DEAR MAYO CLINIC: Many in my social circle are now at the age when we're more likely to have a stroke. What symptoms should we watch for? And what happens if someone has a stroke? 

ANSWER: If you're 55 or older, you're at greater risk of stroke. A stroke is a medical emergency. It happens when either the blood supply to the brain is blocked or a blood vessel in the brain leaks or bursts. In both cases, brain cells begin to die in minutes, so it can be life-changing to recognize the symptoms in your friends and family. 

Stroke risks

In addition to age, lifestyle factors ranging from being overweight, physical inactivity, heavy drinking, smoking or being exposed to secondhand smoke and using illegal drugs such as cocaine and methamphetamine can contribute to your stroke risk. 

There also are medical conditions that increase your stroke risk, including:  

• High blood pressure. 
• High cholesterol. 
• Diabetes. 
• Obstructive sleep apnea. 
• Cardiovascular disease. 
• Personal or family history of stroke or heart attack. 
• COVID-19 infection. 
• Taking birth control pills or hormone therapy. 
  

Men are at higher risk, as are African American and Hispanic people. Women are more likely to die of a stroke than men. 

Time is critical

The American Stroke and Heart Association has created an easy way to remember stroke symptoms: BE FAST.

Here's what each letter stands for: 

• B: Balance or coordination. Sudden onset of walking like you're intoxicated, and not being able to grasp or turn a doorknob with one of your hands, are just two examples. 
• E: Eye. Sudden onset of double vision, loss of vision in one or both eyes, or not being able to see the full visual field can indicate a stroke.
•  F: Face. Sudden onset of one side of your face drooping. A limb on that same side also may become weak. 
• A: Arm. Sudden onset of weakness or complete paralysis in one arm or leg. One way to test for arm weakness is to have the person hold both arms straight out in front of them. Be concerned if one arm begins to drift downward on its own. 
• S: Speech. Sudden onset of slurred speech, or trouble finding words or speaking gibberish. 
• T: Time: It's estimated that a person loses 1.6 to 2 million brain cells every minute when blood supply to the brain is affected, so time is brain. 
  

Because time is critical when a person has a stroke, call 911 for immediate care and transportation to an emergency department. However, if you're living in a rural area, too much time may elapse before help arrives. Give the person one tablet of aspirin, preferably a low-dose aspirin (about 81 mg), then safely drive them to the closest emergency department. Tell staff that you suspect a stroke. 

If your medical facility doesn't have a comprehensive or primary stroke center, the healthcare team may connect via audio-video technology (telestroke) with a stroke neurologist who can examine the patient and recommend treatment options. 

Treatment

Treatments have advanced significantly in the past 30 years. The first breakthrough was the development of clot-busting medications that can dissolve the clot that's blocking blood flow in the blood vessel. For the best outcomes, patients are carefully selected for this treatment. 

For some patients, endovascular intervention is a newer and additional treatment option. It's typically performed within 24 hours of the onset of symptoms. A CT or MRI scan of the blood vessel can pinpoint the blood clot. Using guided imagery, a neurointerventionist threads a thin wire up through an artery in the groin to the brain, grasps the clot, removes it and opens the affected blood vessel. 

In addition to treatments, other factors contribute to better recovery from stroke while patients are in the hospital. These include controlling their blood pressure, ensuring their blood sugar is neither too high nor too low, and maintaining a comfortable body temperature — not too hot or too cold. Their care team will develop a recovery plan for them once they return home. 

Significant strides also have been made to ensure patients don't have another stroke. These include controlling blood pressure and diabetes and treating obstructive sleep apnea. Patients also typically are prescribed a blood thinner to reduce the chance of clots forming. New developments in these medications, such as apixaban, make them simpler to take without regular blood tests. 

On the horizon is the formulation of medications called neuroprotective agents that reduce the catastrophic effects on the brain caused by inflammation when a stroke occurs. But the research and studies in this area continue. 

The best stroke care is still avoiding a stroke by reducing your risks. But if a stroke happens, remember: BE FAST. 

Felix Chukwudelunzu, M.D., Vascular Neurologist, Mayo Clinic Health System in Eau Claire and Menomonie, Wisconsin    

The post Mayo Clinic Q&A: Seeking stroke care when minutes matter appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I was recently diagnosed with a brain tumor, and I'm terrified of the idea of brain surgery. Are there less invasive treatment options available, and how do doctors decide which one is the best? 

