Mayo Clinic Q & A

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.

DEAR MAYO CLINIC: What causes fecal incontinence? Can it be treated? ANSWER: Fecal incontinence, or leakage of stool from the rectum, can range from occasional leakage while passing gas to a complete loss of bowel control. An estimated 8 percent of the general population and 15 percent of people age 70 and older are affected. Although fecal incontinence is more common in middle-aged and older adults, it isn’t an inevitable part of aging. It’s often the result of another treatable medical issue or can be a warning sign of a more serious problem. Your rectum and anus are at the end of your large intestine. Normally, the muscles and nerves in and around these two structures sense the presence of waste, allow storage in the rectum, and then move and eliminate stool. Changes in the function of this complex system can interfere with normal stool elimination.

DEAR MAYO CLINIC: Is it true that some children are more susceptible to getting cavities than others? My 11-year-old has never had a cavity, but my 6-year-old already has needed four fillings. What’s the best way to prevent cavities in kids? At what age should they start flossing? ANSWER: Some people may be more prone to tooth decay than others, even within the same family. To give your children the best protection against cavities, teach them the importance of dental health by showing them how to care for their teeth. That includes daily flossing from a very young age. It is important for parents to have good oral hygiene, too. Make sure you and your children see a dentist regularly. Tooth decay happens when areas in the hard surface of your teeth become damaged and develop holes, or cavities. If left untreated, the holes get bigger and can eventually lead to pain, infection and tooth loss. A combination of factors can trigger tooth decay, including bacteria in the mouth, teeth not being cleaned well, and eating or drinking lots of sugary foods and beverages.

DEAR MAYO CLINIC: Is it true that people with rheumatoid arthritis have a higher risk of heart disease? How are the two conditions related? Is there a way to lower the risk? ANSWER: Studies have shown that if you have rheumatoid arthritis, your risk of developing heart disease is two to three times higher than people who do not have the disorder. Although the exact connection between the two conditions is unclear, a number of factors seem to play into the increased heart disease risk. Regular check-ups, tests to check for heart problems, lifestyle changes and being able to recognize symptoms of heart disease can all help manage the risk. Rheumatoid arthritis is an inflammatory disease that causes swelling. It often affects the small joints in the hands and feet and causes joint tenderness, pain and stiffness. But the disorder can go beyond the joints, too, and that is part of the connection to heart disease.

DEAR MAYO CLINIC: I am 40 years old. After having a period that lasted nearly two months, I had tests done that showed a small, hyperechoic lesion within the endometrium. What exactly does this mean? My primary care doctor suggested a hysterectomy as treatment. Are there other ways to treat this condition? ANSWER: Thank you very much for your important question. This can be a source of much confusion and concern, so I hope I can help you with that. The endometrium is the layer of cells that make up the lining of your uterus. It is not uncommon for small lesions to form within that lining. When that happens, the lesion may trigger abnormal uterine bleeding similar to the kind you are experiencing. In some cases, lesions in the endometrium can signal a larger problem, such as cancer. But in many situations, they are not cancerous and pose no serious health risks. The term “hyperechoic” is used to describe how the tissue looks during an ultrasound exam. This is a rather nonspecific term meaning that during the test the tissue reflected back an unusually large number of ultrasound echoes.

DEAR MAYO CLINIC: I am considering having LASIK surgery, but have a friend who had the procedure done many years ago and is now experiencing regression in her vision and has to wear glasses again. Is this typical? What are the risks of LASIK surgery? ANSWER: It is not typical for a person’s vision to regress after LASIK. Although the procedure may lead to some side effects and complications, they are uncommon. A thorough evaluation before surgery often can help avoid many of the potential problems that can happen after LASIK. LASIK stands for laser-assisted in-situ keratomileusis. It is a type of refractive surgery — surgery that changes the shape of the transparent tissue, called the cornea, at the front of your eye. The surgery corrects vision problems such as nearsightedness, farsightedness and astigmatism, reducing or eliminating the need for eyeglasses or contact lenses.

DEAR MAYO CLINIC: My mother, 67, was recently diagnosed with peripheral artery disease. She has been having leg pain and other symptoms for many months. She was prescribed medication but her doctor said she may need surgery. What would that involve? Are there any other treatment choices? ANSWER: In people who have peripheral artery disease, narrowed arteries limit blood flow to the arms and legs. When the limbs do not get enough blood, it can trigger a variety of symptoms. The most common include leg pain when walking, leg cramps after doing an activity, leg numbness and leg weakness. If left untreated, pain and other symptoms may get worse over time. Treatment for peripheral artery disease usually includes lifestyle changes and medication. For many people, those two therapies are all they need to effectively manage the disease. If they are not enough, though, a procedure to open blocked arteries (angioplasty) may be recommended. Surgery to bypass a blocked or narrowed artery can be another useful treatment option for some cases of peripheral artery disease. Lifestyle changes often can help ease symptoms and slow the disease’s progress. Smoking is one of the biggest risk factors for peripheral artery disease. Smoking frequently leads to artery narrowing and damage. It also can make the disease get worse more quickly. If your mother smokes, quitting is one of the most important steps she can take to combat peripheral artery disease.

DEAR MAYO CLINIC: My daughter, 31, was recently diagnosed with rheumatoid arthritis. Do doctors know what causes the disease, especially at a young age? Will she need to be on medication for the rest of her life? ANSWER: The precise cause of rheumatoid arthritis, or RA, remains unclear. However, both genetic and environmental factors appear to play a role in raising a person’s RA risk. Because we do not know the exact cause, we do not have a cure for RA. Most people with this disease do need long-term treatment. Rheumatoid arthritis is a kind of disease known as an autoimmune disorder. These disorders happen when your immune system mistakenly attacks your body’s own tissues. In RA, the immune system attacks the lining of the membranes that surround your joints, called the synovium. That causes inflammation. The inflammation, in turn, thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

DEAR MAYO CLINIC: Why do children need so many vaccines in their first two years of life? Isn’t it okay and even safer to wait until they are a bit older to give them the recommended vaccinations? ANSWER: The current childhood vaccination schedule has been studied extensively. It is safe. It is also highly effective at preventing a variety of serious diseases. To offer the best protection against those diseases, I strongly urge you to have your child vaccinated on time, according to the recommended schedule. Babies need multiple vaccines because infectious diseases can cause serious health problems in infants. For a short time after they are born, antibodies from their mothers help protect newborns from many diseases. But that immunity begins to fade quickly, with some immunity lasting only about one month after birth. The vaccination schedule that is recommended now has been studied and found safe and effective against the diseases babies face at the time they are getting the vaccines. A delayed schedule is a delay in protection against some diseases that are very serious, and in many cases life-threatening.

DEAR MAYO CLINIC: What is the typical treatment and recovery time for a herniated disk? At what point should surgery be considered? ANSWER: In many cases, pain and other symptoms caused by a herniated disk resolve with time and self-care measures. When medical treatment is required, therapy that doesn’t involve surgery often is all that’s needed to effectively treat herniated disk symptoms. However, if your symptoms significantly limit your day-to-day activities, if you have nerve damage due to a herniated disk, or if your symptoms cannot be controlled with other treatment, then spine surgery may be necessary. Your spinal disks are the cushions between the individual bones, called vertebrae, that make up your spine. The disks have a soft center within a tougher exterior. A herniated disk happens when some of the center pushes out through a crack in the outer portion of the disk. A herniated disk may irritate or compress a nearby spinal nerve root. The result can be back pain, along with pain, numbness or weakness in an arm or leg.