DEAR MAYO CLINIC: My spouse will tell me occasionally that their hands and feet "fall asleep," and they experience numbness, tingling and a pins-and-needles sensation. Is this normal, or does it require medical attention?  

ANSWER: Most people experience numbness or the familiar pins-and-needles sensation from time to time. Often, it's harmless and happens because you've been sitting, standing or sleeping in a position that puts temporary pressure on a nerve. Once you change positions, the sensation usually goes away within a few minutes. 

However, these symptoms can sometimes signal an underlying medical condition. They can occur when a nerve is damaged, compressed or irritated. The nerve itself may not be functioning properly, a condition called neuropathy. In other cases, pressure on a nerve, such as in the spine or somewhere along its path through the arms or legs, can cause numbness and tingling. 

Pinched nerves can occur in several places. Nerves can become compressed in the spinal canal, a condition known as spinal stenosis, or further along their path, such as carpal tunnel syndrome. 

Other health conditions also can damage nerves. Diabetes is one of the most common causes. Diabetic neuropathy often begins in the feet, causing numbness, tingling or burning sensations that usually affect both sides of the body equally. Symptoms often spread in a pattern similar to wearing socks or gloves. 

Vitamin deficiencies, kidney disease, heavy alcohol use, exposure to certain toxins and some medications, particularly chemotherapy drugs, also can contribute to numbness and tingling. 

Anxiety and stress can trigger numbness or tingling, as well. During periods of stress, some people breathe more rapidly than usual, which can lead to tingling around the mouth or in the hands. Panic attacks also may cause these sensations. 

You should schedule an appointment with your healthcare team if numbness or tingling: 

• Becomes constant. 

• Gets worse over time. 

• Interferes with your daily activities. 

• Occurs along with pain, weakness, balance problems or difficulty walking. 

While many causes aren't emergencies, persistent symptoms should be evaluated to identify and treat any underlying conditions. Some symptoms require immediate medical attention. 

Sudden numbness affecting one side of the face, arm or leg, especially when accompanied by weakness, can be a sign of a stroke. If this occurs, call 911 or seek emergency medical care immediately. 

You also should seek emergency care if you develop numbness in the groin or genital area, particularly if it occurs along with difficulty controlling your bladder or bowels, trouble urinating or weakness in your legs. These symptoms can indicate a serious problem, such as a spinal cord injury, that requires prompt treatment. 

When numbness or tingling needs further evaluation, your healthcare professional will begin by asking detailed questions about your symptoms, including when they started, what makes them better or worse, and whether you have other symptoms such as pain or weakness. 

A physical examination helps evaluate how your nerves and muscles are functioning. Depending on the findings, additional testing may be recommended. This could include imaging tests, such as X-rays, ultrasound or MRI, to look for structural problems around the nerves. Nerve studies, including electromyography, can help determine how well your nerves are sending and receiving signals. 

For mild episodes related to body position, simply changing positions, improving your posture or gently moving the affected arm or leg may be enough. When symptoms are more persistent, physical therapy can help improve strength, mobility and function. 

Other treatments may include medications to manage nerve pain, injections to reduce inflammation around pinched nerves, or surgery when nerve compression is severe. Some nerve problems, such as those caused by spinal stenosis, may improve with treatment. Others, including diabetic neuropathy, are often permanent, so treatment focuses on managing symptoms and preventing further nerve damage. 

The most important step is talking with your healthcare team. Identifying the cause early allows you to begin the right treatment and, in many cases, prevent symptoms from getting worse. 

Occasional numbness and tingling that go away quickly after you change positions are usually nothing to worry about. But if symptoms persist, worsen, interfere with your daily life or occur with weakness or other concerning symptoms, don't ignore them. Early evaluation can help identify the cause and guide the most appropriate treatment. 

Megan Everson, M.D., Neurosurgery, Spine Care, Mayo Clinic Health System, Eau Claire, Wisconsin 

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DEAR MAYO CLINIC: My neighbor spends a lot of time outdoors gardening and doing yard work, especially during the summer. Recently, after working outside on a hot day, she became lightheaded and noticed her heart racing. She suspected dehydration was to blame, but it made me wonder: Can dehydration affect your heart? When should symptoms like this be taken seriously? 

ANSWER: Dehydration can affect much more than your thirst. It also can place extra stress on your heart and cardiovascular system. 

Think of the heart as a pump. For it to work properly, enough blood needs to return to it with every heartbeat. When you become dehydrated, the amount of fluid circulating in your bloodstream decreases. That means less blood returns to the heart, so it has to work harder to keep blood moving throughout your body. 

