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Dec 6, 2013 · By Itself, Knee "Crunching" Sound Generally Not Cause For Concern

By Itself, Knee “Crunching” Sound Generally Not Cause For Concern

December 6 , 2013

Dear Mayo Clinic:

One of my knees makes an odd crackling sound (like the sound you might hear when scrunching plastic wrap) when I go down a flight of stairs. However, I do not have any knee pain. Should I be concerned?


The crunching sound from your knee is crepitus. If you do not have any other symptoms, no specific treatment is necessary for crepitus. If you develop other knee problems, however, you should see a doctor to have your knee evaluated.

Crepitus is caused by the rubbing of cartilage on the joint surface or other soft tissues around the knee during joint movement. When knee snapping or catching is painful, that is usually a result of scar tissue, a meniscus tear or a tendon moving over a bony prominence within the knee joint.

The patellofemoral joint — where your knee cap meets your thigh bone, or femur — is typically the source of knee crepitus. Cartilage, the smooth, elastic tissue that covers the ends of bones, normally allows the bones to glide easily in the joint. But over time, the cartilage surface may start to lose its smoothness. The crunching you hear likely is due to the cartilage in your knee becoming rough, so the bones cannot slide as easily in the joint as they normally do.

Knee crepitus typically happens when the knee is bent, such as when you are squatting, going up or down stairs, or rising from a chair. By itself, crepitus generally is not a cause for concern. Once the cartilage gets rough, though, it may be at risk to begin to wear down, leading to arthritis.

To help prevent additional knee problems, work on strengthening the muscles in the front of your thigh, called the quadriceps. Walking, biking and swimming can all be useful for strengthening the quadriceps muscle. A variety of exercises that directly target the quadriceps, both with and without weights, also may be helpful. If you have questions about specific exercises or if you have other medical conditions, talk to your doctor or a physical therapist before beginning a new exercise program.

Strong quadriceps can take some of the load off your patellofemoral joint. That makes it less likely the cartilage in the joint will wear down. Also, to help prevent further cartilage damage and other knee injuries, avoid overloading the joint when your knee is bent.

If you start to notice additional knee symptoms such as knee pain or fluid in the joint along with crepitus, that could signal the beginning of other problems. For example osteoarthritis, a common cause of knee pain and excess fluid around and in the joint, can develop if the cartilage in your knee wears down.

If other knee symptoms do develop, it is important to have your situation evaluated right away. When left untreated, some knee conditions including osteoarthritis can lead to increasing pain, joint damage and, eventually, disability. But if identified and treated promptly, most knee problems can be successfully managed.

— Michael Stuart, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

Dec 4, 2013 · Mayo Clinic Researchers Find Shape-shifting Stops Migrating Cancer Cells

JACKSONVILLE, Fla. — Like a car with a front and back end, a steering mechanism and an engine to push it forward, cancer cells propel themselves through normal tissues and organs to spread cancer throughout the body. Researchers at Mayo Clinic in Florida, however, have managed to turn these cells into shapes like a round fried egg and an exaggerated starfish that sticks out in many directions — both of which cannot now move.

In research published in the December issue of Molecular and Cellular Biology, investigators reveal how interplay of molecules keeps cancer cells moving forward, and how disturbing the balance of these proteins pushes their shape to change, stopping them in their tracks.

Investigators say they have already identified a number of agents — some already used in the clinic for different disorders — that may force shape-shifting in tumor cells.

“We are starting to understand mechanistically how cancer cells move and migrate, which gives us opportunities to manipulate these cells, alter their shape, and stop their spread,” says the study’s lead investigator, Panos Z. Anastasiadis, Ph.D., chair of the Department of Cancer Biology at Mayo Clinic in Florida.

“It is the spread — the metastasis — of cancer that is largely responsible for the death of cancer patients, so stopping these cells from migrating could potentially provide a treatment that saves lives,” he says.

