DEAR MAYO CLINIC: I understand surgery is often included as part of the treatment plan for breast cancer. If I'm a candidate for lumpectomy but am also considering a mastectomy, what are some things I should keep in mind? Should my breast density be a factor in my decision-making?

ANSWER: Women diagnosed with breast cancer are almost immediately confronted with treatment decisions. If your surgical oncologist gave you a choice between a lumpectomy and a mastectomy to remove a tumor, that's often because either option will lead to a similar long-term health outcome.

A lumpectomy is commonly known as breast conservation surgery because it keeps most of the breast intact, whereas a mastectomy removes the entire breast. Regardless of which procedure you choose, the risk of breast cancer recurrence is roughly the same.

Lumpectomy is a treatment option for early-stage breast cancer. Compared with a mastectomy, it's less invasive and tends to have a quicker recovery. It also can help preserve the cosmetic appearance and sensation of the breast. Your healthcare professional will recommend radiation therapy after a lumpectomy to reduce the risk of breast cancer returning in the breast.

A mastectomy removes the whole breast. In many cases, radiation therapy is not needed after mastectomy. Individuals with a genetic predisposition for breast cancer, such as the BRCA1 or BRCA2 gene mutation, may opt for a mastectomy as a preventive measure following their diagnosis.

After a mastectomy, some women choose to forgo reconstructive surgery, opting for what is called an aesthetic flat closure. There can be many reasons for this, including wanting to limit future surgeries, reducing risks and complications, and desiring a faster return to daily life and activities.

For other patients, having a breast mound is part of how they identify as women. Multiple types of breast reconstruction procedures are available following either a lumpectomy or mastectomy. Breast reconstruction surgery can occur at the same time as breast cancer surgery, or you can plan your reconstruction weeks, months or years after treatment.

The surgical technique and cosmetic outcomes after mastectomy and reconstruction have improved over the past 20 years. More women can keep their nipple and areolar complex and, in many cases, a procedure can be performed to help improve sensation to the nipple and areolar complex.

Breast density also could be a factor in your decision-making. About half of people who have screening mammograms have dense breasts. Dense breast tissue is harder to see through on a mammogram image. Having dense breast tissue should not affect one's decision to undergo a mastectomy or lumpectomy.

However, dense breast tissue may influence the need for additional tests before surgery, such as an MRI. An MRI looks for abnormal blood flow within the breast and can "see through" dense tissue. This may help surgeons better determine the extent of disease and guide them in the removal.

Ultimately, determining the option that is best for you is a nuanced decision that can be based on a variety of factors, including cancer-based reasons, family history and genetics, and peace of mind. Choosing which surgical route to take is deeply personal, and there is no one "best choice" for every woman. After careful consideration and consultation with your healthcare team, you should make the decision that you determine is best for you, based on the specifics of your cancer and your individual needs and preferences. — Sarah McLaughlin, M.D., Surgical Oncology, Mayo Clinic, Jacksonville, Florida

Related posts:

• Mayo Clinic leads 4 decades of advances in breast cancer care
• Mayo Clinic research improves dense breast cancer screening and early detection
• Top 10 questions about breast cancer answered
• Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer
• Mayo Clinic Minute: MRI for dense breasts — what to know

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QUESTION: I'm a guy in my late 40s and trying to pay more attention to my health. But I'm confused about whether I should be screened for prostate cancer. Can you help?

ANSWER: The importance of all health screenings is that they can detect issues early. Prostate cancer is one of the most common cancers in the world, and the second-leading cause of cancer deaths among men in the U.S. 

While many prostate cancers grow slowly and remain localized, other types are aggressive and spread quickly. Screening can find prostate cancer early, when it's still confined to the prostate gland. That's when patients have the best chance for successful treatment. If caught early (stage 1), the survival rate after five years is almost 100%. At stage 4, the survival rate is 37% to50% at the five-year mark.  

It's recommended that men begin talking about prostate cancer screening with a healthcare professional around age 50. During this discussion, you and your clinician will decide if the prostate-specific antigen test is right for you based on your personal risk level and age, as well as the chance of overdiagnosis or underdiagnosis, possible biopsy complications, and testing intervals.

