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7 hours ago · Mayo Clinic Q and A: Catching skin cancer early

a medical illustration of normal skin and three types of skin cancer - squamous cell carcinoma, basal cell carcinoma and melanoma

DEAR MAYO CLINIC: My doctor suggested I get a yearly skin check by a dermatologist to check for melanoma. Why is this necessary? I am almost 50 and have never had any suspicious moles or spots.

ANSWER: It’s a good idea to be evaluated by a dermatologist once a year. In addition, checking your skin at home regularly will make it more likely that melanoma and other types of skin cancer are caught early. The sooner skin cancer is found, the better the chances are of curing it.

Melanoma
is the most serious type of skin cancer. It develops in cells called
melanocytes that produce melanin — the pigment that gives your skin its color. The
exact cause of all melanomas isn’t clear, but exposure to ultraviolet, or UV,
radiation increases your risk of developing the disease. This can come from
sunlight, as well as from tanning lamps and beds.

The
number of melanoma cases has increased dramatically over the past 30 years,
especially in middle-age women. The increase may be linked to the rise
of tanning bed use in the 1980s, when many women who are now in their 40s and
50s were in their teens.

Melanoma that goes unchecked and spreads can be difficult to treat. But when it’s caught early, melanoma often is curable. That’s why it’s so important to be familiar with your skin and report any changes to your dermatologist right away, especially if you’ve had a significant amount of exposure to tanning beds in the past. Get into the habit of checking your skin once a month. In particular, watch for moles appearing that haven’t been there before.

Know the ABCs of skin cancer, too,
and report any of them to your dermatologist. “A” is for asymmetry: One half of
a mole looks different from the other half. “B” is border: The borders of a
mole are uneven, jagged or scalloped. “C” is for color: The color of a mole is
different from one area to another. Specifically, if you see colors of the U.S.
flag — red, white or blue — within a mole, that can be a concerning change.

It’s also important to note a mole’s
size. If you have a mole larger than about one-quarter of an inch across — or
about the size of a pencil eraser — have it checked. If there is a change in
the size, shape or color of a mole, or if you develop symptoms such as bleeding,
itching or tenderness, that should be evaluated, as well.

Other kinds of skin cancer that a dermatologist will be looking for include basal cell carcinoma and squamous cell carcinoma. These cancers tend to look like pink, red or scaly spots on your skin that do not go away on their own.

An annual skin check from a dermatologist
often only takes a few minutes, but it is a critical part of catching skin cancer
early. Dermatologists specialize in skin disorders and often can spot problem
areas on the skin quickly. That’s particularly true after you have your first
skin assessment, which may take a little longer than follow-up visits.

Of course, prevention is also key. Protect your skin as much as possible. Stay out of the sun during the middle of the day when UV light is the strongest. But when you are outdoors, use sunscreen no matter the season or weather. The sun protection factor, or SPF, of your sunscreen should be at least 30, and sunscreen should be applied generously and frequently to get the full amount of protection. Never use a tanning light or tanning bed, as they can drastically increase your chances of melanoma. — Dr. Jerry Brewer, Dermatology, Mayo Clinic, Rochester, Minnesota

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4 days ago · Mayo Clinic Q and A: What causes kidney stones?

Portrait of mature man with confident smile and white stylish short beard looking at camera sitting in modern coffee shop.

DEAR MAYO CLINIC: Is diet always the cause of kidney stones, or are some people just more susceptible than others?

ANSWER: Diet can play a significant role in the formation of kidney stones, but it’s not the only reason a person may develop these stones. A family or personal history of kidney stones raises your risk, as do certain medical conditions. If you get a kidney stone, finding out what it’s made of will help determine steps that you can take to lower your risk, including ways to change your diet. By taking such steps, it’s less likely you’ll develop stones in the future.

Kidney
stones are hard deposits of minerals and salts that form inside your kidneys.
They develop when your urine contains more crystal-forming substances, such as
calcium, oxalate and uric acid, than the fluid in your urine can dilute.

