DEAR MAYO CLINIC: We live in a rural area about 40 minutes from our health system's nearest clinic. However, they do offer the option to meet virtually with our healthcare team members. We'd like to try virtual care. Could you tell us more about it? 

ANSWER: Whether you live in a rural or urban community, virtual care can be a great choice for connecting with healthcare. You can save drive time, avoid bad weather and stay home when it's best not to be in a clinic where you could infect others. 

But even better, if your primary care clinic offers video visits (most do), you maintain continuity of care with your healthcare team, whether you're at home or traveling. Any information and care recommendations are entered into your electronic health record.   

Choose your virtual option

There are typically three main types of virtual care (also called telemedicine or telehealth): messaging, video visits to your home, and video visits at a clinic. 

Messaging. You and your healthcare professional exchange information via a secure messaging platform. This can include questions about a condition, medications or follow-up from a previous appointment. Your clinician usually responds within 24 hours or less. Messaging may lead to a video visit or an in-person appointment.

Video visit to your home. Through your health system's patient portal, you can set up a video appointment with a member of your healthcare team, just as you would an in-person appointment. Just as with an office visit, hearing your story about how something happened, symptoms you're experiencing, medication side effects and more, can help your clinician make an informed diagnosis. 

During a video visit, you can discuss your issue with your clinician, upload photos to give your healthcare team a close-up look at something, like a rash or lump. For example, if your child has an ear infection, there's an inexpensive device you can purchase online that takes a video of the ear canal. With this information, your clinician can recommend care.

Your clinician also may order other services or arrange to have a specialist connect with your visit. You can even invite a family member or friend to join the visit to provide an extra set of ears.

In addition, if you need translation services, they can be arranged when you make your appointment. During the video visit, your clinician, interpreter and you will all be online.

Video visit at the clinic. Another variation of video visit is making an in-office appointment but then connecting with a specialist online. This is particularly helpful for patients who may not have stable internet connections.

On-demand care. Your health system may offer other forms of virtual care, such as on-demand care via a mobile app. This service is typically available 24/7 every day, including weekends and holidays. On-demand care can focus on an urgent problem, but you can also schedule an appointment and arrange to receive helpful reminders about prescriptions, lab work, follow-up appointments and more. 

Your in-person and virtual providers collaborate on your care through a shared medical record. However, the level of integration varies widely across healthcare organizations.

When to consider virtual care

The list of conditions that can be addressed virtually is a long one, including:

• Upper respiratory Infections, including colds, influenza and COVID-19 (especially now with home diagnostic kits)
• Sinusitis
• Rashes
• Insect bites
• Constipation
• Mental health conditions
• Urinary tract infections (often coupled with a lab test)
• Monitoring and adjusting medications for chronic conditions
• Follow-up for many chronic conditions, including:
  • Diabetes
  • Weight-loss medications
  • High blood pressure (if you have a home blood pressure cuff)
  • Cholesterol
  • Low thyroid

However, if you're having difficulty breathing or chest pains, you should go to the emergency department. If you suspect something is broken or infected, you should also seek in-person care because these conditions tend to require a "hands-on" exam and assessment or direct treatment.

Before, during and after your video visit

Here are a few tips for a successful video visit:

• When you make your appointment, upload any photos or videos that could give your clinician a close-up view of the problem.
• Be sure you have a reliable internet connection.
• Arrange for a quiet space for the visit, especially since you'll be sharing protected health information. Having a video visit at a coffee shop or on a public computer may not be a good choice.
• Dress comfortably but appropriately. 
• Make a few notes about what you want to cover with your clinician.
• Be sure to ask questions. If someone is joining the visit, let them know they can ask questions, too.
• Following your visit, you'll receive an after-visit summary just as you do with an in-person visit. It's typically delivered to your patient portal.

David Blair, M.D., Family Medicine, Medical Director, Primary Care on Demand, Mayo Clinic Health System, Bloomer, Wisconsin  

The post Mayo Clinic Q&A: When to consider virtual care appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've been diagnosed with atrial fibrillation. I've read that it puts me at greater risk of stroke. Can you tell me more about this?

ANSWER: You may not have known you had atrial fibrillation (AFib) until your condition was discovered during a physical examination. For others, AFib can have life-altering symptoms that affect their ability to perform daily activities.

Atrial fibrillation is a common type of heart rhythm disorder where the heart doesn't beat efficiently. This makes the heart unable to pump enough blood out to the body with each heartbeat. It’s estimated 12.1 million people in the U.S. will be diagnosed with AFib by 2030.

