Professional Documents
Culture Documents
Mayo Clinic Health Newsletter August 2008
Mayo Clinic Health Newsletter August 2008
To o l s f o r H e a l t h i e r L i v e s
VASCULITIS
Sling procedure
Blood vessel inflammation takes
many forms.
DUAL-ENERGY X-RAYS
Two is better than one.
THYROID NODULES
What’s that lump in your throat?
Visit us on the Internet at the address listed to the left, where you’ll find more
www.HealthLetter.MayoClinic.com
health information, great offers and more!
■ The bladder monly used, especially in the last mesh is used, and healing is usu-
■ The narrow tube through which decade. Some sling procedures are ally much faster, taking just a week
urine is eliminated (the urethra) considered minimally invasive. De- or two. However, there can be prob-
■ The thickened muscle where pending on the facility and surgeon, lems associated with mesh healing
the bladder connects to the urethra some can be performed on an out- and the vaginal incision, but these
(the bladder neck) patient basis with local anesthesia. complications are uncommon.
In women, the risk of stress in- Basically, strips of tissue or syn- Regardless of which material is
continence increases with age. It’s thetic mesh are used to construct chosen, with the sling’s support, the
more common in women who are a pelvic sling or hammock under urethra has a backstop of sorts to
obese and in women who have the bladder neck and the urethra. help close the urethra so that urine
given birth vaginally multiple times. The sling is inserted through a small doesn’t leak out even if you sneeze
Although stress incontinence vaginal incision and then directed or cough. If local anesthesia is used,
can be distressing, surgical treat- under the middle part of the urethra. your surgeon may ask you to cough
ment is rarely needed on an urgent The ends of the sling are then in order to help determine the right
basis. Once you have an accurate brought through each of two small sling tension. Some sling techniques
diagnosis of the problem, it’s impor- incisions — either just above the may allow for adjusting sling ten-
tant to carefully consider your sur- pubic bone or in the groin area. sion after surgery. Ask your surgeon
gical treatment options. Choices for sling materials in- about the various sling procedures
clude using your own tissue, a syn- available and which might be best
Added support thetic mesh or tissue from animal suited for you.
The goal in treating stress incon- sources. Using your own tissue ■ Bladder neck suspension pro-
tinence is to strengthen the urethra’s avoids some complications related cedures — These types of proce-
support system. Several procedures to foreign materials, but it also in- dures also provide support to the
do just this. Most of them fall into volves making an additional abdom- urethra and bladder neck, but use
two main categories — sling pro- inal incision to acquire that tissue.
MAYO CLINIC HEALTH LETTER
cedures and bladder neck suspen- As a result, recovery time is longer
sion procedures. and a catheter may be needed for Managing Editor Medical Editor
Aleta Capelle Robert Sheeler, M.D.
■ Sling procedures — These two to three weeks. No abdominal
Associate Editors Associate Medical Editor
procedures are much more com- incision is needed when synthetic Carol Gunderson Amindra Arora, M.D.
Joey Keillor
Editorial Research
Medical Illustration Deirdre Herman
Possible concerns after surgery Michael King
Proofreading
Customer Service Miranda Attlesey
As with surgery of any sort, ■ Difficulty passing urine Manager Donna Hanson
Ann Allen
surgical procedures for urinary and incomplete emptying of Administrative Assistant
Deborah Adler
incontinence aren’t risk-free. the bladder, although usually
Potential complications — temporary. In rare cases, an EDITORIAL BOARD
although uncommon — additional sling-loosening Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.D., Gastroenterology and Hepatology; Brent
include bleeding, wound procedure may be required. Bauer, M.D., Internal Medicine; Tracy Berg, R.Ph.,
infection and organ injury. A ■ Development of overac- Pharmacy; Julie Bjoraker, M.D., Internal Medicine;
Bart Clarke, M.D., Endocrinology and Metabolism;
urinary tract infection (UTI) tive bladder, which in some William Cliby, M.D., Gynecologic Surgery; Diane
may develop in the early post- cases can lead to an urgent Dahm, M.D., Orthopedics; Mark Davis, M.D.,
Dermatology; Timothy Hobday, M.D., Oncology; Lois
surgery time frame, especially if need to urinate (urge inconti- Krahn, M.D., Psychiatry; Michael Mahr, M.D.,
Ophthalmology; Lance Mynderse, M.D., Urology;
temporary catheterization is nence). If severe, this can Suzanne Norby, M.D., Nephrology; Robert Sheeler,
needed. Antibiotics are general- actually lead to loss of urine M.D., Family Medicine; Phillip Sheridan, D.D.S.,
Periodontics; Peter Southorn, M.D., Anesthesiology;
ly effective in treating a UTI. before you’re able to reach the Ronald Swee, M.D., Radiology; Farris Timimi, M.D.,
Cardiology; Aleta Capelle, Health Information. Ex-
Beyond these immediate bathroom. officio: Carol Gunderson, Joey Keillor.