Your body has several built-in ways to respond to dehydration. Blood vessels narrow to help maintain blood pressure, and your heart beats faster to keep blood moving. If dehydration becomes more severe, those usual responses can begin to fail. As a result, organs such as the brain, kidneys, liver and digestive system may not receive enough blood to function properly. 

Recognizing dehydration and knowing your risks

As dehydration worsens, symptoms can include: 

• Racing heartbeat or palpitations 

• Fatigue 

• Lightheadedness 

• Dizziness 

• Vision changes 

• Shortness of breath 

• Chest discomfort 

If dehydration becomes severe, it can lead to heatstroke or fainting. These are medical emergencies and should be evaluated by a healthcare professional immediately. 

Anyone can become dehydrated, but some people are at greater risk, including: 

• Older adults 

• Children 

• Athletes 

• Outdoor workers 

• People with heart disease 

• People taking certain medications, such as diuretics or GLP-1 receptor agonists 

People with heart failure or other forms of heart disease should be especially careful. Their hearts may have less reserve to respond to the added stress of dehydration. Many also take medications that remove fluid from the body, lower blood pressure or slow the heart rate, which can limit the body's usual ability to compensate.  

Staying hydrated and preventing compliations

There isn't a one-size-fits-all recommendation for how much water you need. For most healthy people, thirst is a reliable guide. If you feel thirsty, drink something. If you know you'll be spending time outdoors in the heat or exercising for an extended period, increase your fluid intake beforehand. 

Dehydration isn't always easy to recognize, so it helps to look for other signs. Dry mouth, dry skin, dark urine, foamy urine or a burning sensation when you urinate may all indicate you need more fluids. One of the simplest ways to monitor your hydration is to pay attention to the color of your urine. Pale or clear urine generally suggests you're well hydrated, while darker urine may be a sign that you need more fluids. 

Water is an excellent first choice for staying hydrated, but if you're truly dehydrated, water alone may not always be enough. Your blood contains electrolytes such as sodium, potassium and magnesium. Drinking water along with consuming something salty may help replace both fluids and electrolytes. People participating in prolonged exercise or endurance activities also may benefit from electrolyte-containing sports drinks. 

Alcohol is a large contributor to dehydration because it changes how the brain and kidneys regulate fluids and can increase fluid loss. Highly caffeinated drinks also can contribute to dehydration. If you're trying to rehydrate, choose water or electrolyte-containing drinks instead of sugary drinks or soda. 

The best way to prevent dehydration is to stay ahead of it. Make drinking fluids a regular part of your day. Drinking smaller amounts throughout the day is often more effective than consuming a large amount all at once. If you'll be gardening, exercising or working outdoors in hot, humid weather, plan ahead, stay aware of how you're feeling and adjust your activities if needed. 

Most importantly, know your personal risk. If you're older, have heart disease or take medications that affect your body's fluid balance, you may need to pay especially close attention to staying hydrated. Planning ahead, listening to your body and recognizing the signs of dehydration can help protect your heart and your overall health. 

Brodie R. Marthaler, M.D., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin  

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DEAR MAYO CLINIC: My father frequently experiences heartburn, but sometimes I worry that what feels like heartburn to him could be a heart attack. How can you tell the difference, and when should someone seek emergency care? 

ANSWER: Many people worry that heartburn-like symptoms could be a heart attack — and that concern is understandable. Heartburn and chest discomfort caused by a heart problem can sometimes feel remarkably similar. Although there are important differences between the two, the symptoms can overlap enough that it isn't always possible to tell the difference without a medical evaluation. 

One reason the distinction is difficult is that internal organs don't signal pain the same way muscles, bones and joints do. If you stub your toe, your brain quickly recognizes where the pain is coming from. But the heart, esophagus, lungs, and even the muscles and joints of the chest can all cause discomfort in a similar area. Because those sensations overlap, it can be hard to know where the pain is coming from. Even healthcare professionals often need to get additional information from a good physical examination, an electrocardiogram (ECG or EKG), blood work and other testing to determine the source of the symptoms. 

Heartburn is most commonly caused by acid reflux, which occurs when stomach acid flows back into the esophagus. It typically causes a burning sensation behind the breastbone and may leave a sour or acidic taste in the mouth. Symptoms often develop after eating and may become worse when lying down or bending over. Certain foods and beverages, large meals, excess weight, tobacco use, and lying down soon after eating all can increase the likelihood of heartburn. 