Lowering stroke risk

People with AFib are at a higher risk of stroke — about 1 in 7 strokes are AFib related — due to clots that can form in the upper chambers of the heart. Of the strokes resulting from atrial fibrillation, 90% occur from clots originating in the left atrial appendage in the left atrium of the heart.

Key risk factors for stroke in people with atrial fibrillation include:

• Age
• Gender
• High blood pressure
• Prior history of stroke
• Chronic health conditions, including congestive heart failure, coronary artery disease and diabetes

Treating AFib

There are three main approaches to treating AFib. These are:

• Medical therapy for maintaining normal rhythm and preventing clots.
• Therapy to reset the heart rhythm, called cardioversion.
• Procedures to obtain and maintain normal heart rhythm. 

Medications.

Medications for treating AFib are the front line for managing symptoms and preventing stroke. These medicines can:

• Prevent blood clots.
• Control the speed of the heartbeat.
• Restore the heart rhythm.

This group of medications includes beta blockers, calcium channel blockers, digoxin, arrhythmics and anticoagulants. Your cardiology team will work together to determine which medication will work best for you.

Cardioversion.

Cardioversion is usually done in a hospital as a scheduled procedure. Patients may still need to take medicines for the rest of their lives to control their heart rhythm and prevent future episodes of atrial fibrillation. Even with medicine, AFib could return.

Procedural options.

People who are candidates for procedural options are cared for by a team of cardiologists, including cardiac electrophysiologists and additional specialists as needed. Potential procedures include:

• Left atrial appendage occlusion. The left atrial occlusion is a pouch-like extension of the heart. A minimally invasive procedure provides an alternative to long-term blood-thinner medications. It involves implanting a device, via a catheter, to close and seal off the left atrial appendage. This decreases the risk of blood clots entering the bloodstream, traveling to the brain or other body organs, and causing a stroke or organ damage. Patients typically leave the hospital the same day or the next day.

• Ablation. Ablation stops the generation of abnormal electrical signals in the heart and keeps it in normal, or sinus, rhythm. During ablation, a catheter is fed into the heart through the groin area using a minimally invasive approach and delivers heat or cold to modify the tissues in the heart that are causing the arrhythmia.

• Pulsed field ablation (PFA). PFA stands out from traditional atrial fibrillation (AFib) treatments due to its precision and safety. Unlike radiofrequency or cryoablation, which use heat or cold to destroy heart tissue, PFA uses short electrical pulses to target the myocardium, minimizing damage to the esophagus and nerves.

Benefits to patients include:

• Reduced procedure and anesthesia time
• Quicker recovery time
• Surrounding tissue protection

• Hybrid ablation. For people who have long-standing, persistent atrial fibrillation, ablation alone is successful half of the time. Hybrid ablation is an option for people with atrial fibrillation that's hard to manage or who have been in atrial fibrillation for more than a year. It combines the best of the catheter lab ablation and an open surgical approach.

The procedure is done in two parts:

• Part one is performed by surgeons with a scope inserted through a small incision under the breastbone to ablate the back side of the heart, followed by closure of the left atrial appendage.
• During part two, a catheter ablation modifies the tissues on the inside of the heart.

This whole-heart approach allows patients to return to normal rhythm with excellent results.

Vaibhav Vaidya, M.B.B.S., Gurpreet Singh, M.B.B.S., and Nishant Saran, M.B.B.S., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin.

The post Mayo Clinic Q & A: Why a fluttering heart could lead to stroke appeared first on Mayo Clinic News Network.

Editors Note: May is National Stroke Awareness Month.

Stroke is one of the leading causes of death in the U.S. and a major cause of serious disability for adults. More than 795,000 people in the U.S. have a stroke each year. Risk increases with age, especially after 55, but strokes can occur at any age.

Recovering from a stroke varies from person to person, says Dr. Felix Chukwudelunzu, M.D., a neurologist at Mayo Clinic Health System in Eau Claire, Wisconsin. The rate of recovery is generally greatest in the weeks and months after a stroke. However, there is evidence that performance can improve even 12 to 18 months after a stroke.

What is a stroke?

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes,

A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. 

Symptoms

It is important to be aware of stroke signs and symptoms so you can act quickly and seek necessary treatment. Symptoms of stroke include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing or blurred vision in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.

