DEAR MAYO CLINIC: One of the biggest things I have missed since my office went remote is going on walks with my coworkers throughout the day. With so many added responsibilities at work, I can hardly find time to leave my desk. How is all this sitting affecting me? How can I find a balance?

ANSWER: We understand the reality is that people have less and less time to exercise. While exercising before or after work is extremely important, it is just as important to stay active throughout the day. You may be surprised to hear that sitting for eight or more hours a day is comparable to smoking a pack of cigarettes a day in terms of heart risk. Sitting for too long throughout the day is one of the major risk factors for heart disease, cancer and many medical conditions. The solution? An active office can empower you to break out of a sedentary lifestyle. 

An active workstation is essentially a desk where you are not sitting. This can mean a standing desk or one where you move around, such as biking, walking or using a step machine. An active workstation has many benefits. The main benefit is that it allows the user to be productive while burning calories at the same time. Walking pads or treadmills allow you to walk at a slow speed and answer emails, work on a project or participate in a video conference call.

An active workstation does not mean that you need to be moving all the time. And you don't have to be active for too long to reap the benefits of activity. It has been shown that even when you are standing, you are more likely to be spontaneously mobile than when you are sitting. This is important to keep in mind. Overall, sitting for less than three or four hours throughout the day is a good goal for those who are able.

Another concept that is gaining popularity is the idea of "snack" activities. A "snack" is doing something for two or three minutes after sitting for an hour. This helps you break the sedentary status of your body by taking the stairs for a few flights, doing some pushups or something meaningful in terms of activity for just a few minutes, and then coming back and continuing your work. These little episodes of activity reset your metabolic clock. Activity snacks can cause significant biological changes in your cells, metabolism and cholesterol. You may notice your mind feeling sharper for the next half hour. 

While "activity snacking" is an affordable way to implement movement into your daily routine, you don't need a lot of money or a big investment to switch up your office furniture. There are some adapters out there that you put on top of your desk to raise or lower your monitor or laptop computer, allowing you to stand. Some people get creative and use a stack of books or other existing items. The bottom line is that everyone should feel motivated to redesign their home offices in order to be active longer throughout the day. This leaves us with less room for excuses. And, if you have days where you’re stuck going into the office, you still have options. Consider taking the stairs instead of the elevator. — Francisco Lopez-Jimenez, M.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

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DEAR MAYO CLINIC: I just turned 45 and am dreading my first colonoscopy. Why do I need to be screened if I'm not having issues? Can you walk me through the process?

ANSWER: Feeling anxious or afraid surrounding a procedure, particularly when you've never done it before, is completely normal. The purpose of screening is to act before someone develops symptoms. If we're able to identify polyps, which are precancerous lesions in the lining of the colon, we would then have the opportunity to remove them and prevent the development of cancer in the first place. So through screening, we can prevent cancer. At the time of diagnosing cancer, we've missed that opportunity. 

There are a number of ways we can screen for colorectal cancer. In the U.S., we most often use a colonoscopy. Colonoscopy is an invasive test, but it allows us an opportunity to not only see polyps, but also remove them at the same time. For people with no additional risk factors besides age, it is recommended to start screening at the age of 45. If other risk factors are present, though, it may be recommended to have a colonoscopy sooner than 45. 

The colon preparation prior to the colonoscopy is key. The goal of colonoscopy prep is to make sure that there is nothing in the colon by using a laxative liquid solution. Then, at the time of the colonoscopy, we're able to see and detect even small precancerous lesions so they can be removed. 

It is very common to hear complaints from patients about the preparation, such as the consistency or taste of the solution, cramping, abdominal bloating or discomfort. That's to be anticipated. Unfortunately, some patients also experience nausea. Try slowing down how fast you are drinking the solution. For those who tend to struggle with the taste or consistency, try drinking it through a straw. You can also bite into a small wedge of lime or lemon, or you can chew gum or ice between drinks. 

After you finish the last of the prep solution and check in for your appointment, you'll often be greeted by the front desk team and then escorted back by a healthcare team member. They will review things like your medical history and medications and see how the colon prep treated you. There is a risk that you may have to come back and repeat the test at a later time if the colon prep was not adequate.

Another critical thing they will do is establish your intravenous therapy or IV. The IV is the route in which they will give you the medication to help make the procedure a little bit more comfortable. Some people don't do any sedation at all, but it is totally appropriate to opt for it. There are several different ways that sedation could be done for the procedure. A lot of that depends upon how the procedure is scheduled with your healthcare team. Then, you will end up going back to the procedure room where they will review the nature of the procedure before starting the colonoscopy. Afterwards, there's a bit of a recovery period, and then you're able to head back home. Because of the sedation, we don't want people driving, consuming alcohol or making any critical decisions for 24 hours. 