The study was conducted using tumor material from breast and brain (glioblastoma) cancer. Both of these tumors are generally lethal when they spread — breast to other organs, and brain cancer as it crawls throughout the brain.

The researchers found that a protein called Syx is key to determining how tumor cells migrate. When researchers removed Syx from the cancer cells, they lost their polarity — their leading and trailing edges — and morphed into the fried egg shape. “They are now unable to sense direction, so they are not going anywhere,” Dr. Anastasiadis says.

Nov 8, 2013 · Treatment for Kidney Stones Depends of Type and Cause of Stones

Treatment for Kidney Stones Depends of Type and Cause of Stones

November 8, 2013

Dear Mayo Clinic:

I continue to get kidney stones despite drinking plenty of water. They are quite small and I haven’t had to be treated yet. But my doctor said if my symptoms get worse, I will need treatment. What would that involve?


Treatment for kidney stones depends on the type of stone and their cause. In many cases, dietary changes and medication are all that’s needed for small stones. Larger stones may require additional treatment.

Kidney stones form from minerals and acid salts. About 85 percent of kidney stones are calcium based, typically calcium oxalate. Less common are uric acid stones, struvite stones and cystine stones. Your doctor can use blood and urine tests to find out what kind of stones you have. If you have passed a stone, a laboratory analysis can reveal the make-up of the stone.

If your stones are calcium oxalate — as most kidney stones are — you need to keep doing what you have already started: drink lots of water. The typical recommendation is to drink about 8 to 10 ounces of water every hour you are awake.

There are several benefits to drinking that much water when dealing with kidney stones. First, it flushes out your urinary system and helps small stones pass more easily. Second, diluted urine lowers the chances that calcium oxalate stones will form in the first place. Drinking plenty of water can help prevent uric acid stones and cystine stones, too.

A variety of changes in your diet can lower your risk of forming new calcium oxalate stones. Oxalate is a substance found in certain foods. For people at risk for these kidney stones, eating fewer oxalate-rich foods can help. They include foods such as spinach, beets, Swiss chard, rhubarb, almonds and granola, among others.

A low-salt diet can be useful in preventing calcium oxalate kidney stones, as can getting the right amount of calcium from the foods you eat. Some people with kidney stones are advised to eat more citrus fruits because a substance in those fruits, called citrate, can naturally inhibit stone formation.

For uric acid stones, cutting back on the amount of protein you eat — especially protein from animal sources — may help prevent new stones.

Ask your doctor to recommend a dietitian you can talk with about a diet that is right for you. He or she can review food choices that may lower your risk of new kidney stones and help you plan some sample menus to get started.

In some cases, medication also can treat kidney stones and prevent new ones from forming. Again, the specific medicine you need depends on the type of stone you have. Doctors often prescribe a thiazide diuretic — a water pill — for people with calcium stones. In addition, a citrate supplement may be appropriate for people with very low levels of citrate in their bodies.

Medications can help lower the amount of uric acid in the blood and urine for people who tend to form those types of stones. Struvite stones are associated with infections. In some cases, long-term use of antibiotics in small doses may help keep urine free of bacteria that can cause infection. Medicines can sometimes be used to lower the amount of cystine in the urine for people who have cystine stones.

If you develop larger kidney stones, you may need more invasive treatment. Procedures are available to break up large kidney stones into small pieces that can pass through your urinary tract. For very large stones, surgery is sometimes necessary to remove them.

Right now, the best step is to talk with your doctor about tests that can show what type of kidney stones you have. Once you know that, you can make a plan to help prevent and treat new stones.

— Vincent Canzanello, M.D., Nephrology, Mayo Clinic, Rochester, Minn.

Sep 27, 2013 · Surgery Could Be Best Option For Biceps Injury

Surgery Could Be Best Option For Biceps Injury

September 27, 2013
Dear Mayo Clinic:

I recently had a non-contrast MRI which showed a biceps tendon tear. I’ve already tried four months of physical therapy, rest, ice, anti-inflammatory medications and cortisone injections. Is surgery necessary and, if so, what does the recovery involve?


