DEAR MAYO CLINIC: Recently, I was diagnosed with BPH. This is all new to me, and I hope you can help me better understand the condition and how it's treated. 

ANSWER: Now that you've been diagnosed with benign prostatic hyperplasia (BPH) — noncancerous tissue growth within the prostate — it's time for you and your healthcare team to talk about treatment options. 

These options depend on the severity of your symptoms, which can range from having a weak urine stream to not being able to urinate at all. Most treatments are done in the outpatient setting, including your clinician's office, while others may require a hospital stay. Wherever you are on the range of symptoms, there are treatment options that can relieve them, including:   

Behavior modifications

If you're experiencing bothersome, but not severe, symptoms, such as having a weak urine stream or frequently getting up at night to urinate, your treatment may start with:

• Changes to your diet
  Some foods, such as chocolate, citrus, carbonated beverages and caffeine, can irritate your bladder, which can increase your urge to urinate. Cutting back on these foods may ease your symptoms.
• Fluid intake
  Reducing the amount of fluid you drink before bedtime can decrease your need to urinate during the night.
• Timed urination (voiding)
  Holding your urine can also irritate your bladder, so making a point to urinate every hour and a half to two hours can reduce the urge to go "now."

Medications for BPH

If these behavior modifications are no longer effective, your clinician may prescribe a medication, which you'll need to take every day. These include:

• Alpha blockers
  These drugs relax muscles in the bladder and prostate, and they open up the urinary channel to reduce blockage. Side effects include a decrease in blood pressure, dizziness and lightheadedness. They also can cause semen to go back into the bladder instead of the penis, which may be startling, but is harmless.
• 5-alpha reductase inhibitors
  These medications work to shrink the prostate by lowering the production of a specific hormone. There are more side effects, and it may take six to nine months to see any results. Men may have a lower sex drive, and some will experience erectile dysfunction.

Surgical procedures

You and your healthcare team may decide that in-office therapies or surgery to shrink or remove overgrown prostate tissue would be the best treatment option for you. Some treatments work better than others, depending on your symptoms, treatment goals and the size of your prostate. Most preserve sexual function and have little or no effect on erectile or ejaculatory function. 

These treatments include:

• Temporarily implanted nitinol device
  This procedure reshapes the tissue of the prostatic urethra and the bladder neck to create a wider channel through which urine can flow. A narrow, folded nickel titanium device is inserted into the prostatic urethra. As the device expands, gentle pressure reshapes the urethra and bladder opening. After five to seven days, the device is removed.
• Prostatic urethral lift (PUL)
  This procedure reshapes the prostate using a small, permanent implant to compress and lift the side of the enlarged prostate to increase the urethra opening.
• Steam therapy
  During the treatment, a tiny needle is inserted into the urethra and positioned in the prostate gland. In nine seconds, the needle produces a 2-centimeter-wide steam ball that shrinks the surrounding prostate tissue.
• Transurethral resection of the prostate (TURP) and photo-selective vaporization (PVP)
  During a TURP, a lighted scope is inserted into the urethra and the surgeon uses an electric loop to remove all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. 

PVP is laser therapy performed in an operating room under anesthesia. A surgeon inserts a thin, tube-like instrument into the urethra. This instrument has a lens, light and tool that sends out an electrical current to destroy prostate tissue. Heat from the current seals small blood vessels, reducing the risk of bleeding. This procedure destroys or removes overgrown prostate tissue and is a good choice if you need to stay on blood thinners.

• Prostate enucleation (BipoLEP or HoLEP)
  This procedure removes nearly the entire prostate without an incision. It is often a good option for patients with especially large prostates, the inability to stop blood thinners or in significant urinary retention. A thin instrument is inserted into the urethra. Then, a laser cuts the prostate tissue into small, removable pieces. 
• Simple prostatectomy
  This minimally invasive surgery removes tissue blocking the flow of urine. It usually requires a one-night stay in the hospital and is done laparoscopically through a small incision in your side, most often using a surgical robot.