ANSWER: It's completely understandable to feel nervous or afraid. A brain tumor diagnosis is overwhelming on its own, and many people immediately picture an extensive, open skull operation.

The good news is that brain tumor treatment has advanced significantly, and not every tumor requires the same approach. In some cases, less invasive treatments may be an option. In others, a more traditional operation, such as a craniotomy, remains the safest and most effective choice. What's most important to know is that treatment is individualized for each patient.

Treatment options

Planning your treatment often begins with highly detailed imaging, such as a brain MRI or a positron emission tomography (PET) scan. These images help surgeons carefully map the tumor and identify the safest, most precise path for treatment. Advanced imaging also helps care teams understand which nearby areas of the brain control important functions such as speech, movement and vision, and helps ensure those structures are protected as much as possible.

Minimally invasive treatment approaches include:

• Endoscopic surgery. For some tumors, surgeons can use an endoscope — a thin tube with a camera and specialized instruments — to reach the tumor through small natural pathways such as the nose. Certain tumors near the base of the skull and many pituitary tumors can be treated using this approach.
• Burr hole/mini craniotomy approach. For select lesions close to the brain's surface, surgeons may be able to remove the lesion through a tiny opening in the skull that is only millimeters wide. This technique uses a camera system positioned above the surgical area to view the tumor with high magnification.
  

Minimally invasive treatment doesn't always involve surgery in the traditional sense. For some brain tumors, highly focused stereotactic radiosurgery may be part of the treatment plan or, in certain cases, an alternative to surgery. Gamma Knife and proton beam therapy are examples of treatments that deliver focused radiation to a tumor without any cuts or openings in the skull, but with precision comparable to that of a surgical tool.

Considerations

Your doctor will consider several factors when deciding which approach is best for you, including:

• The type of tumor. Some tumors are more suitable for minimally invasive treatments than others.
• The size and location of the tumor. Tumors near critical areas that control speech, movement, vision or other important functions require especially careful planning.
• The goal of treatment. Sometimes the goal is to remove as much of the tumor as possible. In other cases, it may be to obtain a diagnosis, relieve pressure, control symptoms or a combination of these.
• Safety. The safest approach is always a major consideration, even if it's not the least invasive.
• The patient's overall health. Age, symptoms and other medical conditions can all affect which treatment makes the most sense. 
  

A less invasive treatment can offer real benefits when it's the right fit. Potential advantages may include less injury to nearby healthy tissue, fewer complications, less postoperative pain, a shorter hospital stay and a quicker recovery. That said, the newest or least invasive technique isn't automatically the best option. The right approach is the one that offers the best outcome with the lowest risk, even if that means a more traditional operation is the safer choice for a particular tumor.

Team approach

This is also why brain tumor treatment is often planned by a multidisciplinary team. Depending on the situation, that team may include specialists in neurosurgery, otolaryngology (ENT), radiation oncology, medical oncology, neuroradiology, neuropathology, neuroanesthesiology and other healthcare professionals. This collaborative approach helps ensure treatment is tailored to each patient rather than relying on a one-size-fits-all strategy.

The bottom line is that brain tumor treatment is highly individualized. Some patients may benefit from minimally invasive surgery, while others may require a traditional open procedure. In some cases, focused radiation — such as proton beam therapy or Gamma Knife — may be the most appropriate option, either on its own or as part of a broader treatment plan.

What matters most is careful evaluation, thoughtful planning and a personalized recommendation based on safety, effectiveness, and a patient's goals and quality of life.

Fredric B. Meyer, M.D., Neurosurgery, Mayo Clinic, Rochester, Minnesota

Related post:

• Mayo Clinic researchers outline a new era of personalized care for patients with meningioma

The post Mayo Clinic Q&A: Understanding minimally invasive brain tumor treatment options appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I was just diagnosed with early-stage melanoma, and I am being referred to an oncologist. What happens next? Will I need a lymph node biopsy, or are there cases where it can be safely avoided? What other surgical or nonsurgical treatment options might be recommended?  

ANSWER: Melanoma is a type of skin cancer that begins in melanocytes, which are the pigment-producing cells. The pigment is called melanin. While it is less common than other types of skin cancer, it is more likely to metastasize, or spread, to other parts of the body. But when detected early, it is often highly treatable. 