If you or someone you know is experiencing a stroke, you should call 911 and seek emergency medical care right away.

A stroke can cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications can include paralysis or loss of muscle movement, difficulty talking or swallowing, memory loss or thinking difficulties, emotional problems, pain, and changes in behavior and self-care ability.

Rehabilitation

Stroke rehabilitation is an important part of recovery after stroke. There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.

The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life.

The severity of stroke complications and each person's ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don't have stroke rehabilitation.

The duration of your stroke rehabilitation depends on the severity of your stroke and related complications. Some stroke survivors recover quickly. But most need some form of long-term stroke rehabilitation, lasting possibly months or years after their stroke.

The post Recovering from a stroke appeared first on Mayo Clinic News Network.

Editor’s Note: May is National Skin Cancer Awareness Month 

Skin cancer is the most common cancer in the U.S.  More than 6 million adults are treated for it each year, says Dr. Michael Colgan, a Mayo Clinic Health System dermatologist in Eau Claire, Wisconsin.

Melanoma is an aggressive form of skin cancer. In 2025, an estimated 104,960 cases of invasive melanoma will be diagnosed in the U.S., and an estimated 8,430 people will die of melanoma, according to the American Cancer Society. When detected early, however, the five-year survival rate for melanoma is 99%.

When it comes to who may be most at risk of developing melanoma, it is often thought that those with darker complexions do not have to take the same precautions as those with fair complexions. The reality is that no one is immune to melanoma. 

While people with a darker complexion may have significantly increased protection from the sun, they are still prone to developing melanoma skin cancer. More commonly for those with a darker complexion, melanoma develops on the extremities — hands and feet — with worse tumors at the time of diagnosis and poorer subsequent outcomes if not caught early.

Skin checks

That is why it is incredibly important to become familiar with your skin and conduct regular skin exams at home. When performing skin checks, you'll want to look out for:

• A new growth on the skin that might look like a mole, bump or scab.
• A rough patch on the skin.
• A sore on the skin that won’t heal.
• Changes to a mole or freckle — getting bigger or changing color.
• Itchy skin around a skin growth.
• Pain around a skin growth.

Regardless of your skin color, if you notice any of the above, then you should see a healthcare professional. A skin check by a dermatologist usually only takes a few minutes, but that short time spent in the doctor's office could add years to your life if skin cancer is detected early.

For higher risk individuals, including those with a personal or family history of melanoma, people over age 65, those with a suppressed immune system, people that burn easily, as well as those who have light-colored eyes and hair, a baseline evaluation with a dermatologist is critical and then continued at recommended intervals going forward, as determined by your healthcare team.

Most skin cancers can be prevented by taking a few simple precautions to protect yourself from the sun. It is recommended that you wear sunscreen year-round and reapply during peak sun conditions. 

The post  Who should be screened for skin cancer? appeared first on Mayo Clinic News Network.

Editors note: May is National Stroke Awareness Month

DEAR MAYO CLINIC: My mom had a stroke recently and is really struggling with her speech. She's in speech therapy, but could you please tell me more about this side effect of a stroke?

ANSWER: Aphasia is a disorder that affects a person's ability to retrieve language. It’s as if their brain's word cabinet has fallen over and mixed their words around, resulting in varying levels and forms of impairment, including auditory comprehension and verbal expression.

Causes

A stroke happens when blood vessels supplying the brain burst or are blocked. This reduces blood flow to the brain, depriving it of the essential nutrients and oxygen needed to support brain cell life. A stroke and its damage to the primary language centers in the left hemisphere of the brain are the most common cause of aphasia. 

Aphasia can also develop due to a brain tumor, infection or degenerative disease. The underlying cause of aphasia and the location of a stroke or tumor determine the severity of a person's language difficulties.

Temporary aphasia can arise during a migraine. It can also occur from a seizure or transient ischemic attack (TIA), sometimes called a mini-stroke. Anyone who experiences a TIA is at an elevated risk for a full-blown stroke in the future.

Symptoms

A person who is affected by aphasia may:

• Experience difficulty understanding conversations or directions.
• Have trouble writing coherent sentences.
• Speak in brief or incomplete sentences.
• Use words or sentences that don’t make sense.
• Have difficulty reading and recognizing letters.

Aphasia can be the first sign of stroke. If you or a loved one experiences these symptoms, seek medical help immediately.

