Bicycling is a great way to stay active and enjoy the outdoors. Whether you're a recreational rider or a daily commuter, it's important to protect your hands and wrists. Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon specializing in hands and wrists, shares practical tips to prevent injuries while biking.

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Whether you're a pro or biking for fun, there are common injuries all cyclists might experience.

"The first one is a traumatic injury if somebody falls off a bike," says Dr. Kakar. 

Common breaks from traumatic injury include wrist fractures.

"We also see overuse-type injuries. So, for example, we see patients where they're pressing on the brakes for too long, squeezing hard, putting pressure on their palm, and their hands sometimes fall asleep — called numbness and tingling," Dr. Kakar says.

He says it could be carpal tunnel syndrome, a condition you don't want to ignore.

"If you have numbness and tingling in the fingers, it is something I wouldn't ignore because if you have carpal tunnel, we worry about that," Dr. Kakar explains.

The numbness and tingling can become permanent and result in the loss of muscle strength

Prevent bike injuries

"There are simple preventive measures you can take," says Dr. Kakar. "Having thicker grips so you're not squeezing as hard can also help. Bike gloves help as well and sometimes puts your wrist in a better position than putting pressure on your palm."

You can't always avoid an accident, but you can make your ride safer by always wearing a bike helmet.

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Preventing a stroke is a crucial aspect of healthcare, as about 80% of all strokes are preventable. The focus is on managing risk factors to reduce the long-term risk of stroke.

A stroke results from a blocked or torn blood vessel that decreases blood flow to the brain. In the U.S., stroke is a leading cause of death and disability.

“Because about 80% of all strokes are preventable, we really focus on prevention,” says Dr. Stephen English, a Mayo Clinic neurologist.

Preventing stroke risks

Tips for lowering stroke risk include maintaining blood pressure under 130/80 and keeping cholesterol and blood glucose at appropriate levels.

"(Other modifiable risks include) things like smoking cessation, treatment of sleep apnea with a CPAP device, and some other potential treatments," he says. "We want to make sure that the risk factors are mitigated to help reduce the long-term risk of stroke."

There are risk factors for stroke that cannot be changed. These include age, sex, race and family history. “There are four nonmodifiable risk factors we typically think about. The first is age, so age greater than 55; males; people that have a family history of prior stroke; and then people that are of African American descent,” says Dr. English.

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This dual procedure is especially helpful for patients with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. MASLD happens when fat builds up in the liver, often without symptoms. It's mostly caused by obesity — defined as a body mass index (BMI) of 30 or higher. In advanced stages, MASLD can lead to serious liver damage that requires a transplant.

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"Metabolic-associated steatotic liver disease is the most common liver disease, not only in the United States but worldwide," says Dr. Heimbach.

As obesity rates rise, so does the need to treat patients with MASLD.

"When we have excess fat that builds up in the liver, this can lead to inflammation and scarring and even advanced liver disease," she says.

It won't cause complications for everyone, but, for some, it can progress to cirrhosis.

"When a patient develops cirrhosis, they can then need a liver transplant," Dr. Heimbach says.

And having extra weight can be a reason patients might not be eligible for transplant. At Mayo Clinic, the approach is to help patients with obesity as well as transplant.

"We consider both liver transplant and what's called a sleeve gastrectomy, which is a type of weight-loss operation that can be used as a tool to help patients be successful in managing not only their liver disease with a liver transplant, but their obesity with the sleeve gastrectomy," Dr. Heimbach explains.

The procedures are done simultaneously with multiple teams working together. Dr. Heimbach says it's about providing patients the care they need.

"I'm excited about what transplant offers to all of our patients, which is to be able to return to the life that they had before they got sick. And for patients who were carrying extra weight, not only are they healthy again, but now they're able to really fully enjoy and be fully participating in their life," she says.

Additional Resources:

• Study finds long-term health benefits from bariatric surgery and liver transplant

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Imagine if your one life could help save the lives of many. Organ donation has the power to transform a single act into the gift of life for countless people in need.

"This tremendous gift of organ donation can make a new life possible for patients who are waiting for transplant, and there is a critical shortage of available donor organs," says Dr. Heimbach.

The need for living organ donors

As the need for kidneys and livers grows, living donation is becoming an increasingly important option for patients waiting for a transplant.

"The primary benefit of living donor transplant is to be able to go ahead to transplant sooner, so patients don't continue to wait on the list, become more sick, have a risk of dying on the list," she says.

Whether you consider being a living or a deceased donor, it's important to ask questions and plan ahead. 

"It's very important to make your wishes known, talk it through with your family and recognize that all of this is possible because of this remarkable altruism," Dr. Heimbach says.

If you want to be an organ donor, you can sign up for your state's donor registry, mark your choice on your driver's license when you get or renew it, and make sure your family knows you want to be an organ donor. 

Read more about living donor transplants.