Early detection

After a biopsy confirms the diagnosis, your care team will evaluate details of the tumor, including its thickness, and other features seen under a microscope, along with a physical exam to determine the clinical stage and guide treatment recommendations. 

In most cases, a procedure called wide local excision, which removes the melanoma along with a 1- to 2-centimeter margin of surrounding healthy tissue, is performed to ensure all cancer cells are removed. Some patients also may be recommended to have sentinel lymph node surgery. This procedure looks for cancer in the first lymph node, or nodes, that drain the area where the melanoma developed.  

For years, sentinel lymph node biopsy has been an important part of staging melanoma. It can help determine how advanced the cancer is and whether additional treatment might be beneficial. However, it's also a surgical procedure, and like any procedure, it carries some risks and isn't necessary for everyone.  

In fact, recent studies show that most people who undergo this operation, nearly 80%, do not have cancer in their lymph nodes. Because of this, researchers have been working to better identify which patients are most likely to benefit from the procedure and which patients may be able to safely avoid it. 

Advanced options for melanoma staging

One newer approach involves genomic testing of the melanoma tumor. This test analyzes the activity of the specific genes in the tumor, along with clinical factors such as age and tumor thickness, to estimate the likelihood that the cancer has spread to nearby lymph nodes. 

For some people with early-stage melanoma, a low-risk result on this type of test may indicate that the chance of lymph node involvement is very small. In these cases, patients and their care teams may decide, through shared decision-making, to safely avoid lymph node biopsy. 

At the same time, it's important to note that lymph node biopsy remains an appropriate and important option for patients with higher-risk features. The decision is individualized, based on both traditional staging and new tools that help refine risk. 

For many people with early-stage melanoma, surgery is the only treatment needed and is often curative. In these cases, follow-up care and regular skin checks are an important part of long-term management. 

However, additional therapies may be recommended in certain situations. If melanoma is found in the lymph nodes or has higher-risk features, your care team may discuss adjuvant therapy, which is systemic treatment given after surgery to reduce the risk of recurrence. This may be immunotherapy or targeted therapy, depending on your individual situation. 

Melanoma care is increasingly moving toward a more personalized approach. Traditional factors, such as tumor thickness and lymph node status, remain essential, and newer tools, such as genomic testing, are helping to refine decision-making. 

This means that instead of a one-size-fits-all approach, treatment can be better tailored to each person's tumor biology. In some cases, that may mean avoiding unnecessary procedures, while still ensuring that higher-risk cancers are treated appropriately. 

Tina Hieken, M.D., Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota 

The post Mayo Clinic Q&A: Advances in staging and surgical treatment of melanoma  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I was recently diagnosed with esophageal cancer, and I was told I may need surgery. How do doctors determine whether surgery is the right option? Are there newer, less invasive approaches available?

ANSWER: Treatment for esophageal cancer has evolved significantly in recent years, and surgery remains one of the most important tools for treating this disease. For many patients, it is one part of a larger, carefully planned treatment approach. Determining whether surgery is appropriate and when it should occur depends on the stage of the cancer and other individual factors.

Cancer stage

One of the most important considerations is the stage of the cancer, which describes how deeply the tumor has grown into the esophagus and whether it has spread elsewhere in the body. If cancer has spread to distant organs, known as metastatic disease, surgery typically isn't recommended. Instead, treatment may focus on systemic therapies, such as chemotherapy, immunotherapy or a combination of both.

For people whose cancer is still localized or regionally advanced, surgery is often considered as part of the broader treatment plan. However, it's uncommon for surgery to be the first step. Esophageal cancer frequently doesn't cause symptoms until it has progressed, so many people are diagnosed at a stage when additional therapy is needed before surgery. This is called neoadjuvant therapy, and it may include chemotherapy, radiation therapy, immunotherapy or a combination of these treatments. The goal is to shrink the tumor, improve the chances of complete surgical removal and address any microscopic cancer cells that may have spread.

In contrast, very early-stage esophageal cancers, often found during endoscopy for another condition such as chronic acid reflux or Barrett's esophagus, may be treated endoscopically. In select cases, physicians can remove these superficial tumors using endoscopic techniques, which are performed through the mouth without external incisions. These approaches can be highly effective when the cancer is confined to the innermost layers of the esophagus.

