Treating pancreatic cancer
Pancreatic cancer is one of the deadliest cancers. Even with aggressive treatment, the prognosis is poor. Early detection is uncommon, it tends to spread quickly and recurrence is likely. In addition, pancreatic cancer tends to be relatively resistant to chemotherapy. Learn more from Dr. Timothy Moynihan, an emeritus Mayo Clinic medical oncologist.

EXPERT ANSWERS
Can a slow metabolism cause weight gain?
Metabolism is the process by which your body converts what you eat and drink into energy. Although there is such a thing as a slow metabolism, it's rare. And it's usually not what's behind being overweight or obese. Learn more from Dr. Donald Hensrud, a Mayo Clinic preventive medicine specialist.

Is aortic calcification a sign of heart disease?
Aortic valve calcification is a condition in which calcium deposits form on the aortic valve in the heart. These deposits can narrow the opening of the aortic valve. Severe narrowing can reduce blood flow through the aortic valve — a condition called "aortic valve stenosis." Aortic valve calcification may be an early sign that you have heart disease — even if you don't have any other heart disease symptoms. Learn more from Dr. Francisco Lopez-Jimenez, a Mayo Clinic cardiologist.

PLUS ADDITIONAL HIGHLIGHTS
Medication errors: Cut your risk with these tips
First aid for burns
Narcolepsy
7 signs you might have endometriosis

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HEALTH TIP OF THE WEEK
Quit smoking: Ask for help
Don't be afraid to ask your health care provider for help to stop smoking. Treatments that can lessen cravings include nicotine replacement therapies, which can be administered with a skin patch, lozenges, gum, inhalers and nasal sprays. These items are meant to be used starting on your quit day. Other non-nicotine medication can help reduce nicotine withdrawal symptoms by mimicking how nicotine functions in your body. Treatment with these drugs should begin one to two weeks before your quit day.

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Acute flaccid myelitis: What is it, and can it be prevented?
Acute flaccid myelitis is a rare condition that affects the nerves in the spinal cord and can cause sudden weakness in the arms or legs. It tends to happen mainly in children. Recently, cases have been reported in children across the U.S. Learn more from Dr. James Steckelberg, a Mayo Clinic infectious diseases specialist.

EXPERT ANSWERS
Does alcohol and tobacco use increase diabetes risk?
Alcohol and tobacco use may increase your risk of developing Type 2 diabetes. And the more you drink or smoke, the greater the risk. Learn more from Katherine Zeratsky, a Mayo Clinic registered dietitian nutritionist.

What's the difference between bacterial and viral infections?
Many illnesses, including pneumonia, meningitis and diarrhea, can be caused by either bacteria or viruses. And in some cases, it may be difficult to determine which is causing your symptoms. Perhaps the most important distinction between bacteria and viruses is that antibiotic drugs usually kill bacteria, but they aren't effective against viruses. Learn more from Dr. James Steckelberg, a Mayo Clinic infectious diseases specialist.

PLUS ADDITIONAL HIGHLIGHTS
Broken collarbone
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Narcolepsy
Sudden cardiac arrest

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Rx check: Do you know what you're taking?
When your health care provider prescribes a medication, make sure you know the basics. Ask your health care provider or pharmacist:

1. What are the brand and generic names of the medication?
2. Why do I need the medication?
3. How soon can I expect results?
4. When should I take the medication and for how long?
5. What are the side effects?
6. Does it interact with other medications or with foods?

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ANSWER: The sleep disorder narcolepsy is a lifelong condition often treated with potent medications. Because of that, it is essential that anyone suspected of having narcolepsy be carefully evaluated by a sleep medicine specialist to arrive at a diagnosis. I recommend your daughter seek testing with such a specialist. If her diagnosis of narcolepsy is confirmed, the sleep medicine specialist can work with her to create a treatment plan that best fits her needs.

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. About 70 percent of people with narcolepsy also experience a symptom known as cataplexy — sudden muscle weakness that follows a positive emotional reaction, especially laughter.

Symptoms of narcolepsy often begin between the ages of 10 and 30. The exact cause of this disorder is not known. But it is usually connected to a brain chemical called hypocretin that helps regulate wakefulness and sleep. Many people with narcolepsy have low levels of hypocretin in their spinal fluid.

Accurately diagnosing narcolepsy requires evaluation by a sleep medicine specialist. Testing for the disorder includes a polysomnogram. For this test, your daughter would need to stay overnight at a sleep center. The polysomnogram measures a variety of signals during sleep using electrodes placed on the scalp and elsewhere on the body. The test measures the electrical activity of the brain and heart, monitors breathing, and measures muscle and eye movement during sleep.

Testing also includes a set of daytime nap studies known as a multiple sleep latency test. It would measure how long it takes your daughter to fall asleep during the day. In addition to these tests, a sleep medicine specialist would talk with your daughter about her sleep history and habits. She also may be asked to keep a detailed record of her sleep patterns for several weeks.

If testing verifies your daughter’s narcolepsy diagnosis, then her specialist can help develop an appropriate treatment plan. In many cases, treatment usually starts with a mild stimulant such as modafinil. If that does not provide enough symptom control, then a stronger stimulant, such as methylphenidate or amphetamines, may be needed. These stronger drugs are typically given in controlled-release form to avoid peaks of over-stimulation and the jitteriness you mention.

If the stimulants are not effective, or if their side effects are not acceptable, then an alternative for some people is the medication sodium oxybate. This medication can be highly effective for cataplexy. It usually helps improve nighttime sleep, as well, which is often poor in people who have narcolepsy. There can be serious side effects with this drug, however, including nausea, bed-wetting and sleepwalking.

The typical goal of narcolepsy treatment is to provide about an 80 percent improvement in alertness with minimal side effects. Once a person with narcolepsy is on a stable dose of medication with symptoms acceptably under control, the primary care provider can then take over further management with help as needed from the sleep medicine specialist.

Although there is no cure for narcolepsy, treatment that controls the disorder’s symptoms often can be quite effective. It allows most people with narcolepsy to lead productive and satisfying lives. — Michael Silber, M.B., Ch.B., Center for Sleep Medicine, Mayo Clinic, Rochester, Minn.

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Narcolepsy

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