One
of the most straightforward ways to lower your kidney stone risk is to drink
plenty of fluids. Extra fluids dilute urine, making stones less likely. If you
have a history of kidney stones, health care providers usually recommend
passing about 2½ liters of urine per day. One way to gauge whether you have
adequate fluid intake is to check the appearance of your urine. If it’s light or
clear, you’re likely drinking enough fluids.

The amount of salt in your diet
makes a difference, too. Taking in too much salt
increases the amount of calcium your kidneys have to filter, and that raises
your risk of kidney stones. Reducing the amount of salt in your diet may lower
your risk of stones.

If
you’ve already had kidney stones, knowing the type of stone you form will help
with dietary choices to prevent future stones. For example, if your stones are calcium
oxalate, you may need to limit foods rich in oxalates. They include certain
fruits and vegetables, as well as nuts and chocolate. Uric acid kidney stones can
form in people who don’t drink enough fluids, lose too much fluid or eat a high-protein
diet. In that case, choosing a diet low in animal protein can help.

Crafting
a diet to prevent kidney stones can be complicated, so if you’ve had stones,
talk to a dietitian. He or she can review your situation and work with you to
create an eating plan tailored to your needs.

Your
health care provider also may recommend a test called a “metabolic urine
profile.” This test involves analyzing your urine over a 24- to 48-hour period.
It gives specific information about how your kidneys are working and helps
identify modifiable risk factors for kidney stone development.

Heredity plays a role in kidney stones.
People who have a family member with kidney stones are twice as likely to
develop stones as those who don’t have that family history. And once you
develop a kidney stone, your risk for future stones goes up. Most people get
their first kidney stone between the ages of 40 and 60. After you have one
stone, the chance of getting another within a year is about 15%. The likelihood
of developing more stones in three to five years is 35% to 40%, and within 10
years, it’s 50%.

Finally, your medical history can contribute to the formation of kidney stones. Diseases and conditions that may increase the risk of kidney stones include inflammatory bowel disease, chronic diarrhea, renal tubular acidosis, cystinuria, hyperparathyroidism and urinary tract infections. High body mass index, large waist size and weight gain also are associated with kidney stones. Having gastric bypass surgery and taking certain medications can raise your risk, too.

If you’ve had kidney stones in the past, or if you’re concerned you may be at high risk for them, talk to your health care provider. He or she can review your risk factors with you and, if necessary, recommend steps you can take to help prevent kidney stones. — Dr. Mitchell Humphreys, Urology, Mayo Clinic, Phoenix

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Tue, Jul 16 2:00pm · Mayo Clinic Q and A: Heart disease and kidney disease -- what's the connection?

a smiling older woman outdoors

DEAR MAYO CLINIC: My 78-year-old mother had a heart attack three weeks ago. She was feeling better for a bit, but became ill again and was told she has an acute kidney injury. Are the two conditions somehow related? Is she at higher risk for more kidney and heart problems after this?

ANSWER: Heart attack can trigger acute kidney injury, also sometimes called kidney attack. That is because the heart and kidneys are inter-related, and disease in one can raise the risk for illness in the other. Once a person develops heart disease or kidney disease, the chances of having future heart and kidney problems are higher than in people without a history of heart or kidney issues. The good news is that there are preventive measures that can be taken to keep those problems from getting worse.

Diseases in the kidneys can affect the heart. It is common for people with chronic kidney disease or end-stage kidney disease to develop heart disease, including heart attack or heart failure. The opposite also is true. Patients who have heart failure or who suffer a heart attack can develop kidney problems — either acute kidney injury or chronic kidney disease. When a person develops both heart and kidney problems, the condition sometimes is referred to as cardiorenal syndrome.

In the case of a heart attack, a
number of factors can contribute to a subsequent decline in kidney function.
The stress of a heart attack can result in hormonal changes within the body,
and that can have a negative effect on how well the kidneys work. Changes in
heart function may lead to kidney damage by decreasing the blood supply to the
kidneys. Medications given after a heart attack — including the contrast dye
used in imaging exams, such as angiography and CT scans — also can affect
kidney function.

