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14 hours ago · Mayo Clinic Q and A: Mild hypothyroidism may not need treatment

a medical illustration of hypothyroidism

DEAR MAYO CLINIC: I recently was diagnosed with mild hypothyroidism that isn’t causing symptoms. My doctor says I don’t need treatment now, but she wants me to come back for regular checkups. Does hypothyroidism usually get worse over time? If it does, how is it treated?

ANSWER: For mild cases of hypothyroidism, not all patients need treatment. Occasionally, the condition may resolve without treatment. Follow-up appointments are important to monitor hypothyroidism over time, however. If hypothyroidism doesn’t go away on its own within several months, then treatment is necessary. If left untreated, this condition eventually may lead to serious health problems.

The thyroid gland is a small butterfly-shaped gland in the front of the neck that makes the hormones triiodothyronine, or T3, and thyroxine, or T4. Those hormones affect all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins. The amount of thyroid hormones your body makes is regulated by another hormone called thyroid stimulating hormone, or TSH, that’s produced by the pituitary gland.

Hypothyroidism
develops when the thyroid doesn’t make enough hormones. As a result, your
metabolism slows down. As thyroid activity slows, the level of T4 in your body
decreases, and the level of TSH increases to encourage the thyroid gland to
raise T4 production.

Some mild cases
of hypothyroidism, called subclinical hypothyroidism, are associated with an
elevated TSH while the T4 level stays within the normal range. At that point,
the condition may not produce any noticeable symptoms. But if the decrease in
T3 and T4 continues (referred to as overt hypothyroidism), it can affect many
bodily functions.

Common early
symptoms of hypothyroidism include unexplained weight gain, fatigue and low
energy. It also may cause dry skin, constipation, sensitivity to cold, a puffy
face, muscle weakness, hoarseness, and joint pain or stiffness.

Hypothyroidism can affect the heart by slowing the heart rate. It also has an effect on the body’s ability to effectively metabolize cholesterol. That can lead to a rise in blood cholesterol, increasing the risk of heart disease and cardiovascular events, such as heart attack and stroke.

Hypothyroidism can affect the brain and lead to difficulty with concentration and memory. It can affect the gastrointestinal system, too, causing less frequent bowel movements and constipation. In premenopausal women, hypothyroidism can affect the menstrual cycle and fertility.

Hypothyroidism is
diagnosed using a blood test that measures the level of thyroid hormones in the
body. That blood test is repeated at regular intervals to monitor thyroid
hormone levels. If hypothyroidism persists for more than a few months, treatment
often is recommended.

Standard treatment for hypothyroidism involves taking a daily oral medication called levothyroxine, a synthetic form of thyroid hormone. It restores the body’s hormone levels to normal, which reverses the signs and symptoms of hypothyroidism.

The amount of levothyroxine needed
varies from person to person. To
determine the right dosage for you, your health care provider will regularly
check your level of thyroid hormone. The first blood test is done six to eight
weeks after you start taking the medication. After that, blood levels generally
are checked every six months. Then, if the levels stay within the normal range
for several years, monitoring usually can switch to once a year. Some
medications, including nonprescription (over-the-counter) ones, can affect the
absorption or metabolism of thyroid hormone tablets, so you should notify your health
care provider whenever you begin or discontinue other medications.

It’s important to receive the correct amount of this
medication because too little levothyroxine won’t adequately control
hypothyroidism and too much can cause side effects, such as increased appetite,
insomnia, shakiness, and heart palpitations or an irregular heartbeat.

Work with your health care provider to set up a schedule for your follow-up visits. With careful monitoring and treatment, when necessary, hypothyroidism can be effectively controlled, eliminating symptoms and decreasing your risk of complications from this condition. — Dr. Robert C. Smallridge, Endocrinology, Mayo Clinic, Jacksonville, Florida

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4 days ago · Mayo Clinic Q and A: Bone marrow transplants save lives -- more donors are needed

a happy family in a living room; a woman hugging her mother, with her husband and children in the background

DEAR MAYO CLINIC: Who can be a bone marrow donor? What’s the process for becoming one?

