DEAR MAYO CLINIC: My older sister recently went through menopause and was surprised to learn it could affect more than periods and cause hot flashes. What should women know about these changes to heart, brain and bone health as we get older?

ANSWER: Menopause is a natural transition that marks the end of a woman's reproductive years. It's defined as 12 consecutive months without a menstrual period. However, there are exceptions. Procedures that affect the uterus or certain types of hormonal birth control can stop monthly bleeding, even if menopause has not yet occurred.

While many people associate menopause with hot flashes and changes in periods, it can also influence several aspects of long-term health. These effects can vary from person to person, but they also are a common part of aging.

Hormones

A key reason for these changes is the decline in estrogen and progesterone — hormones that play a role in many systems throughout the body. As levels decrease, these changes don't happen overnight; rather, they develop gradually over time.

Estrogen helps support healthy blood vessels and cholesterol levels. As levels decline during menopause, blood vessels may become less flexible and cholesterol levels may rise, which can lead to plaque buildup in blood vessels. These changes may increase the risk of heart disease after menopause, especially in people who have other risk factors.

Many women notice changes in memory, focus or mood during menopause. Symptoms such as "brain fog," difficulty finding words or forgetfulness are common and can be linked to hormonal changes, sleep disruption and stress.

In most cases, these changes are mild and may come and go. However, symptoms that are persistent, worsening or noticeable to others may need further evaluation. These can include difficulty following conversations, getting lost in familiar places or changes in thinking or behavior.

Bone health is another important consideration. Estrogen helps maintain bone density and strength, and as levels decline, the body loses bone more quickly than it can rebuild it. Over time, this can lead to lower bone density and an increased risk of fractures.

Bone loss often begins around menopause and can continue for several years. Risk factors include older age, a smaller body frame, smoking, inactivity, certain medical conditions and use of some medications. Screening can help identify changes early, since bone loss often occurs without noticeable symptoms.

Menopause can affect daily life in ways that aren't always immediately recognized. Some women experience fatigue, joint aches, weight or skin changes, or shifts in sex drive. There may also be an increased risk of metabolic conditions or urinary tract infections.

Treatment and care

Healthy habits can make a meaningful difference before, during and after menopause. Regular physical activity, including cardiovascular and weight-bearing exercise, and a balanced diet can help support overall health. Prioritizing sleep, avoiding tobacco and limiting alcohol also are important. Small, consistent lifestyle changes can have a lasting effect over time, so it's best to start making them before transitioning to menopause.

Routine checkups are an opportunity to share your symptoms and concerns. Your healthcare team can help guide next steps, including monitoring risk factors and deciding when screenings or treatments are appropriate.

Hormone therapy may help manage symptoms and support bone and heart health. This therapy is most effective when started near the time of menopause and may be appropriate for certain people after discussing the risks and benefits with their healthcare professional.

Nonhormonal options also are available for those who are at risk of hormone-related complications or prefer not taking hormones. Medications and lifestyle approaches are available to address symptoms like hot flashes, vaginal dryness and sleep disturbances.

Menopause is more than a change in menstrual cycles. It's a shift that affects multiple aspects of your health. With education and discussions with a healthcare professional, women can make informed decisions about preventive care and treatment options to support their health during menopause.

Amy Hagen, C.N.P., Obstetrics & Gynecology, Mayo Clinic Health System, Mankato, Minnesota

Related posts:

• Managing menopause symptoms
• Mayo Clinic Minute: Perimenopause and menopause

The post Mayo Clinic Q&A: How menopause affects heart, brain and bone health appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:04) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Close to 90% of all strokes are preventable," says Dr. Felix Chukwudelunzu, a Mayo Clinic neurologist.

The first step in stroke prevention is recognizing the risk factors.

"There are those that are modifiable and those that are nonmodifiable. Certain nonmodifiable would be age," says Dr. James Klaas, a Mayo Clinic neurologist.

The older you are, the greater the chance of having a stroke.

Stroke risks

"If you're above the age of 65, you're more likely to have a stroke than someone in their 20s or 30s, for example," says Dr. Chukwudelunzu.

Another nonmodifiable risk factor is family history of stroke — especially a first-degree relative.

"In terms of the modifiable risk factors, what we'd be looking for is high blood pressure — is probably the most significant — then we look for high cholesterol, smoking, diabetes, obesity, sedentary lifestyle, amongst others," says Dr. Klaas.

Maintaining physical activity and watching what you eat are both important factors in stroke prevention.

"We know that people that eat, for example, high-salt diet, they are more likely to have high blood pressure than people that don't. So dietary changes can also help reduce chances of a stroke," says Chukwudelunzu. "Identifying these risk factors and making sure that they're being treated appropriately goes a long way into preventing that stroke from happening in the first place."

