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Mayo Clinic Q&A






Ask the Mayo Mom: The eyes of a child

The retina is a thin layer of tissues, cells, and nerves that line the back wall inside the eye. This layer has millions of light sensing cells that receive and organize visual information according to the Mayo Clinic. On this Ask the Mayo Mom edition of the Q&A podcast, host Dr. Angela Mattke is joined by Dr. Brittni Scruggs, an ophthalmologist at Mayo Clinic Children’s Center. Dr. Scruggs is a physician, surgeon, and scientist with a research laboratory at Mayo Clinic studying gene therapy and stem cell therapy for retinal degenerations, including for children. She treats all ages, ranging from newborns to adults. Dr. Scruggs is a member of the national workgroup developing ACMG evidence-based guidelines for diagnosis and clinical management of inherited retinal diseases. Dr. Mattke and Dr. Scruggs explore retinal issues in children and discuss eye safety and health.


Advancing treatments for acute myeloid leukemia

Acute myeloid leukemia (AML), also called acute myelogenous leukemia, is a cancer of the blood and bone marrow, the spongy tissue inside bones where blood cells are made. The disease progresses rapidly, affecting a group of white blood cells called myeloid cells, which normally develop into mature red blood cells, white blood cells and platelets. "There are acute and chronic leukemias, explains Dr. James Foran, an oncologist at Mayo Clinic. "The chronic ones tend to happen slowly over many years. You can watch it for a period of time until it really becomes active. The acute leukemias come on more quickly and cause people to get sick more quickly. Hence, the word acute." AML occurs when a bone marrow cell develops mutations in its DNA that cause the cell to continue growing and dividing. When this happens, blood cell production becomes out of control. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells. Signs and symptoms of AML include: Treatment of acute myeloid leukemia depends on several factors, including the subtype of the disease, and a person’s age and overall health. At the time of diagnosis, a bone marrow biopsy is performed, and testing is done to determine the subtype of AML. Genetic testing on leukemia cells helps oncologists plan treatment that will give patients the highest chance of remission. "There have been massive advances in the last five or seven years," explains Dr. Foran. "We understand that almost everybody with acute myeloid leukemia will have some genetic abnormality in the leukemia cells. Some mutations predict for a lower remission rate with standard chemotherapies. Those are situations where we're looking for new therapies that would be more effective, new strategies — whether that's an immune treatment, a targeted therapy, a different type of chemotherapy. So those mutations really helped guide us on how to apply the new strategies." Dr. Foran says Mayo Clinic is a leader in ongoing research and clinical trials to refine and improve targeted and immune therapy treatments. New approaches include expanding the use of bone marrow transplants and using CAR-T cell therapy. "Mayo Clinic is in the front of the field, I believe. We're studying more targeted treatments to go after cells with mutations, to try to spare side effects, and get the most benefit in treating leukemia," he says. "We're continually and actively looking for new strategies to improve outcomes for patients." On this Mayo Clinic Q&A podcast, Dr. Foran discusses acute myeloid leukemia, including the latest research and advances in treatments.