Surgery

When surgery is recommended, the procedure most commonly performed is an esophagectomy, which involves removing part or most of the esophagus and reconstructing it using the stomach.

In recent years, there have been important advances in how this surgery is performed. Traditionally, esophagectomy required large incisions in the chest and abdomen. Today, many patients may be candidates for minimally invasive approaches, including laparoscopic and robotic-assisted surgery. These techniques use smaller incisions and specialized instruments, allowing surgeons to perform the same operation with less trauma to the body. These approaches are designed not only to treat the cancer effectively but also to support recovery and reduce the physical effects of surgery.

Minimally invasive surgery can offer several potential benefits, including reduced pain, shorter hospital stays and faster recovery times. Not everyone is a candidate for these approaches, but they're increasingly used when appropriate and when performed by experienced surgical teams.

Even with these advances, esophageal surgery is a major, complex procedure, and it's important to understand how it may affect daily life afterward. Because the stomach is reshaped into a narrow tube to replace the esophagus, patients often need to adjust how and what they eat. Smaller, more frequent meals are usually necessary, and some people may experience symptoms such as reflux, dumping syndrome or a sensation that food moves more slowly. These changes can be significant, but many patients adapt over time with guidance from their care team.

Researchers are continuing to study whether some patients who respond well to chemotherapy and radiation may be able to delay or avoid surgery. However, current imaging tools for esophageal cancer can't always detect small amounts of remaining cancer. For that reason, surgery is still commonly recommended when a patient is a good candidate, even if scans show a strong response to treatment.

Multidisciplinary team approach

Because esophageal cancer care often involves multiple therapies, treatment planning typically includes input from several specialists. Reviewing all available information, including tumor stage, response to therapy and overall health, helps guide a plan that balances effectiveness with the potential effects on daily life. 

Given the complexity of esophageal cancer and the surgery used to treat it, patients may benefit from care at centers that have extensive experience with this disease and a coordinated, multidisciplinary team. This approach can help ensure that treatment decisions are carefully considered and that patients are supported throughout each phase of care.

Carlos Puig Gilbert, M.D., Thoracic Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: When is surgery recommended for esophageal cancer? appeared first on Mayo Clinic News Network.

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

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

Questions from my patients usually fall into three categories:

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

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

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

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

Deciding on surgery

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

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

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

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

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

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

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

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

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

After surgery

After surgery, knee and hip recovery differ:

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

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

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

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

Related post:

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

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

DEAR MAYO CLINIC: My child seems more tired than other kids, they don't keep up like they used to and have complained of chest discomfort when playing or running. Could these be signs of a heart condition?

ANSWER: Symptoms like fatigue or chest discomfort in children are common and often have simple, nonserious explanations. Chest pain is one of the most common reasons children are referred to a pediatric cardiologist, but fewer than 5% of cases are related to the heart. However, symptoms during exercise or a noticeable change in your child's usual activity level may be worth a closer look.

Heart conditions in children can present in several ways. Some are congenital, meaning a child is born with them. Others are acquired and develop later, sometimes after an illness or infection. There are also genetic conditions that may not be obvious at first but can lead to heart problems over time. More severe congenital heart conditions are usually diagnosed soon after birth and may require treatment in the first months of life. Milder forms may not cause symptoms right away and are sometimes found when a murmur is heard or as symptoms develop over time.

Warning signs

Warning signs can look different depending on a child's age. In infants, heart problems may show up as poor feeding, tiring during feeding, poor weight gain, fast breathing or fewer wet diapers. Some babies may seem sleepier than usual or not waking well enough to feed. These symptoms can appear in the first weeks of life, particularly in babies with larger congenital heart defects. 

Because babies can't tell you what they feel, noticing changes in these everyday patterns is especially important and should be evaluated promptly.

In older children, symptoms that occur during physical activity tend to raise more concern. For example, chest pain is more worrisome when it happens during intense exercise, feels like pressure and doesn't change with breathing. It may be especially concerning if the child also experiences shortness of breath, dizziness or fainting during activity. 

Shortness of breath can have several causes in children, but what matters most is whether there has been a change. A child who previously kept up with others but now falls behind, takes more breaks or struggles with activity should be evaluated more closely.