The post Mayo Clinic Minute: Know the risk factors to prevent stroke appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I need to have a joint replacement, but I'm really nervous. What questions should I ask my orthopedic doctor?

ANSWER: Knee and hip replacements have changed so much due to advanced surgical techniques, making them far different from those even five years ago. From multiple-day hospital stays, total joint replacement has advanced to a one-night stay or even going home the same day as surgery.

Questions from my patients usually fall into three categories:

• How do I know it's time for surgery? 
• What will happen during surgery? 
• What will recovery be like?

Let's start with the "when" question. Patients undergoing replacement surgery have arthritis in the joint. Arthritis is the loss of the protective cartilage layer between bones, and when that cushioning is gone, you have bone-on-bone contact, pain and swelling. Physical therapy, over-the-counter medications and injections can help for a while. 

Eventually, the pain and discomfort affect your mobility and activities of daily living, whether it's walking the dog or playing with grandkids. That's when you may decide it's time.

But joint replacements aren't only for older patients. Total joint replacement in people in their 50s is no longer uncommon.

Deciding on surgery

Once you've decided on surgery, the next step is preparation, particularly making sure any chronic conditions like diabetes or high blood pressure are under control. To reduce your risk of infection, stop any steroid injections at least three months before surgery. You'll also need to address dental work, such as cleanings.

Your orthopedic care team will provide you — through classes and printed guides — with a wealth of information on how to prepare, including:

• Required preoperative tests and exams.
• Adapting your home for recovery.
• Arranging for care when you return home, such as having a support person with you through the early weeks.
• Setting up transportation to and from physical therapy and medical appointments. 
• Requesting a temporary accessible parking permit.

If you have questions or concerns, be sure to ask your care team so that you feel ready for surgery and recovery.

Your surgeon also will be preparing. This includes using X-rays or CT scans to study your bones and anatomy. 

If your surgeon is using robotics, they're able to make a 3D model of the joint to assist with planning your joint replacement. In knees, this lets them correct issues caused by arthritis, such as bow-leggedness or knock knees.  During your surgery, the surgeon will map your knee in the operating room to the 3D model on the computer built from your preoperative CT scan. Your surgeon will use the robot to collect information on ligament balance and alignment so they can determine the best position to place your implants. 

While robotics makes total joint replacement more accurate, it doesn't make it less invasive. It helps achieve a more precise balance, which can lead to less pain and wear and tear on the implant.

When it comes to hip replacement, there are multiple surgical approaches available. The two most common approaches are the posterior and the direct anterior. The direct anterior approach is a more recent surgical technique that has gained popularity over the last decade. The anterior approach is considered "muscle-sparing" because the surgeon is working between the muscles. As a result, patients tend to recover faster, and there's less risk of dislocation.

For both knee and hip replacements, don't hesitate to talk with your surgeon about the techniques they'll be using.

After surgery

After surgery, knee and hip recovery differ:

• Knees. For the first two weeks, there's pain and swelling, but also the need to regain range of motion to minimize stiffness and scar tissue. Therapy is a big focus of early recovery. At-home physical therapy is every day; in-person is typically twice a week. 
• Hips. The first few weeks are for letting the incision heal and reducing pain and swelling. That means gradually increasing activity, using a walker, then a cane. Most patients do home-based therapy but not in-person therapy.

Whether you've had a knee or hip joint replacement, you're able to return to your regular activities within three months. However, there may be some restrictions. For the hips, these may include avoiding extreme positions, such as deep squatting and certain yoga poses, to decrease dislocation risk. For knees, kneeling may be uncomfortable and often isn't recommended. Also, don't be alarmed by clicks and pops from your implants — they're normal. 

Overall, patients do well with total joint replacement. This is a long journey, so an incredibly important part of your success is the relationship with your surgeon and care team. They'll be with you from beginning to end to ensure you have the best possible outcome.

Kariline Bringe, M.D., Orthopedics and Orthopedic Surgery, Mayo Clinic Health System, La Crosse, Wisconsin

Related post:

• AI, robotics and motion-preserving implants expand spine surgery options for patients

The post Mayo Clinic Q&A: Questions to ask before joint replacement surgery appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I like to challenge myself physically, whether it's working out, cycling or cross-country skiing. I've heard about VO2 max testing. What could I gain from it?

ANSWER: A VO2 max test measures the amount of oxygen you breathe in and use at peak levels of exercise intensity, and it assesses how well your heart, lungs and muscles work together during aerobic (cardio) exercise. Whether you're an athlete or not, a VO2 max test can provide insights into your cardiopulmonary fitness.

Due to the cost and specialization of the equipment, a VO2 max test is typically conducted in a sports medicine setting or an academic exercise science department. Be sure to check with your insurance provider to see if this service is covered.