Heart-related chest discomfort has some characteristic features, although symptoms can vary from person to person. Many people describe pressure, heaviness, squeezing or tightness in the center of the chest rather than a burning sensation. A common misconception is that every heart attack causes sudden, severe chest pain. While some people experience symptoms that way, others notice milder pressure or fullness instead. The discomfort also may spread to the shoulders, one or both arms, neck, jaw, back, or upper abdomen. And it may occur with shortness of breath, nausea, lightheadedness or dizziness. 

Some symptoms make a heart problem less likely. Chest pain that's very sharp, lasts only a few seconds, changes when you take a deep breath or moves from one location to another is generally less suggestive of a heart problem. However, that doesn't necessarily mean it's harmless. Conditions affecting the lungs, major blood vessels or digestive system also can cause chest pain and may require prompt medical evaluation.  

If your chest discomfort is new, different from your usual symptoms or occurs with shortness of breath, nausea, dizziness or pain that spreads to the arm, jaw, neck or back, call 911 or seek emergency medical care right away. Don't wait to see whether an antacid relieves the symptoms or assume they will simply pass. 

It's also important to remember that heartburn and heart disease aren't mutually exclusive — many people have both. Having a history of heartburn or acid reflux doesn't rule out the possibility that new chest discomfort could be related to your heart. Likewise, frequent heartburn shouldn't be ignored simply because it isn't an emergency. Persistent reflux symptoms can signal an underlying digestive condition that may require evaluation and treatment. 

If you're unsure whether you're experiencing heartburn or a heart problem, don't try to diagnose yourself. It's far better to be evaluated and learn your symptoms weren't caused by your heart than to delay treatment for a condition that could be life-threatening. 

Andrew Calvin, M.D., Cardiology, Mayo Clinic Health System, Eau Claire and Bloomer, Wisconsin 

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DEAR MAYO CLINIC: My friend was recently diagnosed with leukemia, and I've learned there are several types. How do these differences affect her treatment options and decisions? 

ANSWER: It's true — leukemia isn't a single disease. It's a group of blood cancers, and the exact type plays a major role in how it's treated. Understanding these differences can help patients and families feel more informed and prepared. 

Leukemia is a cancer of the blood and bone marrow, where blood cells are made. Unlike cancers that start in one organ and spread, leukemia is usually considered a whole-body, or systemic, disease right from the beginning. 

In leukemia, the bone marrow produces abnormal white blood cells. These cells don't work properly and can crowd out healthy cells. This can lead to: 

• Fatigue and weakness (from low red blood cells). 

• Easy bruising or bleeding (from low platelets). 

• Frequent infections (from a weakened immune system). 

• Shortness of breath. 

• Bone pain or tenderness. 

• Swollen lymph nodes. 

• Enlarged liver or spleen. 

• Fever or chills. 

• Unintentional weight loss.  

Patients may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses. 

Types of leukemia

There are four main types of leukemia: 

• Acute lymphocytic leukemia (ALL), which is the most common type of leukemia in young children, but it can also occur in adults. 

• Acute myeloid leukemia (AML), which is the most common type of acute leukemia in adults. 

• Chronic lymphocytic leukemia (CLL), which is the most common chronic leukemia in older adults. 

• Chronic myeloid leukemia (CML), which mainly affects adults of various ages. 

They're grouped based on how fast they grow and the type of blood cell involved:  

• Acute leukemias develop quickly and need urgent treatment. 

• Chronic leukemias grow more slowly and may not need treatment right away. 

• Lymphocytic leukemias affect lymphocytes, a type of white blood cell involved in the immune system.  

• Myeloid leukemias affect cells that develop into red blood cells, platelets and other types of white blood cells.  

Each type — and even subtypes within them — can behave quite differently. For example, some people may have a slow-growing form of CLL that may not need treatment for years, while others may have a faster-growing subtype that requires treatment soon after diagnosis. 

Diagnosis

Diagnosis often begins with a routine blood test that shows abnormal cell counts. If leukemia is suspected, a bone marrow biopsy — taking a small sample from the hip bone — is usually needed to confirm the diagnosis. From there, more detailed testing is done, including: 

• Flow cytometry to identify cell types. 

• Cytogenetics to study chromosomes. 

• Molecular testing to look for genetic changes. 

Accurate diagnosis is essential because different types of leukemia require different treatments. Some therapies work only for certain genetic markers, and the expected outcome can vary widely. These tests allow doctors to match patients with therapies that target their specific disease, making leukemia treatment highly individualized.  

Treatment

Treatment may include: 

• Chemotherapy, a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. 

• Targeted therapy, a treatment that uses medicines that attack specific targets in the cancer cells.  