ANSWER: In general, anyone between the ages of 18 and 60 who’s in good health can be a bone marrow donor. To be considered, all you need to do is join the national registry of potential donors.

People who need a bone marrow transplant often have blood disorders or diseases that affect bone marrow function, such as leukemia, lymphoma or aplastic anemia. A transplant becomes necessary for these people when their bone marrow cannot make enough healthy blood cells, or when the bone marrow has been invaded by a blood cancer.

Although the procedure is called a bone marrow transplant,
it’s actually the blood-forming stem cells within bone marrow that benefit the
transplant recipient. Bone marrow stem cells can develop into different things:
red blood cells that carry oxygen to the body, platelets that help blood clot,
or white blood cells that help fight infection.

An ideal bone marrow donor should be HLA-matched to the
transplant recipient. HLA stands for human leukocyte antigens — markers on the
surface of the cells in the body. The immune
system uses these markers to recognize which cells belong in the body and which
do not. A test is performed to identify eight of these markers. To
match, all eight of those HLAs in the donor need to be identical to those of
the recipient.

Siblings usually are tested first as potential donors. If no sibling matches, then the care team turns to the registry run by the National Marrow Donor Program — a federally funded nonprofit that keeps a database of volunteers willing to donate. To join, go to Be the Match and follow the instructions. Once you register on the website, you’re sent a kit that you can use to collect cell samples from inside your cheek. After you do that, you send the kit back. There’s nothing else you need to do unless you’re identified as a potential match. 

If you’re selected as a donor from the registry, you
receive a phone call asking if you’re willing to come to a transplant center
for evaluation. That evaluation involves a review of your medical history, a physical
exam and blood tests. If you are approved to donate based on the evaluation,
the transplant goes forward.  

In most cases, stem cells for a transplant are collected from
blood. For that procedure, first you receive an injection of a medication that
stimulates your bone marrow to produce a large supply of extra stem cells.
Several days later, stem cells are collected from your blood. Blood is removed from
one of your arms and circulated through a machine that separates out the stem cells.
After that, the blood is returned to your body through your other arm.

Less common is a
procedure where stem cells are collected directly from bone marrow. That’s more
complex because it’s done in an operating room and requires a short hospital
stay. The donor is given general anesthesia, and needles
are inserted through the skin, into the bone to draw the marrow out. The
procedure usually lasts one to two hours, and most donors go home the same day.
Full recovery takes about two to three days.

Becoming a bone marrow donor is a selfless act of generosity. Currently, about 5,000 bone marrow transplants are done in the U.S. each year. That’s far below the number of people who could benefit from these transplants if a donor could be found for all of them. The more people who register as potential bone marrow donors, the better the chances of finding a suitable donor for all those in need. Please consider signing up at Be the Match today. — Dr. Ernesto Ayala, Hematology/Oncology, Mayo Clinic, Jacksonville, Florida

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Tue, Sep 10 1:00pm · Mayo Clinic Q and A: Fecal transplant for treatment of Clostridium difficile

a portrait of a serious-looking young woman

DEAR MAYO CLINIC: I’ve had recurring instances of C. diff. that normally is treated with antibiotics. I have read about fecal transplant as a potential treatment. How does this work?

ANSWER: Clostridium difficile, also known as Clostridioides difficile and often called C. diff., is a bacterium that causes gastrointestinal symptoms ranging from diarrhea to life-threatening inflammation of the colon. In many cases, antibiotics are an effective treatment. If the infection recurs after two or three rounds of antibiotics, a fecal transplant may be an appropriate alternative.

C. diff. bacteria are found throughout the environment
— in soil; air; water; human and animal feces; and food products, such as
processed meats. C. diff. is now the most common infection affecting hospital
patients. The most common risk factors for C. diff. are taking antibiotics,
being older than 65, and being in a hospital or other health care facility.

Taking antibiotics can lead to C. diff. infection by disrupting the healthy balance of bacteria that’s normally present in your intestines. The intestines contain about 1,000–2,000 different kinds of bacteria. Many of them help protect your body from infection. When you take antibiotics to treat an infection, such as for a sinus, urinary tract or kidney infection, those drugs destroy many of the helpful bacteria in the gut along with the bacteria causing the infection. Without enough healthy bacteria to keep it in check, C. diff. quickly can grow out of control.