What to expect

During the test, the person wears a breathing apparatus while running on a treadmill or biking on a stationary cycle. Gradually, the exercise protocol becomes more difficult, such as increasing speed, ,grade or pedaling resistance. They're instructed to exercise as hard and for as long as they feel like they physically can. 

The equipment then captures the peak volume and flow rate of air being inhaled, later converting that data into the maximal volume of oxygen consumed and the rate of energy expenditure.

The results give the participant a baseline value. For instance:

• If a person is more sedentary, their baseline may be in the 20s (20 milliliters/kilogram/minute — ml/kg/min) of peak oxygen consumed. 
• For someone who's fairly active — maybe participating in a recreational activity coupled with some strength and cardio training — their score may be in the 40s. 
• Those with a VO2 max in the 70s probably are elite-level endurance athletes. 
• Elite cross-country skiers may have a VO2 max score in the 80s and possibly even 90s (80-90 ml/kg/min).

Thousands of published studies support the finding that cardiopulmonary fitness is associated with reduced risk of cardiovascular disease, obesity, sleep apnea, metabolic syndrome and a number of other chronic health conditions, in addition to reduced risk for all causes of mortality. 

Improving cardiopulmonary fitness

Your VO2 max isn't static. It can be improved with consistent exercise or training. 

For example, someone who's inactive can use their baseline values as a starting point. Working with a trainer or other fitness professionals, they can build a cardiopulmonary workout program using the most effective strategies to improve their cardiopulmonary fitness. Doing cardiovascular exercise three to four days a week may improve their VO2 max by 20%-30% over three to six months. The key is exercising regularly, and as fitness improves, gradually push the limits. This also can be done by adding high-intensity intervals to a program.  

Those with higher VO2 max scores to start with will have less room for improvement, since they're already at a higher fitness level. Genetics also play a role in aerobic fitness.

Test functions

Athletes are the most common participants in VO2 max tests. They're usually familiar with the test and how the measurement can be used to enhance their performance. This objective feedback is one way to help them measure progress and shape their training regime. For example, they may map out their training sessions based on what percentage of their VO2 max they want to work at that day. 

People who have had heart attacks or heart surgery typically enroll in a cardiac rehabilitation program. This often involves a stress test with cardiovascular function measured in real time by an electrocardiogram (ECG) unit. Throughout their rehabilitation, the test provides feedback for exertion levels, which also helps them rebuild their cardiopulmonary fitness. While not a VO2 max test, it encourages similar behavior of consistent, progressive physical activity.

Wearables, such as smartwatches, can provide good feedback on heart rate and regular exercise outputs. However, they aren't sophisticated enough yet to reliably measure VO2 max. 

But people also have a built-in measure of fitness. You know when you get out of breath and tired, whether it's on a long walk, climbing stairs or shooting hoops. This knowledge is subjective and doesn't provide hard numbers, but it can be a useful guide as you work to improve your fitness. 

For instance, you may be winded after climbing a flight of stairs. You start moving more, walking for 30 minutes rather than 15, notching up your walking speed or walking a more challenging route. After a few weeks, climbing those stairs might not be so hard. You know your cardiopulmonary fitness has improved, but you don't know by how much.

Some people want to see the hard numbers to confirm how they feel. That's what a VO2 max test can provide. 

Andrew Jagim, Ph.D., Sports Medicine, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

The post Mayo Clinic Q&A: What does a VO2 max have to do with overall fitness?  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My brother was experiencing severe back pain last year and decided to see a neurosurgeon for treatment. Now he is experiencing little to no discomfort. When I think about seeing a neurosurgeon, I picture major spine surgery and a long, difficult recovery. Seeing that he is doing better made me reflect on my own situation. I have been dealing with some intense back pain myself. Am I at a point where I should schedule an appointment to see a neurosurgeon?

ANSWER: Back pain is common. As many as 80% of people experience it at some point, and about 90% of cases improve within six weeks. For that reason, acute back pain often does not require immediate evaluation by a neurosurgeon. Sciatica, which refers to pain that radiates down the leg, is also common and generally resolves in the same time course.

When to seek medical care

An MRI (a type of diagnostic imaging test) usually isn't needed in the first six weeks for low back pain or sciatica unless you have concerning symptoms. Patients should seek medical care right away if they have leg weakness, loss of bladder or bowel control, fever or chills, unexplained weight loss, a personal history of cancer, or recent trauma.

Initial management focuses on conservative care. This includes over-the-counter medications, such as acetaminophen or ibuprofen, and physical therapy. Bed rest is not recommended. Patients are encouraged to stay active and limit rest to no more than 48 hours.

Common causes of back pain

Common causes of back pain include muscle strain, inflammation involving the spinal joints or discs, poor posture, or sleeping in abnormal positions. Sometimes discomfort also may originate from abdominal or pelvic organs that can refer pain to the back.