• Immunotherapy, treatments that help the immune system fight cancer. These include CAR-T cell therapy — engineered immune cells that attack cancer cells — and bispecific antibodies that help immune cells find cancer cells. 

• Stem cell transplantation, a treatment that replaces diseased bone marrow with healthy cells, often using donor cells. 

When deciding the best treatment, doctors consider several factors, including: 

• The exact type and subtype of leukemia. 

• Genetic and molecular test results. 

• How quickly the disease is progressing. 

• The patient's age and overall health. 

• The patient's personal preferences. 

The future of leukemia treatment is focused on precision medicine — tailoring treatments to the genetic makeup of each patient's leukemia — and improving long-term outcomes with fewer side effects. With advances in testing and therapy, care is becoming more personalized than ever, offering hope for even better results in the coming years.  

William Hogan, M.B., B.Ch., Hematology, Mayo Clinic, Rochester, Minnesota 

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DEAR MAYO CLINIC: My neighbor recently had an X-ray after hurting their leg, and the doctor found a bone lesion that needs more testing. They're terrified it could mean bone cancer. It got me wondering: Does every bone tumor or bone lesion mean cancer?  

ANSWER: Hearing that an imaging test found a bone tumor or bone lesion can be frightening. Fortunately, most bone tumors aren’t cancerous. The key is finding out exactly what type of tumor or lesion you have, so your healthcare team can recommend the right care. 

A bone tumor is an abnormal growth of cells within the bone. Some bone tumors are benign (noncancerous) and may simply be monitored over time. Others are malignant (cancerous) and require treatment because they can grow, damage the bone or spread to other parts of the body.  

It's also important to understand that primary bone cancer is different from cancer that has spread to the bone from another part of the body. Cancers are named for where they begin. For example, if lung cancer spreads to the bone, it's still lung cancer, not bone cancer. Likewise, if bone cancer spreads to the lungs, it's still bone cancer.  

Knowing where a cancer began helps your healthcare team recommend the most appropriate treatment. Primary bone cancers are also usually not caused by something you did or didn't do, which can be reassuring to know. 

Pain in your bones, muscles or joints is common and is usually caused by conditions other than cancer. However, pain that continues to worsen, doesn't improve over time, wakes you from sleep or is associated with other symptoms, such as swelling, fever, weight loss or limping, deserves medical evaluation. 

In children and teenagers, persistent pain shouldn't automatically be dismissed as growing pains. While growing pains are common, ongoing pain that interferes with sports, school or daily activities should be evaluated by a healthcare professional.  

Persistent back pain in children is also uncommon and should be checked. Another warning sign is a fracture that occurs after little or no trauma. Some bone tumors can weaken the bone enough that it breaks more easily than expected. 

Sometimes bone tumors don't cause symptoms at all. Instead, they’re discovered when an X-ray or other imaging test is performed after a sports injury or another unrelated problem. In these situations, the injury didn't cause the tumor; the imaging simply revealed something that was already there. 

When a bone tumor or lesion is found, your healthcare team will review your medical history, perform a physical examination and determine whether additional imaging, such as a CT scan or MRI, is needed to better understand the abnormality. Based on those imaging findings, a biopsy may be recommended. 

During a biopsy, a small tissue sample is removed and examined under a microscope to determine exactly what type of cells are present. The biopsy results help your healthcare team make an accurate diagnosis and recommend the most appropriate treatment. Waiting for answers can be difficult, but taking the time to make an accurate diagnosis helps ensure you receive the most appropriate treatment. 

Treatment depends on the type of bone tumor. Many benign tumors don't require treatment and can simply be monitored if they're not causing pain, limiting function or weakening the bone. Other benign bone tumors may require surgery. Malignant bone tumors, however, require treatment. Depending on the type of cancer, treatment may include surgery, chemotherapy, radiation therapy or a combination of these approaches. 

Because bone tumors are rare, it's important to be evaluated by a healthcare team with experience diagnosing and treating your specific condition. Specialists, including radiologists, pathologists, orthopedic surgeons and medical oncologists, work together to make an accurate diagnosis and recommend the most appropriate treatment plan. 

If you've been told you have a bone tumor or bone lesion, try not to assume the worst. Many bone tumors are benign, and even malignant bone cancers can often be treated successfully. If you have persistent pain, an abnormal imaging finding or symptoms that concern you, don't ignore them. Talk with your healthcare team. An accurate diagnosis is the first step toward getting the care that's right for you. 

Wendy Allen-Rhoades, M.D., Ph.D., Oncology, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I've seen emergency defibrillators in public places, but I've also heard that some people need to wear them or have them implanted for heart rhythm problems. Can you explain the differences? 