Ross Avant, M.D., Urology, Mayo Clinic Health System, Austin and Red Wing, Minnesota; Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: When I go for a walk or to the gym, people always seem to be checking their pulse, whether by hand or with a wearable. Why is heart rate so important?

ANSWER: Your heart rate, or pulse, is the number of times your heart beats per minute. Your resting heart rate is when the heart is pumping the lowest amount of blood you need because you're not exercising. If you're sitting or lying down ― and you're calm, relaxed and aren't sick ― your heart rate is typically between 60 and 100 beats per minute. 

Other factors that can affect your heart rate include: 

• Air temperature 
  When temperatures or humidity increases, the heart pumps more blood, so your pulse or heart rate may increase. 
• Body position 
  Sometimes, when going from sitting to standing, your pulse may go up a little. After a few minutes, it should return to a typical rate. 
• Emotions 
  If you're stressed, anxious or incredibly happy, your emotions can raise your heart rate. 
• Body size 
  Body size usually doesn’t increase your heart rate. However, if you're obese, you may have a higher resting heart rate. 
• Medication use 
  Medications that block adrenaline tend to slow your heart rate. Thyroid medication may raise it. 

Why your heart rate matters 

Cardiovascular exercise, also called cardio or aerobic exercise, keeps you and your heart healthy. This specific type of exercise gets your heart rate up and your heart beating faster for several minutes. Cardiovascular exercise helps strengthen your heart, allowing it to pump blood more efficiently and improving blood flow to all parts of your body. It also boosts your high-density lipoprotein (HDL), or "good" cholesterol, and lowers your low-density lipoprotein (LDL), or "bad" cholesterol. This may result in less buildup of plaque in your arteries.

Abnormal heart rate 

If you experience irregular heartbeats, including a racing heartbeat, slow heartbeat or a feeling of fluttering in your chest, you may be experiencing a heart arrhythmia. Heart rhythm or heartbeat problems can occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, slow or irregularly. Talk with your healthcare team if you have heart rhythm concerns.  

Know your numbers 

Many wearable activity trackers can monitor your heart rate when you exercise and periodically throughout the day. If you don't have an activity tracker, you can use the radial artery in your wrist or the carotid artery in your neck. If you have heart disease or long-standing diabetes, it's best to use the artery on your wrist. 

To find your heart rate manually: 

• Locate the artery you will use to find your heart rate. 
• Using the tips of your first two fingers, press lightly over the artery. 
• Count your heartbeats for 30 seconds and multiply by 2 to find your total beats per minute.  

What's your target heart rate? 

Your target heart rate is the rate you need to maintain over a set amount of time to reach the energy level necessary to give your heart a good workout. The first step in finding the target heart rate that will maximize your cardiovascular exercise is determining your maximum heart rate. 

Your maximum heart rate is 220 minus your age. Your target heart rate for moderate to vigorous exercise is about 50%–85% of your maximum heart rate. 

A general guide for averages by age is: 

• 20: 100–170 beats per minute 
• 30: 95–162 beats per minute 
• 35: 93–157 beats per minute 
• 40: 90–153 beats per minute 
• 45: 88–149 beats per minute 
• 50: 85–145 beats per minute 
• 55: 83–140 beats per minute 
• 60: 80–136 beats per minute 
• 65: 78–132 beats per minute 
• 70: 75–128 beats per minute 

How to give your heart a good workout

Start slowly. 
If you’re beginning an exercise program, aim for the lower end of your target heart rate zone, and then gradually build up intensity. If your heart rate is too high, take it easier. If it's too low, add some intensity and push yourself to get your heart rate closer to your target.

Try interval training. 
Interval training, which includes short bursts of 15–60 seconds of higher-intensity exercise, alternated with longer, less strenuous exercise, effectively increases cardiovascular fitness. Talk with your healthcare team before trying interval training, but it’s typically safe for those with existing heart disease and type 2 diabetes. 

Take the "talk test." 
If you can carry on a conversation in brief sentences while exercising, you're probably in the moderate intensity range. You'll be breathing faster, developing a light sweat and feeling some muscle strain. If you're working at a vigorous intensity, you won't be able to say more than a few words without catching your breath. If you can sing while working out, you're probably in the low-intensity range, so step it up.