Patients should first see a primary care clinician for evaluation and initial treatment. If discomfort lasts beyond six weeks, imaging should be obtained. If imaging findings are irregular and back pain or sciatica persist, referral to a neurosurgeon may be appropriate.

Imaging is generally not performed before six weeks because some abnormalities such as disc herniation may resolve over time. An MRI also can be misleading because degenerative changes are often seen on scans in people without symptoms, particularly with aging.

A common misconception is that a neurosurgery referral will automatically result in surgery being recommended. That is not the case. Many spine conditions can be managed without an operation and improve over time or with conservative measures.

When surgery may be considered

Surgery for pain is considered after nonoperative treatments, such as medication, physical therapy or injections, have not provided further relief and when imaging findings align with a patient's symptoms. Establishing the correct diagnosis is a necessary first step before contemplating surgery.

Conditions that may require surgery include scoliosis, spondylolisthesis, lumbar stenosis with claudication or radiculopathy, disc herniations, and sacroiliitis.

In most spine cases, surgery is elective rather than urgent. The decision depends on whether the benefits outweigh the potential risks.

Implants and surgical techniques have improved significantly in recent years. Minimally invasive approaches are more common, and surgeons may use advanced imaging, image guidance and computer software for planning.

Recovery varies based on the procedure performed. After less complex operations, patients often resume normal activities within about six weeks. During that time, heavy lifting, bending and twisting are restricted. More extensive procedures, including fusion, require longer healing times (six months to a year), though most people who perform desk work can generally return within six weeks. More physically demanding jobs may require up to three months.

In appropriately selected patients, many procedures offer a 70% to 90% chance of improvement. However, every surgery carries some risk, and thus, conservative measures should always be tried for pain unless a patient also has more urgent symptoms such as progressive weakness, infection or trauma.

Maintaining a healthy body weight, exercising regularly with both cardiovascular and strength training, not smoking, and following a balanced diet are important lifestyle factors to stay healthy, and they may help reduce back problems. They also can help reduce the risk of complications when surgery is required.

If discomfort becomes more severe or includes concerning symptoms, seek medical evaluation. A primary care clinician can determine whether referral to a neurosurgeon is appropriate.

While most back pain resolves without surgery, persistent or progressive symptoms deserve careful evaluation to determine the most appropriate next step.

Grant Mallory, M.D., Neurosurgery, Mayo Clinic Health System Eau Claire and La Crosse, Wisconsin

The post Mayo Clinic Q&A: When should I see a neurosurgeon about my back pain? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My daughter is on her high school soccer team and has seen teammates sidelined with ACL injuries. What can she do to prevent this from happening to her?

ANSWER: No one wants to hear the distinctive pop of an ACL tearing or rupturing, which typically means the player's season is at an end. The ACL, or anterior cruciate ligament, is located inside the knee and provides stability during movements such as cutting, turning, twisting and jumping. 

Risks of ALC injuries

Women and girls are up to 8 times more likely to experience ACL injuries than men. While the causes are still being studied, several factors may contribute to the increased risk:   

• More girls and women are participating in competitive sports.
• Women's wider pelvises create a greater angle from the hip to the knee, which changes how force travels through the knee.
• The ACL in women is thinner than in men.
• The strength of women's quadriceps — the muscles in the front of the thigh — is greater than the strength of their hamstrings — the muscles in the back of the thigh. The opposite is true in men. When women land from a jump, their quads can overpower their hamstrings, reducing the stability of their knees.
• Recent research is exploring the effect of hormones on the ACL during the menstrual cycle. One hormone, relaxin, does just that — relaxes women's ligaments before giving birth. It's also at higher levels in their bodies leading up to their period, which may relax the ACL and make it more prone to injury.
  

Prevention

Awareness of the factors behind increases in injuries can lead to improved training for women that addresses proper technique, muscle strength, balance and biomechanics. One resource for helping prevent ACL injuries is the FIFA 11+ Warm-up Program. It was developed by an international group of experts and is available online for free.

Divided into three segments, each segment has its own set of exercises with progression levels to add difficulty and variation. The exercises pay special attention to knee strength and position. Although this 20-minute warmup was developed for soccer players, it can be translated to any sport, from basketball to pickleball.

Whether you follow this program or something similar, players should commit to strength, balance and knee-position work for at least 10 minutes, three or more times a week. There's a push to incorporate this kind of training into youth, high school and college programs.

No one is completely protected from ACL injuries, which range from sprains to partial tears to ruptures. With a partial tear, segments of the ligament remain connected. A rupture rips the ligament in two. 

Treatment

If you experience an injury, you may seek treatment first from a sports medicine or orthopedics clinician. They'll ask questions about how the injury happened and if contact was involved. About 70% of injuries are noncontact and may have been caused while pivoting or landing from a jump. Typically, patients undergo an MRI to clarify the extent of the injury.

