Mayo Clinic Q & A

DEAR MAYO CLINIC: I was diagnosed with primary biliary cirrhosis three months ago. I don’t have any symptoms yet but wonder what I should look for. Are there things I can do to slow its progression? ANSWER: Your situation is common. Most people diagnosed with primary biliary cirrhosis, or PBC, in its early stages do not have any symptoms. Many remain symptom-free for years. Medication is available that can slow the progression of the disease, making it less likely that you will develop symptoms soon. PBC is a disease in which the bile ducts in the liver become damaged. Bile, a fluid that your liver makes, plays a role in digesting food. It also helps your body get rid of worn-out red blood cells, cholesterol and toxins. When bile ducts don’t work the way they should, harmful substances can build up in your liver. In time, that may lead to irreversible scarring of your liver tissue.

DEAR MAYO CLINIC: Six years ago I was diagnosed with acid reflux and a hiatal hernia. I have had an endoscopy as well as other tests, but doctors say there is nothing I can do other than take medication. (I am currently on doxepin.) But I am still having sharp pains that wake me up around 4 a.m. Do you have any suggestions? ANSWER: Your situation is very common in people who have a hiatal hernia. There are a number of lifestyle changes that may help reduce your nighttime symptoms. Taking an acid-reducing medication may make a difference, too. In rare cases, surgery may be necessary if nothing else works to relieve symptoms. A hiatal hernia happens when part of your stomach pushes up through your diaphragm. Your diaphragm has a small opening, called a hiatus, which your esophagus passes through on its way to your stomach. The stomach can push up through this opening and cause a hiatal hernia. Acid reflux — a condition in which stomach acid flows up into the esophagus — is often associated with a hiatal hernia.

DEAR MAYO CLINIC: What causes vertigo? Does having it one time mean I’m more likely to experience it again? ANSWER: Vertigo is a sensation that either you or your surroundings, or both, are spinning or moving when they are not. Some people confuse vertigo with dizziness, but there is a difference. Dizziness typically is a feeling of being lightheaded, or it may be a loss of balance that makes you unsteady on your feet. Dizziness usually does not involve the feeling that either you or something in your environment is moving. A number of disorders can trigger vertigo. The most common is a condition called benign paroxysmal positional vertigo, or BPPV. If you have BPPV once, you are at an increased risk of getting it again. In many cases, BPPV can be successfully treated. For many adults, BPPV is the underlying source of vertigo. With BPPV, vertigo happens when you move a certain way. Sitting up, tilting your head or lying down may all trigger vertigo if you have BPPV.

DEAR MAYO CLINIC: I am 53 and about 60 pounds overweight. I want to start walking to lose some weight but don’t know where to start. What do you recommend? Would a tracking device help someone like me, or should I aim for a certain distance or number of minutes? ANSWER: Walking can be an excellent part of a weight-loss plan, and wearing a monitor that tracks your activity can help you see if you are reaching your goals. It also gives you useful information about how much you are moving throughout the day, not just while you exercise. In addition, some studies show that wearing an activity tracker makes it more likely you will increase your activity. The U.S. Department of Health and Human Services recommends that all healthy adults get at least 150 minutes a week of moderate aerobic activity, or 75 minutes a week of vigorous aerobic activity. When you want to lose weight, however, you may need up to 300 minutes a week of moderate physical activity. The guidelines suggest that you spread out your exercise over the course of a week. Activity sessions should be at least 10 minutes long.

DEAR MAYO CLINIC: My husband is 68 and was recently diagnosed with Barrett’s esophagus. The doctor said it was low-grade dysplasia, and that he could be treated for now without having surgery, but that surgery may be necessary in the future. We are worried that his condition will eventually lead to esophageal cancer and want to know if having surgery now should be considered. ANSWER: Before you and your husband decide on what type of treatment to pursue, there are several factors you need to carefully consider and discuss with a gastroenterologist. First, the way the condition is diagnosed is critical. In Barrett’s esophagus, the color and composition of the cells lining the lower esophagus change. Normal esophagus tissue appears pale and glossy. In Barrett’s esophagus, the tissue is red and velvety instead. When Barrett’s esophagus is found, tissue samples (biopsies) are taken to determine the degree of tissue change.

DEAR MAYO CLINIC: My daughter is 12 and has coarse, dark hair on her upper lip and wants to have it removed. I’m worried that it’s not safe for someone her age. Is laser hair removal safe for kids? Are there other methods that would be better? ANSWER: A variety of techniques are available to remove facial hair. When used correctly, all are safe and none have age restrictions. No hair removal method is permanent, although some do last quite a while. Some hair removal techniques can be painful. Carefully consider the pros and cons of each method with your daughter before deciding which one to use. Puberty often triggers facial hair growth in girls. But other factors can contribute to the development of facial hair, too. Some endocrine disorders, such as polycystic ovary syndrome and adrenal hyperplasia, cause changes in the body’s hormone production that can increase facial hair growth. Excess hair also can be a side effect of some medications.