While antibiotics can contribute to C. diff.
infection, some antibiotics, such as vancomycin or fidaxomicin, also can
effectively eliminate C. diff. infection. In about 75% to 80% of people who get
C. diff., one round of antibiotics is enough to get rid of the infection and prevent
it from recurring.

For the other 20%
to 25%, a recurrence happens because the antibiotics again take out too much of
the good bacteria with the C. diff. Once C. diff. infection recurs, the chances
of it returning again after a second round of antibiotics is 40%. After three
or more occurrences, the risk of another infection rises to 60%.

One way to break the cycle of recurrent infections is to restore the natural balance of healthy bacteria in the intestines. This can be done through a process known as fecal microbiota transplantation. The procedure — considered investigational at this time — restores healthy intestinal bacteria by placing another person’s processed stool into the colon of a person affected by recurrent C. diff. infections.

Potential donors
need to go through a strict screening process that involves an extensive list
of medical history questions before they can be approved as donors. They also
need to undergo comprehensive testing for infections in the blood and stool.

Once a donor is
approved, his or her stool is collected, mixed
with saline water and filtered. Then the stool mixture is transferred into the
patient’s colon, most commonly via a colonoscope — a thin, flexible tube with a
small camera at the tip.

The procedure is
considered to be generally safe. The Food and Drug Administration, however,
recently released a report about two patients who underwent fecal transplantation
and contracted drug-resistant infections. It’s unclear if these cases were
related to fecal transplants for C. diff. or if the fecal transplants were done
for another condition. More needs to be learned about those incidents, but they
speak to the importance of carefully and methodically screening donors.

Clinical trials to study fecal transplants are underway at medical centers across the country, including Mayo Clinic. So far, research has shown that this procedure can reduce the risk of contracting another C. diff. infection in people who have had three or more of the infections. In this patient population, the risk has been reduced from 60% down to less than 15%. With these findings in mind, this treatment appears to show significant promise in providing a more effective treatment option for recurrent C. diff. infections. — Dr. Sahil Khanna, Gastroenterology, Mayo Clinic, Rochester, Minnesota

Fri, Sep 6 2:30pm · Mayo Clinic Q and A: Reduce your risk of side effects from anesthesia

a middle-aged man in a exam room with a medical staff person taking information

DEAR MAYO CLINIC: I’m scheduled to have surgery next month. I’ve have never had general anesthesia before, and I’m nervous about it. I’ve heard of people getting sick and having other problems as result of anesthesia. Is there anything that can be done to make sure that doesn’t happen to me?

ANSWER: To help ensure a smooth surgical experience, ask to meet with your anesthesiologist before your procedure. She or he can review your medical history, and discuss your current health status and concerns. By having this conversation, and following the guidelines you’re given about eating, drinking and taking medications before your procedure, you can significantly reduce your risk of complications and side effects due to anesthesia.

It’s natural to
be nervous. But as you consider your upcoming surgery, keep in mind that
anesthesia is safe overall. The risk of serious complications happening as a
result of anesthesia is much less than 1%, and the overall mortality risk from
an anesthetic is less than 1 in 100,000. The risk of less serious side effects,
such as nausea, vomiting or otherwise feeling ill after an anesthetic, also is
low, with only about 1% to 5% of people experiencing those issues when preventive
measures are taken before surgery.

Many
anesthesiologists want to meet with their patients in person before a
procedure. That’s especially true for patients undergoing a procedure that
presents higher risks for complications. Part of the purpose of that discussion
is to make sure that there are no medical issues that will interfere with the
patient’s ability to safely receive anesthesia.

Tell your
anesthesiologist about any existing medical conditions you have now or have had
in the past, as well as any medications or supplements that you take. Using
your medical history as a guide, the anesthesiologists
can tailor the anesthetic you receive
to your circumstances. While the delivery of anesthesia in today’s medical
practice follows a standard approach, it’s typically individualized for each
patient. The more information and details you can provide about your health
history and current health status, the better.