If it's a sprain, treatment may involve wearing a knee brace while the ligament heals, which can take weeks to months. Intensive physical therapy to strengthen the knee and alleviate biomechanical imbalances is a mainstay of treatment. Once the ACL heals, the athlete may return to their sport.

If the ACL is torn, the severity of the tear will determine if surgery is needed. A rupture requires surgery to reconstruct the ACL using a graft from the patient's patellar, quadriceps or hamstring tendon. No matter the type of graft, athletes can expect at least nine months of recovery and rehabilitation before returning to play.

For any ACL injury, part of recovery is regaining confidence in the injured knee. Physical therapy can help restore and reinforce confidence.

Recovery

While the recovery period may be up to a year or more, return-to-play rates are excellent — around 80%. However, once athletes return to play, there's a risk of reinjury, especially for those in their teens and early 20s. About 1 in 4 athletes will experience a second ACL injury.

Studies show that reinjury to the reconstructed knee is similar for men and women. However, some studies report women have a greater risk of ACL injury in the opposite knee. So prevention through strength and biomechanics training is key.

Before an injury happens, youth and student athletes should consider a biomechanical assessment by their team's athletic trainer, a sports medicine specialist or a physical therapist.

While this approach will lessen injuries, it won't completely prevent them.

Deanna Brinks, M.D., Physical Medicine and Rehabilitation, Sports Medicine, Mayo Clinic Health System, Mankato, Minnesota

The post Mayo Clinic Q&A: Addressing ACL injuries in women appeared first on Mayo Clinic News Network.

 DEAR MAYO CLINIC: I have a slow heart rate, and my cardiologist has recommended that I have a pacemaker implanted. Can you tell me what a pacemaker does and what I should consider when I make this decision? 

ANSWER: A heart rate slower than 50 beats per minute is called bradycardia. When the heart beats too slowly, it may not pump enough blood to meet the body's needs. People may experience fatigue, tiredness, shortness of breath, weakness and difficulty exercising.  

Some causes of bradycardia are reversible. These include: 

• Athletic training, which strengthens and conditions the heart. 
• Medications, such as beta blockers or calcium channel blockers.  
• Lyme disease, which can cause Lyme carditis and affect the heart. 
• Electrolyte imbalances. 

Once your heart team has identified and addressed any reversible causes, the most common irreversible cause is a problem with the heart's electrical system — specifically, its ability to properly conduct electrical signals between the chambers. When this happens, a pacemaker — a small, battery-operated device — can regulate the heart rate by delivering carefully timed electrical impulses to the heart.

Types of pacemakers

There are two types of permanent pacemakers: transvenous and leadless. Your heart team will determine which type is best for you based on your medical condition and lifestyle. 

Transvenous pacemaker. To implant a transvenous pacemaker, a cardiac electrophysiologist creates a small pocket just below the collarbone between the skin and chest muscle. Depending on your needs, up to three wires, called leads, are guided through a blood vessel into the heart. The leads are connected to the pacemaker, which is then placed into the pocket. Patients may go home the same day or the following day. 

The first four to six weeks after pacemaker implantation are especially important. You’ll need to avoid lifting anything heavier than five pounds and raising your left arm above your head to prevent the leads from getting dislodged. After this period, you can return to your usual activities without restrictions. 

It's a myth that pacemakers are affected by cellphones, microwave ovens, X-rays or airport scanners. Most modern pacemakers are MRI compatible, but your heart team may need to reprogram the device before the scan. 

However, strong magnetic fields, such as those found in certain industrial settings or during arc welding, can interfere with pacemakers. Talk with your healthcare professional if you're concerned about this type of exposure. 

Leadless pacemaker. This newer pacing technology allows the pacemaker to be implanted directly inside the heart. There is no surgical pocket or leads. The device is about the size of a large vitamin capsule or one-third the size of a standard AAA battery. 

A leadless pacemaker may be a good option for people on dialysis, who are at higher risk of infection, or those who rely heavily on their upper body for mobility, such as those who use a walker or wheelchair. 

To implant a leadless pacemaker, a small incision is made in the groin. The device is attached to the end of a delivery system, which is threaded through a vein in the leg and into the heart. 

Because there is no chest incision or leads to dislodge, recovery is often simpler. The main restriction is avoiding heavy lifting until the groin incision heals, typically within one to two weeks. 

Like transvenous pacemakers, leadless devices are safe around common household electronics, but they can be affected by strong magnetic fields. 

All pacemakers must be checked periodically to ensure they're functioning properly. After implantation, you'll be sent home with a monitor. Every three months, you will either transmit data remotely or visit your clinic for follow-up.  