Xiaoke (Ken) Liu, M.D., Ph.D., Cardiovascular Medicine, Mayo Clinic Health System, La Crosse, Wisconsin

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

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

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

Choose your virtual option

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

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

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

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

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

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

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

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

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

When to consider virtual care

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

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

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

Before, during and after your video visit

Here are a few tips for a successful video visit:

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

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

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DEAR MAYO CLINIC: I am thrilled to say I am a breast cancer survivor. It has been almost six months since I finished treatment. But I can't shake the fatigue. I was never a napper, but I find myself feeling desperate to close my eyes in the middle of the workday. I don't feel sharp in my thinking, and I fall asleep in front of the TV at night. I'm worried. How can I get past this stage? I want my life back.

ANSWER: Cancer-related fatigue can be distressing. It is a persistent, subjective sense of physical, emotional and cognitive tiredness and/or exhaustion related to cancer or cancer treatment that is not proportional to recent activity. It interferes with daily function and quality of life. Cancer-related fatigue is different from the usual tiredness we all experience. It's more intense, it's not temporary and it's not relieved by rest alone.

Several factors can contribute to cancer-related fatigue. The cancer itself can lead to fatigue. 

Some cancers weaken muscles, damage organs or alter hormones, which can cause fatigue.

Sometimes treatment damages healthy cells in addition to cancer cells. Treatments such as chemotherapy, molecular targeted therapy, hormonal therapies and radiation all may cause fatigue. 

Side effects of treatment may result in a blood problem called anemia, pain or stress, all of which can add to your fatigue. 

If you're not feeling well, your activity level may lower, which causes the body to decondition, causing fatigue. Preexisting conditions, such as anxiety and depression, also may worsen with cancer and play a role in fatigue.

Cancer-related fatigue can happen at any stage. It might start before treatment, become more pronounced during treatment, and sometimes linger even after treatment has ended. Everyone experiences this differently. 

The duration of cancer-related fatigue can be variable. For some people, it might improve a few weeks after finishing treatment. For others, it can last for months or even longer. It affects a lot of cancer patients but doesn't always get proper attention from healthcare professionals. It's important to communicate with your healthcare team about any ongoing fatigue. 

Treatments can include physical therapy and exercise guidance to help increase activity levels, medications, complementary and integrative medicine approaches such as yoga and tai chi, and psychological and mindfulness-based strategies to manage emotional stress and monitor fatigue levels. As every patient is different, a combination of these approaches typically works best.

While there's no way to prevent cancer-related fatigue, several self-care strategies can help boost energy levels, including: 

• Staying as active as possible, even if it's just light exercise. Start slow and find a routine.
• Eating a balanced diet and staying hydrated. When you have cancer, you may need more protein and nutrients than ever. Drink plenty of fluids, and limit caffeine.
• Setting a regular sleep schedule, taking short naps if needed, and finding time to relax and reduce stress. 

If you need guidance or you are experiencing fatigue that is not responding to these modalities, ask your primary care team for help. You may need help from family and friends to help with household tasks too. — Touré Barksdale, M.D., Physical Medicine & Rehabilitation, Rochester, Minnesota

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DEAR MAYO CLINIC: My husband and son are constantly coming home with an energy drink in hand. I tell them that they are bad for you, but I don't know enough to make a strong case. What are the effects of energy drinks on the body?

ANSWER: Energy drinks are a multibillion-dollar industry and are the most consumed supplement not under the control of the Food and Drug Administration other than multivitamins. It's a bit like the "Wild West" in the sense that energy drinks and their stimulating ingredients are under no FDA regulation and are not classified as a food or a drug but as a supplement. 

Energy drinks contain ingredients such as caffeine, taurine and guarana that affect the heart, the heart's electrical system and the heart's muscular pump. When our bodies react to these chemicals, the heart rate and blood pressure can change. The heart's recharging of the electrical system can be affected by these chemicals. For most people with a healthy heart, the consumption of an energy drink would have no serious impact on our health. However, if you have a genetic heart condition that predisposes you to sudden cardiac death, exposure to an energy drink may not be as harmless. 