Although it doesn’t apply in your situation
because you haven’t had anesthesia before, it’s important for patients to tell their
anesthesiologist if they have had unpleasant side effects or reactions to
anesthesia in the past. If so, steps often can be taken to minimize or prevent
those problems from recurring.

During the
conversation with your anesthesiologist, you also should review the
restrictions for eating, drinking and taking medication before your procedure. The
general rule is to avoid consuming any solid food eight hours prior to the
scheduled procedure, according to guidelines from the American Society of
Anesthesiologists. But the specifics for your surgery could vary.

The amount of
liquid you may have and whether or not you should take your usual medications the
night before or the morning of your surgery will be determined in conjunction
with your anesthesiologist and surgeon. In some cases, preparing to receive
anesthesia may involve taking certain medications prior to your procedure.

By closely following all the directions that you receive from your care team about preparing for surgery, you’ll reduce your risk of experiencing complications and side effects as a result of anesthesia. If you have questions or concerns, you should talk to your anesthesiologist about them. The anesthesia care team can ease your nervousness and help you feel more comfortable. Their goal is to make the surgical experience as pleasant and safe as possible for each patient. — Dr. Alberto Ardon, Anesthesiology, Mayo Clinic, Jacksonville, Florida

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Tue, Sep 3 5:00pm · Mayo Clinic Q and A: Pain after knee replacement surgery

a medical illustration of a nerve ablation procedure for pain after knee replacement

DEAR MAYO CLINIC: It has been months since I had knee replacement surgery, but my knee is still hurting. Can anything be done at this point, or does the surgery just not eliminate pain in some patients?

ANSWER: Although it’s uncommon, a small percentage of patients continue to have chronic knee pain after knee replacement surgery. But when that happens, you don’t have to just put up with the pain. Have your situation evaluated. Several additional treatment options may ease chronic knee pain after knee replacement.

Knee replacement surgery, also known as knee arthroplasty, is one of the most common orthopedic surgeries performed today. It is most often used to repair joint damage caused by osteoarthritis or rheumatoid arthritis that causes severe knee pain and makes it hard to perform daily activities.

During knee replacement, a surgeon
cuts away the damaged bone and cartilage from your thighbone, shinbone and
kneecap, and replaces it with an artificial joint. For most people, knee
replacement significantly improves mobility and relieves knee pain. But in some
patients, the pain persists after surgery.

Your first step in dealing with
ongoing knee pain in this situation is to make an appointment to see the
surgeon who performed your knee replacement. He or she can evaluate your knee
and check for possible complications from the surgery, such as an infection or
a problem with the artificial joint.

In the past, if a surgeon didn’t
uncover potential issues that could cause the ongoing pain at that point,
patients were left with few treatment options to reduce the pain, other than
taking pain medication. Over the past several years, however, there have been
some new developments to treat pain after knee replacement surgery.

The first is a minimally invasive
procedure where the nerves that carry pain information away from the knee are
ablated, or destroyed, with the use of a special needle. Studies of this
approach are showing promising results for pain reduction in people with
chronic knee pain who are not good candidates for surgery. This approach also
is helping those who have had surgery, but knee pain remains a problem, as in
your case.

Another minimally invasive
procedure that has shown some benefit for chronic knee pain after surgery is
the use of dorsal root ganglion, or DRG, stimulation. The dorsal root ganglion
is a collection of nerves near the spinal canal that can be stimulated to
provide pain relief in certain conditions.

Results of multiple research
studies published in medical literature have shown this to be a promising approach
for the relief of chronic pain. The DRG stimulator is a device that’s implanted
beneath the skin that connects to multiple leads. Those leads conduct
electricity to the area that requires the stimulation. The electrical signals
interfere with the transmission of pain signals to the brain, and that results
in a decrease in chronic pain.

Although these new interventions show promise in reducing chronic knee pain after knee replacement surgery, they do not work for everyone. If you’re interested in learning more, ask your surgeon for a referral to a pain clinic for a full evaluation and consultation. A pain medicine specialist can review your condition and discuss what options might work best in your individual situation. — Dr. Markus Bendel, Pain Clinic, Mayo Clinic, Rochester, Minnesota

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Fri, Aug 30 11:01am · Mayo Clinic Q and A: Hospitals are always in need of new blood donors

a graphic illustration of a bag of donated blood, with the tubing forming a valentine heart

DEAR MAYO CLINIC: I’ve never donated blood before because I’m nervous that I’ll faint when I see the needle or blood. Is there anything that I can do to prevent that from happening?