It sounds as if surgery could be a reasonable next step in treating this injury. Several surgical techniques can be used depending on the location and nature of the tear. The type of technique used determines your recovery time, which can range from just a few days to about three months.

Your biceps is the muscle at the front of your upper arm. You use it when you rotate your forearm and bend your elbow. Two tendons attach the bicep to your shoulder. These tendons combine into one that crosses the elbow and attaches to your forearm.

A biceps tendon tear can be either partial — the tendon is not completely severed through — or complete. A partial biceps tendon tear can be very irritating and lead to symptoms such as pain, tenderness and aching. A complete biceps tendon tear does not cause ongoing pain. But it does lead to a loss of forearm rotation strength, along with some pain if it occurs at the elbow.

Several treatment options are available for biceps tendon tears. Because you have already tried a number of more conservative treatments without success, surgery may be appropriate.

For a partial biceps tendon tear in the shoulder, one surgical approach is to complete the tear and release the damaged tendon from its attachment to the shoulder joint. As a result, the tear no longer irritates the joint and symptoms disappear.

With this procedure, called a tenotomy, you will lose little function in your biceps muscle. The other tendon that attaches to your shoulder can do the work instead. But because the tendon no longer keeps the muscle tight against the upper arm bone, it will leave a bulge in your upper arm. Some people are fine with that extra bulge. Others prefer to eliminate it by having the tendon reattached to the bone further down the arm.

A biceps tendon tear at the elbow is much less common than at the shoulder. Most often, elbow biceps tendon tears are complete. These tears usually are the result of a forceful extension of the elbow when, for example, you try to hold a heavy object with your palm up. The injury results in weakness when rotating the forearm and bending the elbow.

Surgical repair for complete tears should take place as soon as possible. If left untreated, the muscle and tendons begin to shorten and scar, making surgical repair difficult later.

If an elbow biceps tendon tear is partial and causes ongoing symptoms, it may be treated surgically by removing the affected tissue and reattaching the tendon to the bone using stitches or special screws. A similar technique can be used when a shoulder biceps tendon needs to be reattached.

Recovery time after surgery varies, depending on the procedure you have. When the shoulder tendon is simply released and not reattached, recovery is almost immediate. There are usually no restrictions on activity following that type of surgery.

When the tendon is reattached to the bone, healing takes about three months. Patients should not lift anything heavy for about six weeks after surgery. Manual labor, sports and other physical activities that involve your arm may be limited for another six weeks. Physical therapy can be done with a home-based program to regain the arm’s strength and range of motion.

The long-term outlook often is good after surgery to treat a torn biceps tendon. The surgery typically relieves pain symptoms. Most people recover a full range of motion in their arm, and arm function is effectively restored.

— Mark Morrey, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

Aug 30, 2013 · Stress May Play A Role In Hair Loss, But Other Triggers Could Be The Cause

Stress May Play A Role In Hair Loss, But Other Triggers Could Be The Cause

August 30, 2013
Dear Mayo Clinic:

Is it true that chronic stress can cause hair loss, and if so, is the hair loss reversed once the stress is lessened?


There isn’t an easy yes or no answer to this question. Some hair loss may be related to stress, and, in some cases, it is possible that hair loss could be reversed. But it depends on the type of hair loss you have and other triggers for the hair loss that could be at work.

It is generally accepted that some connection between high levels of stress and hair loss is likely in certain situations. But that connection has not been proven in clinical research trials in people. Research on mice and human hair that has been grown in laboratories seems to show that stress may play a role in two specific kinds of hair loss: telogen effluvium and alopecia areata.

The first, telogen effluvium, is the more common of the two. This type of hair loss involves shedding hair faster than normal from all over your head. It typically does not lead to baldness, but your hair does become thinner than usual. Telogen effluvium has been linked to a range of triggers, and some of them do involve stress.