Tips for living younger, longer by preventing disease

While we know that health affects longevity and quality of life, it can be difficult to change bad habits. People often try to make sweeping New Year's resolutions, only to fail. In fact, Jan. 17 is the date that the average America breaks their New Year's resolution. Dr. Stephen Kopecky, a Mayo Clinic preventive cardiologist, says a better approach is to focus on small steps that add up over time. "The answer, I think, is to make small, sustainable steps that you can live with," says Dr. Kopecky "And when I say small steps, like for diet, I tell patients one bite, one bite of something healthy. Take some processed meat or foods off your plate, and put on something like a legume or a bean. After a couple of years, that one-bite difference will lower your risk of having a heart attack." In his book, "Live Younger Longer: 6 Steps to Prevent Heart Disease, Cancer, Alzheimer's and More," Dr. Kopecky shares strategies for making changes, including thinking of a compass of habits: Healthy eating Eating lots of fruits and vegetables provides antioxidants and anti-inflammatory nutrients that help the immune system fight infections. Dr. Kopecky recommends fruits, vegetables and healthy fats from olive oil and nuts, all found in the Mediterranean diet. Exercising Regular moderate exercise increases the activity of virus-killing immune cells. “Exercise has been shown to give the immune system a boost by maximizing the body's ability to take in and efficiently use oxygen, among other things,” says Dr. Kopecky. “Moderate exercise, where you can talk but not sing while exercising, is enough to increase the activity of virus-killing cells both in the short term and long term. Even 20 minutes daily can help quell inflammation and boost immunity, and exercise can be divided up during the day. The best part about exercise is that it can be done anywhere. Leg lunges, sit-ups, squats and stair-climbing are all easy exercises you can do at home." Managing stress Calming activities and supportive relationships minimize stress, reduce cortisol production and enhance the immune system's function. "Concern about the health of our loved ones, our jobs, children's schooling and other stressors will cause an increased production of the hormone cortisol in the body, which in turn can suppress the immune system," says Dr. Kopecky. "Practicing mindfulness and stepping away from what's causing anxiety can help us stay grounded. Exercises that have calming or meditative qualities, such as qi gong and yoga, also are beneficial." Getting enough sleep Adequate sleep boosts the number of immune cells circulating in the body and improves infection outcomes. The interaction between the immune system and sleep is a two-way street. "When your immune system response kicks in, it changes your sleep,” explains Dr. Kopecky. “You may find yourself sleeping longer, for example, as your immune system stages an attack against a virus. When you're not sleeping well, you may notice that you get sick more easily. Getting adequate sleep can help support the way your immune system functions by increasing the number of immune cells circulating in your body." Making positive changes in these areas can help improve health and longevity. "We cannot prevent aging. We can slow aging," says Dr. Kopecky. "But we can prevent disease. It's certainly possible to do. And if you adopt a certain healthy lifestyle, you can affect that." On the Mayo Clinic Q&A podcast, Dr. Kopecky discusses developing healthy habits one small step at a time.


Understanding pituitary tumors

Pituitary tumors are abnormal growths that develop in your pituitary gland. Pituitary tumors can cause too much or too little of the hormones that regulate important functions of your body to be produced. Most pituitary tumors are noncancerous growths called adenomas, which remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body. "It's very uncommon for any pituitary tumor to be a malignancy or what one would commonly think about as a cancer or something that would travel elsewhere," says Dr. Jamie Van Gompel, a Mayo Clinic neurosurgeon. "Almost all of these are benign tumors." Pituitary tumors are categorized as functioning or nonfunctioning, depending on if they are producing hormones. The signs and symptoms of nonfunctioning pituitary tumors, those that don't make hormones, nonfunctioning are related to their growth and the pressure they put on other structures. "Out of all pituitary tumors, about half of them aren't making any kind of a substance," explains Dr. Van Gompel. "And those are called nonfunctioning adenomas or tumors. And they cause problems by putting pressure on things nearby. So they'll either take up enough room where the pituitary gland is so that it doesn't function well, and you have to get medications to replace some of that function. Or you may start to lose vision. That's another very common presenting symptom with these. " Pituitary tumors that make hormones, called functioning, can cause a variety of signs and symptoms depending on the hormone they produce. "Functioning tumors cause distinct syndromes," says Dr. Van Gompel. "The three most common are prolactin-secreting tumors, Cushing's and acromegaly." Dr. Van Gompel explains overproduction of prolactin from a pituitary tumor can cause breast milk to develop in women, even when they aren't postpartum. In men, it often affects sexual function. In Cushing syndrome, the body creates too much cortisol. The hallmark signs of Cushing syndrome are a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome also can result in high blood pressure, bone loss and, sometimes, Type 2 diabetes. Acromegaly is a hormonal disorder that develops when the pituitary gland produces too much growth hormone during adulthood, causing bones to increase in size. In childhood, this leads to increased height and is called gigantism. But in adulthood, a change in height doesn't occur. Instead, the increase in bone size is limited to the bones of the hands, feet and face. There are various options for treating pituitary tumors, including removing the tumor, controlling its growth and managing your hormone levels with medications. Surgery often is needed if a pituitary tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones. Most often, surgery is done endoscopically through the nasal cavity. The neurosurgeon removes the tumor through the nose and sinuses without an external incision. No other part of the brain is affected, and there's no visible scar. Mayo Clinic is one of the largest pituitary centers in the U.S., evaluating and treating more than 1,600 people with pituitary tumors every year. Dr. Van Gompel explains that being treated at a referral center that sees a high volume of pituitary tumors is important. "Here at Mayo, we have huge expertise, and a group of people that know how to manage these adenomas," explains Dr. Van Gompel. "We're fortunate to have excellent colleagues in neuroradiology because the imaging matters to help locate the tumors. We also have a team of endocrinologists who focus specifically on treatment and management of pituitary tumors. And we have surgeons, like me, who focus on adenomas. We're constantly working together studying our outcomes to make sure they're as good, if not better, than they were last year, to improve care for our patients." On the Mayo Clinic Q&A podcast, Dr. Van Gompel discusses...


