didn't want Howell's music — or their moment with Mae — to end. "Maureen created a remarkable, sacred space."

A devastating decision

It was only a couple of days later that Mae's family was faced with the devastating decision they'd hoped to avoid. As the severity of Mae's brain injury became apparent, they realized their daughter wouldn't be coming home. The question shifted from "Can we save her?" to "How do we say goodbye?"

Following their lead, the team began focusing on end-of-life care.

"Dr. Schiltz gave us the space to think and process our emotions — it didn't feel rushed," says Matt. "I think she would have sat there all day with us. There were some pretty long, quiet times with her next to us, which was what we needed."

From the beginning, Julie and Matt had been clear that a meaningful life for Mae would include photographing her beloved birds and enjoying nature.

"Life in that way for Mae was really not negotiable," Julie says. "They supported us following our instincts. To stay true to who we believe Mae is and what she would want."

"Sometimes, we just need to give the families 'permission' to know what's best," says Dighton.

The team also sat down with the extended family to explain Mae's condition, which wasn't always obvious, since she still looked like Mae — a beautiful sprite of a girl with sun-kissed hair.   

"We wanted to make sure that everybody walked away from this awful, tragic situation feeling as at peace as possible," says Dr. Schiltz.

With the guidance of the Child Life team, the parents took their boys — Henrik, 9, and Oscar, 7 — to a nearby park to prepare them, but also to seek their perspective, which they considered as valuable as their own. "I asked them, 'What would feel like a good life for Mae?'" says Julie.

Even as young kids, they knew what their parents did — that a life for Mae was a life spent outdoors. Freedom for Mae meant engaging intimately with the natural world.  

Before heading to the hospital, Henrik and Oscar chose a leaf to give to their sister, which they planned to add to the growing collection of bird feathers clutched tight in her hands.

Back in Mae's room, the boys peered quietly at the medical equipment, soaking it all in. They showed Dighton the leaf they'd found. Too nervous to place it in Mae's hand, they asked their dad to do it — their own quiet goodbye.   

"This family handled everything with such compassion and tenderness," says Dighton. "They were the epitome of creating something beautiful and impactful," while facing the outcome no family wants.

A beautiful goodbye

With the support of the care team, Julie and Matt carried that beauty into Mae's final day.

"When they were ready to take her off life support, they wanted to do it outside," says Dr. Schiltz.

Several days before, the team had brought Mae into a courtyard near the PICU, giving her the fresh air she loved so much. Now, the family wanted to venture farther out to a quiet, grassy knoll on Mayo's grounds. "We found these big, majestic trees — not just one kind, but like four different species," says Matt. He and Julie appreciated the nod to Mae's love of natural diversity.

Dr. Schiltz, Katie Schiltz, a nurse, and Nanette Matzke, a respiratory therapist, were determined to give them this gift. Together, the trio created a plan to transport Mae, along with her ventilator and other medical items they would need to keep her comfortable.

"This is what we do for our kids and families," says Dr. Schiltz. "We will do everything humanly possible to give every child the best possible care. And that care doesn't end because we can't save them."

As the little group wheeled Mae outside, others in the unit came together to show their love and support. "We turned the corner, and every single nurse was lining the hallway," remembers Julie. "I just dropped to the floor. That moment was as challenging as it was beautiful."

After taking Mae to the family's chosen spot, Matt laid his little girl on a blanket spread across their laps under the trees. The team extubated her, and as the ventilator quieted, chickadees and nuthatches flittered nearby. A brave squirrel ventured close to the blanket.

"Nature showed up right when we needed it," says Matt. "We couldn't have hoped for anything else in that moment."

In the stillness of the day, "her parents just held her," recalls Dr. Schiltz. "They spent a couple of hours outside, with the birds and the sunshine coming through the trees. It was as beautiful a situation as you could ever want."

Later the next day, on Sept. 9, 2024, Mae passed away in her room at Saint Marys with her parents by her side.

Remembering Mae

During her time in Mae's room, Howell had watched Julie and Matt listen to their daughter’s heartbeat with a nurse's stethoscope. She'd asked them if they wanted to record the sound.

Their "yes" enabled Howell to care for them in one final way.

When invited to sing at Mae's funeral, Howell suggested a more lasting way to honor her legacy — recording a song with Mae's heartbeat thrumming in the background. The family played the song at the service, an audible reminder illuminating their daughter's boundless, beautiful energy.

The care team has found their own ways of remembering Mae, who left a mark on all their hearts.

"It was so clear that Mae and her family touched so many people and that so many people were able to support them," says Howell. "This was one of the most beautiful examples of that in my time at Mayo."

Many of the staff still cry when they talk about her. When teaching trainees, Dr. Schiltz makes a point to bring up Mae, encouraging them to care for patients the way the PICU team cared for her.

"None of this was because any one individual did something. It was because we had an entire team focused on helping this family," she says. "It was about giving them everything we could in such a tragic situation."

For Julie and Matt, that care was apparent in the tender way the nurses cleaned Mae's hair. The shared sadness they saw in others' eyes. The willingness to do whatever it took to give them their goodbye. "We were all praying for a miracle at the end of this," says Matt. "It was the miracle we didn't get, but the care we received was remarkable. It was just as much about what we wanted for her as what we needed for us. There was care for all of us."

The post Honoring a young girl’s love of nature on her final day appeared first on Mayo Clinic News Network.