We still don't have a perfect recipe for preventing polyps, but maintaining a healthy diet and exercise can protect you. It is important to be aware of any symptoms and then follow through with screening. Best of luck as you take this important first step. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota.

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DEAR MAYO CLINIC: It seems like no matter what I do, I can't lose weight. Most of my family members struggle with their weight too. Do our genetics play a part in this?

ANSWER: It's important to understand that we are all unique and gain weight for many different reasons. When trying to understand weight gain and why some of us have difficulty losing weight, there are factors such as gut and brain connections, how we control our sensation of hunger and fullness and how long we stay full. Over a decade of studies at Mayo Clinic have helped identify characteristics that can be associated with groups of people called obesity phenotypes. 

Each phenotype has a single genetic predisposition (an increased likelihood of developing obesity based on a person's genetic makeup) and interacts differently with their environment. In many environments we see today, there is an excess of food, and we're less active than before. Some people may feel hungry between meals, while others only have one big meal a day — our genetics drives this. Your genetic makeup determines which phenotype you're going to have. These phenotypes can help guide treatment for weight loss. Each of these genetic phenotypes, or genotypes, identifies the type of obesity and which medication would work best. 

The first phenotype is what we call "hungry brain." These patients start eating and don't feel full even after consuming large meals with second and third helpings. Usually, this runs in families. The other phenotype is what we call "hungry gut." These patients start eating and feel full after their usual portion, but the gut does not send those signals to the brain. Because of that, they feel hungry between meals. Signals from the gut to the brain are hormones, such as glucagon-like peptide-1 (GLP-1). Semaglutide medications such as Wegovy, Ozempic and Rybelsus work on behalf of the GLP-1 hormone. They connect between the gut and the brain, and they signal to the brain that you're full. 

Patients who have emotional hunger are another group. Whether having a good or bad day, these patients look to cope with life by eating food. The fourth group is patients with a "slow burn" or abnormal metabolism where the body does not burn all the calories they consume. 

Looking at these four phenotypes can help individualize obesity therapy. How genes correlate with an obesity phenotype can help determine which medications should be prescribed. Each of us also should have a unique diet approach based on our genotype and phenotype. Many diets have mainly focused on obesity-related complications, such as managing Type 2 diabetes or preventing heart risk, but none have been customized to phenotypes. The concept of the phenotype-tailored diet came from multiple studies that showed metabolic benefits during and after the diet plan began. These findings were then matched to each phenotype to define recommended diets.

At Mayo Clinic, we work closely with our colleagues in bariatric surgery through endoscopic procedures to find out, based on our genetics, how we can identify who will be the most responsive to each course of action. We want to bring precision medicine as we have for any other disease, and I think it's time we do the same for obesity. — Andres Acosta, M.D., Ph.D., Bariatrician, Gastroenterologist, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I recently read that more and more young people are getting diagnosed with colorectal cancer. I'm in my 30s, am I at risk? What does colorectal mean?

ANSWER: The term colorectal cancer combines colon and rectal cancer, two parts of the intestine. The first part of the large intestine is called the colon, and the last part refers to the rectum. These two divisions of colorectal cancer are important because they're often treated differently. Cancers of the colon, for example, may initially be treated through surgery. With cancers of the rectum, we may do treatment long before someone goes to surgery. 

Symptoms of both cancers are similar and can include unintentional weight loss, overall changes in bowel characteristics such as more frequent diarrhea, blood from the rectum or in the stool and ongoing abdominal pain, cramps or gas. These symptoms can be embarrassing for some people to talk about, and that is normal. However, it is extremely important if you have any of those symptoms to share it with your healthcare team. Early diagnosis of colorectal cancer increases your chance of survival.

People of all ages are at risk for colorectal cancer. It is true that there have been increased rates of colon and rectal cancer in younger patients, which has led to a shift in screening recommendations. We used to start screening average-risk individuals at age 50, but because of this new trend, we're now encouraging average-risk individuals to start screening at age 45. Through screening, we can prevent the development of cancer and capture polyps (precancerous growths) even before symptoms start.