One trigger that is frequently noticed by women with infants is the hair loss that often starts about three to five months after the birth of a child. While you are pregnant, you lose less hair than normal. Several months after delivery, the body then sheds hair down to its typical level. That hair loss may be concerning, especially if you did not notice the buildup of hair during pregnancy. But for most women, the loss tapers off once the hair has returned to its usual thickness.

Other triggers that can cause telogen effluvium include thyroid problems, massive weight loss, significant medical illness and general anesthesia. If you have recently stopped using a method of birth control that contains hormones, that also could lead to this kind of hair loss. A few specific medications may trigger telogen effluvium, too, although that is rare.

The other type of hair loss that may be linked to stress is alopecia areata. It usually involves patchy hair loss, with bald patches about the size of a quarter or half-dollar. In extreme cases, alopecia areata may affect all the hair on a person’s head, including eyebrows and eyelashes.

In most people with alopecia areata, the hair grows back in one to two years. Treatment with steroid injections into the affected areas can often prompt the hair to regrow faster. The larger the area of hair loss, though, the less effective treatment tends to be.

If you are dealing with hair loss, whether you think it is related to stress or not, keep in mind that there are many variations of hair loss, and many medical diagnoses that can lead to hair loss. Some kinds of hair loss may be reversible, while others are not. In some cases, treatment may be able to reverse hair loss. But that is not always the case.

Be very cautious of products and services that claim to restore hair in all cases. Many products related to hair loss available in the marketplace today are expensive but do little, if anything, to effectively treat hair loss. If you are concerned about hair loss, see a dermatologist who specializes in hair issues. He or she can help you investigate the cause of hair loss and decide on possible treatment options.

— Rochelle Torgerson, M.D., Ph.D., Dermatology, Mayo Clinic, Rochester, Minn.

Aug 9, 2013 · Shingles More Common After Age 50, but Can Affect Younger People as Well

Shingles More Common After Age 50, but Can Affect Younger People as Well

August 9, 2013

Dear Mayo Clinic:

I was diagnosed last year, at the age of 38, with shingles. What causes someone who is relatively young to get shingles? Does this mean I am more likely to get it again? Should I get the vaccine at this point or wait until the recommended age of 60?


Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Once you have had chickenpox, varicella-zoster stays in your body for the rest of your life. When the virus is reactivated, the result is shingles.

Shingles typically involves a band-like rash on one side of the chest, abdomen or face. The rash is usually quite painful. Most people recover from shingles over several weeks. A small number have lingering severe pain, called post-herpetic neuralgia, along the nerve that was irritated when the virus came back.

Shingles often occurs when a person’s immune system is impaired. A weakened immune system can be part of the aging process. That’s why shingles tends to be more common in people older than 50. The risk of shingles continues to increase as people age. Some experts estimate that half the people who live to age 85 will get shingles at some point.

Shingles can affect younger people, too, as a result of factors that can affect the immune system.  Periods of high stress, depression and prolonged fatigue may weaken the immune system in otherwise healthy young adults and lead to shingles. Chronic illnesses such as chronic kidney or lung disease, cancer, HIV/AIDS or other diseases that affect the immune system also may increase the risk of a shingles eruption, regardless of age.

Certain medications — such as steroids or immunosuppressive medications used to treat autoimmune diseases or to prevent rejection of transplanted organs — weaken the immune system, as do some types of medical treatment, such as chemotherapy. These also can make a person more vulnerable to shingles.

The fact that you had shingles at your age does not necessarily mean you are at high risk for developing the illness again. In general, only about one to four percent of people who have shingles once go on to have a recurrence. That percentage is higher in people who have chronic diseases that affect their immune systems or who are on long-term drugs to suppress the immune system.