The screening is relatively simple. The most common is a prostate-specific antigen, or PSA, test. It's conducted by your primary care clinician once a year. Here's what you need to know about the PSA test:

• It's a blood test used to measure the amount of prostate-specific antigen in your blood. 
• High levels may indicate the presence of cancer. However, other conditions may also increase this level.
• Screening intervals are personalized. Based on test results, men with low long-term risk may decide to discontinue testing or lengthen the time between tests. Those with higher PSA levels may require more frequent screening.

Who's at risk?

Risk factors include age, family history and race. 

Age: The risk for prostate cancer is highest beginning at age 50 or older.

Family history: If you have a blood relative who has or has had prostate cancer, a family history of genes such as BRCA1 or BRCA2 that increase the risk of breast cancer, or a strong family history of breast cancer, your risk may be higher. 

Race: In the U.S., prostate cancer is deadlier for Black men than for men of other races. They're more likely to get prostate cancer and more than twice as likely to die from it than other men. Black men should consider being screened starting at age 40.

Active surveillance

Not all prostate cancers need to be treated — some can remain under active surveillance. When prostate cancer is found early, it can be watched for many years. If it becomes aggressive, treatment can begin. In active surveillance, regular follow-up tests may be performed to monitor the progression of your cancer.

Treatment options

Along with active surveillance, a full range of treatments for prostate cancer is available, including radiation, hormone therapy, chemotherapy, cryosurgery and surgery, including robotic removal of all or part of the prostate.

Many patients who have just a few sites of metastatic disease, meaning that the cancer isn't widely spread, also can benefit from aggressive treatment. This treatment combines radiation and oral or IV cancer medication therapy to put the cancer into remission and extend the patient's life. 

Another radiation technique includes intensity-modulated proton beam therapy with pencil beam scanning. This localized treatment can minimize significant adverse events from the treatment.

Talk with your healthcare professional to learn more about prostate cancer screening and if it's right for you.

Mohammed Solaiman, M.D., Family Medicine, Mayo Clinic Health System, St. Peter, Minnesota

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DEAR MAYO CLINIC: I've read so much about the health benefits of tracking my steps. But there's a lot of confusing information out there. How many is the right number? Are some "steps" better for you than others? Please help.

ANSWER: Whether you're tracking steps with your phone, a smartwatch or an old-school pedometer, the result is the same: you'll have a good indicator of how much you're moving during the day. The best device for you is the one you'll use. With many devices, you can set up alerts and goals that remind you to move. And that's what counts. The ultimate goal is to move 150 minutes per week.

Reaping the benefits

You're right about the health benefits of getting in your steps. Here's what walking can help you do:

• Control your blood pressure.
• Lose or maintain weight.
• Improve balance and coordination.
• Increase core strength.
• Manage stress and improve mood by releasing endorphins.
• Manage your diabetes.
• Reduce the risk of a heart attack.
• Reduce the risk of developing type 2 diabetes.
• Stay strong and active.

Walking also has been shown to:

• Improve sleep.
• Slow mental decline.
• Lower the risk of dementia.
• Reduce the risk of some cancers.
• Help you lead a longer life.
• Maintain independent living into older age.

If you're on a medically assisted weight-loss journey, whether that's bariatric surgery or a GLP-1 drug, being physically active will help burn calories, build strength, maintain muscle mass and bone density, and promote sustainable weight loss. It also can help medications work better.

Tracking steps

Is there a magic number of steps for reaping these health benefits? Not really. If you can get in 10,000 steps a day, great. Research has shown that 10,000 steps a day can lead to reductions in premature death, with a majority of that reduction happening between 4,000 and 8,000 steps. After 10,000, you'll still see benefits, but they start to plateau. 

How you get your steps doesn't really matter. Walking has a cumulative effect on your body across your day. So whether you walk your dog for 15 minutes in the morning and 15 minutes at night, go for a brisk 30-minute walk or spend an hour moving around the house or working in the yard, those steps all count.