It is unknown what has caused this increase among young people. Findings show that it may be an environmental factor. Over the last 50 years, we've seen major changes in diet. Ultraprocessed foods and higher quantities of red meats have potentially led to some negative changes to the bacteria that are normally in our gut, making it not as protective as it once was. A decrease in exercise and an increase in obesity also could be contributing factors. Living a healthylifestyle is critical — exercise and a well-rounded diet can help protect you.

We typically divide people into two groups — those who are at average risk and those who are at high risk for colorectal cancer. Average-risk individuals are people who don't have any associated symptoms that would be linked to colorectal cancer or have any of the factors that would place them at high risk. 

For those who are at high risk, there tends to be at least one of three variables:

1. A medical condition that places them at higher risk.
2. A genetic condition that increases their risk. 
3. A family history that places them at higher risk. For example, a first-degree family member such as parents or siblings who have a diagnosis of colorectal cancer or advanced polyps.

Any of those three components would place you at higher risk, and therefore, you should start screening sooner and possibly more often than average-risk individuals.

When it comes to cancer care, we try to make our efforts personalized, particularly with rectal cancer. The treatment team consists of a gastroenterologist, an oncologist, a surgeon and a radiation oncologist who help direct what the next best step would be for you, whether that's chemotherapy, immunotherapies, surgery or radiation. 

Any delay in sharing information translates to a delay in diagnosis, which can lead to later-stage cancer. It is the later-stage cancers that can be a bit more challenging to treat. Don't delay in making an appointment. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I've had a sensitive stomach since I can remember. My life has been constantly inconvenienced by too many trips to the bathroom. My family thinks I have undiagnosed irritable bowel syndrome. I should have sought care sooner, but what can I do now to treat it? What causes IBS? What are its symptoms?

ANSWER: First off, you are not alone. Irritable bowel syndrome (IBS) is common and affects approximately 1 in 10 adults in the U.S. IBS is characterized by abdominal pain with disordered defecation (constipation, diarrhea or both). IBS can generally be easily treated with a combination of education, reassurance, diet and medications.

IBS is categorized as a disorder of gut-brain interaction. This means that the bidirectional pathway between the brain and the gut is overactive. Patients with IBS are more sensitive in their gut than other patients. IBS may develop due to genetic reasons or insults to the gastrointestinal (GI) tract including food poisoning, prior infections, surgeries, trauma and stressful life events. Stress can greatly affect the GI tract via the brain-gut axis. This can include physical, emotional or financial stress and other types.

The key symptom of IBS is abdominal pain, which would be present at least one day per week on average. In addition, patients have symptoms of disordered defecation, meaning constipation (going days without a bowel movement or straining during a bowel movement) or diarrhea (watery, loose and urgent bowel movements). Some patients have alternating constipation and diarrhea. Overriding symptoms for many patients include gas, bloating and distension, which means a visible or measurable increase in belly size. 

Patients often wonder when to see a healthcare professional. A diagnosis of IBS is based on:

• Unintentional weight loss
• New anemia
• Family history of IBS or colorectal cancer

It is important to note that for most patients, extensive testing is not required to make a diagnosis of IBS, but rather taking a careful history and performing a thoughtful physical exam while using the criteria above. Since IBS is a disorder of gut hypersensitivity and of the gut-brain axis, blood tests, X-rays, colonoscopies, CT scans and other tests generally do not reveal an underlying problem such as an ulcer or a blockage.

It is also important to note that the "best" therapy for IBS is very patient-independent. Every patient is a unique individual with different types and levels of symptoms: 

• Mild symptoms: Symptoms are somewhat bothersome but not intrusive.
• Moderate symptoms: Symptoms are affecting daily quality of life.
• Severe symptoms: You may have been to the emergency department because of your symptoms.

One of the exciting things in the field of gastroenterology is the recognition in the last 10 years that we have this very dynamic gut-brain connection, this bidirectional pathway. What that really means to a patient is that it's not just the standard prescription of over-the-counter medications for IBS with diarrhea or adding more fiber to help improve symptoms of constipation — it's using different therapies such as FDA-approved medications, behavioral therapy and diet to quiet down this hyperactive, extra-sensitive GI tract in either the brain or gut. This improves overall symptoms, especially that of abdominal pain, which is the cornerstone of the diagnosis of IBS. The future is exciting, and there is hope for you and many others. —Brian Lacy, M.D., Ph.D., Gastroenterology, Mayo Clinic, Jacksonville, Florida

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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

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DEAR MAYO CLINIC: My 36-year-old sister recently noticed an unusual mole on her shoulder. She is scheduled for some tests. Her primary care physician believes it might be melanoma. What is melanoma? What treatment options are available, and is surgery necessary? Have there been recent advancements in treatments?  