Types of aphasia

Your healthcare team may classify aphasia as:

• Broca's (non-fluent) aphasia. Non-fluent aphasia is marked by decreased language output, difficulty identifying words, and incomplete or short sentences. People with non-fluent aphasia are usually aware of their communication difficulties because their cognition and comprehension are mostly intact.
• Wernicke (fluent) aphasia. Fluent aphasia is identified by incoherent word order, word combination errors, grammar mistakes and incorrect word choices. People with fluent aphasia may have a steady flow of speech filled with jargon and made-up words. They also experience paraphasias — substituting a different sound or word for the intended word. People with fluent aphasia typically have difficulty comprehending spoken and written language.
• Global (mixed) aphasia. Global aphasia results from a major stroke that extensively affects the brain, causing cognition, comprehension and language difficulties. This type of aphasia usually has both receptive and language-expression components.

Testing

A common initial test to determine the cause of aphasia is a CT scan or MRI. In addition, testing usually involves exercises and observations to gauge the person's ability to:

• Explain a situation shown on paper.
• Follow directions.
• Answer questions.
• Have a conversation.
• Read and write.
• Repeat words and sentences.

Treatment and coping

Speech-language therapy is the most common form of treatment. Early intervention and timely treatment are essential for achieving maximum results.

A speech-language pathologist works with patients to regain as many previous language skills as possible or, with certain diseases and conditions, to maintain their communication ability.

Treatment exercises often incorporate activities relevant to the patient to increase motivation and participation. Exercises may include saying their name, address, birth date or family members' names; ordering food from a menu; or writing on a greeting card.

To help someone with aphasia, family and friends can:

• Continue to treat the person as a mature adult and include them in conversations.
• Reduce visual distraction and background noises, such as the TV, radio and other conversations.
• Be sure you have the person's attention before speaking to them.
• Keep messages short and simple. Speak slowly but naturally. Speaking louder doesn't increase understanding.
• Use gestures, facial cues and voice intonation to help the person understand the message.
• Don't assume they understand what you're saying. Your loved one may respond with head nods and sounds of agreement but not understand what's being said.
• When repeating a statement, avoid changing your language around, use simple language and repeat the phrase the same way.
• Recognize that their intelligence has nothing to do with their ability to communicate. 
• Encourage communication and be patient.
• Give your loved one plenty of time to respond, and try not to answer for them.

Support groups can also aid healing and coping for patients and family members.

Delaney Collins and Kinsey Weyer, Speech-Language Pathology, Mayo Clinic Health System, La Crosse, Wisconsin.

The post Mayo Clinic Q and A: Aphasia can be the first sign of stroke appeared first on Mayo Clinic News Network.

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

The post Mayo Clinic Q & A: 7 strategies to build resiliency appeared first on Mayo Clinic News Network.

Heart disease is the No. 1 cause of death in women in the U.S. African American women have an even higher risk of dying from heart disease ― and at a younger age ― than white women, according to the National Heart, Lung and Blood Institute. Each year, more African American women die from heart disease than breast cancer, lung cancer and strokes — combined.

This serious issue is compounded by the fact that less than half of African American women are aware of their risk.

Factors that increase their risk of developing heart disease include:

• Having the highest rates of high blood pressure, or hypertension, among non-Hispanic Black women.
• Having the highest rates of obesity among non-Hispanic Black and Hispanic women.
• Being the least physically active group of women in the U.S.
• Experiencing early onset of menstruation at less than 11 years of age.
• Experiencing premature menopause at less than 40 years of age.
• Developing polycystic ovary syndrome.
• Developing disorders related to high blood pressure during pregnancy.
• Developing gestational diabetes.
• Being prone to preterm delivery and having low- or high-birth weight babies.
• Using oral contraceptives and hormone replacement.

Being aware of and addressing these risk factors is important in preventing heart disease.

Another step toward making a healthy heart a priority is to follow the American Heart Association's "Life's Essential 8" lifestyle changes:

1. Manage blood pressure.
2. Control cholesterol.
3. Reduce blood sugar.
4. Get active.
5. Eat better.
6. Lose weight.
7. Quit tobacco.
8. Get healthy sleep

Campaigns, such as Go Red for Women, also help raise awareness about heart disease in women, risks and how-tos for healthy living.

If you have concerns about your heart health or would like to start your healthy-heart journey, consult your healthcare professional.

Monique Freund, M.D., is a cardiologist in La Crosse, Onalaska and Tomah, Wisconsin.

This article first published on the Mayo Clinic Health System blog.