Getting started

The best way to start tracking your steps is to take it slow and steady. Listen to your body — it will tell you whether you're trying to do too much. Work more steps into your day by parking farther away from entrances, walking in place while you're waiting for the timer on the microwave to go off, and making multiple trips to bring in packages rather than loading up in just one. You may want to consider getting a walking pad and use it while watching TV or doing food prep in the kitchen.

Setting the pace

When you're advised to go for a brisk walk, what does that mean? "Brisk" is different for everyone. The average walking speed to aim for is 3 to 3.5 mph, which a device can help you measure. If you can walk faster safely, great. However, walking slowly is better than not walking at all and will still give you the benefits of moving your body.

The talk test is an easy way to identify a proper intensity. If you're able to talk but find it difficult to carry on a full conversation, that's "brisk" for you. You may not be out of breath, but your breathing is definitely elevated. New research indicates that brisk walking can boost brain function and well-being, as well as physical health.

Even if you're able to get in a little bit of walking every day, your body responds to this exercise, and you gain the benefits.

By Mackenzie Long, Physical Therapy/Sports Medicine, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

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DEAR MAYO CLINIC: I've read that following the Mediterranean diet is good for your heart, but I'm not quite sure why. If I decide to give it a try, how would I get started? 

ANSWER: Extensive research over the years continues to pinpoint the Mediterranean diet as one of the best for your heart. Why? It helps reduce chronic inflammation in the body.

Not all inflammation is bad, but once it becomes chronic, it can lead to heart disease, type 2 diabetes, dementia and cancer. One of the main risk factors for chronic inflammation is a high-fat, high-sugar diet. 

The Mediterranean diet is the opposite of that. And the best part is that eating healthy with the Mediterranean diet feels more like eating and living well. Basically, it's a model eating plan for good health.

What the Mediterranean diet does

Built around plant-based foods, the Mediterranean diet:

• Replaces harmful fats with healthy, monounsaturated fats, which have been found to lower total cholesterol and low-density lipoprotein, also known as LDL, or "bad" cholesterol levels.
• Includes food rich in antioxidants and phytochemicals that help reduce inflammation in the arteries.  
• Supports healthy blood pressure by stressing potassium-rich foods and decreasing salt intake.
• Promotes whole grains, legumes, fruits and vegetables, which are high in fiber, support gut health and reduce blood sugar fluctuations. 
• Encourages healthy weight because it focuses on nutrient-dense, satisfying foods that naturally curb overeating.

Change up what you eat

If you're interested in trying the Mediterranean diet, these tips will help you get started:

Aim for 2 to 3 servings of fruit and 4 or more servings of vegetables daily.  

Expand your fruit and veggie horizon with pomegranates, figs, grapes, peaches, nectarines, cantaloupe, spinach, kale, Swiss chard, and collard and mustard greens. Wander through a farmers market for local choices. Swap in fruits and veggies when you're craving a snack.

Opt for whole grains.

Switch to 100% whole-grain bread, cereal and pasta. Experiment with whole grains, such as bulgur and farro.

Add in nuts and seeds.

These foods are high in fiber, protein and healthy fats. Try to eat 4 servings of raw or unsalted nuts and seeds per week. One serving is ¼ cup.

Use healthy fats.

Try olive, avocado or grapeseed oil instead of butter when cooking. Rather than putting butter or margarine on bread, try dipping it in flavored olive oil. 

Eat fish twice a week.

Fresh or water-packed tuna, salmon, trout, mackerel, sardines, and herring, along with seafood such as shrimp, crab and mussels, are high in healthy omega-3 fats. Opt to grill, steam, or bake fish and seafood rather than frying it.

Reduce red meat.

Substitute fish, poultry, eggs, or beans and lentils for red meat. If you eat red meat, make sure it's lean, keep portions small — usually about 3 ounces of cooked meat — and eat it sparingly.

Don't forget dairy.

Eat low-fat Greek or plain yogurt, cottage cheese, milk, and a variety of soft cheeses. Try cheeses made from goat or sheep milk, such as chèvre and feta. Stir fresh or frozen fruit into yogurt to avoid added sugars. 