People with underlying genetic heart disease or adults with coronary artery disease or weaker heart pumps can be more vulnerable to the chemicals in energy drinks. About one in 200 people have a sudden death-predisposing genetic heart disease, including hypertrophic cardiomyopathy, long QT syndrome, arrhythmogenic cardiomyopathy and catecholaminergic polymorphic ventricular tachycardia. A healthy heart can handle caffeine in moderation, but a fragile heart may not be able to. 

Consuming up to 400 mg of caffeine a day is safe for most adults — some energy drinks contain over half this amount in a single can. Depending on the age of your son, he may need to stay under 100 mg of caffeine per day, which is the recommended amount for adolescents ages 12-18. 

In addition to heart risk, studies have suggested an increased risk of stroke with energy drink consumption. Long-term exposure to these substances over time affects how the blood vessels and heart react to the chemicals. Our blood vessels that control our blood pressure are reacting to these chemicals, and the potential reason behind stroke risk is the tightening of our blood vessels. 

For the 199 out of 200 people who have a healthy heart and who do not have a genetic heart disease, energy drink consumption in moderation is safe. However, you might want to ask yourself: Can you go three days without it? If not, you may be experiencing some dependency on the chemicals in the energy drink. Heavy caffeine consumption can cause physical and psychological dependence, restlessness and insomnia. 

Overall, there is very little health value to energy drinks. Listen to your body — Are they making you feel shaky or causing you to experience withdrawals? Can you be satisfied with your morning coffee or tea instead? 

There is a lot of room for future research on these beverages. Consuming the wrong thing at the wrong time in the wrong person is a setup for the perfect storm. Caffeine may also interact with a person's medications. Tell your healthcare team that you are consuming energy drinks and the unregulated supplements they contain, and you can decide together what the right choice is for you. — Michael Ackerman, M.D., Ph.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: My friend swears by intermittent fasting since her recent weight loss. I know it works for some people, but is it actually healthy? 
 
ANSWER: Although it may appear to be a new trend, intermittent fasting has been popular for over 1,500 years. While we know that it works for some people to lose weight, the reality is that whether or not it helps organs such as the heart is still to be determined. Early research presented at a recent scientific meeting suggested that intermittent fasting might be harmful or risky in general. It showed that people practicing intermittent fasting are twice as likely to die from heart disease or die in general than those who don't practice. 
 
The main problem is that intermittent fasting is not standardized. There are many ways to do intermittent fasting. Over the past few decades, it has been popularized in the UK as "eat whatever you want for five days, then don't eat for two full days other than fluids and soups." People were losing weight, and from that point on, people started adapting to fasting in very different ways. Some people will restrict their time for eating to 10 a.m. to 3 p.m., for example. The most common form of intermittent fasting I have seen is that people just skip breakfast.
 
Whether breakfast is "the most important meal of the day" is still under debate. Skipping breakfast historically hasn't been something necessarily healthy. It is not fully understood why, but there are numerous studies showing that people who skip breakfast have an increased risk for heart disease and other ailments. Early morning is the time when people have the most heart attacks. Part of the reason for that is the high-adrenaline state that occurs early in the morning. If you match that with no food, no calories at all, that might be the reason why studies show that people practicing intermittent fasting are not necessarily healthier or safer. I think that's important to keep in mind.
 
People who lose weight through intermittent fasting can benefit their overall health, but that doesn’t necessarily mean that they have to continue forever. We have to consider many other factors when people don't have breakfast or other meals. Stress hormones go up, which may increase blood pressure and adrenaline, causing many changes in our system that might actually be more harmful than beneficial.
 
When patients ask if intermittent fasting is healthy, the response should be, "It all depends." If they start skipping dinner, having very light dinners or just trying not to have dinner too late, that's an excellent way to practice. Or perhaps having a very light lunch or skipping lunch altogether — just not necessarily going for too long with no food.
 