Symptoms

Some symptoms shouldn't be ignored. These include: 

• Passing out, especially during exercise.
• Chest pain with activity.
• Fast heart rate that doesn't slow down at rest.

A racing heartbeat that is difficult to count or doesn't slow after activity should be evaluated right away.

Changes in skin color can be another warning sign. A bluish color around the lips, tongue or inside the mouth may indicate low oxygen levels and should be checked out promptly.

Family history also matters. A history of heart disease in close relatives can increase the likelihood that a child may be affected. Family history is especially important when there's cardiomyopathy or unexplained death, particularly during exercise or sleep. In these cases, children may need screening even if they seem healthy. Some inherited heart conditions don't cause symptoms early in life, so knowing the family history can help identify children who need follow-up. 

If a child is evaluated for a possible heart problem, the visit often starts with a detailed history and a careful physical exam. Depending on the situation, the child may have one or more tests. These may include: 

• An electrocardiogram to assess the heart's electrical activity. 
• An echocardiogram or ultrasound of the heart to evaluate its structure, blood flow and function. 

Not every child will need testing. Sometimes the history and exam suggest a harmless cause, such as an "innocent" murmur, that doesn't require additional tests or treatment. In other cases, these studies help clarify whether there's a structural or rhythm-related problem. 

Most of the time, symptoms in children, such as chest pain, palpitations or fatigue, aren't caused by heart disease. Pediatric heart conditions are relatively rare. Even so, symptoms still deserve attention so that children who need care are identified early, and others can be reassured.

Most children with these symptoms won't have a heart condition, but signs such as fainting, a racing heartbeat that doesn't slow down at rest, or a clear change in activity level shouldn't be ignored. If something feels different or concerning, it's appropriate to have your child evaluated.

Josué Maldonado Custodio, M.D., Cardiology, Mayo Clinic Health System, Eau Claire and La Crosse, Wisconsin

The post Mayo Clinic Q&A: What are the signs your child may have a heart condition? appeared first on Mayo Clinic News Network.

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

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

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

What to expect

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

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

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

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

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

Improving cardiopulmonary fitness

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

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

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

Test functions

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

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

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

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

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

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

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

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

DEAR MAYO CLINIC: I was recently diagnosed with oral cancer after an unusual lesion was discovered during my last dental exam, and I was referred to an oral and maxillofacial surgeon. What does surgical treatment entail, and will the surgery change my appearance or my ability to speak, chew, or swallow? 

ANSWER: Being diagnosed with oral cancer can feel overwhelming, especially when considering treatment options. Because surgery is often central to treatment, it's natural to have questions about what it involves and how it may affect your appearance and daily activities, like speaking, eating and swallowing. 

For many oral cancers, particularly those in the tongue, gums, cheeks or jaw, surgery is often the most effective treatment. Surgeons can remove the cancer and, when needed, rebuild the area to preserve appearance and function. Today, care focuses on treating the cancer and maintaining quality of life after treatment. 

Surgical treatment  

After cancer is confirmed with a biopsy, your care team will complete a detailed evaluation. This typically includes imaging, such as CT or PET scans, to determine the tumor's size and location, and whether it has spread. This process, called staging, helps guide treatment. 

During surgery, the goal is to remove the tumor along with a small margin of surrounding healthy tissue to ensure no cancer cells are left behind. Some centers, like Mayo Clinic, can analyze tissue during the operation using a technique called frozen section pathology to confirm that all cancer has been removed before the procedure is finished. This real-time feedback can reduce the need for additional surgery later. 

Because oral cancers can spread through the lymphatic system, lymph nodes in the neck are often evaluated or removed. Examining these lymph nodes, along with the tumor, gives surgeons additional information about the cancer, sometimes called surgical staging. This can determine whether additional treatment is needed after surgery, most commonly radiation therapy, and sometimes radiation with chemotherapy. 

Preserving appearance and function 

A common concern is how surgery will affect your appearance and the ability to speak, chew or swallow. These are important considerations, given the visible and essential role of your mouth and face in everyday life. 

One way surgeons help preserve appearance and function is through advanced planning before surgery even begins. Using detailed imaging, the surgical team can create a personalized plan based on each person's unique anatomy. In some cases, this includes 3D modeling and printed surgical guides and custom titanium implants, which allow surgeons to remove the tumor and rebuild the area with high precision — all during the same operation. 