Spice it up.

Herbs and spices boost flavor and lessen the need for salt.

Drink wine, alcohol sparingly.

While red wine is often a choice in the Mediterranean diet, it's optional. If you do drink wine or alcohol, limit your intake to one glass or less each day. Light to moderate alcohol consumption may reduce heart disease risk, but it's generally not advised to start drinking alcohol or increase your consumption. Remember to include water, since it's the best fluid for your body.

Modify your lifestyle

While much of the Mediterranean diet revolves around healthy eating, a large part includes slowing down and savoring life — something most of us can benefit from for our well-being and mental health. 

The basics of Mediterranean-style eating include:

• Sitting down at a table for at least two lunches or dinners per week.
• Taking time over the meal, not eating and running.
• Eating with friends and family.
• Engaging in physical activity with a goal of at least 150 minutes of moderate intensity exercise per week.

Plenty of eating plans are out there, but the Mediterranean diet is a holistic approach that encompasses healthy, delicious food and lifestyle choices that promote well-being. Many people who switch to this style of eating say they'll never eat any other way again.

For more information, talk to your healthcare professional or a registered dietitian nutritionist.

Janet McCann, Registered Dietitian Nutritionist, Mayo Clinic Health System, Eau Claire, Wisconsin

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DEAR MAYO CLINIC: I've always been active, but after being diagnosed with breast cancer and starting my treatment, I'm a little worried about getting back into my routine. Is it OK to exercise during cancer treatment?

ANSWER: Exercise decreases the risk of developing cancer. Studies have shown there is a 30%- 35% reduction in the risk of breast cancer among the most physically active women compared with those who are least active. Exercise also plays a protective role in many other cancers, including lung, endometrial, colon, kidney, bladder and esophageal.

However, exercise can also be helpful during and after cancer treatment. According to the American Cancer Society, research shows that exercise during cancer treatment can improve physical functioning and quality of life.

Moderate exercise can:

• Increase strength and endurance.
• Strengthen the cardiovascular system.
• Reduce depression.
• Decrease anxiety.
• Diminish fatigue.
• Improve mood.
• Raise self-esteem.
• Lessen pain.
• Improve sleep.

Of course, there may be certain issues that prevent or affect a person's ability to exercise due to disease or type of treatment, including:

• Anemia — having a low number of red blood cells or quantity of hemoglobin or protein.
• Weak immune system.
• Some forms of radiation treatment.
• Some surgeries limit certain exercises.

Some people should use extra care to reduce the risk of injury, including older people and those with bone disease, arthritis, or nerve damage, also called peripheral neuropathy.

Exciting studies show that regular physical activity is linked to increased life expectancy after a cancer diagnosis. In many cases, it also decreases the risk of cancer recurrence. Multiple studies in cancer survivors, with the strongest evidence in breast and colon cancer survivors, have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive.

The American Cancer Society, the American Institute for Cancer Research, the American College of Sports Medicine, and the U.S. Department of Health and Human Services all advocate physical activity for cancer patients and survivors.

The American Cancer Society recommends cancer survivors take these actions:

• Participate in regular physical activity.
• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.
• Exercise at least 150 minutes per week.
• Include strength training exercises at least two days per week.

Not everyone is ready to head to the gym during or after cancer therapy. However, reconnecting with an activity you like to do can increase your enjoyment and ability to stick with an exercise program. Exercise may include a bike ride with friends or chasing your dog around the park.

Walking is a great activity for almost everyone, and swimming can be a wonderful alternative for those with joint issues. Yoga is fantastic for strengthening, flexibility and balance concerns.

Kaye Sturz, D.N.P., Hematology/Oncology, Mayo Clinic Health System, Eau Claire, Wisconsin

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DEAR MAYO CLINIC: For my kids, the best part of back-to-school shopping is picking out a new backpack. While I want them to have backpacks they like, I also want to make sure they have features that support their backs. What should I look for?

ANSWER: The backpack is as much a part of school life as homework, pencils and recess. Kids use backpacks to carry everything they need during the day and make a fashion statement. Unfortunately, the excess weight of supplies stuffed into an improperly worn backpack may lead to sore joints and muscles.