But it is important to note that the presence of existing kidney disease risk factors before a heart attack, along with the severity of a heart attack, make a significant difference in the chances of developing kidney damage after a heart attack or recovery of kidney function after the damage. For example, if a person already has chronic kidney disease, diabetes, high blood pressure or other kidney-related issues, and then that individual suffers a heart attack or acute heart failure, the risk of acute damage to the kidney after the heart attack is substantially higher and a chance of kidney recovery is lower than it would be for someone without any kidney disease who has a mild heart attack.

Research has shown that people who
experience kidney damage after a heart attack have significantly worse outcomes
than people who do not have kidney damage. That includes higher chances of
developing chronic kidney disease; progression of existing chronic kidney
disease to a point that requires dialysis; and an increased risk of dying within
one year of the heart attack.

Although that sounds daunting,
there are steps that can be taken to lower those risks. First, there should be
a careful assessment of the extent of the kidney damage after a heart attack.
In some cases, kidneys may recover and resume normal functioning within a day
or two of the injury. If that is the case, and the patient does not have any
other kidney problems, then regular follow-up with a primary care provider to
monitor kidney function may be all that is necessary.

If the kidney damage is more severe and lasts longer before it recovers or if a patient has other existing kidney issues, then follow-up should include working with a kidney specialist to ensure proper care, monitoring, medication adjustments and patient education. — Dr. Kianoush Kashani, Nephrology, Mayo Clinic, Rochester, Minnesota

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Fri, Jul 12 1:00pm · Mayo Clinic Q and A: New treatment for hard-to-treat depression

a serious-looking middle-aged woman sitting on a couch, with her arms wrapped around her knees

DEAR MAYO CLINIC: How is the new nasal spray for depression different than other drugs used to treat depression? How do doctors determine who is a good candidate for this new kind of antidepressant?

ANSWER: This medication, called esketamine, is a fast-acting antidepressant recently approved by the Food and Drug Administration that can be used for hard-to-treat depression. It’s intended for adults who have previously received at least two other antidepressant treatments that did not adequately control their symptoms.

Esketamine is a step forward in
therapy for treatment-resistant depression because it works within the brain in
a different way than other antidepressants. The most commonly prescribed
antidepressants, called selective serotonin reuptake inhibitors, or SSRIs, have
an effect on the brain’s serotonergic system. They
ease depression by increasing levels of serotonin — chemical messengers that
carry signals between brain cells. SSRIs block the reabsorption, or reuptake,
of serotonin, making more serotonin available in the brain.

The antidepressant esketamine affects a different system within the brain:
the glutamatergic system, which is important for processing information. People
with depression often don’t have as many connections, or synapses, between
brain cells, which may contribute to an increase in symptoms of depression. Esketamine
helps create more of those connections between the brain cells. That may ease
symptoms of depression. Esketamine also has been shown to decrease suicidal
thoughts and tendencies more effectively and more quickly than other
antidepressants.

Esketamine
is given as a nasal spray, which allows it to enter the bloodstream and be delivered to the brain much
faster than is possible with a pill or other form of oral medication. That
swift delivery of the medication to the brain results in depression symptoms
beginning to ease within several hours, and many people report feeling
significant relief within one day.

A drawback to this medication is that, at this time, it can only be
administered in a clinical setting under the supervision of a health care
provider. That’s primarily because it’s classified as a Schedule III drug,
which means it has potential for patients to become addicted to it.

Also, research still is needed to determine how long a person can take
esketamine safely. Right now, standard dosing involves taking the medication
twice a week for about four weeks, then switching to once a week for another
four weeks, and then tapering off of it. The long-term effectiveness of esketamine is unclear, and long-term side effects are
not yet well understood.

A
number of short-term side effects of esketamine have been reported. They include
blurred vision, dizziness, drowsiness, nausea, vomiting, confusion about
identity or time and place, and a sense of detachment or disassociation from
one’s self or body.