Ask the Mayo Mom: Peanut allergies

Recently, new treatment options have become available to those living with severe peanut allergies. We will be exploring what's new in this area and who could potentially benefit. On this Ask the Mayo Mom edition of the Q&A podcast, host Dr. Angela Mattke is joined by Dr. Martha Hartz. Dr. Hartz is a Pediatric Allergist-Immunologist at Mayo Clinic Children's Center and is also an Assistant Professor of Medicine and Pediatrics who will also discuss what is on the horizon in the world of allergy treatment.


Microsurgery can help treat lymphedema

One of the potentially painful side effects of cancer treatment is lymphedema. Lymphedema is tissue swelling caused by the buildup of fluid that's usually drained through the body's lymphatic system. Because lymph nodes are an important part of the lymphatic system, lymphedema can be caused by cancer treatments that remove or damage the lymph nodes. "During cancer treatment, sometimes lymph nodes need to be removed, and the lymphatic system that travels around and through these lymph nodes, gets damaged as well," explains Dr. Antonio Forte, a Mayo Clinic plastic surgeon. "It's impossible to remove the lymph nodes without damaging the system." Lymphedema most commonly affects the arms or legs, but can also occur in the chest wall, abdomen, neck and genitals. Severe cases of lymphedema can affect the ability to move the affected limb, increase the risks of skin infections and sepsis, and can lead to skin changes and breakdown. An estimated 20% to 40% of patients undergoing an axillary lymph node dissection — removal of lymph nodes from the armpit, which is a common part of surgery for breast cancer — will develop lymphedema. Nonsurgical treatment options include compression bandages or garments, massage, and careful skin care. If compression treatment isn't successful, a microsurgery technique, known as lymphovenous bypass, may be an option. Microsurgery refers to the fact that the surgery is done using powerful microscopes that are magnified 20 to 25 times. Using special dye injected under the skin to identify the lymphatic pathways, surgeons then use small incisions to reroute the lymphatic system by connecting tiny lymphatic vessels to tiny veins, creating a detour around the damaged lymph nodes. The new connection restores the body's ability to drain lymphatic fluids. Dr. Forte specializes in lymphovenous bypass surgery and has seen great benefits for patients. He points out that it's a minimally invasive procedure that can be done in an outpatient setting. The incisions are small, scarring is minimal, and patients can see significant reduction of their swelling. "A very good study that was published almost a decade ago looked at patients that had lymphovenous bypass, and on average, 42% of the swelling improved over one year," says Dr. Forte. "Now there are patients that will have much more improvement than that. And some other patients will have very little improvement. But, on average, patients that have lymphovenous bypass surgery improve by 42%." On this Mayo Clinic Q&A podcast, Dr. Forte explains the lymphovenous bypass procedure, who is a candidate for the surgery, and the risks and benefits of this lymphedema treatment. Related Articles: A regenerative detour for lymphedemaVideo: Lymphovenous Bypass Surgery for Lymphedema


Holiday travel, gatherings likely to increase the spread of respiratory viruses

Three respiratory viruses — COVID-19, influenza and respiratory syncytial virus, or RSV — are currently circulating in the U.S., and experts worry that holiday travel and gatherings could fuel their spread and further increase the number of cases. Recently, the Centers for Disease Control and Prevention (CDC) issued a health alert about the fall season increase in cases of influenza and RSV infection, primarily affecting young children. To help protect against severe disease and hospitalization, the CDC recommends vaccinations against influenza and COVID-19 for all eligible people 6 months or older. While not yet available, there is good news on the vaccine front for fighting RSV, too. "A number of vaccine manufacturers have developed vaccines, including a couple of them through phase three trials," says Dr. Gregory Poland, head of Mayo Clinic's Vaccine Research Group. "Very likely, certainly before this time next year, I think we'll have a licensed RSV vaccine for adults, and then they'll move clinical trials down to kids. So we're definitely making progress there." In addition to available vaccines, the toolkit for stopping the spread of viruses is familiar now after two years of battling COVID-19. The most basic protection measure, masking, is still effective, but many have grown tired of using it. "Most people now are not wearing a mask, they're embarrassed to wear a mask, they're fatigued of it," explains Dr. Poland. "Over these holiday wintertime periods, it's very likely we'll have a surge of influenza and COVID-19 related to this kind of behavior. Don't let fatigue and letting your guard down be the reason that you get infected and suffer a complication." On the Mayo Clinic Q&A podcast, Dr. Poland discusses the latest news on RSV, COVID-19 and this year's flu season. Related articles: Early increase of flu, RSV viruses affecting children — when to seek helpCare tips for upper respiratory infections in childrenRSV season: What parents need to know