As a new school year begins, follow these tips to help kids take a load off to keep their backs healthy:

Limit the weight.

Students of all ages seem to carry heavier loads in their backpacks. They often tote a day's worth of textbooks, a change of clothing for after-school activities, school projects and lunch. As a result, many parents have heard their school-age children complaining of back pain.

Overall, adults and children shouldn't carry more than 15% of their body weight in a backpack. For a 60-pound child, that means a pack weighing less than 9 pounds.

Even when worn properly, your student may need to lean forward to compensate for extra backpack weight. This can affect the natural curve in the lower back. Extra weight also can cause a rounding of the shoulders and an increased curve of the upper back. As a result, children may experience back, shoulder and neck pain.

Adjust them properly.

When worn properly, backpacks are the best way to carry things, especially for long periods of time.

Backpacks should be worn using both straps. Slinging a backpack over one shoulder can cause a person to lean to one side to compensate for the uneven weight, causing a curve in the spine. Over time, this can lead to lower and upper back pain, strained shoulders and neck, and even functional scoliosis (curvature of the spine). Teenage girls are especially susceptible to scoliosis.

Tighten the straps so the pack sits high on your child's back with the top of the pack about even with the shoulder blades. It also should be snug, so it doesn't sway side to side while walking.

When properly worn, the back and abdominal muscles support a backpack. These are the strongest muscles in the body, stabilizing the trunk and holding the body in proper postural alignment. Improper backpack use presents some dangers to young, still-growing joints and muscles.

Look for key pack features.

Urge your children to look past the color or design when selecting a backpack. These features can make a significant difference in how they feel while wearing the pack at school:

• Wide straps
  Wide, padded straps won't dig into the shoulders, and they're more comfortable. Narrow straps can hinder circulation, causing numbness or tingling in the arms, which may lead to weakness in the hands over time.
• Multiple sections
  Select a backpack with many pockets and sections to keep children organized. This also helps distribute the weight more evenly across the pack.
• Waist belt
  Tightening the waist belt helps to evenly distribute the weight of the backpack and support children's abdominal muscles.
• Lightweight when empty
  Consider the weight of the backpack when it's empty so your children don't have additional weight beyond books and supplies. For example, a canvas backpack will be lighter than leather.
• Reflective material
  If your children walk or bike to school, look for a backpack with reflective strips that make them more noticeable to drivers. You also can add strips of reflective tape at home.

Encourage your children to wear their backpacks properly. To help keep them light, they should make frequent stops at their lockers throughout the day to avoid carrying all their books at once. And leave nonessentials at home.

If they're in pain or have discomfort, talk with their primary care clinicians before a problem becomes serious.

Michelle Rein, M.D., Family Medicine, Mayo Clinic Health System, Caledonia, Minnesota

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DEAR MAYO CLINIC: I received a notice from my health system that I'm due for a colorectal cancer screening. I'm 45. Do I really need to have this done now? 

ANSWER: It's easy to be confused or overwhelmed by screening recommendations for common types of cancer. Your healthcare team is a trusted resource for keeping you up to date on screenings, including screening for colorectal cancer. 

Why, when and how should you be screened for this cancer? Test your knowledge of colon cancer screening with these myths and facts.   

Colorectal cancer is rare. 

Myth: Colorectal cancer is the second-leading cause of cancer-related death in men and women combined. Roughly 1 in 26 women will have colorectal cancer, and about 1 in 24 men will have colorectal cancer. To put that in perspective, when watching a football game, of all the players on the field, about one player would be diagnosed with colorectal cancer in their lifetime. 

Colorectal cancer can happen when you're young. 

Fact: The rate of colorectal cancer is increasing in people under 50. Rates of colorectal cancer in people under 50 have doubled since 1990. In people over 65, the diagnosis rates have been decreasing, most likely because of colorectal cancer screening.

Many younger adults don't consider themselves at risk. 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.

Screening for colorectal cancer starts at age 45.  