The shingles vaccine can help prevent the disorder and lower the likelihood of complications, such as lingering pain. The Centers for Disease Control and Prevention recommends that all adults age 60 and older who have had chickenpox get the shingles vaccine, even if they have already had shingles. Studies also have shown the vaccine to be effective in patients between 50 and 59 years of age. Because it has not been studied in younger people, it is not clear how effective the vaccine is for healthy adults younger than 50 in lowering the risk of recurrent shingles.

The vaccine is made from a weakened form of the live shingles virus, but it does not cause the illness in healthy people. For those who have chronic diseases or who are on chronic medications that weaken the immune system, the vaccine is not an option due to a risk that it may cause shingles in those groups.

At your age, whether or not you get the vaccine is an individual decision that should be based on your medical history and what, if any, other health conditions you may have. Talk with your health care provider to see if the shingles vaccine is a good choice for you at this time.

— James Watson, M.D., Neurology, Mayo Clinic, Rochester, Minn.

Jul 26, 2013 · Likelihood of Child Outgrowing Food Allergy Depends of Type, Severity of Allergy

Likelihood of Child Outgrowing Food Allergy Depends of Type, Severity of Allergy

July 26, 2013

Dear Mayo Clinic:

Is it possible for children to outgrow food allergies?


Some children may outgrow their food allergies. But the likelihood of that happening depends in large part on the type of food a child is allergic to, as well the severity of the allergy.

In people who have a food allergy, the body’s immune system mistakenly identifies a specific food or part of a food as something harmful. When that happens, the immune system releases into the body immunoglobulin E, or IgE, antibodies. The next time the IgE antibodies sense that food, they cause a variety of chemicals, including histamine, to be released into the bloodstream.

Those chemicals trigger the symptoms of the food allergy, such as hives, skin or throat swelling, gastrointestinal problems, or breathing problems. In some people, a food allergy may lead to a life-threatening reaction known as anaphylaxis. Symptoms of anaphylaxis can include the above symptoms as well as severe tightening of the airways (causing breathing problems), rapid pulse, drop in blood pressure, and/or loss of consciousness. Without emergency medical treatment including epinephrine, anaphylaxis may result in death.

Food allergies affect about 6 to 8 percent of children under age 5, and about 3 to 4 percent of adults. Food allergies often are confused with a much more common reaction known as food intolerance. While bothersome, a food intolerance often is less serious. Usually, its symptoms come on gradually and are limited to digestive problems. Testing generally is not available for food intolerance. A severe form of food intolerance called food protein-induced enterocolitis syndrome, or FPIES, should be evaluated by an allergist or gastrointestinal specialist. Most children outgrow FPIES.

It is possible to have an allergic reaction to almost any type of food. But some foods lead to allergies more frequently than others. Of the common food allergies, milk, egg, soy and wheat allergies are the ones children most often outgrow by the time they are in their late teens.

About 60 to 80 percent of young children with a milk or egg allergy are able to have those foods without a reaction by the time they reach age 16. Recent studies suggest that children with egg or milk allergies who can eat those foods in a baked form, such as a muffin, without an allergic reaction are very likely to be able to tolerate plain egg or plain milk in the future.

Some other food allergies are much less likely to be outgrown. These foods are also common allergens and include peanuts, tree nuts, finned fish and crustacea. They tend to cause a more severe food allergy reaction. Only about 20 percent of children who have a peanut allergy outgrow it. An even lower number of those with tree nut allergies — 14 percent — will lose that allergy. And only 4 to 5 percent of children with a fish or crustacean (shellfish) allergy will go on to be able to eat those foods without a reaction later in life.

In many cases a blood test or an allergy skin test, combined with a thorough assessment of a child’s health history, can help determine how likely it is for that child to outgrow his or her food allergy.

If it seems a child has outgrown a food allergy, a test called a food challenge may be recommended. It involves giving the child small amounts of the food in a controlled setting. A very small amount is given first. It is then doubled every 15 to 30 minutes until the child eats one serving size. This test is not recommended for children who are at high risk of anaphylaxis.