The battery life of a pacemaker is typically 8 to 12 years, depending on the device and how often it's used. If you have a transvenous pacemaker, you'll receive a notice, usually about six months in advance, that it's time to replace the generator. Your electrophysiologist will remove the device from its pocket and replace it with a new one. A leadless pacemaker can be removed or left in the heart with a new one implanted alongside it. 

As patients with pacemakers approach the end of life, they may choose to have the device turned off or the settings adjusted so it doesn't prolong life. This is an important discussion to have with your family and heart care team, and it should be included in your advance healthcare directive. 

If you've been diagnosed with bradycardia, talk with your heart team about your options. If a pacemaker is recommended, ask which one best fits your health and lifestyle goals. 

Divya Korpu, M.B.B.S., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin 

The post Mayo Clinic Q&A: What are the different types of pacemakers?  appeared first on Mayo Clinic News Network.

Jenny Gottfredsen and Shar Ballentine were accustomed to being on the other side of the hospital bed. 

Both nurses at Mayo Clinic Health System in Eau Claire, Wisconsin, spent their days teaching, supporting colleagues and advocating for patients. Within days of one another, however, both began navigating serious diagnoses of their own — experiences that strengthened their friendship and deepened their understanding of vulnerability, resilience and patient-centered care. 

Careers grounded in care 

Jenny's interest in healthcare began early in life. After earning a degree in cardiopulmonary rehabilitation, she went on to complete nursing school and build a career in cardiology. For more than a decade, she cared for patients with heart disease before joining Mayo Clinic seven years ago. Today, she works in Nursing Professional Development while continuing to support cardiology teams. 

Shar brings decades of experience in healthcare. After more than 20 years in academic medicine in Madison, Wisconsin, she relocated to the Eau Claire area in 2021 to be closer to family and begin a new chapter. As a seasoned nurse and team lead, she quickly became a mentor to colleagues — including Jenny, who leaned on Shar's experience as she transitioned into an educator role. 

What began as a professional collaboration grew into a close friendship built on trust, humor and shared values. 

A conversation and an unexpected turn 

That trust mattered the day Shar asked Jenny to meet privately. 

After a routine mammogram led to additional imaging and a biopsy, Shar learned she had breast cancer. Healthy and active with no family history of cancer, she struggled to reconcile the news. She chose to tell Jenny face-to-face. As Shar shared her diagnosis, she noticed Jenny glance at her smartwatch — checking her heart rate rather than a message. 

Moments later, Jenny began experiencing chest pain and arm discomfort. She initially attributed it to anxiety and hesitated to seek care. Shar listened carefully. She asked questions, reflected Jenny's words back to her and stayed present — a familiar Mayo Clinic approach rooted in listening first. 

That hesitation is something Dr. Fearghas O'Cochlain, a Mayo Clinic Health System interventional cardiologist involved in Jenny's care, says he sees far too often. 

"Unfortunately, it happens more often than we'd like. Especially in younger, otherwise healthy people, the first thought is usually, 'It's a pulled muscle,' or 'It's something else.' Heart disease isn't top of mind. Most people haven't experienced what cardiac pain feels like before — it's internal, unfamiliar and hard to describe — so they explain it away," Dr. O'Cochlain says. 

"We do see women, in particular, attributing symptoms to anxiety. Anxiety is real, but it typically doesn't come out of nowhere and feel completely different from anything you've experienced before," he adds. "New, persistent or escalating symptoms — especially chest tightness, arm pain or shortness of breath — shouldn't be ignored. We would much rather see someone in the emergency department and reassure them than ask later why they didn't come in sooner. Care begins with the call." 

Shar allowed Jenny time to process while gently encouraging her to get checked. Eventually, Jenny agreed to go to the emergency department — as long as Shar went with her. 

From educator to patient 

Once evaluated, Jenny's electrocardiogram was abnormal and lab work showed elevated troponins, a protein released into the bloodstream when the heart muscle is damaged. Cardiology teams moved quickly, and she was taken to the cardiac catheterization laboratory (“cath lab”) — a place she knew well, now from a very different perspective. 

She was diagnosed with spontaneous coronary artery dissection (SCAD), a rare cause of heart attack that more often affects younger, otherwise healthy women. Jenny required three stents, an intra-aortic balloon pump, intubation and several days in the coronary care unit. 

The diagnosis was unexpected. Jenny was active, health-conscious and well-versed in cardiology — yet she suddenly found herself on the other side of a condition she had rarely encountered in nursing. 

That surprise is common, Dr. O'Cochlain says, and underscores an important message about awareness — even for people who appear otherwise healthy. 

"Everyone needs to be aware of the signs and pay attention to their own body — especially what feels different," he says. "You're healthy until you're not. Even young, active women are not immune. It's not productive to live in constant fear of a diagnosis, but it is important to know what's normal for you. When symptoms come out of the blue or feel irregular, they deserve to be evaluated." 