Fact: In 2021, the recommendation for colorectal cancer was updated to begin screening at age 45. This is because the rate of diagnosis is increasing at younger ages.  

Colorectal cancer can be prevented with screening. 

Fact: The goal of colorectal cancer screening is to prevent cancer, not just find it when it has already developed. Most colorectal cancer develops from a polyp, a small, precancerous growth. The presence of polyps can easily be identified using colonoscopy screening tests. Polyps can be removed during a colonoscopy to prevent them from developing into cancer.

You can also help keep your colon healthy by:

• Add bulk to your diet with lots of veggies and whole grains.
• Eat healthy fats found in olive oil, salmon, avocados and nuts.
• Strive for 30 minutes of exercise most days of the week.
• Watch your weight. Carrying extra pounds has been shown to increase your risk for colon cancer.
• Drink alcohol in moderation, and don't smoke.

Family history is the only risk factor for colorectal cancer.  

Myth: While a family history of colorectal cancer influences your risk of developing cancer, other important risk factors increase the risk of developing colorectal cancer. Medical conditions including obesity and inflammatory bowel disease (IBD), and lifestyle choices, such as a diet high in red meats, smoking and alcohol use, increase risk. Because colorectal cancer is common, all adults over 45 should be screened regardless of family history.  

African Americans have a higher risk of developing colorectal cancer, and American Indian/Alaska Native people have the highest risk of colorectal cancer.   

A positive stool-based screening for colorectal cancer is the same as a cancer diagnosis.  

Myth: A stool-based test looks for more than cancer, and it can identify precancerous lesions or polyps. These tests don't address the polyp if a polyp is present in the colon. A follow-up colonoscopy is needed to identify the polyp and potentially remove it.  

If you have more questions, talk with your healthcare team about screening options for colorectal cancer at age 45.  

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

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DEAR MAYO CLINIC: I have two sons, ages 5 and 11. My eldest is always excited to start school and have new adventures. My younger son will begin kindergarten this year. Although he went to child care part-time, my younger son has begun to express concern about being away from me all day and is showing increased anxiety as we talk about school. How can I help him be less anxious?

ANSWER: Getting ready for a new school year can be exciting for children, parents and caregivers. It may also be a major cause of anxiety or stress. 

Most people get nervous when they face change. Whether kids are heading off to elementary, middle or high school, or even college, leaving the safety and familiarity of home can prompt feelings of fear. 

One of the most helpful things you can do is reassure your son that what he's feeling is normal. Separation anxiety happens to many people of all ages. Then, as much as possible, help him gradually gain exposure to, and get comfortable with, going to school. 

Talking through fears

Try to gain a sense of what it is about school that makes your son nervous. Is he concerned about making new friends? Is he concerned about the teachers? Is he worried about the classwork? Is there something new that may be causing anxiety, like riding a bus? Sometimes, just being able to talk about those details and put the nervousness into words can help a child who is feeling anxious. 

Continuing to show love, support and warmth can go a long way. Share with your son an experience you had when you were anxious about facing something new. Talk to him about how you handled the situation. Ask your older child to share some experiences and how he overcame his fears. Doing this will let your younger child know that he is not alone in the situation, that it is OK to be nervous, and he can get through it. 

Preparing ahead of time

To help your son prepare for school, talk to him about what his school day might be like. You could also visit the school to meet his teachers, take a tour of his classroom, see the playground, or even locate the bus stop. If your son is nervous about getting on the school bus, call the transportation department to see if he can meet the bus driver early. 

Another idea is to find social opportunities with other incoming kindergarten students. Reach out to parents of children in your neighborhood who will be going to school for the first time. Then, plan a social gathering at a local playground. 

A week or two before school starts, develop a routine. Begin to wake up early and get ready on time. Also, consider practicing some schoolwork. You can get your older child involved in sharing his thoughts about what was the best part of school when he was that age. 

Spending time apart

Begin by spending some time away from your son. Maybe it's having your child go to a friend's home for an hour. Then, slowly increase the time away from your son so that he has an opportunity to feel comfortable being with others for longer periods of time. 