An inside look at invention at Mayo Clinic

At Mayo Clinic, the Department of Business Development is the front door to business. From technology commercialization to strategic partnerships, the ultimate goal of innovation at Mayo Clinic is to improve health outcomes and benefit patients. Business Development has two divisions: "Mayo has about 7,000 active inventors across its campuses, which is quite incredible," says Dr. Clark Otley, medical director for the Department of Business Development at Mayo Clinic. "Every week, I receive a list of the new invention ideas and technologies that they think up, and I am frankly in awe of their creativity and drive to help our patients." Mayo Clinic Ventures works hand in hand with all three shields at Mayo Clinic — Research, Practice and Education — to advance the best ideas to the marketplace. "In many parts of health care, a 10% success rate is considered standard," explains Dr. Otley. "Mayo’s success rate in achieving at least some degree of commercial success is closer to 30%, thanks to our amazing inventors and the hard work of our Mayo Clinic Ventures staff." Mayo’s key invention activities and innovations align with the strategic plan to "Cure. Connect. Transform." Business Development supports key activities in each of those areas: CuresConnectMayo Clinic PlatformTransformPast successes help support future endeavors at Mayo Clinic. "The big news is that Mayo is about the hit a milestone related to inventing," says Dr. Otley. "Sometime this winter, Mayo will reach the $1 billion milestone of revenue brought back from our inventing activity, supported by Mayo Clinic Ventures. And the beautiful thing is that those proceeds are reinvested back into our three-shield mission of Practice, Education and Research to maintain the virtuous cycle of invention in patient care." On the Mayo Clinic Q&A podcast, Dr. Otley joins host, Dr. Halena Gazelka, to share an inside look at invention at Mayo Clinic.


Ask the Mayo Mom: Facial paralysis and reanimation surgery

Facial paralysis can affect one side or both sides of the face and can affect eye closure, the smile and lower lip movement. Facial paralysis can be caused by a variety of syndromes and can also be the result of a birth defect, a tumor, or trauma. When facial paralysis occurs in children, it impairs a child’s ability to move their facial muscles and show facial expression. Surgery can be done to reanimate the face and give children back the ability to show their smiles and expressions on the outside. The Facial Paralysis and Reanimation Clinic at Mayo Clinic Children's Center brings together a team of experts including neurologists, plastic surgeons, optometrists and physical therapists to develop a treatment plan tailored to each child. On this Ask the Mayo Mom edition of the Q&A podcast, host Dr. Angela Mattke is joined by two experts— Dr. Samir Mardini, a plastic surgeon and chair of the Division of Plastic Surgery and co-director of the cleft and craniofacial clinic at Mayo Clinic Children's Center, and Dr. Waleed Gibreel, a craniofacial and pediatric plastic surgeon at Mayo Clinic — to discuss facial reanimation surgery in children.