problems, you need to be ■ Difficult or painful inter-
Mayo Clinic Health Letter (ISSN 0741-6245) is published
aware that surgery for urinary course. monthly by Mayo Foundation for Medical Education
incontinence may result in Before surgery, ask your and Research, a subsidiary of Mayo Foundation, 200
First St. SW, Rochester, MN 55905. Subscription price
urinary and genital problems surgeon about the risks and is $27 a year, which includes a cumulative index
published in December. Periodicals postage paid at
that previously didn’t exist. benefits associated with the Rochester, Minn., and at additional mailing offices.
These may include: different types of surgery. POSTMASTER: Send address changes to Mayo Clinic
Health Letter, Subscription Services, P.O. Box 9302,
Big Sandy, TX 75755-9302.
These problems develop gradu- ■ Getting daily exercise — This including tiotropium (Spiriva), have
ally over the years and produce few increases the efficiency of your mus- a similar effect on symptoms, but
signs and symptoms in early stages. cles and circulatory system. haven’t been proved to improve lon-
If you’re a smoker, a breathing test ■ Using short-acting broncho- gevity. Recently, concern was raised
called spirometry and a chest X-ray dilators — These help relax muscles about stroke risk among those tak-
can determine if you’re on your way around your airways that can go into ing tiotropium. The Food and Drug
to developing COPD, even before spasm, helping to relieve coughing Administration announced a cau-
symptoms develop. And, don’t dis- and making breathing easier. tion for the drug, but it’s not known
miss a chronic cough or a change ■ Avoiding irritants — In addi- whether the benefits of tiotropium
in your breathing as a case of smok- tion to stopping smoking, you’ll outweigh this small risk. A major
er’s cough or as being out of shape. need to avoid lung irritants such as study due this fall should answer
They may be early signs of COPD. secondhand smoke, air pollution, questions about tiotropium.
wood smoke, strong odors or dust. ■ Corticosteroids — For more
Easing your breathing ■ Maintaining a well-balanced severe and uncontrolled COPD, a
Slowing COPD progression re- diet —Maintaining a healthy weight corticosteroid inhaler may be added.
quires eliminating exposure to the is best. Being too thin may make you ■ Supplemental oxygen — If
cause. For most, this means stop- frail, while being overweight in- normal breathing doesn’t get enough
ping smoking. If you have mild to creases shortness of breath. oxygen into your blood, you may
moderate COPD, one study found Additional therapies for moder- need to use a device that delivers
that 11 years after stopping smok- ate to more severe COPD include: oxygen to your lungs.
ing, risk of developing severe COPD ■ Long-acting bronchodilators Because these therapies are a lot
dropped from 18 to 3 percent. — Long-acting beta-agonist bron- to manage, many people benefit
Strategies that can help mild to chodilators, including salmeterol from a comprehensive pulmonary
moderate COPD include: (Serevent) and formoterol (Foradil), rehabilitation program.
■ Avoiding respiratory infections can improve life span, lung function If you have advanced emphyse-
— This involves getting the pneu- and quality of life, and can reduce ma, a procedure in which diseased
monia vaccine and annual flu vac- risk of life-threatening infections portions of lung are surgically re-
cinations, and taking basic sanitary (exacerbations) and hospitalization. moved to allow remaining lung tis-
precautions such as washing your Another class of bronchodilators sue to work more effectively may be
hands frequently. called long-acting anti-muscarinics, considered. ❒
ed factors — consuming too many genetic disorders body in a moderately strenuous way
■ Taking certain medications, for about 30 minutes a day can sig-
calories, inadequate exercise, and
being overweight or obese. That’s such as thiazide diuretics, beta nificantly lower triglyceride levels,
why, for most, weight loss from blockers or hormone therapies particularly in men.