Esketamine
is intended for adults who have tried at least two other antidepressant
medication therapies in adequate doses and for an appropriate amount of time
without a decrease in symptoms. This medication is not approved for children or
teens.

Although more study is necessary to fully understand how esketamine works and how long it can be used, its development is significant. It is the only fast-acting FDA-approved antidepressant available for hard-to-treat depression that works to ease depression symptoms, as well as suicidal thoughts and tendencies. For the right type of patient, there is great promise that esketamine can offer help for depression and lower the risk of suicide where other treatment options have failed. — Dr. Jennifer Vande Voort, Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota

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Tue, Jul 9 4:00pm · Mayo Clinic Q and A: Treating cervical spinal stenosis

a medical illustration of cervical spinal stenosis

DEAR MAYO CLINIC: I was diagnosed with cervical spinal stenosis after several months of neck pain, along with weakness, numbness and tingling in one arm and hand that kept getting worse. My health care provider recommends surgery, including spinal decompression and fusion. Is there a less-invasive treatment I could try before surgery?

ANSWER: Although it is possible that nonsurgical treatment may be reasonable for you, it sounds likely that surgery is in your best interest. That decision should be based on several factors, though, including the severity of your symptoms and whether the condition is affecting your spinal cord function.

Spinal stenosis happens when the main channel for the spinal cord — called the central spinal canal — or the openings for individual nerve roots in your spine become narrowed, causing pressure on nerve tissue. Spinal stenosis often is a result of aging and the formation of bone spurs from arthritis. Many people also are born with a narrow spinal canal, making them more prone to stenosis as they age.

When
spinal stenosis affects the spine in your neck, called the cervical spine, it can
affect a single arm (as in your case) if an isolated nerve root is compressed,
or it may affect the entire body if the spinal cord is involved. The spinal
cord is a vital structure because all the movement-related messages your brain
sends to your body, as well as all the sensory messages your body generates
below your neck, travel through the cervical spinal cord.

Cervical spinal stenosis often triggers pain; weakness;
numbness; or clumsiness in a hand, foot, arm or leg. It also can cause problems
with walking and balance. If left untreated, these symptoms may worsen, and
additional symptoms, such as bowel or bladder problems, may develop.

When spinal stenosis is suspected, a detailed medical history
and physical exam are necessary to find the cause of the symptoms. Imaging with
MRI typically is performed to confirm the diagnosis and localize the stenosis.
X-rays and CT scans usually are part of the evaluation, too, especially when
there is significant neck pain, a spinal deformity or history of trauma. An
electromyogram and blood tests also may be needed to confirm that symptoms are
a result of spinal stenosis.

Spinal stenosis treatments that don’t involve surgery include
self-care measures, medication, physical therapy and steroid injections. These treatments
often can relieve symptoms of mild spinal stenosis. But for individuals like
you who have complaints that grow steadily worse, surgery may be necessary to prevent
permanent spinal cord or nerve root damage, and relieve — or at least stabilize
— symptoms.

When surgery is necessary, the goal is to create more space for the nerve tissue. During spinal decompression, a surgeon removes the bone, ligament or disc that’s putting pressure on the spinal cord or nerve roots. Spinal fusion is performed if the spine is deformed or unstable, or if the spine’s alignment and stability are compromised by decompression.

Spinal fusion involves reinforcing the spine
by linking two or more of the vertebrae together with a bone graft. Metal
implants are used to maintain proper alignment and aid bone fusion. Spinal
fusion is needed more often when stenosis surgery is performed in the cervical
spine because that area tends to become unstable as a result of spinal
decompression.

In some cases, an artificial disc can be
inserted instead of performing a fusion to allow the vertebrae to continue to
move normally. But that approach is only appropriate for people who have a
well-aligned spine without instability or significant arthritis. Occasionally,
the cervical spine can be decompressed without fusion, especially when opening
it from the back instead of the front.