ANSWER: It’s common to be nervous about donating blood if you’ve never done it before. But blood donation center staff members are skilled at making the experience as smooth as possible, and your donation will make a difference. Hospitals are always in need of new blood donors.

It is estimated that less than 3% of Americans donate blood. That’s a concern because many people in the U.S. need blood every day. Some may need blood during surgery. Others may require blood transfusions after an accident. Still others have a disease that makes it necessary for them to receive red blood cells or other blood components. In some cases, receiving donated blood may be the difference between life and death for these people.

Fear of fainting, needles
and seeing blood are all reasons people cite for avoiding blood donation. But
these worries often turn out to be much less daunting than people anticipate.

For example, the
needlestick for blood donation is similar to what you feel when you get a
vaccination or have blood drawn. Also, you do not have to watch as the needle
is inserted, and you do not have to see the blood. Many blood donation centers
offer TVs or small video screens that you can use during a donation to help
keep your mind occupied while you are donating.

Fainting before,
during or after blood donation is rare. Studies suggest that drinking about 16
ounces of water and having a salty snack before you donate may lower your risk
of fainting. Eating a healthy meal before you donate blood also makes it less
likely that you will have other side effects, such as dizziness,
lightheadedness or nausea, after you donate.

As you consider
donating blood, be assured that the process is safe. A new sterile collection
set, including the needle, is used for each donor. That means there is no risk
of getting an infection or disease by donating blood. Most healthy adults can
donate about a pint of blood without any health risks. Your body replaces the
fluids it loses during a blood donation within about 24 hours. The red blood
cells that you donate are replaced in your body within several weeks.

When you arrive at
the blood donation center, you are given a confidential medical history form to
fill out. You’ll also have your blood pressure, pulse and temperature taken. A small sample of blood taken from a finger-stick is
used to check your hemoglobin, the part of your blood that carries oxygen. If
your hemoglobin concentration meets eligibility criteria and you meet all the
other screening requirements, you can donate blood.

Finally, keep in mind that there is no substitute for human blood. One donation of whole blood can help at least three people. By donating blood, you are offering a lifesaving gift. — Dr. Manish Gandhi, Transfusion Medicine, Mayo Clinic, Rochester, Minnesota

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Fri, Aug 23 12:01pm · Mayo Clinic Q and A: Worrying about your health -- what's normal, what's too much

Doctor and worried female patient at office during consultation

DEAR MAYO CLINIC: What is the difference between occasionally worrying that something is wrong with me and somatic symptom disorder? How can I stop worrying that I’m not as healthy as my doctor says?

ANSWER: A little worry over your health is normal. But for some people, fear and concern over symptoms can get out of control. These people can become convinced that they have a particular illness, even when test results are normal. These are common features of somatic symptom disorder, a mental health concern that’s thought to affect roughly 5% of the population.

People with
somatic symptom disorder develop an excessive preoccupation with physical
symptoms, including pain or fatigue, that results in significant emotional
distress or disruptions to daily living. Stress responses to these uncomfortable
symptoms, such as dizziness, heart palpitations, nausea, chest pain or
shortness of breath, may further amplify worries. These symptoms may or may not
be attributed to a diagnosed medical condition.

The thoughts,
feelings and behaviors of somatic symptom disorder may manifest in several
ways, including constant worrying about illness; interpreting normal sensations
as potentially threatening or harmful; and fearing that symptoms are serious or
life-threating, despite exams or testing that suggest otherwise. It’s also
common for people with somatic symptom disorder to feel that medical evaluations
or treatments haven’t been adequate. Repeatedly checking the body for
abnormalities, researching symptoms online, and frequent health care visits or
testing that doesn’t relieve concerns — or makes them worse — also are signs of
the disorder.

Women are more likely to show signs of somatic symptom disorder, as are people with more than one health condition. People with a history of childhood illness, sexual abuse or other trauma are at increased risk of developing the disorder, as are those with depression or an anxiety disorder.