For larger tumors, reconstruction may involve using tissue from another part of the body, such as the leg, arm or shoulder blade, to rebuild areas of the face or jaw. Surgeons use a technique called microsurgery to connect very small blood vessels under a microscope, so the transplanted tissue remains healthy. Once connected, the tissue can help restore both structure and function. 

Reconstruction is designed to rebuild what was removed and support everyday activities like speaking, chewing and swallowing. In many cases, this includes planning for dental rehabilitation. If teeth are removed as part of treatment, dental implants are often placed at the time of surgery to support replacement teeth. 

By combining cancer removal with immediate reconstruction and dental planning, oral and maxillofacial surgeons aim to help patients return to daily life with as few long-term changes as possible. The goal is to restore both appearance and function so patients can feel comfortable eating, speaking and interacting with others. 

Many patients can return to eating, drinking and speaking relatively soon after surgery. However, some may need additional support from speech and swallowing specialists to regain function. 

Key considerations 

Oral cancer care often involves a team of specialists, including surgeons, speech and swallowing experts, and, when needed, radiation and medical oncologists. Coordinating this care closely and starting the right treatments at the right time can make a meaningful difference in outcomes and recovery. 

It's also important to remember that treatment is highly individualized. Not every patient will need extensive surgery, reconstruction or additional therapy. Your care team will guide you through what to expect based on your specific diagnosis. 

Ultimately, the goal is twofold: to treat the cancer while balancing quality of life. Today's surgical approaches are designed to do both — removing the disease while helping you maintain the ability to speak, eat and engage in daily life. 

Because treatment needs vary from person to person, it's important to work with a care team experienced in managing oral cancer. Asking questions and understanding your options can help inform your decisions and make you feel more confident about your care.  

Kyle Ettinger, M.D., D.D.S., Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, Minnesota 

The post Mayo Clinic Q&A: Understanding surgical options for oral cancer  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've heard that colorectal cancer is becoming more common in younger adults. If either my husband or I were diagnosed with that or some other type of cancer, would it affect our plans to build a family?

ANSWER: No one at any age wants to receive a cancer diagnosis. But it can be particularly difficult for younger adults who are told they have cancer in the prime of life. What many young adult patients don't realize is that treatments that can save lives, such as chemotherapy, radiation and surgery, also can potentially affect their ability to have biological children. 

For some women, their cancer treatment may include hormone deprivation therapy, which can stretch five or more years. The completion of treatment may correspond with their natural menopause or put them into an early menopause, impairing their ability to conceive. 

Although fertility risk centers around the treatments and intensity of treatments, certain cancers often require therapies known to carry a higher risk to reproductive cells, including blood, gynecological and soft tissue/bone cancers, and breast and testicular cancer.

Fertility preservation

Along with explaining the diagnosis, the oncologist will explain the type of treatment the patient will receive and the potential risks to fertility. A conversation about fertility preservation may be conducted with the oncologist, nurse, social worker or reproductive specialist. This designated member of the patient's healthcare team can provide information to help them make this personal decision. Keeping religious, cultural and social values in mind, they may ask questions to better understand the patient's goals and support their decisions about family building. 

Decisions about fertility can feel especially overwhelming when patients are still grappling with the shock of hearing the word "cancer." Many people find it helpful to include a spouse, partner, family member or close friend in these conversations to provide support and help process the information. 

Fertility decisions often have to be made quickly because cancer treatment may need to begin soon after diagnosis. In some cases, patients may have only a few days to consider fertility preservation options. Some people don't desire biological children in the future, and so the decision is straightforward. For others, preserving the option for biological children is important, and they are willing to postpone cancer treatment. 

Family building options

Sometimes, with aggressive cancers, time doesn't allow for fertility preservation, and family-building conversation takes a different direction toward helping the patient cope with feelings of grief and loss or toward considering their options for building a nonbiological family. These options can include adoption, use of donor eggs, sperm or embryos, or use of a gestational carrier (surrogacy).

If it's medically safe to briefly delay cancer treatment, and a patient wishes to preserve the option of having biological children, then eggs, embryos or sperm may be cryopreserved (frozen) for future use.

For men, typically the sperm collection process can be done quickly, either at a fertility clinic or with a mail-in kit, which allows for collection in the privacy of their own home.

