Mayo Clinic Q & A

DEAR MAYO CLINIC: I know that heart disease is the leading killer among men and women, but is it true that men and women have different risk factors for heart disease? ANSWER: You are correct that heart disease is the leading cause of death in men and women in the United States. Many risk factors are the same for both genders. But there are some differences between men and women that can have an impact on an individual’s risk of heart disease. One of most significant heart disease risk factors for both men and women is smoking. Nicotine can narrow your arteries, and carbon monoxide can damage their inner lining. That makes the vessels more likely to become thick and stiff, a condition known as arteriosclerosis. Eventually arteriosclerosis limits blood flow, increasing the risk of a heart attack. Because of this, heart attacks are more common in smokers than in nonsmokers.

DEAR MAYO CLINIC: I often hear about colon cancer, but not a lot about rectal cancer. How is it diagnosed, and is it treatable? ANSWER: Rectal cancer is cancer that occurs in the last several inches of the colon, called the rectum. The primary treatment for rectal cancer is surgery and — depending on how advanced the cancer is — may also include radiation therapy and chemotherapy. If rectal cancer is caught early, the long-term survival rate is about 85 to 90 percent. Those numbers decline sharply if rectal cancer has spread to lymph nodes. Most rectal cancers begin as small, noncancerous growths of cells called polyps. Removing polyps before they become cancerous can prevent rectal cancer. That’s why timely colon cancer screening with a colonoscopy is important. Guidelines generally recommend that screening should begin at age 50. Your doctor may recommend more-frequent or earlier colon cancer screening if you have other risk factors, such as a family history of colorectal cancer.

DEAR MAYO CLINIC: How soon can Alzheimer’s disease be diagnosed? What are the early symptoms to watch for? ANSWER: There is no one test that can be used to diagnose Alzheimer’s disease. But based on an assessment of symptoms, along with a variety of tests and exams, Alzheimer’s can often be identified in its earliest stages. Seeking medical attention as soon as Alzheimer’s symptoms become noticeable is key to a prompt diagnosis. The most common early symptom of Alzheimer’s disease is forgetfulness. Distinguishing between memory loss that is due to aging and memory loss due to Alzheimer’s can be tricky, though. As people get older, the number of cells, or neurons, in the brain goes down. That can make it harder to learn new things or to remember familiar words. Older adults may have difficulty coming up with names of acquaintances, for example, or they may have trouble finding reading glasses or car keys. In most cases, these memory lapses do not signal the beginning of Alzheimer’s disease.

DEAR MAYO CLINIC: Eleven years ago I developed deep vein thrombosis, which led to a pulmonary embolism. A vena cava filter was put in place, and I’ve been on warfarin since that time. Will I ever be able to discontinue warfarin and take aspirin instead? Would changing my diet allow me to eventually stop taking warfarin? ANSWER: This is a very common and important question for people in your situation. How long you need to continue to take warfarin depends on several factors. They include the circumstances surrounding the development of your deep vein thrombosis and whether you have had any recurrences since then. As you and your doctor consider your long-term treatment plan, your medical history and your preferences should be taken into consideration, too. Deep vein thrombosis, or DVT, happens when a blood clot forms in one or more of the deep veins in your body, usually in your legs. DVT is a serious condition because the blood clot can break loose, travel through your bloodstream and become stuck in your lungs, blocking blood flow. This condition, called a pulmonary embolism, can be life-threatening if it is not treated right away. When a DVT results in pulmonary embolism, it is known as venous thromboembolism.

DEAR MAYO CLINIC: Is preventative surgery an option for people with a strong genetic predisposition to pancreatic cancer? If not, are there any screening tests that can catch it early? ANSWER: Although removing the pancreas is a possibility for people who have a strong family history of pancreatic cancer, it is used only rarely as a means of preventing the disease. That’s because there are significant health risks associated with not having a pancreas. No formal screening methods are in place for this type of cancer. But certain imaging exams may be able to detect pancreatic cancer in its early stages. Your pancreas is located in your abdomen, behind the lower part of your stomach. One of its main jobs is to make insulin, a hormone that regulates the transfer of sugar, or glucose, from your bloodstream into your cells. The pancreas also makes enzymes that aid in your body’s digestion.

DEAR MAYO CLINIC: Last year I had an allergic reaction (swollen lips and face, itching around the neck and jawline) after getting the flu shot. Since then I found out I am allergic to thimerosal. Is it safe for me to get the vaccine this year? ANSWER: It is likely you can find a vaccine that you can take safely. There are influenza vaccines available that do not contain thimerosal. Before you get the vaccine again, make an appointment to see a doctor who specializes in allergies. That specialist can do tests to check your allergies and help you find an influenza vaccine that is safe for you. Influenza, or the flu, is a viral infection that often causes fever, chills, coughing and headaches. In people who have other diseases or medical conditions, and in healthy people older than 50, the flu can lead to serious illness that may require hospitalization. Each year thousands of people die as a result of complications from the flu.