Despite Jenny's background in cardiology, SCAD was new to her. The experience gave her a deeper understanding of what patients face when diagnoses are unexpected and frightening. For Shar, supporting Jenny during her hospitalization while beginning her own cancer treatment was challenging but also grounding.  

Both women leaned on humor and honesty as they adjusted to being seen not as nurses and caregivers, but as patients. 

Parallel paths, shared support 

As Jenny began cardiac rehabilitation, Shar showed up, standing nearby during workouts, offering encouragement and conversation. When Shar began chemotherapy, Jenny checked in before and after each treatment, understanding the mental weight of waiting for labs, results and side effects. 

Both were learning how to stay present in their own experiences while continuing to support one another. They made space for difficult days, talked openly and continued moving forward together. "This was chosen for us," Shar says. "So we choose how we're going to make it through." 

Living Mayo Clinic values together 

Throughout their care, Mayo Clinic's team-based approach was evident. Jenny benefited from close coordination between local cardiology teams and specialists at Mayo Clinic in Rochester, Minnesota.  

That collaboration is intentional, Dr. O'Cochlain says, and especially important in complex cardiac events like SCAD. 

"The Mayo Model of Care is what we strive for every day," he says. "We work as a group to care for the patient in front of us, and that means having world experts readily available to one another. It allows us to leverage the best knowledge at the best time in the best way for the patient. 

"In Jenny's case, once we addressed the acute issues in the cath lab, we were able to integrate expertise from Rochester's specialized SCAD team in the Women's Heart Clinic to guide her outpatient follow-up. We can work seamlessly across locations, even when we aren't in the same place." 

Shar's oncology care reflected careful attention to both treatment and quality of life. 

Equally meaningful was how colleagues lived Mayo Clinic values in everyday moments — listening, advocating and showing up as people first. 

Moving forward 

Today, Jenny is feeling well and continuing follow-up care locally. She continues to share her story to raise awareness about SCAD and the importance of listening to symptoms, even when they don't seem to fit expectations. 

Shar’s treatment continues, now transitioning to radiation and ongoing immune therapy, but so does her optimism and her friendship with Jenny. She encourages others to stay current on recommended screenings, especially mammograms. 

Their relationship, shaped by mentorship and strengthened through shared experience, reflects the power of connection in healing. 

They remain nurses and advocates, with a deeper understanding of what it means to be a patient and what it looks like when care begins with listening. 

The post When caregivers become patients: A story of heart, healing and friendship appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: For the past several years, I've been competing in half-marathons. This year, I've decided to challenge myself and enter full marathons. What recommendations do you have for preventing sports injuries as I go to this next level?

ANSWER: Congratulations on continuing to stretch your goals — and for thinking about preventing injury before you begin more intense workouts. For anyone striving to boost their performance, injury prevention shouldn't be separate from your training program; it should be embedded into it. That includes incorporating it into warmups, strength sessions and practice design.

Preventing sports injuries

What does that look like? Starting with your warmup, think of it as preparing your system for the activity you're about to do. Your warmup should go beyond static stretching and focus on dynamic movements that activate the muscles that you're going to use in training and competition.

Then add sports-specific patterns to your warmup. For example, if you're a basketball player, jumping is a key movement. So, add that to your warmup. Not only does jumping mimic gameplay, but it also raises your heart rate and preps your system for the activity.

Remember, when you're designing your training program, you’re training for capacity, not just the sport itself. That means building general strength, having a good aerobic base, and sound technique and movement quality. 

That's what underlies your ability to progress to a higher level. Even elite athletes have become injured because they haven't built that capacity. Sudden spikes in the intensity and volume of exercise can lead to overuse injuries.

One of the key elements of building capacity and preventing injuries is progressive load management. The principle behind progressive load management means not going from zero to 100, but gradually increasing volume or intensity to build capacity.

Before you take any activity to the next level, address any underlying conditions. If you have knee pain while running, work with a physical therapist or an orthopedic or sports medicine clinician so you're not pushing through an injury and potentially making it worse.

Looking at your own experience, you've already built the capacity for running a half-marathon. A full marathon doubles the distance, making it a perfect example of how to apply progressive load management. That increased distance is a significant load not only on your cardiovascular system, but also on the orthopedic structures like bones, tendons and ligaments.

To condition your body and build capacity, design your running program so that over the next several months, you gradually increase mileage each week until you're at full marathon distance.

For someone who is coming back from a sports injury, the same progressive load management applies. A sports medicine specialist will work with the athlete to gradually rebuild strength, measuring progress along the way. Before getting back onto the court or field where they'll be expected to deliver 100%, they'll need to simulate the sport. 