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• Mayo Clinic Minute: Liver transplant for patients with advanced colorectal cancer
• Mayo Clinic Minute: What to expect as a living kidney donor

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

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

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

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

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

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

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

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

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

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

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

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Dr. Denise Harnois, a Mayo Clinic transplant hepatologist, explains how this innovative strategy is expanding treatment options and improving outcomes.

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Learning you have advanced colorectal cancer that has spread to the liver can be scary. In some cases, a liver transplant may offer hope, providing better outcomes when other treatments aren't an option. 

"In those circumstances where patients have colon cancer that's gone to the liver that doesn't seem to be anyplace else within the body, but they're not eligible for consideration of doing a surgical resection — in those circumstances, we can consider replacing the entire liver, and that involves a liver transplant," explains Dr. Harnois.

It's a complex surgery requiring experts from multiple teams working together.

"We're working together as a team to make sure we are offering the best options for the potential for cure for these patients," she says.

Liver transplants have greatly improved survival rates. One-year survival is 80% to 100%, three-year survival is around 80%, and five-year survival is between 60% and 80%.

"Without consideration of liver transplant, their five-year survival rate would have been 15%. So we can offer a dramatic improvement in survival rates in patients that undergo liver transplant," says Dr. Harnois.

Related posts:

• Liver transplants offer new hope for colorectal cancer patients with liver metastasis
• Mayo Clinic Q and A:  Understanding colorectal cancer
• Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults
• Innovative treatments for rectal cancer

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A brain aneurysm, also called a cerebral aneurysm, is a bulge or ballooning in a blood vessel in the brain. Dr. Chris Fox, a Mayo Clinic neurosurgeon, says there are two broad categories of aneurysms: ruptured aneurysms, which are neurosurgical emergencies, and unruptured aneurysms, where there is time to establish a treatment plan that may involve multiple options. 

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"For unruptured aneurysms, we have the ability to plan and make a decision on the best treatment upfront in a nonemergent situation," says Dr. Fox.

But when a brain aneurysm ruptures, prompt medical attention is required. 

"Typically, when we see a patient with a ruptured aneurysm, we treat it as quickly as possible. That's usually within a matter of hours because there's a risk that the aneurysm can rerupture," he says.

Symptoms

Symptoms of a ruptured aneurysm can include severe head pain, nausea, vomiting, confusion and loss of consciousness.

"The classic presentation for a ruptured aneurysm is a patient has the worst headache of their life," Dr. Fox says.

Brain aneurysms are more common in women, and there may be a genetic component because aneurysms can run in families.

"But smoking and hypertension are two of the biggest risk factors for causing an aneurysm or having an aneurysm form," says Dr. Fox.

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When blood vessels are damaged or blocked, it can deprive your brain of vital oxygen and nutrients, which could lead to a condition called vascular dementia.

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"Vascular changes in the brain most often damage the axons — or cables — that connect different parts of the brain," says Dr. Stephen English, a Mayo Clinic neurologist. "Therefore, signals take longer to travel, so our brains are not working at full speed."

Dr. English says the signs of vascular dementia include problems with reasoning, planning, judgment, memory and other thought processes. Factors that increase the risk of heart disease and stroke also raise vascular dementia risk.

"High blood pressure, high cholesterol, diabetes, smoking, obesity and sleep apnea — these are the modifiable risk factors that, if untreated, can cause wear and tear on the small blood vessels in the brain over time," says Dr. English.

If you are at risk or show signs of vascular dementia, consult a neurologist.

"We can potentially augment some of these risk factors," says Dr. English. "Medications and lifestyle changes can lower blood pressure and cholesterol; we can treat sleep apnea with certain devices or surgeries; and we can help you stop smoking. These are some things that can reduce the risk of developing vascular dementia."

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"Many patients will wonder: 'I have a lump on my arm or my leg. Should I have this evaluated? Who should I see, and when are these symptoms concerning?'" says Dr. Krista Goulding, a Mayo Clinic orthopedic surgeon.

She explains when you should seek medical care, "If you have a lump on your arm or your leg that is growing rapidly or is bigger than the size of a golf ball, this needs rapid attention."

The first step in diagnosing a lump is to get advanced imaging, typically starting with a radiograph or X-ray.

"The next step is to get cross-sectional imaging, which means either an MRI or a CT scan," says Dr. Goulding.

Imaging is then followed by a biopsy to remove a sample of tissue for testing.

"And this helps our multidisciplinary team make decisions about how to treat these tumors because these tumors can be benign. They can be benign aggressive, meaning that they are not cancerous, but they can cause problems locally. And then there can be cancer diagnosis similar to sarcomas and other types of cancers that will need rapid attention," says Dr. Goulding.

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

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

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

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

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

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

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

Saline solutions using distilled water are also helpful.

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

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

Using saline solutions or a neti pot

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

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

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

Related posts:

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

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