A comprehensive review published by Mayo Clinic researchers advances the understanding of Autosomal Dominant Polycystic Kidney Disease (ADPKD), the most common inherited form of kidney disease and the fourth leading cause of kidney failure worldwide.

Published in the Journal of the American Medical Association (JAMA), the review advances the understanding of ADPKD, which accounts for 5-10% of kidney failure in the U.S. and Europe. Its prevalence in the U.S. is 9.3 cases per 10,000 people.

"This is a vital resource for healthcare providers to stay informed about the latest diagnostic tools and treatment strategies to enhance patient care," says Fouad Chebib, M.D., a Mayo Clinic nephrologist and first author of the review. "It covers how the disease disrupts the normal functioning of the body, signs and symptoms of the disease, diagnosis, treatment and the likely outcome, equipping healthcare providers to manage this complex condition, improving the quality of life through timely, evidence-based care."

Physicians typically diagnose ADPKD in patients who are between the ages of 27 and 42. The disease causes fluid-filled cysts to grow on the kidneys, leading to kidney failure. Over 90% of people over age 35 diagnosed with ADPKD also present with multiple liver cysts, which can cause discomfort or pain.

ADPKD symptoms can vary from person to person. Some people may not have any symptoms, while others may experience high blood pressure, pain in the back or side, blood in the urine, frequent urinary tract infections and kidney stones. 

Hypertension affects 70-80% of people with ADPKD, and 9-14% of them develop brain aneurysms (a weakened and bulging area in the wall of a blood vessel), which have a low rupture rate.

A change in one of two genes, PKD1 (78%) or PKD2 (15%), causes most cases of ADPKD. If a person has one of these changes, they have a 50% chance of passing the condition on to their children. However, 10-25% of people have a genetic alteration not inherited from either parent.

The review provides practical guidance on managing blood pressure, sodium intake, hydration and lifestyle changes to delay complications such as kidney failure, liver cysts and hypertension to slow disease progression.

A key tool in managing the disease is the Mayo Imaging Classification (MIC), which predicts the severity of the disease based on a person's kidney size and growth rate. Higher MIC classifications indicate faster growth and an earlier need for kidney replacement (dialysis or kidney transplantation). Roughly half of ADPKD patients need kidney replacement therapy by age 62.

The review also explores the use of novel therapies, such as the drug tolvaptan, recently approved by the Food and Drug Administration to slow kidney function decline for high-risk adults at risk of rapidly progressing ADPKD.

"This drug improves care and paves the way for future therapies that enhance the quality of life and delay kidney failure," explains Neera Dahl, M.D., Ph.D., Mayo Clinic nephrologist and senior author of the review.

The review recommends that a kidney specialist who manages patients with ADPKD should share decision-making with the patient regarding genetic testing, treatments, monitoring and aneurysm screening. This collaborative approach recognizes the importance of the physician's medical expertise and the patient's values, preferences, and goals. It also says patients with ADPKD should be aware of the symptoms of ruptured aneurysms (sudden, severe headache) and the need for immediate medical attention should they experience those symptoms.

Review the study for a complete list of authors, disclosures and funding.

The post Autosomal Dominant Polycystic Kidney Disease: Early intervention and lifestyle crucial appeared first on Mayo Clinic News Network.

While hay fever alone may not be life threatening, it can be uncomfortable, says Dr. Arveen Bhasin, a Mayo Clinic allergy and immunology expert. She offers these tips for relief from spring pollen and allergies and tells you when it's time to see an allergist.

Watch: Mayo Clinic Minute

Journalists: Broadcast-quality video (1:02) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"If you're prone towards allergies, you develop an antibody called IGE to that particular allergen. When you're exposed to that allergen, it causes the release of histamine and these other mediators," says Dr. Bhasin.

And that is when spring's unfurling can feel downright bad. The first step is to control your exposures, says Dr. Bhasin.

Some of those environmental control measures include keeping windows at home, in the car and at work closed.

"If it's a dry and windy day, the pollen is blowing. You want to run the air conditioning because, that way, you're recirculating the clean air," she says.

For regular allergy sufferers, start your medication a couple weeks before the season starts.

"First-line treatment is what we call oral antihistamines that help with some of the itching, running, sneezing. And the nasal spray is really helping to focus on some of the congestion and the runny nose," Dr. Bhasin says.

Saline solutions using distilled water are also helpful.

And if these tips don't help? Dr. Bhasin says that is the time to make an appointment.

"The best time to engage an allergist is really when you've tried all the environmental control measures that you can, and you've tried over-the-counter medications, but you're still symptomatic," says Dr. Bhasin.

Using saline solutions or a neti pot

Saline irrigation solutions can be purchased ready-made or as kits to add to water. You can also use a homemade solution. Look for a squeeze bottle or a neti pot — a small container with a spout designed for nose rinsing — at your pharmacy or health food store.

To make up the saline irrigation solution, do not use tap water, as it can contain organisms that could cause infection. Use water that's distilled or sterile. You can also use water that was boiled and cooled. Another option is using water that has been filtered using a filter with an absolute pore size of 1 micron or smaller.

To prevent infections, wash the bottle or pot with hot soapy water and rinse it after every use and leave it open to air-dry. Do not share a container with other people.

Related posts:

• Mayo Clinic Q and A: Is it allergies or a sinus infection
• Mayo Clinic Minute: How to manage hay fever allergy symptoms
• Mayo Clinic Minute: How to get spring allergy relief

The post Mayo Clinic Minute: Spring pollen and allergy tips appeared first on Mayo Clinic News Network.