DEAR MAYO CLINIC: I have been diagnosed with vaginal prolapse and am not sure where to begin with treatment. What is the best long-term treatment? I am only 53. ANSWER: Surgical and nonsurgical treatment options are available for vaginal prolapse. The treatment you choose usually depends on the severity of the condition, as well as how much the symptoms bother you. For long-term relief of vaginal prolapse that is causing persistent symptoms, surgery is often recommended to repair the vagina’s support. Vaginal prolapse happens when the muscles, connective tissue and ligaments that support the vagina weaken and stretch, causing the tissue to drop down, or prolapse, into the lower portion of the vagina or out the vaginal opening. Prolapse of the uterus, bladder (cystocele), and rectum (rectocele) can accompany vaginal prolapse and lead to a feeling of pelvic pressure or fullness, or a feeling of a bulge within the vagina. In some cases, these symptoms may be mild in the morning but get worse as the day goes on.

DEAR MAYO CLINIC: At my last physical, my doctor suggested that I should be screened for lung cancer. I used to smoke about a pack of cigarettes a day, but I quit 12 years ago. I am 63 now and in good health. Is screening really necessary for me? What does it involve? ANSWER: Screening programs are used to find lung cancer at an early stage, when it is more likely to be successfully treated. In general, screening is recommended for people at higher risk of developing lung cancer. That often includes people like you who smoked heavily at some point in their lives. Lung cancer is currently the number one cancer killer in the United States. More people die in the U.S. each year from lung cancer than from colon, breast and prostate cancer combined. But studies have shown that a properly organized screening program can reduce the number of people who die from lung cancer by 20 percent.

DEAR MAYO CLINIC: I am 58 and asked my doctor for a prescription for erectile dysfunction. He recommended I also have tests done to evaluate my heart. How are ED and heart disease related? ANSWER: In some cases, erectile dysfunction, or ED, may be an early warning sign of heart disease. It is often a good idea for men diagnosed with ED to have tests to make sure that ED is not a symptom of a heart condition. That is especially true if you have risk factors that increase your chances of developing heart problems. If a heart condition is found, treatment for that disorder also may help reverse ED. The connection between ED and heart disease involves a condition known as atherosclerosis — sometimes called hardening of the arteries. Atherosclerosis happens when plaques build up in your arteries. When plaques start to accumulate, the smaller arteries in the body, including those in the penis, are the first to get plugged up. The plaque lowers blood flow in the penis, making an erection difficult. Erectile dysfunction alerts doctors to look for atherosclerosis in larger arteries that supply your heart and other organs and, if found, to take steps to treat atherosclerosis. In addition to heart problems, atherosclerosis also increases your risk of other serious health problems, including aneurysm, stroke and peripheral artery disease.

DEAR MAYO CLINIC: My husband is 68 and has some hearing loss but won’t go to see the doctor. He says it’s a normal part of aging and thinks there’s not much that can be done for it anyway. How is age-related hearing loss treated, other than a hearing aid? Is there a benefit to having his hearing evaluated now as opposed to waiting until it gets even worse? ANSWER: This is a great question and something we frequently hear from our patients. It is often because of concerned family members and friends — rather than the patient — that people come to a doctor for hearing loss evaluation. There are two main reasons why it is important to have hearing loss evaluated as soon as it is recognized: first, to determine the cause and second, to review possible treatment options. Early intervention may be associated with a better outcome, depending on the cause of the hearing loss.

DEAR MAYO CLINIC: My 16-year-old granddaughter was recently diagnosed with a low white blood cell count after going to the ER twice with a migraine headache, vomiting and temporary loss of sight. What could cause a low white blood cell count in someone her age? I am worried it’s something serious and am wondering what other tests should be done. ANSWER: Many diseases and conditions can lead to a low white blood cell count. It is difficult to say what the specific cause might be in your granddaughter’s situation without more information. It is unlikely that the low count is related to her migraine and other symptoms. It would be wise to do another blood test to see if the problem persists. Her doctor can then decide if she needs to be evaluated further. Blood has a number of components. In addition to white blood cells, which fight infection, red blood cells carry oxygen and platelets help blood clot. Bone marrow, the spongy tissue inside bones, makes the blood cells.

DEAR MAYO CLINIC: I have severe arthritis in my shoulder. I recently found out my rotator cuff is also torn. I can’t lift my arm much anymore without a lot of pain. My doctor recommends reverse shoulder arthroplasty. What does this surgery involve? How successful is it for someone in my situation? ANSWER: Reverse shoulder arthroplasty is surgery used to replace a damaged shoulder joint. The procedure differs from standard shoulder replacement surgery because it switches the shoulder’s normal ball-and-socket structure around to allow for more stability in the joint after surgery. Reverse shoulder arthroplasty is particularly useful for people like you who have a damaged rotator cuff along with shoulder arthritis. In such cases, this surgery often can effectively reduce pain and increase shoulder mobility.