Mayo Clinic Q&A podcast: The latest options for treating epilepsy

Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy and epilepsy affects both males and females of all races, ethnic backgrounds, and ages. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Medications for epilepsy have improved and remain the most common way to treat epilepsy. Open surgery to remove the portion of the brain that's causing the seizures is still an important treatment option for epilepsy that isn't controlled by medication. In recent years, new treatment options for epilepsy, including minimally invasive options, have developed. The latest treatments include: Deep brain stimulationResponsive neurostimulation.Laser interstitial thermal therapy (LITT)Minimally invasive surgery."The game is much different now," says Dr. Jamie Van Gompel, a Mayo Clinic neurosurgeon. "We've really improved the outcomes for patients. I think it's important to explore treatment options because they can have substantial, meaningful impacts in people's lives." Dr. Van Gompel encourages people with epilepsy to check in with their primary care provider or neurologist about their current treatment, and don't hesitate to seek a second opinion at an epilepsy center, especially if you have side effects from your medications or are continuing to have seizure events. “If you haven’t seen a specialist in the last five years, you should see an epileptologist at a specialized care center,” says Dr. Van Gompel. "Epilepsy treatments are changing so rapidly right now with the introduction of robotics and stereotactic techniques that there might be something new that can help you with your seizures or epilepsy management." Research in the field continues to focus on seizure prevention, prediction and treatment. Dr. Van Gompel predicts that the use of artificial intelligence and machine learning will help neurologists and neurosurgeons continue to move toward better treatment options and outcomes. "I think we will continue to move more and more toward removing less and less brain," says Dr. Van Gompel. "And in fact, I do believe in decades, we'll understand stimulation enough that maybe we'll never cut out brain again. Maybe we'll be able to treat that misbehaving brain with electricity or something else. Maybe sometimes it's drug delivery, directly into the area, that will rehabilitate that area to make it functional cortex again. That's at least our hope." On the Mayo Clinic Q&A podcast, Dr. Van Gompel discusses the latest treatment options for epilepsy and what's on the horizon in research.


Ask the Mayo Mom: Vitamins, nutritional supplements and special diets for children

Commercials and advertisements often target parents, suggesting they should give their kids vitamins and supplements to help them grow strong and stay healthy. But is it true? The short answer is no. "By and large, when kids are generally healthy, when they're growing well, when there is no big concern, there's really no need for any extra vitamins or supplements," says Dr. Erin Alexander, a Mayo Clinic gastroenterologist. Experts agree that most kids should get their vitamins from food, not supplements. The American Academy of Pediatrics states that healthy children receiving a normal, well-balanced diet do not need vitamin supplementation over and above the recommended dietary allowances that they get from the foods they eat. While many young children may be selective about what they eat, that doesn't necessarily mean that they have nutritional deficiencies. Many common foods — including breakfast cereal, milk and orange juice — are fortified with important nutrients, such as B vitamins, vitamin D, calcium and iron. So your child may be getting more vitamins and minerals than you think. Nutrition for kids is based on the same ideas as nutrition for adults. Everyone needs the same types of things, such as vitamins, minerals, carbohydrates, protein and fat. Children need different amounts of specific nutrients at different ages. Food packed with nutrients — with no or limited sugar, saturated fat, or salt added to it — is considered nutrient-dense. Focusing on nutrient-dense foods helps kids get the nutrients they need while limiting overall calories. Nutrient-dense foods include: Protein.Fruits.Vegetables.Grains.Dairy."When we're thinking about a child's nutrition, it's really important that we think very broadly," says Dr. Dana Steien, a gastroenterologist and director of pediatric nutrition at Mayo Clinic Children's Center. "Macronutrients — protiens, carbohydrates and fats — are where we get our calories. Micronutrients are all our minerals and vitamins." Another important part of a healthy diet is limiting a child's calories from added sugars, saturated fats and salt. Check nutrition labels on food products for information on calories and serving sizes. While most kids get what they need from the foods they eat, there are certain medical situations or conditions where children need nutrient supplementation or specialized diets. For instance, babies born prematurely may require nutritional supplements to help them grow. Some children may develop iron, vitamin D or calcium deficiencies that require supplementation. Another common issue is kids who develop allergies or food intolerances that may require them to follow a modified diet such as gluten-free, low fructose or low lactose. These special diets should be supervised by a dietitian or your child's health care team. On this "Ask the Mayo Mom" edition of the Q&A podcast, Drs. Alexander and Steien join host, Dr. Angela Mattke, to talk about nutrition, supplements and special diets for children. Related Articles: Should I give multivitamins to my preschooler?Nutrition for kids: Guidelines for a healthy dietKids and sodium: Serious risks, alarming realities.