All of these steps will help him know what to expect, prepare him gradually for what school will be like, and ease the transition. This approach is based on one of the core principles of treating anxiety. That is, when you are frightened of something that is not dangerous, you need to have practice dealing with the source of your fear until it becomes routine or boring. You cannot be talked out of anxiety. You need exposure to, and experience in, dealing with the situation. 

If your child is resistant to the attempts you are making, or if his anxiety doesn't decrease even after you've taken these steps, talk with your pediatrician or primary care clinician about seeing a healthcare professional who can help. Books on coaching for anxiety can also be a resource. Anxiety is a normal part of life that can't be completely eliminated, but many successful strategies can reduce anxiety and how often it causes problems.

Stephen Whiteside, Ph.D., Psychology, Mayo Clinic, Rochester, Minnesota 

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DEAR MAYO CLINIC: We just moved to an area with a lot of opportunities for water recreation and are so excited about our first summer on the water. But we want to make sure everyone stays safe. Can you give us some pointers for water safety?

ANSWER: Nothing beats a day at the lake, river, beach or pool for fun, fitness, fishing and relaxation. While spending time on and around the water this summer, these tips can ensure that everyone is safe, has fun and enjoys the time together.

Learn to swim

Every year in the U.S., about 4,000 people die by drowning. Children, men and nonwhite people are at the highest risk. 

Learning to swim is one of the most important ways to stay safe on the water. The American Academy of Pediatrics supports swimming lessons for most children ages 4 and older. Lessons for children ages 1 to 4 could be appropriate, depending on how often they're exposed to water. Even infants can be introduced to the water. Check to see what classes are available in your area.

Swimmers of all ages may be more familiar with pools than rivers and may not know what to do if caught in a current. Stay calm, float on your back, and when you come to a calmer area, flip over and swim diagonally toward shore with the flow of the current.

Keep these safety tips in mind too:

• Don't swim alone.
• Supervise children when they're swimming, and stay close enough to reach out to a child at any time.
• Before diving into a body of water, know the water depth and if there are any underwater obstacles.
• Keep pool gates closed at all times, and consider an alarm to alert you if the gate is opened.

Wear a personal floatation device

Even expert swimmers can get into trouble during an emergency. It's important to be sure everyone in a watercraft wears a U.S. Coast Guard-approved personal flotation device. While boating or swimming, remember that arm floaties and inflatable toys aren't a substitute and tend to give kids and families a false sense of security. 

Excellent, comfortable, easy-to-put-on models of personal flotation devices are available, so there's really no excuse not to wear one.

Stay safe while boating, no matter your craft

One of the most popular and fun activities of summer is spending time on the water. Boating creates lifelong memories and gives us the opportunity to unplug, spend time together, learn new skills and explore new areas. 

Whether your craft is a power boat, fishing boat, pontoon, personal watercraft, canoe or kayak, you should remember these basic safety rules as you head out for a day on the water:

• Be a weather watcher. Summer weather can change quickly. Check the forecast before heading out and check again frequently while on the water. If you do get caught in a storm, navigate to the shore as quickly as possible.
• Tell someone the details of your trip. Tell your trip plan to a friend who's staying ashore. Share details about who's on the boat, where you'll be and how long you'll be gone.
• Always operate your boat at a safe speed. Waterways can become crowded during the summer. Slow down, stay alert and steer clear of larger vessels. Be sure to follow speed limits in "no wake" areas.
• Respect buoys and other navigational aids. They've been put in place to ensure your safety and the safety of other boaters and swimmers. If you're not familiar with them, the U.S. Coast Guard has a handy water navigation system guide.
• Leave alcohol on shore. The risk of drowning or injury significantly increases when alcohol or drugs are involved. More than 70% of water recreation deaths are related to alcohol use.

Be sun savvy

The sun's rays can be intense on the open water. Protect everyone with hats, sunglasses and sunscreen. Look for water-resistant, broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. Apply sunscreen generously and reapply every two hours, or more often if you're swimming or sweating.