ANSWER: While melanoma is much less common than other types of skin cancer, it is the most serious because it is more likely to metastasize, or spread, to other parts of the body. 

Melanoma starts in the melanocytes, which are cells that make the pigment that gives skin its color. The first signs of melanoma often are either a change in an existing mole or the development of a new pigmented or unusual-looking growth on the skin. 

The ABCDE guide helps you determine if a mole or a spot may indicate melanoma or another type of skin cancer:

• A is for asymmetrical shape. One half is unlike the other half.
• B is for border. Look for moles with irregular, notched or scalloped borders.
• C is for color. Look for growths that have changed color, have many colors or have uneven color.
• D is for diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters, or the diameter of a pencil eraser).
• E is for evolving. Watch for moles that change in size, shape, color or height, especially if part or all of the mole turns black. Moles may also evolve to develop new signs and symptoms, such as itchiness or bleeding.

If you notice any of these signs, make an appointment with your primary care clinician or a healthcare professional.

A few types of tests are used to diagnose melanoma. The first is a punch biopsy performed with a circular blade pressed into the skin around the suspicious mole. Another technique is called an excisional biopsy, which uses a scalpel to remove the entire mole and a very tiny bit of normal skin around it. It’s also important to have a total skin exam at the initial diagnosis because some patients will have a second primary melanoma found at the same time.

Once melanoma is diagnosed, your care team will determine the extent of the cancer by measuring its thickness, identifying whether it has spread to the lymph nodes and looking for signs of cancer beyond the skin. If there's a chance the cancer could spread to nearby lymph nodes, you might need a sentinel node biopsy. During this procedure, dye is injected into the area where your melanoma was removed and flows to the closest lymph node or nodes. Those lymph nodes, called the sentinel lymph nodes, are removed and tested for cancer cells. 

Understanding the stage of melanoma will help your healthcare team create a treatment plan. Melanoma treatment often starts with surgery to remove the cancer. The treatment for thinner melanomas generally removes the melanoma with a margin of tissue, typically 1 to 2 centimeters of normal tissue. If the sentinel lymph node biopsy determines that the cancer has spread or your melanoma grows deeper into the skin, active surveillance with imaging, additional surgery and/or systemic treatment may be recommended.

Other treatments include radiation therapy and systemic therapy. Recent advancements have significantly improved the prognosis for patients diagnosed with melanoma. These include targeted therapies, an approach that uses medicine that attacks specific chemicals in cancer cells, and immunotherapies, which use medicines that help the body's immune system to kill cancer cells. Either option might be recommended for selected patients. Some patients also may benefit from systemic therapy before an operation.

Clinical trials have led to recent advancements in melanoma treatment because physician-scientists can test new and better approaches. Efforts are being made to enhance the accessibility and ease of patient participation in clinical trials. If you are interested in participating in a clinical trial, ask your care team about what options might be available.

While melanoma is a serious form of skin cancer, you can reduce your risk. Exposure to ultraviolet (UV) light is considered the leading cause of melanoma. UV light comes from the sun and tanning lamps and beds. You can reduce your risk by avoiding tanning beds, wearing broad-spectrum sunscreen with SPF 30 or higher, avoiding sun exposure during peak hours (10 a.m.–3 p.m.) and wearing sun protective gear outdoors. Use about 1 ounce of sunscreen and reapply every two hours, or more if you've been sweating or swimming. 

If you notice rapidly growing or changing skin lesions, it's important to notify your primary care physician or a care team member. The earlier melanoma is found, the better the chance of successful treatment. — Tina Hieken, M.D., Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I am in my 30s and overweight, but I thought I was too young to worry about cholesterol. I just learned my cholesterol is high. I know diet and exercise are important. Do I need medication? 

ANSWER: Cholesterol is a type of fat in our blood. Our bodies need a small amount of cholesterol to build the structure of cell membranes, make certain hormones and help with metabolism, such as producing vitamin D. The catch: We don't need too much cholesterol. 

Atherosclerosis, also known as narrowing of the arteries, happens when cholesterol builds up and blocks blood flow. This buildup is called plaque, which can clog arteries and can burst, leading to a blood clot. Atherosclerosis can cause heart problems such as chest pain (angina) or heart attack. It also can lead to problems in the brain, including transient ischemic attack, stroke, peripheral artery disease in the legs or arms, and even kidney failure.