If your child has a food allergy, it is a good idea to work with a doctor who specializes in childhood allergies. An allergist can help you monitor and manage a food allergy over time as your child grows.

— Nancy Ott, M.D., Pediatric Allergy and Immunology, Mayo Clinic, Rochester, Minn.

Jul 12, 2013 · When Diagnosed Early, Stopping Diabetic Kidney Disease May Be Possible

When Diagnosed Early, Stopping Diabetic Kidney Disease May Be Possible

July 12, 2013

Dear Mayo Clinic:

My father was recently diagnosed with diabetic kidney disease. Is there a chance this can be reversed, or will he have it for life? What changes, if any, should he be making to his diet?


It is not uncommon for people who have diabetes to develop kidney problems. When diagnosed early, it may be possible to stop diabetic kidney disease and fix the damage. If the disease continues, however, the damage may not be reversible.

Diabetic kidney disease, also called diabetic nephropathy, happens when diabetes damages blood vessels and other cells in the kidneys. This makes it hard for them to work as they should. In the early stages, diabetic kidney disease has no symptoms. That’s why it is so important for people with diabetes to regularly have tests that check kidney function.

In later stages of the disease, as kidney damage gets worse, signs and symptoms do appear. They may include ankle swelling, test findings that show protein in the urine, and high blood pressure. Over time, diabetic kidney disease can lead to end-stage kidney disease.

If your father is in the early stages of diabetic kidney disease, there are several steps he can take to help protect his kidneys. First, it is critical to keep blood sugar as well controlled as possible. This not only helps the kidneys, but decreases the risk of other serious problems that can come from diabetes, such as blindness, heart attack and damage to the blood vessels and nerves.

Keeping blood pressure under control also is important. High blood pressure can speed up the process of diabetic kidney disease and make kidney damage worse. In general, blood pressure of 140/90 in the doctor’s office and 135/85 at home is a good goal. But your father should check with his doctor to find out what’s appropriate for him.

Eating a diet low in salt, quitting smoking, and limiting alcohol can all lower blood pressure. In addition to these lifestyle changes, medication to control blood pressure may be useful. The most common blood pressure medications for people with diabetes are angiotensin converting enzyme, or ACE, inhibitors and angiotensin receptor blockers, or ARBs.

Healthy cholesterol levels can help kidney function, too. Typical recommendations include keeping the level of “bad” cholesterol — called low density lipoprotein cholesterol, or LDL — to less than 100 milligrams (mg) of cholesterol per deciliter (dL) of blood. An ideal level for someone with diabetes is 80 mg/dL.

Diet has a direct impact on cholesterol. A diet rich in fiber, vegetables, fruits, heart-healthy fish and whole grains that is also low in fat and dietary cholesterol can go a long way toward lowering LDL cholesterol. Eating a healthy diet can also help shed extra pounds. That’s good for the kidneys because being at a healthy weight helps keep blood sugar, blood pressure and cholesterol levels down.

In addition, your father needs to be careful when taking medications. He should not take over-the-counter medications that belong to the group of drugs known as nonsteroidal anti-inflammatory drugs, or NSAIDs. These include ibuprofen and naproxen. Some prescription medications may lead to kidney damage, too. If a doctor recommends a new medication to him, your father should ask about the possible impact on his kidney disease. Some medications may need to be avoided completely. But many more simply need the dose adjusted to fit his kidney function.

If he needs medical imaging tests that normally use dye, such as CT scans, your father should remind his health care providers that he has diabetic kidney disease. Because these dyes may lead to kidney damage in people with kidney disease, it is generally recommended they avoid them.

Finally, to monitor his condition and to help protect his kidneys’ long-term health, encourage your father to see a nephrologist regularly.

— John Graves, M.D., Nephrology/Hypertension, Mayo Clinic, Rochester, Minn.