Survivorship after surgery for lung cancer

More than 200,000 people in the U.S. will be diagnosed with lung cancer in 2022, according to the National Cancer Institute. A new lung cancer diagnosis can be scary and confusing, but having a support system can help. "Probably the best advice I give patients with lung cancer is to build your village of support around you," says Dr. Shanda Blackmon, a Mayo Clinic thoracic surgeon. "Always see if you can have somebody come with you for your appointment, just to help you emotionally deal with things, to help you record what's being said, to help you collect that information, and then to also advocate for you." If the cancer is confined to the lungs, surgery may be an option for treatment. Surgery is performed to remove the lung cancer and a margin of healthy tissue around the cancer site. Procedures to remove lung cancer include: Wedge resectionSegmental resectionLobectomyPneumonectomyThe surgeon also may remove lymph nodes from a patient’s chest to check them for signs of cancer. The type of operation used for lung cancer treatment depends on the size and location of the cancer as well as how well a person’s lungs are functioning. Dr. Blackmon recommends that patients explore all their surgical options. "When you look at actual surgical options, you have minimally invasive surgery, or open surgery," explains Dr. Blackmon. "And the minimally invasive surgery has a lot of different options as well. Not every lung cancer surgery can be done minimally invasively. But if it can, certainly, the patient benefits." Another important consideration is having your lung cancer surgery performed at a center that does a high volume of cases and is familiar with the type of procedure needed. "When you go to have your car worked on — you go to the dealership that deals with your car specifically and someone who does it every day — they're going to be doing a better job than going to someone who's never even seen that type, make or model of car," says Dr. Blackmon. "I think we do that in life all the time. And it makes sense to do it in medicine, and in surgery especially." After surgery for lung cancer, patients are often worried about short-term side effects, like shortness of breath and pain, as well as long-term worries about cancer recurrence. Both should be addressed as part of a cancer survivorship plan. "Survivorship is part surveillance and part symptom management," says Dr. Blackmon. "The survivorship program here at Mayo Clinic really focuses on treating the whole patient. We have things like massage therapy. We have acupuncture. We have meditation. We have all kinds of resources that help patients to get their life back, get back in shape, and get all the parts of their body whole again as they start to heal from this really big surgery. But one thing that is so important is to continue to go back for that survivorship care with continued symptom monitoring and continued surveillance. That five-year period after the lung cancer surgery is so critically important." On this Mayo Clinic Q&A podcast, Dr. Blackmon discusses what people can expect after surgery for lung cancer, and how to achieve the best quality of life.


Caring for veterans

Like all patients, military veterans bring their unique experiences and backgrounds with them as they navigate medical and end-of-life care. At Mayo Clinic, programs are in place to honor military service and care for veterans. Mayo Clinic Hospice is a partner of the We Honor Veterans Program run by the National Hospice and Palliative Care Organization. The Hospice team provides the high level of medical, emotional, spiritual and social care that those who have served in the U.S. armed forces deserve. Team members recognize and honor the hospice patient’s military service with a veteran pinning ceremony. Ceremonies are provided after approval by the patient and family and can include anyone whom the military member and family would like to participate, along with the hospice team. “It's just a small, simple way of saying thank you to a veteran,” says Loren Olson, a chaplain with Mayo Clinic Hospice. “We bring a pillowcase that represents their branch of the service and a small pin that they could put on a lapel, or a lot of them put them on their military hats. We bring a coin and a certificate from Mayo Clinic expressing our appreciation and we invite them to share their experiences in the military.” Building on the We Honor Veterans program, Charlie Hall, a Mayo Clinic security operations supervisor, helped develop a "Final Honor Walk" for deceased veterans at his Mayo Clinic Health System location in La Crosse, Wisconsin. Hall served in the Army as an active-duty rifleman with a combat tour to the Balkans and as a paratrooper with close to 100 military parachute jumps. In addition to his role as a security supervisor, Hall and his team in La Crosse meet with families of deceased veterans to arrange a “Final Honor Walk," where family and staff line the hallway to honor veterans while they are moved out of the hospital room in a flagged-draped cart. “The final honor walk is something that I wanted to develop,” explains Hall. “I had worked with the We Honor Veterans program in Rochester, with hospice, and the near-end-of-life things with veterans, all the great things they do there. I had the privilege of doing that, but I saw us being able to do a little bit more in an inpatient setting.” In addition to care at the end of life, it's important to acknowledge the unique needs of veterans every day in the clinical setting. Issues including post-traumatic stress disorder (PTSD) and substance use disorders are more common among veterans than the general population, and they often go hand in hand. More than 2 in 10 veterans with PTSD also have a substance use disorder, according to the U.S. Department of Veterans Affairs. “If a veteran is wearing a hat that signifies their veteran’s status if you will, that to me is the OK to come up and thank them for their service,” says Hall. “And I do that routinely here. It's usually a surprise to the veteran. They're usually extremely grateful. Probably the No. 1 thing is to acknowledge them. It's so important to make people feel at ease when care is coming, especially when there are some complex situations with medical care. There are some very sensitive conversations that have to happen. We all know that happens so much easier when we have great rapport with our patients.” “Honoring veterans is part of the culture at Mayo Clinic, at least in my experience,” says Olson. “One of the first things I learned as I came to work the hospice program was that We Honor Veterans partnership with the Veterans Administration is important to us. We want to spend time honoring our veterans. So I do think we have developed a corporate culture that just helps us to think of the specific needs of our veterans.” On this special Veterans Day edition of the Mayo Clinic Q&A podcast, Olson and Hall join host, Dr. Halena Gazelka, for a conversation on caring for veterans.