Women face greater barriers. The process of stimulating ovaries to produce multiple eggs includes two to three weeks of hormones, frequent lab and transvaginal ultrasound monitoring, and a minor surgical procedure called an "egg retrieval."  With this longer time frame, women need to partner with their care teams to weigh the benefits of egg collection against the risk of delaying treatment. 

Fertility preservation can involve considerable financial costs, and insurance coverage varies. Patients are encouraged to check their benefits early, and many nonprofit organizations offer grants or financial assistance to help offset expenses.

It's important to remember that cancer treatment doesn't always lead to infertility. Some patients maintain fertility and can have children after treatment, either naturally or with medical support.

Patients interested in learning more about fertility preservation should consult with a reproductive specialist who can provide detailed information about the fertility preservation option that is right for them.

A cancer diagnosis can stop young adults in their tracks. It's usually something they never thought they'd have to deal with, just as they're starting their careers, establishing relationships, becoming more financially stable and envisioning their future, including building a family. Throughout this journey, their cancer care team is there to support them and help navigate decisions they never expected to face.

Elysse Casson, Oncology Certified Nurse, Adolescent and Young Adult Cancer Program, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic in Arizona

The post Mayo Clinic Q&A: How does a cancer diagnosis affect family building appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: A close friend of mine recently received an organ transplant, and another acquaintance is considering becoming a living donor. What is life really like after an organ transplant or donation?

ANSWER: Organ transplantation is often described as a second chance at life, and for many people, that description is accurate. The purpose of a transplant is to restore health for people with end-stage organ failure so they can return to a near-normal life.

Whether someone receives an organ or chooses to donate one, the experience doesn't end when surgery is over. Recovery, adjustment and follow-up care all become part of life afterward.

In the first few weeks after a transplant, patients are recovering from major surgery and healing from the incision. As they recover, they gradually become more active. Some patients say they notice improvements soon after surgery and begin to feel better early in recovery. Even so, the body still needs time to heal; many patients say they begin to feel fully back to normal within about six to eight weeks.

Before a transplant, people with organ failure often live with significant limitations that affect their energy, activity and daily routines. After recovery, many are able to return to work, travel, family life and other activities they previously had to give up.

After organ transplant

A transplant also comes with long-term medical responsibilities. One of the most important is taking anti-rejection medications, which help prevent the immune system from attacking the new organ.

Most transplant recipients take these medications every day, often twice daily. As with any medication, side effects are possible. However, many people tolerate these medications well and eventually incorporate them into their daily routines.

After a transplant, patients have several follow-up visits. As they stabilize, those visits become less frequent. Routine lab tests every few months help the care team watch for signs of rejection.

How long a transplanted organ lasts depends on the type of organ and how closely a patient follows the treatment plan. The liver, for example, has a remarkable ability to regenerate. Some people are still living with the same transplanted liver more than 40 years after surgery.

Kidneys don't regenerate the same way the liver does. On average, a kidney transplant from a living donor can last a little more than 20 years, although many last much longer. Taking medications as prescribed and keeping regular follow-up appointments help transplanted organs function well over time.

Beyond physical recovery, receiving an organ transplant can also bring emotional changes.

Many recipients express deep gratitude toward the donor who made their transplant possible. Some become more involved in raising awareness about organ donation and helping others understand the need for donors. For many recipients, being part of that community is meaningful.

At times, transplant recipients may struggle with complicated feelings, such as guilt or a sense of indebtedness to the donor. Healthcare teams often help patients understand that the donor's decision to give an organ is separate from the recipient's situation. Organ donation is ultimately a personal decision made by the donor or donor family.

Becoming a living donor

For people considering becoming living donors, recovery also varies depending on the type of donation. Kidney donation is the most common form of living organ donation and is often performed using minimally invasive techniques. Many donors stay in the hospital for one night and are encouraged to begin walking the same day as surgery.

While any surgery carries risks, studies suggest that most living donors go on to live healthy lives after they heal from the operation.

Ultimately, organ transplantation is possible because of the generosity of donors willing to help someone else in need. For people living with end-stage organ failure, a transplant can restore health and independence in ways they may not have imagined possible. For donors, the decision to give an organ offers the chance to save another person's life.

Timucin Taner, M.D., Ph.D., Transplant Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: What is life like after an organ transplant or donation? appeared first on Mayo Clinic News Network.