ANSWER: Pacemakers and defibrillators are devices that help manage heart rhythm problems, but they work differently. 

A pacemaker helps the heart when the rhythm is too slow or irregular. A defibrillator is a specialized pacemaker designed to treat life-threatening heart rhythms that are dangerously fast or chaotic. It acts by shocking the heart out of a dangerous rhythm. 

Sometimes people unexpectedly have an irregular heartbeat that can cause sudden cardiac death or unconsciousness. During this emergency situation, the heart stops or quivers uselessly and is unable to pump in a coordinated way.   

That's when an automated external defibrillator (AED) can be lifesaving. These are the portable devices you see in airports, schools, gyms and other public places. An AED analyzes a person's heart rhythm during sudden cardiac arrest. If it detects a dangerous rhythm, it delivers an electrical shock to help the heart return to a normal rhythm.  

While people who take CPR courses learn how to use an AED, the devices also provide simple step-by-step instructions, including written, picture and voice prompts, so that a bystander can use one in an emergency.  

Defibrillators also can be worn or implanted. In general, they are used for people who are at higher risk of dangerous heart rhythms, including: 

• Those with heart conditions, such as a weakened heart muscle (also called cardiomyopathy), low pumping function or a history of heart attack. 
• Those born with electrical abnormalities of the heart, called channelopathies, or other inherited heart conditions. These can sometimes affect younger people, including athletes, and may cause fainting, sudden cardiac arrest or sudden cardiac death.  

A wearable defibrillator looks like a vest and is worn under clothing. It continuously monitors the heart rhythm and can deliver a shock if it detects a life-threatening rhythm. It's usually worn temporarily, often while a care team is deciding whether a person needs a permanent, implanted device or while the heart is recovering.  

An implantable cardioverter-defibrillator (ICD) is a permanent device placed inside the body. It monitors the heart rhythm and can deliver treatment if a dangerous rhythm occurs. Some ICDs are placed under the skin in the chest, with one or more wires, called leads, connected to the heart.  

Recovery after ICD placement usually takes about four to six weeks. During that time, patients may need to limit certain arm movements, especially on the side where the device was placed, and watch for signs of infection or increasing pain around the incision.  

After recovery, most people return to their usual daily activities. However, they should avoid strong magnetic fields and certain activities, such as arc welding, unless their care team says it's safe. 

Most patients aren't aware of their defibrillator unless it delivers treatment. If a person is unconscious when a shock occurs, they usually don't feel it. If they're awake, the shock may feel like a sudden jolt or kick in the chest. It can be startling, but it's meant to save a life. In some cases, people may not feel the shock at all, and the event is only found later during a device check. 

Anyone who feels a shock from their defibrillator, or is notified by their healthcare team that a shock occurred, should contact their care team for further evaluation. The device may need to be checked, and medications or other parts of the treatment plan may need to be adjusted. 

There's another type of device therapy called cardiac resynchronization therapy (CRT), which may include features of a pacemaker or defibrillator. It's used for some people with moderate to severe heart failure whose lower heart chambers don’t beat in a coordinated way. 

When the heart’s pumping chambers are out of sync, the heart may not pump blood as efficiently. CRT helps coordinate the timing of the heartbeat. 

As with implanted pacemakers or defibrillators, CRT implantation requires a minor surgical procedure to place a device in the chest, and the recovery and post-procedure care are similar. There are two main types: 

• Cardiac resynchronization therapy with a pacemaker (CRT-P). This device sends electrical signals to help the lower chambers of the heart beat together. 
• Cardiac resynchronization therapy with a defibrillator (CRT-D). This device combines resynchronization pacing with defibrillator protection. It may be recommended for people with heart failure who also are at risk for sudden cardiac death. 

Defibrillators, whether they're used in public places, worn temporarily or implanted permanently, are designed to protect people from dangerous heart rhythms. They can be lifesaving, helping people live more safely and confidently. 

Divya Korpu, M.B.B.S., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin 

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DEAR MAYO CLINIC: My back pain keeps getting worse. I've tried all the nonsurgical options, but is it time to consider surgery? 

ANSWER: It might be. The back is a highly complex part of the human body with several potential sources of pain — bones, joints, muscles and nerves.  

Joints: On the back of each spinal vertebra is a pair of facet joints that allow you to bend and twist. These two facet joints, together with the disc, enable the bones of the spine to move. Lower in the back is the sacroiliac joint, which connects the spine to the pelvis. As with any joint, these can be affected by arthritis and injury. The discs, which provide cushioning between the vertebrae, can slip out of place, allowing the bones to rub together. 