Several related disorders share common features with somatic symptom disorder, including illness anxiety disorder (formerly known as hypochondriasis) and functional neurologic disorders, which consist of neurological symptoms that can’t be explained by a neurological disease or other condition.

If you’re
experiencing unusual symptoms, it’s important to be evaluated by a health care
provider to rule out any medical problems. Your health care provider can perform
a comprehensive examination that focuses on your specific concerns. However,
keep in mind that evaluations may need to be limited, as repeated or extensive
testing may worsen your level of distress.

A questionnaire
may be used to assess the presence of somatic symptoms. Regardless of whether
an identifiable medical diagnosis is present, if you’re in distress, you may be
given a questionnaire to evaluate your level of health anxiety. Or you may be referred
to a psychologist or psychiatrist.

The symptoms of
somatic symptom disorder and related disorders often come and go. But recovery
is possible — studies suggest that 50% to 75% of people with somatic symptom
disorder show eventual improvement.

The main goal of managing these disorders is to improve your ability to cope with your symptoms, tolerate uncertainty and reduce health anxiety. The most effective treatment is psychotherapy, particularly cognitive behavioral therapy. Individual or group cognitive behavioral therapy can help you change behaviors, such as learning how to resist the urge to do excessive reassurance seeking. Therapy also can provide social support and challenge any disease-related worries and beliefs, such as learning alternate ways to interpret unusual and uncomfortable physical sensations. Help also can be given to restore your work, social or volunteer activities.

Antidepressants such as amitriptyline (Endep) and fluoxetine (Prozac or Sarafem) may be recommended for these disorders. However, they have shown only limited benefit. At Mayo Clinic, we recommend that antidepressant and anti-anxiety drugs be used to treat only the mood or anxiety-related disorders that often coexist. (adapted from Mayo Clinic Health Letter) — Dr. Craig Sawchuk, Psychology, Mayo Clinic, Rochester, Minnesota

Fri, Aug 16 10:00am · Mayo Clinic Q and A: Treating persistent anal itching

a serious-looking middle-aged man seated at a work space, with his eyes closed and his head in his hands

DEAR MAYO CLINIC: I’ve had anal itching for some time. It’s an embarrassing topic that I’m reluctant to bring up with my doctor. Do you have any self-care tips?

ANSWER: Anal itching is an intense itching inside and around the opening of the anus. It’s potentially embarrassing, but bringing it up with your health care provider is recommended, especially if it has become persistent. That’s because there are a number of possible causes with specific treatments that likely will help. These causes include hemorrhoids, anal fissures, skin diseases, infections, fecal seepage and ongoing diarrhea. At the most serious end of the spectrum, cancer occasionally can cause these symptoms.

Less
serious causes of anal itching, also called pruritis ani, may include dry skin,
irritation from wiping too hard and too often, use of soaps or frequent cleaning
of the area, and excess moisture due to sweating.

When no specific cause of anal itching is found, self-care steps successfully eliminate itching about 90% of the time. The first step is to gently clean the area with water and a mild, fragrance-free soap after each bowel movement. This may involve a quick shower, or using a soft washcloth or squeeze bottle. Avoid scrubbing, or using moist towelettes or wipes, abrasive cloths, or moist toilet paper.

Next,
pat the area dry with a cloth, or dry the area with a hair dryer on the
fan-only setting. Using the heat setting could further irritate this delicate
area.

Wear
nonconstricting cotton underwear to keep the area cool and dry. Apply zinc
oxide or petroleum jelly to the anal area to provide a moisture barrier. If
necessary, a cream of 1% hydrocortisone applied two to three times a day can be
used for a week or two to stop itching.

Finally,
avoid scratching the area as much as possible to minimize further irritation.
It may even be necessary to wear cotton gloves to bed so that you don’t
unknowingly scratch the area while sleeping.

Although anal itching may be a topic that’s uncomfortable to bring up to your health care provider, it is a common condition, and there are treatments that can give you some relief once the cause of the itching is determined. (adapted from Mayo Clinic Health Letter) — Dr. Stephanie Hansel, Gastroenterology, Mayo Clinic, Rochester, Minnesota