Cholesterol and triglycerides are types of lipids. They travel in our blood by attaching to proteins. Adults 20 and older should ask their healthcare team about their lipid profile and how to interpret the numbers. 

• Low-density lipoprotein (LDL) cholesterol: We call LDL "bad" cholesterol. Below 100 milligrams per deciliter (mg/dl) is optimal for healthy people in the absence of coronary artery disease. If you have heart disease, your LDL should be below 70 mg/dl. Treatment decisions to reach appropriate levels need to be based on personal risk factors.

• High-density lipoprotein (HDL) cholesterol: We call HDL "good" cholesterol. It absorbs cholesterol in the blood and brings it to the liver, which flushes it from the body. For females, it should be above 50 mg/dl. For males, it should be above 40 mg/dl.

• Triglycerides: Triglycerides are a type of fat we use for energy. If you have too high of a triglycerides level, it can cause heart disease. Less than 150 mg/dl is optimal. 

• Total cholesterol: This is the sum of LDL and HDL cholesterol plus 20% of triglyceride levels. A total cholesterol level below 200 mg/dl is desirable.

Some people who are overweight may get heart disease not because their LDL is high but, rather, because their HDL is low and their triglycerides are high. That relationship can cause heart disease as much or even more than just high LDL cholesterol. These lipid abnormalities are significant for young people in their 30s or 40s who are overweight. Their triglyceride levels increase, and their HDL lowers. They're becoming prediabetic. Their LDL is staying the same, but they're still heading to heart disease. 

Treating high cholesterol depends on individual risk. The higher the risk — for example, with someone who already had a heart attack — a higher percent of reduction is needed. Medication to lower cholesterol can reduce LDL by about 60% to 65%. Lifestyle changes can reduce LDL by 10% to 15%. 

Several medications can help manage lipids. Discuss options with your healthcare team.

The body's ability to handle cholesterol is genetically determined. Genetic disorders that raise cholesterol levels are common. Familial hypercholesterolemia usually is caused by a genetic mutation preventing the body from clearing cholesterol. People with the condition are more likely to require medication to reduce their cholesterol levels. 

For people with genetic disorders that expose them to elevated cholesterol since birth, heart disease can happen at a younger age. So we start treating their high cholesterol with medication at a young age. 

Beyond medication, lifestyle modifications help manage lipids:

• Limit meat and dairy intake; they have saturated fat, which raises LDL cholesterol.
• Consume more fish, soluble fiber, fruit and vegetables. 
• Avoid diets high in carbohydrates, particularly refined carbs like sugar and white flour. They raise the blood sugar level quickly, raising triglycerides. Reducing simple refined carbohydrates helps lower triglycerides and weight because you store less fat. 
• Control your weight. It lowers your triglycerides and improves your HDL levels. 
• Exercise about 150 minutes of aerobic activity a week at a moderate intensity. Moderate intensity means you must breathe through your mouth. If you're breathing through your nose, that is low intensity. Exercise prevents cholesterol from building up, but it doesn't change LDL concentration levels. You must burn about 2,000 calories a week to lower LDL concentration. However, exercise helps lower triglyceride levels and maintain weight loss. 
• Do strength training at least twice a week. It helps your cardiovascular and muscular systems. Not everything we do to prevent heart disease is about cholesterol. 

The National Heart, Lung and Blood Institute recommends people get their first cholesterol screening between ages 9 and 11, and repeat it every five years. For men 45 to 65 and women 55 to 65, cholesterol screenings should occur every one to two years. Over 65? Test annually. More frequent testing may be needed for people who have or are at risk for coronary artery disease. — Regis Fernandes, M.D., Cardiovascular Medicine, Mayo Clinic, Phoenix

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DEAR MAYO CLINIC: We hear a lot about "heart-healthy" diets, but the guidance seems to always change. It's confusing to me. What foods are important, and what should we avoid? 

ANSWER: One of the most important factors for a healthy heart is to try to follow a healthy diet. We usually recommend a Mediterranean diet, which is mostly based on trying to eat more white meat, such as fish and chicken, instead of red meat, such as beef or pork. This type of diet also focuses on eating more vegetables, fruits, nuts, seeds, legumes, beans, whole grains and olive oil. 

Studies have shown that people living in Mediterranean countries, such as Italy and Greece, are less likely to die of heart disease. The World Health Organization recognizes the Mediterranean diet as a healthy eating pattern. Many nutrition experts in the U.S. recommend it and it is important to follow the diet long term in order to see heart benefits.