Muscles: An intricate muscle structure supports the spine. Strains, overuse and underuse can weaken and damage these muscles. 

Nerves: The spinal cord, which is a bundle of nerves, runs through the spine, ending where the mid back and lower back connect — about at your belly button. From there, nerve roots branch to each leg, providing function to your legs. Anywhere along the spine, but especially in the lower back, the nerves can become compressed. It's radiating leg pain that frequently drives patients to seek relief through surgery. 

The first step in finding back pain relief is to be assessed by a healthcare professional, who, as part of the examination, will check your ability to sit, stand, walk and lift your legs. You also may undergo some imaging. This assessment will help your clinician develop a treatment plan.  

Nonsurgical pain-relief options include: 

• Physical therapy. A physical therapist can teach you exercises to increase flexibility, strengthen back and abdominal muscles, and improve posture. Building these exercises into your daily routine can help prevent pain from returning. The therapist also can show you how to modify the exercises and your movement during a back pain episode.  

• Ice/heat. The use of an ice pack or heating pad can help relieve pain from muscle tension and spasms. 

• Pain relievers. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil); acetaminophen(Tylenol); topical creams and patches that deliver substances through the skin; medicines containing opioids, such as oxycodone or hydrocodone (rarely used); and some antidepressants, including duloxetine (Cymbalta).  

• Muscle relaxants. If mild to moderate back pain doesn't improve with ice, heat or pain relievers, a muscle relaxant is another option.  

• Injections. If other measures don't relieve pain that radiates down the leg, an injection of cortisone plus a numbing medicine might help. 

• Other treatments. Yoga, massage, chiropractic adjustments and acupuncture also may bring relief. 

When these measures are no longer effective, patients typically seek out surgical options. For the best outcomes, it's essential that the surgical procedure matches the problem that needs to be addressed. These can include neurological compression, instability or spine deformity issues.  

A consultation with a surgeon usually includes an examination and imaging to pinpoint the problem, followed by a discussion of what surgical approach will provide the greatest benefit. After the consultation, you may want to talk over your options with family and friends or seek a second opinion to ensure you're comfortable with the plan. 

Before surgery, you'll be thoroughly assessed to determine if you're physically ready for the procedure. This will include evaluating your bone health and ensuring that any medical conditions are stable or optimized. 

The surgery depends entirely on what is needed to correct the problem. Some surgeries are relatively simple, while others may be quite complex. 

Recovery and healing depend on how extensive the surgery was. For instance, a herniated disc may require only a small incision, followed by a short period of limited activity. Recovery from a more involved surgery requiring a large incision may take months. 

However, most people fall somewhere in the middle of this spectrum. They generally feel pretty good within six to 12 weeks, although full recovery typically takes six to 12 months. 

Once a person has recovered, the key is developing a lifestyle that helps prevent back issues from returning. These include building good core muscle strength, increasing mobility, staying active, not smoking, and maintaining a healthy weight and diet. 

Being active and maintaining good core strength not only are essential to recovery from surgery, but they also are key to preventing back pain. 

Mel Helgeson, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota  

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DEAR MAYO CLINIC: My neighbor is in his 60s and has spent years competing in marathons and long-distance cycling events. Despite being in excellent shape, he recently learned that he has a high coronary calcium score. I thought endurance athletes were less likely to develop heart disease? I'm in my 50s, run regularly and am training for a half-marathon. Should I be worried about this? 

ANSWER: It's understandable to wonder how this can happen. Regular exercise is one of the best things you can do for your heart. It lowers the risk of heart disease, improves blood pressure, helps control weight and supports overall health. 

However, being physically fit doesn’t make someone immune to heart disease. A coronary calcium score can help identify people who may be at increased risk despite having an active lifestyle. 

A coronary calcium score measures calcium buildup in the arteries that supply blood to the heart. The test uses a CT scan to identify calcified plaque, which is a marker of atherosclerosis, also known as hardening of the arteries. 

The score helps estimate a person's future risk of heart disease and provides additional information about overall cardiovascular health. In general, a score of 0 is associated with a lower likelihood of future heart disease than higher scores. Scores above 100 suggest a higher risk, while scores above 300 may lead healthcare professionals to recommend treatment or other steps to lower that risk. 

It's important to understand what the test does and does not show. A high score doesn’t mean a heart attack is about to happen, nor does it automatically mean an artery is blocked. Some people have elevated calcium scores but still have enough blood flowing to the heart and may not experience any symptoms. Instead, the score can help guide decisions about prevention, treatment and follow-up care. 