Surgery for spinal stenosis usually is not a matter of urgency, so take time to discuss your concerns with your health care provider. Together, you can review the goals, risks and benefits of surgery, and decide what’s best for you. Results of surgery for spinal stenosis generally are excellent when the operation is performed for the right indications and the correct procedure is chosen. — Dr. Bradford Currier, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Fri, Jul 5 11:00am · Mayo Clinic Q & A: Managing irritable bowel syndrome

a medical illustration of irritable bowel syndrome

DEAR MAYO CLINIC: Can irritable bowel syndrome be managed without medication, or is it typical that someone with this condition will need medication to control symptoms?

ANSWER: Medications can be used to treat irritable bowel syndrome, but not everyone who has this disorder needs medication. For some people, particularly those with mild symptoms, lifestyle adjustments, such as diet modification, stress management and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s
important to be aware that some abdominal issues are not associated with this
disorder and could signal another underlying problem. In particular, these
symptoms require prompt medical attention: blood in the stool, unexplained or
rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting,
significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and
symptoms tend to come and go over time. There’s no cure, but symptoms often can
be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome
say their symptoms are connected to food in some way.
However, because symptoms vary significantly from one person to another, it’s difficult
to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty
of fluids are beneficial for many people with irritable bowel syndrome. Avoid
foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and
vegetables such as cabbage, broccoli and cauliflower. Reducing or
eliminating gluten may ease diarrhea that’s related to irritable bowel
syndrome.

Research has shown that certain carbohydrates known
as fermentable oligosaccharides, disaccharides,
monosaccharides and polyols (FODMAP) can lead to abdominal pain, bloating and
gas in people with irritable bowel syndrome. These are found in certain fruits
and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk,
cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can
ease symptoms of irritable bowel syndrome. But because so many foods contain
these compounds, it can be difficult for patients to create such a diet on
their own. Finding a dietitian familiar with irritable bowel syndrome can help.
A dietitian can review a patient’s symptoms and dietary needs, discuss
recommended dietary changes, and develop an individualized food plan to ease
symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress
associated with an increase in symptoms. Using stress reduction techniques and
participating in activities that relieve stress, such as yoga and meditation,
may decrease stress-related flare-ups. Working with a therapist or counselor
experienced in stress management, mindfulness and behavior modification also
may help those with irritable bowel syndrome better control stress and ease
symptoms.

Regular exercise is recommended for
people who have irritable bowel syndrome. Daily physical activity relieves
stress, stimulates normal contractions of the intestines and promotes overall
wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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Tue, Jul 2 2:00pm · Mayo Clinic Q and A: Treating a carotid artery tear

a medical illustration of carotid artery dissection (tear)

DEAR MAYO CLINIC: My doctor told me I had a transient ischemic attack caused by an internal tear in my carotid artery. So far, I’m only being treated with a drug to prevent blood clotting. Shouldn’t the tear be fixed?

ANSWER: It’s not uncommon after an internal tear in the carotid artery to see if the tear heals on its own before having it surgically repaired. In the meantime, taking a blood thinning medication will make it less likely that a blood clot will form, which is the main concern for someone in your situation.

Your carotid arteries are among the main vessels that carry blood to your brain. You feel the carotid artery when taking a neck pulse. An artery tear, also called a “dissection,” occurs when layers of the interior arterial walls separate. With carotid dissection, the dissection rarely goes completely through the artery due to its elastic outer layers.

But it’s still a dangerous situation. Blood in the separated layers of the vessel wall can lead to blood clot formation. A clot can grow, creating an inward bulge that may partially or fully block blood flow of the artery. More commonly, clots can break free of the dissection area and block an artery supplying blood to a portion of the brain. The result is a stroke or a transient ischemic attack.

A transient ischemic attack is common but doesn’t always occur with carotid dissection. Other symptoms of carotid dissection include headaches and neck pain. Horner syndrome, a condition with an abrupt onset in which one pupil is smaller than the other and the eyelid may droop, also can be a sign of a carotid dissection. If you have a stroke due to carotid dissection, the first priority is emergency treatment of the stroke or transient ischemic attack.