One group of athletes particularly susceptible to overuse injuries is youth and adolescents. While participation in multiple sports is encouraged, young athletes still need time to build the physical capacity required for each sport as they transition between seasons. Gradually increasing training demands, rather than jumping from zero to 100, is key to reducing the risk of injury.

Pitchers are particularly vulnerable to overuse injuries. Finding the right balance between adequate time off and maintaining arm strength and conditioning can be challenging. Although there are published recommendations for annual time away from throwing, many athletes enter the season having done little or no arm-specific training in the offseason.

To reduce injury risk, conditioning and capacity building should begin well before the season starts. High-quality return-to-throwing programs, which are available both in person and online, can help guide athletes through a structured, progressive plan to safely get back in the game.

While the emphasis in youth sports is often on pitchers, catchers also throw at similar or higher volumes. They may not be throwing at the same velocity, but the volume is there. It's important to take this into consideration when tracking pitch counts. Pitching and catching in the same game should be avoided in most situations.

For student athletes, single-sport specialization and year-round competition are not in their best interest when it comes to injury prevention. Athletes need time away from each sport to allow their bodies to recover.

Participating in multiple sports is generally better for any athlete's overall physical health and helps reduce the risk of overuse injuries. It also promotes broader skill development and improved overall athleticism. By varying movement patterns and training demands, the body becomes more adaptable and is given a break from repetitive stress. Athletes often gain transferable skills that improve performance in their primary sport while also enhancing motivation and mental well-being.

Taylor North, D.O., Sports Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin

The post Mayo Clinic Q&A: Sports injury prevention strategies that boost performance appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My coworker had been telling me they were having pain in their lower back that extended down into their hips. They were diagnosed with a sacroiliac (SI) joint issue. I occasionally experience back pain myself and wonder whether surgical treatments are available for sacroiliac joint problems.

ANSWER: Yes, surgery can help relieve SI joint pain, but it’s usually considered only after the diagnosis has been confirmed and when nonsurgical treatments haven’t worked. Because back pain can come from many sources, finding the true cause is essential before considering surgery. When pain persists or affects daily life, evaluating the sacroiliac joint as a potential cause of the pain can help identify more effective treatment options.

Where is the sacroiliac joint?

The sacroiliac joint sits between the base of the spine (the sacrum) and the pelvis. It is one of the body’s largest weight-bearing joints, helping transfer force from the upper body into the legs during activities such as standing, walking and lifting. Arthritis or excessive motion in the joint can lead to significant pain in the lower back, hips or buttocks, sometimes radiating into the legs.

SI joint pain can closely mimic conditions affecting the spine or hips, which makes diagnosis challenging. Research suggests that up to 15% to 30% of people with chronic low back pain may have pain originating from the SI joint. Some individuals live with symptoms for years or even undergo other procedures before the SI joint is correctly identified as the source.

Diagnosis typically begins with imaging to rule out other causes, such as infection or tumors. However, imaging alone is not enough. A physical exam that stresses the joint, followed by a diagnostic injection into the SI joint, helps confirm whether it’s truly responsible for the pain. If an injection significantly reduces your pain, it confirms that the SI joint is the cause.

Surgery isn’t the first step for SI joint pain. Most people begin with conservative treatments, including anti-inflammatory medications, physical therapy or therapeutic injections. These approaches aim to reduce inflammation, improve joint stability and relieve pain without surgery.

Physical therapy may help strengthen supporting muscles, while injections can provide temporary relief, sometimes lasting several weeks or months, although symptoms may return. Surgery is generally considered when pain has lasted longer than six months and hasn’t improved with nonsurgical care.

People with confirmed SI joint pain who don’t find relief through conservative treatments may be candidates for surgery. Certain conditions, such as widespread inflammatory arthritis or serious medical issues that make anesthesia unsafe, may rule out surgery. Smoking can also interfere with bone healing and affect surgical outcomes.

Modern SI joint surgery is typically minimally invasive. Through a small incision near the hip, surgeons place implants across the joint to stabilize it. The implants are relatively small and resemble screws, with specialized surfaces designed to encourage bone growth. Over time, bone grows across the joint, helping create lasting stability and reduce painful movement. The procedure often takes less than an hour, and some patients can return home the same day.

Most people have activity restrictions for about six weeks after surgery. Pain relief may be noticeable early, particularly when excessive joint motion was the cause, while arthritis-related pain may improve more gradually. By six months, about 80% of patients report improved quality of life and pain. Studies show these improvements can last for years.
 
If you’ve been told nothing can be done for chronic low back pain, don’t lose hope. For some people, SI joint pain may be the cause, and effective treatments, including surgery, are available. 

Grant W. Mallory, M.D., Neurosurgery, Mayo Clinic Health System, Eau Claire and La Crosse, Wisconsin

The post Mayo Clinic Q&A: Can surgery alleviate sacroiliac joint pain and issues? appeared first on Mayo Clinic News Network.