Researchers continue to study why some older endurance athletes have higher coronary calcium scores than people who participate in moderate levels of exercise. While this finding has been observed in studies, more work is needed to understand why it occurs and what it means for long-term cardiovascular health. 

At the same time, people who regularly participate in endurance activities generally have lower rates of heart-related problems than those who are sedentary and tend to have better overall cardiovascular fitness. Even so, some highly active people still develop elevated calcium scores despite years of regular exercise. 

A high calcium score shouldn’t be viewed as a reason to stop exercising. Instead, it should prompt a discussion with a healthcare professional about your overall risk for heart disease. 

The score is only one piece of the puzzle. Other important factors include: 

• High cholesterol. 

• High blood pressure. 

• Diabetes. 

• Obesity. 

• Smoking history. 

• Family history of heart disease. 

• Dietary habits. 

Many of these risk factors can be managed through lifestyle changes, medications or both. Addressing them can help lower overall cardiovascular risk and support long-term heart health. 

Depending on your symptoms and other risk factors, your healthcare team may recommend additional testing, such as a cardiac stress test. 

If you notice any of the following symptoms during physical activity, even if you otherwise feel healthy and active, talk with your healthcare team: 

• Chest pain or pressure. 

• Unusual shortness of breath. 

• Symptoms that seem unusual for your normal level of activity. 

The most important takeaway is simple: Don't stop exercising. Instead, use the results as an opportunity to better understand your heart health and work with your healthcare team to address any modifiable risk factors. Understanding your overall risk for heart disease and taking steps to lower it can help you continue exercising safely for years to come. 

Gurpreet Singh, M.D., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin 

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DEAR MAYO CLINIC: I have a benign lesion on my liver that needs to be removed. My surgeon said he would use robotic-assisted surgery. Can you tell me more about that? 

ANSWER: Yours is a common question. When people first hear "robotic surgery," they often think of a robot on autopilot doing the procedure. However, that couldn't be further from the truth. The robotic arm is a tool driven by the surgeon, following maps created from preoperative imaging. 

Robotic technology is being used during abdominal surgery for benign and cancerous tumors in the liver, pancreas, colon and rectum, as well as gallbladder removal. 

Your liver helps digest food, rids the body of waste products and makes clotting factors that keep blood flowing well, as well as performs other tasks. Parasites, diseases, viruses, infections, injury, cancer, alcohol use, obesity and inherited factors can all damage your liver. 

Any of these causes may lead to surgery, including the use of robotic technology, which can benefit patients in several ways. 

With open surgery, an incision would be made from the breastbone to your navel or sometimes with a right-angle turn like a hockey stick. The benefits of robotic-assisted surgery include:  

• Smaller incisions, which lead to less blood loss and stress on the body. 

• Reduced postoperative pain.  

• A lower risk of surgical complications.  

In general, with less pain, recovery is faster, and the risk of complications such as pneumonia or intestinal temporary paralysis, which can occur in up to 20% of all open abdominal surgeries, is less because patients are up and moving sooner. 

Prior to surgery, patients undergo a CT scan and MRI, which will provide the imaging needed for your surgeon and for mapping. If surgery is due to cancer, this imaging may have been done periodically to watch for changes or as part of the patient's treatment. 

The surgery includes a team of professionals who administer anesthesia, fluids and blood, if needed, and monitor the heart and blood pressure. Patients also have a urinary catheter inserted most of the time. 

Once the patient is under anesthesia, the surgeon makes multiple incisions slightly less than 1/2 inch long and one incision about 2 inches long, if needed, to remove larger specimens from the abdomen. Using the robot's arms as extensions of their hands, the surgeon uses a variety of tools, including those to make incisions, apply clips, seal structures, sew sutures and remove tissue from the surgical site. Tiny cameras deliver magnified views to allow the surgeon to see the whole process in detail. 

Once the surgery is complete, the incision typically is closed with absorbable sutures and glue so that stitches don't have to be removed postoperatively. No bandages are needed, and patients can shower 48 hours after the surgery. 

Some surgeries require the removal of a portion of the liver. Up to 70% of a healthy liver can be removed and still function effectively. However, if a liver has been damaged by chemotherapy and other causes, as little as 50% may be removed. It's a myth that the liver regenerates. However, the remaining liver segment will grow large enough to function and compensate for the loss. 

While robotic-assisted surgery is minimally invasive, it's still invasive. After surgery, patients are watched for complications from bleeding and anesthesia, as well as any effects on their hearts and lungs, similar to other general surgical procedures.  