Studies show that having multiple small meals throughout the day versus just two big meals results in better cholesterol and many other positive changes in the metabolism. So, this idea of not having any food or calories for long periods of time is still under debate. Based on recent evidence, intermittent fasting is particularly unsafe for patients with heart disease or with a history of heart disease. Practicing intermittent fasting can be safer with supervision from your healthcare team. — Francisco Lopez-Jimenez, M.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
 

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

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

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

There are usually two parts to an advance directive:

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

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

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

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

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

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

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

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

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

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

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

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

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

1. Improve your physical health

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

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

2. Free up time to have fun playing and exploring

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

3. Make social connections

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

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

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

4. Boost your mood

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

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

Related post:

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

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DEAR MAYO CLINIC: A friend was just diagnosed with colorectal cancer. She's only 30. I didn't know young people could get this cancer. Can you tell me more about it?

ANSWER: Unfortunately, your friend is among a growing number of adults under 50 who are being diagnosed with colorectal cancer. Many younger adults don't consider themselves at risk, since screening for colorectal cancer typically doesn't start until age 45.

That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

 What is colorectal cancer?

It's not one type of cancer but two: colon and rectal cancer. The large intestine has several regions. The last part of the large intestine is known as the rectum. The other areas of the large intestine are called the colon. The treatments for cancers of the colon and rectum are different.

Who is at risk for this cancer?

Risk factors for colorectal cancer include:

• Older age
• Black race 
• Low-fiber, high-fat diet 
• Not exercising regularly
• Diabetes 
• Obesity 
• Smoking
• Drinking alcohol 

Those who are at higher risk for colorectal cancer tend to have at least one of these factors:

• Medical condition that places them at higher risk.
• Genetic condition that increases their risk. 
• Family history that places them at higher risk. For example, this is could be a first-degree family member such as parents or siblings who have had a diagnosis of colorectal cancer or advanced polyps.

Are there warning signs?

Four warning signs of colorectal cancer are:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

Although these symptoms can be embarrassing, you need to share them with a healthcare professional — don't put it off.

You may not easily notice blood loss after bowel movements, but that bleeding can lead to low iron levels. If a routine blood test reveals iron deficiency in a young adult, it can prompt the primary care clinician to consider colorectal cancer.

What is the screening process for colorectal cancer?

Your primary healthcare professional may order a screening that can help detect colon polyps or cancer. These tests include:

Stool DNA test. This test uses a stool sample to look for changes in cells' genetic material. Certain DNA changes are a sign that cancer is present or that it might happen in the future. The stool DNA test also looks for hidden blood in the stool.

If your stool DNA test returns positive (abnormal), you'll need a follow-up colonoscopy.

Colonoscopy. This test looks inside the colon. For it to be most effective, you need to thoroughly cleanse your colon, which involves reducing the fiber in your diet. The last step is consuming a special solution to ensure your colon is clean so the gastroenterologist is able to get a clear view. Although preparing for the procedure can be unpleasant, your care team can provide tips to make it more doable.

If the gastroenterologist finds any precancerous growths, called polyps, these will be removed during the colonoscopy and sent for testing. The number, size and type of polyps removed help determine when the next colonoscopy should be scheduled. If cancer is found, your care team will discuss treatment options with you.

How can I reduce my risk for colorectal cancer?  

No matter your age, there are five steps you can take to avoid developing colon cancer:

1. Eat your vegetables and healthy fats. Research has shown that the Western diet correlates to higher colorectal cancer rates. People who eat high-fiber diets are less likely to develop the disease.
2. Get moving. Exercise benefits your heart and helps you maintain your weight. It also can lower your colon cancer risk. Aim for 30 minutes of moderate exercise on most days of the week.
3. Watch your weight. Talk to your health care team if you need help losing weight.
4. Limit alcohol and don't smoke. If you choose to drink alcohol, do so moderately. That means no more than one drink a day for women or two drinks a day for men. And if you smoke, quit.
5. Follow colorectal cancer screening guidelines.

Derek Ebner, M.D., Gastroenterology, Mayo Clinic in Rochester

The post Mayo Clinic Q and A: Colorectal cancer in young adults appeared first on Mayo Clinic News Network.

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.

The post Mayo Clinic Q and A: Active work stations because sitting all day is bad for your health appeared first on Mayo Clinic News Network.