The post Heart disease: Why African American women need to take their hearts to heart appeared first on Mayo Clinic News Network.

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
  
  

The post Mayo Clinic Q and A: 4 health benefits to cutting back screen time appeared first on Mayo Clinic News Network.

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

The post (VIDEO) When seizures don’t stop: The battle against drug-resistant epilepsy appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: A friend from my book club recently had a stroke. I learned that women have a higher risk of strokes. What are the risk factors, and are there signs to watch for that indicate someone is having a stroke? 

ANSWER: A stroke can happen at any time and to anyone. You might be talking to your loved one and notice they're suddenly slurring their words. Or, while grocery shopping, you realize you can't move your hand to pick up a jar from the shelf. You can go from feeling as usual to feeling sick within a matter of seconds to minutes. Here are five key things to know about stroke.

1. Strokes affect the oxygen and nutrients supplied to your brain.

Strokes occur when nutrients and oxygen are not delivered to the brain through blood vessels, leading to the death of brain cells. This lack of delivery can be caused by a clot in a blood vessel obstructing the blood flow to the brain, known as an ischemic stroke, or when a blood vessel ruptures and prevents blood flow to the brain, known as a hemorrhagic stroke.

Sometimes, the obstruction to the blood flow and the resulting symptoms are caused by a temporary clot and are transient, resulting in a transient ischemic attack, or TIA, often called a ministroke.

2. Strokes can happen to anyone.

Strokes can happen to anyone regardless of age, gender or race. Certain risk factors can put you at a higher risk of stroke.

Risk factors are divided into two categories:

• Controllable — the ones you can control or improve
• Uncontrollable — those that are not within your control

Common controllable risk factors include:

• Atrial fibrillation, which increases stroke risk by five times
• Diabetes
• Excessive alcohol intake — an average of more than one drink per day for women or more than two drinks a day for men
• High blood pressure
• High cholesterol
• Obesity
• Obstructive sleep apnea
• Physical inactivity
• Smoking or vaping

Uncontrollable risk factors include:

• Gender
• Heredity
• Increasing age
• Race

3. Be prepared to spot the signs of a stroke.

Learn to recognize the signs of stroke quickly.

The American Stroke Association lists these symptoms to help you know when to seek medical care:

F = Face drooping: Ask the person to smile and see if the smile is uneven.

A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down.

S = Speech difficulty: Ask the person to speak and see if the speech is slurred.

T = Time to call 911: Stroke is an emergency. Call 911 at once. Note the time when any of the symptoms first appear.

Other stroke symptoms to watch for include:

• Numbness of the face, arm or leg, especially on one side of the bod.
• Sudden confusion, trouble speaking or difficulty understanding speech.
• Sudden-onset, severe headache with no known cause.
• Sudden vision issues, such as trouble seeing in one or both eyes.
• Trouble walking, loss of balance, dizziness or coordination.

If you or someone you are with have any strokelike symptoms, seek immediate medical care.

4. A stroke is a medical emergency.

Every second counts when someone is experiencing a stroke. Once a stroke starts, the brain loses around 1.9 million neurons each minute. For every hour without treatment, the brain loses as many neurons as it typically does in nearly 3.6 years of regular aging.

While waiting for paramedics, do these things if possible:

• If the person is conscious, lay them down on their side with their head slightly raised and supported to prevent falls.
• Loosen any restrictive clothing that could cause breathing difficulties.
• If weakness is obvious in any limb, support it and avoid pulling on it when moving the person.
• If the person is unconscious, check their breathing and pulse, and put them on their side.
• If they do not have a pulse or are not breathing, start CPR straight away.

5. Women have an increased risk of stroke.

According to the American Stroke Association, stroke is the third most common cause of death in women. Over 90,000 women die from a stroke in the U.S. each year. Every 1 in 5 women will have a stroke, and about 55,000 more women than men have a stroke each year, with Black women having the highest prevalence of stroke.

The risk of stroke increases in women who smoke, have atrial fibrillation or migraines with aura, take birth control pills, use hormonal replacement therapy, are pregnant, or have preeclampsia.

Talk to your healthcare team about your stroke risk and ways to lower your risk by addressing controllable factors. — Prashant Natteru, M.B.B.S., M.D., Neurology, Mayo Clinic Health System, La Crosse, Wisconsin

The post Mayo Clinic Q and A: 5 things to know about stroke appeared first on Mayo Clinic News Network.