■ Alcohol, which for some peo-
changes in diet and improved exer-
cise habits are the first steps toward ple can dramatically raise triglyc- Drugs that can help
lowering triglyceride levels. If that’s erides independent of other factors. If healthy lifestyle changes don’t
not enough, medications can help. sufficiently lower your triglyceride
Lowering levels levels, adding supplemental niacin
What are triglycerides? If you’re found to have elevated or high-dose fish oil to the treatment
Any time you consume calories, triglyceride levels, your doctor will mix is often effective. Drugs in the
your digestive system makes triglyc- likely look for triglyceride-raising statin class — often prescribed to
erides, which are an important source side effects of any drugs you’re tak- lower LDL cholesterol — can have
of energy for your body. Once your ing — and test for and treat diseases, a modest positive impact on triglyc-
immediate energy needs have been such as type 2 diabetes, that may be eride levels. Drugs known as fibrates
met, extra triglycerides can be stored underlying or contributing factors. — including fenofibrate (TriCor, oth-
in your body’s fat cells for later use. Still, most people benefit from ers) or gemfibrozil (Lopid, others)
Elevated triglyceride levels most lifestyle modifications including: — can help lower triglyceride lev-
commonly mean you’re consuming ■ Moderating your diet — els, but haven’t been shown to
more calories than you burn — par- You’ll likely need to consume fewer improve longevity. ❒
A fracture in time
Your spine is a series of bones
From a hands-and-knees position,
(vertebrae) and springy cartilage
raise one leg at the hip, keeping your
disks between the vertebrae. These knee bent and without changing the
are held in place by tough, fibrous position of your trunk. Maintain
ligaments and supported by back this position for five seconds.
muscles. At the top of your spine are Repeat with the other leg.
seven neck (cervical) vertebrae fol-
lowed by 12 middle-back (thoracic) In older adults, kyphosis asso- tial for more compression fractures
vertebrae and five lower back (lum- ciated with osteoporosis is typical- to occur. On the flip side, straight
bar) vertebrae. Below that are the ly found in the vertebrae of the tho- posture reduces excess pressure on
five fused vertebrae of the sacrum racic spine, which is the portion of the front portion of the vertebra that
and at the tail end are the three tiny the spine that supports your shoul- otherwise can lead to wedging and
fused vertebrae that make up the ders, arms, chest and trunk. Multiple contribute to kyphosis curvature.
tailbone (coccyx). compression fractures can produce What can you do to help de-
The most common fractures due a loss of height and a curvature of crease your risk of vertebral frac-
to osteoporosis occur in the verte- the spine, possibly creating the ap- tures? In conjunction with an over-
brae and hipbones. A compression pearance of a hump on your back. all treatment plan for osteoporosis,
fracture occurs when bone is lost From the standpoint of posture, ask your doctor about specific exer-
and weakened to the point of col- kyphosis creates the appearance of cises to help strengthen your back
lapse within the bone’s structure. a forward bend in the back. Wed- muscles and improve posture.
Sometimes, these compression ging from the compression fractures As a general rule, avoid exer-
fractures in the spine are painful, causes the front of the vertebra to cises that round the back, as this
producing stiffness or tenderness in be shorter than the back, which cre- posture combined with activity can
the area of the compressed verte- ates the curve. increase pressure on the vertebrae,
brae. However, it’s not uncommon especially if you have osteoporosis.
for these fractures to go undetected Strengthening the back Instead, you can strengthen your
until a spinal X-ray is done or they’re Stooped posture due to com- back muscles and minimize bone
seen when a chest X-ray is done for pression fractures adds to pressure stress by doing exercises that gently
a different reason. along the spine, creating the poten- straighten the trunk and back. ❒
leach out because water and oil the daily mucus production is We appreciate every letter sent to Second
stepped up considerably. Opinion but cannot publish an answer to each
don’t mix. question or respond to requests for consultation
In the chart below, note the dif- Essentially, the lining of the nose on individual medical conditions. Editorial
ferences in 3 ounces of drained, becomes inflamed. Blood flow is comments can be directed to:
white tuna depending on whether increased, which leads to conges- Managing Editor, Mayo Clinic Health Letter,
200 First St. SW, Rochester, MN 55905, or
it was canned in water or oil: tion, and the mucus glands are stim- send e-mail to HealthLetter@Mayo.edu
ulated, which leads to increased For information about Mayo Clinic services,
mucus production. All of this occurs you may telephone any of our three facilities:
to help clear the virus or allergens Rochester, Minn., 507-284-2511;
Jacksonville, Fla., 904-953-2000;
from your nasal passages. ❒ Scottsdale, Ariz., 480-301-8000 or visit
Water Oil
C al www.MayoClinic.org
ories 158
Fat 109 Clarification
Om 2.5g 6.9g
ega-3s 0.4g
Second Opinion in the April issue Check out Mayo Clinic Health Solution’s
0.8g
of Mayo Clinic Health Letter incor- Web site, at www.MayoClinic.com