Cutting out trans fats in fried food, frozen pizza and microwave popcorn, and added sugar in soda, sweets and pastries is also important for your heart health. Switching your snacks, especially before or after exercising, from cookies or chocolates to carrots or broccoli, can help you continue to snack but with beneficial ingredients. Staying hydrated helps your heart pump blood more effectively and benefits your blood vessels and muscles. Drink at least 2 liters of water each day.

Avoiding tobacco and alcohol consumption are important factors to prevent future cardiovascular conditions. It has been shown that after just one year of quitting tobacco use, your risk of having a cardiovascular event drops in half in comparison with patients who smoke tobacco. That's how big the impact of quitting tobacco use is on your heart, and it's never too late to stop. Alcohol use can trigger difficulty for you to fall asleep, and sleep disorders have been linked to heart disease. Incorporating these healthy habits will make you more likely to have refreshed sleep.  

Following diet trends such as making the switch to strictly plant-based or vegan or going gluten- or lactose-free is individual to each person because patients may have an intolerance to this type of food or its components. In general, low-sugar, low-salt and low-carb diets are usually helpful for all our patients to stay out of cardiovascular risk. 

By maintaining a healthy lifestyle, you can avoid some medical conditions in the future such as hypertension, diabetes and high cholesterol. These conditions increase your risk of having a cardiovascular event such as a heart attack or a stroke. One of my best tips is to start adjusting your lifestyle little by little but consistently, taking baby steps — even if you adjust just one factor per day or per week, whether that's trying to cut down on the amount of high sugar, high fat or high salt in your diet. Little by little and with time, those changes will remain and will help you prevent any type of long-term medical condition in the future. — Juan Cardenas Rosales, M.D., Internal Medicine, Mayo Clinic, Jacksonville, Florida

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DEAR MAYO CLINIC: My neighbor had a stroke and received a "clot buster" medication. Then, I found out my uncle had a surgery after a stroke. Can you help me understand different kinds of stroke treatments? My neighbor seems almost back to normal, but my uncle is still in rehabilitation because of some paralysis on his left side.

ANSWER: We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time dependent. This is a good opportunity to remind people to seek emergency medical care — call 911 — as soon as possible at the first sign of a stroke.

Treatments also depend on the type of stroke. During an ischemic stroke, blood vessels in the brain are blocked or narrowed. During a hemorrhagic stroke, there's bleeding into the brain.

The first treatment for stroke is to potentially offer a medication called tissue plasminogen activator (TPA) that helps dissolve blood clots. This often is called a clot buster. It has to be given within 4.5 hours from when symptoms began.

These drugs are administered by IV, and they can help dissolve blood clots in the brain and restore blood flow. The faster you're able to restore blood flow, the less likely that the stroke symptoms are permanent. 

Another treatment for stroke is a flexible tube called a catheter that is placed in the blood vessels at the groin. The catheter is navigated up to that clot in the brain using X-ray. A device can be administered to help remove that blood clot. This procedure can help with large clots that can't be dissolved with TPA. This procedure often is performed in combination with TPA that's injected into the bloodstream.

Hemorrhagic stroke is treated by lowering blood pressure to help prevent continued bleeding. So if people are on blood thinners, we use other medications to try to reverse the blood thinner medications. If patients have a coagulopathy, or a tendency to bleed, medication is used to try to reverse that. 

Then there are surgical interventions that potentially help remove that blood in the brain to prevent the downstream swelling that can occur after a brain bleed.

Unfortunately, stroke outcomes are incredibly variable. We'd love to have excellent outcomes for every patient who experiences an acute stroke. But with timeliness of treatment, we are much more likely to have a favorable outcome. 

The goal is to keep people independent after their stroke. So the faster someone arrives to the hospital, the more likely to achieve that outcome. 

Stroke symptoms include trouble speaking and understanding others; numbness or weakness, often on one side of the face, arms or legs; vision problems; a severe headache; and trouble walking. 

We use an acronym you may have heard previously to help people recognize warning signs of a stroke:

FAST

• F = Face drooping: Ask the person to smile. Does one side of the face droop?
• A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down or if one arm is unable to be lifted.
• S = Speech difficulty: Ask the person to speak and see if the speech is slurred.
• T = Time to call 911: Stroke is an emergency.

With any of these signs, call 911 or emergency medical care at once to allow for the treatment of stroke. Note the time when any of the symptoms first appear. — Stephen English Jr., M.D., Neurology, Mayo Clinic, Jacksonville, Florida

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