In liver surgery, there's also a small risk of bile leakage. Bile is the green fluid produced by the liver and channeled to the small intestine to aid with digestion. Leaks typically can be spotted during surgery, but if one develops, it can be corrected with endoscopic procedures or radiological interventions. 

Opportunities for using robotic technology in liver and abdominal surgeries are expanding. Robotic technology opens the door to training more physicians in its use for surgeries ranging from less complex to more complex. As more surgeons become proficient in its use, the pool of patients who can undergo surgery to benefit their health, recovery and general well-being also widens. 

Guido Fiorentini, M.D., Ph.D., Surgery and Surgical Oncology, Mayo Clinic Health System, Eau Claire, Wisconsin

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DEAR MAYO CLINIC: Our teenagers are both student athletes and active in their sports year-round. I'm concerned about injuries that could sideline them. What should we watch for?

ANSWER: As the school year ends, summer sports heat up for students and adults alike. Summer may be a prime season for a sport, such as baseball or running, but athletes of all types also may be on a traveling team, heading to a sports camp or just honing their skills with off-season practices.

No matter an athlete's age, they need to be aware of and condition their body to prevent injuries that can put their sport on hold. Here are several to watch for:

Heat-related injuries. When it's hot and humid, proper hydration is essential. Signs of overheating include not sweating, feeling extremely thirsty, becoming dizzy, experiencing a headache or vision changes. These symptoms call for immediate attention. All athletes should hydrate before, during and after their activity. Water is best, as are drinks that replenish electrolytes lost through perspiration.

Sprains and strains. These common injuries can affect ankles, knees, hips and shoulders. However, they aren't traumatic injuries like fractures or a complete ligament tear, and they tend not to require long-term recovery.

Tendons attach muscles to bones, while ligaments attach bones to bones. A sprain is the stretching or partial tearing of the fibers in a ligament. A muscle or tendon strain may result from overuse, leading to inflammation. Both are treated by modifying activity, rest, icing, and taking over-the-counter pain and anti-inflammation medications. Physical therapy may be needed to rebuild strength and range of motion.

Fractures. A fracture is a broken bone. Fractures often occur during falls, such as when skateboarding, or from collisions with other players or objects. Fractures can be cracks or complete breaks that may or may not require surgery. Treatment and recovery depend on the severity of the injury. Athletes should plan to be in recovery for at least 6 weeks.

Overuse injuries. With the emphasis on early sports specialization, young athletes often spend more time practicing or competing, increasing the risk of injury. This injury risk is especially true for young athletes who are still skeletally immature. That means they still have open growth plates in their bones, making them susceptible to injury, particularly from repetitive motion.

Athletes understand that repetitive motion is the way to improve. However, if a young athlete is pitching every day or repeatedly practicing a volleyball serve, they can overuse a single part of their body. This can lead to inflammation or even damage those areas. One indication of overuse is pain after a game or practice that takes longer to resolve, increasing recovery time.

Safeguards such as pitch counts, which limit the number of pitches a player throws during a game, and built-in rest days are important to preventing overuse injuries.

Another way to avoid overuse injuries —and burnout — is cross-training. For instance, a hockey player may add swimming to their routine, a runner may add weight training, or a soccer player may shoot hoops with friends. This allows an athlete to use different muscles and movements to build strength, flexibility and coordination, while also giving them a mental break.

Concussion. A concussion is a mild traumatic brain injury that affects brain function. Effects are often short-term and can include headaches and trouble with concentration, memory, balance, mood and sleep. Concussions can happen in any sport, not just those in which players intentionally run into each other, such as football or hockey.

If a player experiences dizziness, headache or nausea after an incident during a game or practice, they shouldn't shrug it off — they should step out of the game and tell a coach or parent. Today, most coaches are trained in concussion and return-to-play protocols developed for most sports. Athletes, parents and coaches should take concussions seriously to prevent further injury or long-term symptoms.

Injuries in older athletes. Older athletes returning to a sport or trying a new one are susceptible to the same injuries as young athletes. However, osteoarthritis, or the wearing down of the cushioning cartilage in joints, increases with age. This can lead to pain, swelling and a decrease in range of mobility. Once again, cross-training is key, no matter your age.

All athletes can reduce the risk of injury by getting plenty of sleep, developing healthy eating habits, hydrating and warming up properly before any sports activity.

For parents, if your child finds a sport they enjoy and are passionate about, encourage them, but don't let it become a "job." As a former professional athlete, I advise that, first and foremost, sports should be fun.

Michael Stuart, M.D., Orthopedics & Orthopedic Surgery, Mayo Clinic Health System, Owatonna, Minnesota

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