Drink plenty of water

Even when surrounded by water, it's possible to become dehydrated. Sitting in the sun can increase your body's temperature. Pack plenty of water for each person, and drink some water every 15 to 20 minutes to remain properly hydrated.

Jason Wray-Raabolle, M.D., Family Medicine, Mayo Clinic Health System, Owatonna, Minnesota

The post Mayo Clinic Q&A: Tips for summer water safety appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've taken up running again and decided to enter a half-marathon. I know I have to push myself to get ready for the race, but I don't want to overdo it. What should I watch out for as I train?

ANSWER: We're surrounded by warning signs — on the roads, at work, and on packaging and equipment. Your body sends warning signs, too. As your race date nears, it's tempting to pull out all the stops. But that makes this a prime time to watch for warning signs of overtraining.

Overtraining or overuse injuries are any muscle, joint or bony injuries, such as tendinitis or a stress fracture, that result from repetitive trauma. Overuse injuries typically occur because of training or technique errors.

Runners are tenacious athletes. Pulling back and slowing down may be tough, but while some overtraining issues can be resolved with simple rest, others may evolve into more significant problems.

How overtraining and overuse injuries occur

Going too fast, exercising for too long or simply doing too much of one type of activity can strain your muscles and lead to an overuse injury. Improper technique also takes a toll on your body. For example, if you use poor form while running or doing strength-training exercises, you may overload certain areas of the body, which can cause an overuse injury.

Thankfully, most overuse injuries are avoidable. Try these suggestions to prevent them:

• Use proper form and gear.
  Whether you're starting a new activity or have been playing a sport for a long time, taking lessons can help ensure you're using the correct technique. Talk with an expert about proper form, equipment and gear fit to help ensure success.
• Pace yourself.
  Rely on your training program, which should spread your aerobic activity throughout the week. Take time to warm up before physical activity and cool down afterward.
• Gradually increase your activity level.
  When changing the intensity or duration of physical activity, do so gradually. Try not to increase anything by more than about 10% per week. Your body needs time to adapt to the new stress.
• Mix up your routine.
  Instead of focusing on one type of exercise, build variety into your training program. Doing a variety of low-impact activities prevents overuse injuries and allows your body to use different muscle groups.

Overtraining signs and what to do 

It can be hard to know when you’re pushing through your training for continuous improvement and when you’re moving into overtraining. Your feet and legs take a pounding as you run mile after mile, so watch for these issues: 

• Callous blistering and broken toenails are common overtraining problems. 
• Early morning pain on the sole of your foot can be a sign of plantar fasciitis. 
• Tendinitis can leave you with pain in the back of your ankle or in the front of your shins, also called shin splints.

Typically, these can be treated with rest and medication to relieve pain and inflammation. Slow down your training. Return to the level you were at before the problem or consider cross-training with low- or no-impact exercise, such as a stationary bike, elliptical or swimming. Take an extra day off. These symptoms can be short-term if you treat them early and appropriately.

If pain continues despite rest or gets worse, it could indicate a bone issue, which is potentially serious. Stress reactions or stress fractures are common in the mid-foot, mid-shin or, most concerning, high up in your leg by your hip. Pain that doesn't go away is a symptom, so consult your healthcare team.

What to do if you suspect an overuse injury

Tell your healthcare practitioner if you've recently changed your workout technique, intensity, duration, frequency or types of exercises. Identifying the cause of your overuse injury will help you correct the problem and avoid repeating it. You can seek further guidance by talking with specialists such as sports medicine physicians, athletic trainers and physical therapists.

Once your injury has healed, ask a specialist to check that you've completely regained strength, motion, flexibility and balance before beginning the activity again. Pay special attention to proper technique to avoid future injuries.

Staying strong

Don't allow an overuse injury to prevent you from being physically active. By working with a specialist, listening to your body and pacing yourself, you can avoid this common setback and safely increase your activity level.

Knowing you worked hard to prepare will add to your feeling of accomplishment on race day, but don’t overdo it. You’re almost there. Take care of yourself so you can keep going strong all the way to the finish line.

Corey Wencl, Sports Medicine, Mayo Clinic Health System, La Crosse, Wisconsin

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