Aside from that, the main danger of carotid dissection is a stroke — or a second stroke — caused by a blood clot. Thus, a drug to prevent clot formation is typically the go-to treatment for the first three to six months after diagnosis.

In
many cases, the dissection will seal itself off or heal over time. Follow-up
imaging often is performed to assess healing progress. Ask your health care
provider if this would be a good next step for your situation.

Surgery is sometimes warranted, such as when transient ischemic attacks or strokes continue despite drug therapy. A decision on the method of repair is individualized and is best made after a discussion with your health care provider. (adapted from Mayo Clinic Health Letter) — Dr. Brian Chong, Radiology, Mayo Clinic, Scottsdale, Arizona

Fri, Jun 28 1:00pm · Mayo Clinic Q and A: What causes low white blood cell count?

a medical illustration of bone marrow, neutrophils, basophils and eosinophils

DEAR MAYO CLINIC: What are the risks of having a low white blood cell count, and can birth control pills cause it? I never had this issue until I began taking birth control pills.

ANSWER: A low white blood cell count almost always is related to a decrease in a type of infection-fighting white blood cell called neutrophils. When you have a low level of neutrophils, the condition is known as neutropenia. There are many causes of neutropenia, and some medications can lead to this problem. Birth control pills, however, typically are not linked to a decrease in neutrophils.

Neutrophils are manufactured in
bone marrow, which is the spongy tissue inside some of your larger bones.
Neutrophils circulate through your body in blood, and they are stored in the
spleen. Anything that disrupts normal neutrophil production, increases destruction
of neutrophils or causes abnormal storage of neutrophils can result in
neutropenia.

While
all white blood cells help your body fight infection, neutrophils are important
for fighting certain infections, especially those caused by bacteria. Having
neutropenia can make you more vulnerable to infections. When the condition is
severe, even the normal bacteria in your mouth and digestive tract may trigger
serious illness.

For
most people who have neutropenia, though, the condition doesn’t cause any
obvious symptoms. Many find out about it when they have a blood test done for
another reason. But a single blood test showing low levels of neutrophils
doesn’t necessarily mean you have neutropenia. Those levels can vary day to
day, so if one blood test seems to indicate that you have neutropenia, you
should have the test repeated to confirm the diagnosis.

The
most common reason people develop neutropenia is as a side effect of
chemotherapy medication to treat cancer. But several other medications may
cause neutropenia, as well, including antibiotics. Although oral contraceptives
typically do not cause neutropenia, it would be worthwhile to discuss your
concerns about the pill with your health care provider and review other
medications you may be taking to see if one of them could be the cause of your
low white blood cell count.

Neutropenia also may be triggered by an underlying medical disorder, including viral infections — such as hepatitis B, hepatitis C, cytomegalovirus and HIV — and sepsis, an overwhelming bloodstream infection that uses up neutrophils faster than they can be produced. Vitamin deficiencies; enlarged spleen; and bone marrow cancers, such as leukemia, myelodysplastic syndromes and myelofibrosis, may cause neutropenia.

Adults who have rheumatoid arthritis or other autoimmune disorders can develop neutropenia as a complication of those conditions. Radiation therapy to the bone marrow may result in neutropenia, too. Rare causes of neutropenia in children include Kostmann’s syndrome, a congenital disorder involving low production of neutrophils, and myelokathexis, a congenital disorder involving failure of neutrophils to enter the bloodstream. In some cases, no cause can be found for persistently low white blood cell counts — a condition known as “chronic idiopathic neutropenia.”

Talk to your health care provider about what your low white blood cell count might mean. You may need additional tests or procedures to uncover the cause. In the meantime, because neutropenia can make it harder for your body to fight off germs, your health care provider might recommend ways to protect yourself, such as washing your hands more often or wearing a face mask. — Dr. Rajiv Pruthi, Hematology, Mayo Clinic, Rochester, Minnesota

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