DEAR MAYO CLINIC: My six-week-old granddaughter is extremely fussy for much of the day, sometimes crying off and on for four or five hours. I understand it’s probably just colic, but should she be seen by a pediatrician to rule out other problems? Is there anything we can do to help her? ANSWER: In most cases, colic does not require medical care, nor is it a symptom of a larger medical problem. It usually improves on its own within several months. All babies cry and get fussy from time to time. But colic is different than normal fussiness. Babies with colic typically cry more than three hours a day, three days a week for three weeks or longer. The crying tends to come around the same time each day. There appears to be no clear reason for the crying. Babies with colic are otherwise healthy and may cry even when well-fed and clean.

DEAR MAYO CLINIC: Is it possible to have a successful reverse vasectomy nine years after the vasectomy was done? What should I expect as far as recovery? I am 42 years old. ANSWER: For most men, vasectomy reversal is a viable option at any time. But the amount of time since your vasectomy can have an effect on the likelihood of the procedure’s success. The type of surgery you require to achieve the reversal makes a difference, too. It’s also important to take into consideration other factors that can have an impact on fertility, such as your partner’s age. The purpose of vasectomy reversal is to allow sperm to travel from the testicles into the semen. There are two ways a vasectomy reversal can be performed. The first is a simpler repair called a vasovasostomy. In this procedure, the ends of the vas deferens (tubes that carry sperm from the testicles into the semen that were cut apart during a vasectomy) are sewn back together. The second procedure, known as epididymovasostomy, is more complex. It involves attaching the vas deferens directly to the small organ at the back of each testicle that holds sperm, called the epididymis.

DEAR MAYO CLINIC: For the past several months I have had a high-pitched ringing in my ears. It comes and goes, but lately it seems to happen more frequently. My doctor said that it is tinnitus and is quite common, but I am concerned and want to know what could have caused it. Could it be related to stress? Does it ever lead to hearing loss? ANSWER: Tinnitus involves hearing noise in one or both ears that is not caused by an external sound. Tinnitus is common, but it is not a condition on its own. Rather, it is a symptom of another underlying condition. The noise of tinnitus often sounds like a ringing in the ears, but it can also be buzzing, clicking, roaring or hissing. The noise may vary in pitch from a low roar to a high squeal. In some cases, the sound can be so loud that it interferes with your ability to concentrate or to hear actual sound. Tinnitus may be present all the time, or it may come and go.

DEAR MAYO CLINIC: I have been diagnosed with anxiety but really do not want to take medication for it. What does cognitive behavioral therapy involve? How effective is it in treating anxiety? ANSWER: Although an anxiety disorder can be difficult to manage on your own, anxiety is a highly treatable condition. Cognitive behavioral therapy, or CBT, is an evidence-based psychotherapy that addresses the thoughts and behaviors that contribute to anxiety. Research has shown CBT often can be effective in treating anxiety, even when it is used without medication. Feeling anxious occasionally is part of life. But an anxiety disorder is different. People with anxiety disorders have intense, excessive and persistent worry and fear about everyday situations. These feelings often are hard to control and are out of proportion to the actual danger a person is facing. For many people, an anxiety disorder can disrupt daily life and interfere with normal routines. For example, you may have a tendency to think about worst-case scenarios and worry that you will be unable to cope with them. As you do, your mood may become more anxious. You may then try to control your anxiety by engaging in avoidance behaviors, which may include repeatedly asking for reassurance from others that everything will be okay, or staying away from situations that make you anxious.

DEAR MAYO CLINIC: At what age should I be concerned about my child’s weight? My six-year-old son is healthy and gets plenty of exercise, but I feel like he is quite large for his age. He does have a huge appetite and is always saying he’s hungry, and I don’t want to keep food from him when he wants to eat. Are BMI calculators for kids accurate or useful? ANSWER: There is not one specific age at which weight should become a concern. Instead, keep track of weight consistently at each well-child visit from the time your child is born. If at any time weight begins to rise quickly, a health assessment can identify diet and lifestyle changes that may help. Calculating weight for length or body mass index (BMI) can often be a useful part of that assessment. In a situation like your son’s, it is a good idea to make an appointment for him to see his primary health care provider to evaluate his weight and review his diet and health history.  At that appointment, the doctor will weigh your son and calculate his BMI to see where he falls in the weight range for his age.

DEAR MAYO CLINIC: Are there any new treatment options for chronic lymphocytic leukemia? I am 61 and was diagnosed 18 months ago. Until recently, I have not had any symptoms so have not received treatment for it. ANSWER: Researchers are currently studying a variety of potential new treatments for chronic lymphocytic leukemia, or CLL. Many of them are available now through clinical trials. Depending on your situation, you may be eligible to participate in a clinical trial and receive one of the new therapies. CLL is a cancer of the blood and the spongy tissue inside bones where blood cells are made, called bone marrow. In particular, this disease affects a group of white blood cells called lymphocytes that help your body fight infection. CLL usually progresses slowly. As in your situation, many people in the early stages of CLL do not have any symptoms. When symptoms start to develop, they may include enlarged lymph nodes, pain in the upper left abdomen, fatigue, fever, night sweats, weight loss and frequent infections.