Barrett’s esophagus requires monitoring and treatment to decrease esophageal cancer risk

Barrett's esophagus is a condition in which the lining esophagus becomes damaged by acid reflux, which causes the lining to thicken and become red. Over time, the valve between the esophagus and the stomach may begin to fail, leading to acid and chemical damage of the esophagus, a condition called gastroesophageal reflux disease, or GERD. In some people, GERD may trigger a change in the cells that line the lower esophagus, causing Barrett's esophagus. "The stomach is well designed to handle highly acidic conditions," explains Dr. James East, a gastroenterologist at Mayo Clinic Healthcare in London. "But the esophagus is not designed to cope with acid. And so when acid comes up, that acid reflux damages the cells, replacing them with more acid-resistant cells that develop into Barrett's esophagus." While frequent heartburn may be a sign, many people with Barrett’s esophagus have no symptoms. Having Barrett's esophagus does increase your risk of developing esophageal cancer. Although the cancer risk is small, it's important for people with Barrett's esophagus to have regular checkups to check for precancerous cells. Those at highest risk for Barrett's esophagus include: "If you have three of those risk factors, then you should have a screening endoscopy for Barrett's esophagus, according to current guidelines," says Dr. East. To screen for Barrett's esophagus, a lighted tube with a camera at the end, called an endoscope, is passed down the throat to check for signs of changing esophagus tissue. A biopsy is often done to remove tissue and confirm the diagnosis. Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health. Treatments in the early stages can include lifestyle measures and medications to help reduce acid reflux and therefore, the esophageal acid exposure. If the cell damage is more extensive, radiofrequency ablation may be be used. In this technique, a balloon is used to heat the abnormal esophagus tissue and burn it away. Another technique, cryotherapy, applies cold liquid or gas to destroy the abnormal cells. The best way to prevent Barrett's esophagus is to address acid reflux and GERD through lifestyle changes. "Lifestyle measures that reduce the risk of reflux are the key here because once Barrett's esophagus develops, it's a permanent change unless we use some of the ablation techniques," says Dr. East. "So absolutely quit smoking, and limit alcohol and caffeine. And even losing a small amount of weight can really help reduce reflux symptoms." On the Mayo Clinic Q&A podcast, Dr. East discusses diagnosing and treating Barrett’s esophagus.


Navigating a new epilepsy diagnosis

Epilepsy is a neurologic central nervous system disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of awareness. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two seizures without a known trigger (unprovoked seizures) that happen at least 24 hours apart are generally required for an epilepsy diagnosis. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. When a child is diagnosed with epilepsy, families may need support to adjust to this new diagnosis. Parents and schools can partner with the medical team to help. "One of the things that's really important for families to remember is they are not fighting this battle on your own," explains Dr. Elaine Wirrell, a pediatric neurologist and chair of Child and Adolescent Neurology at Mayo Clinic Children's Center. "You need to share the diagnosis and inform those who are caring for your child — teachers, daycare, coaches — so they are prepared to help." Medication is generally the first course of treatment for epilepsy. Finding the right medication or combination of medications, and the optimal dosages, can be complex. Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. For some children with drug-resistant epilepsy, surgery is an option. Epilepsy surgery, which is considered when at least two anti-seizure medications have failed to work, removes or alters an area of the brain where seizures originate. Experts at Mayo Clinic Children's Center also are studying neurostimulation treatments for epilepsy, an alternative treatment for children with severe epilepsy or for those who cannot have surgery. This treatment applies electricity to the central nervous system with the goal of reducing seizure frequency and severity. On this Ask the Mayo Mom edition of the Mayo Clinic Q&A podcast, host Dr. Angela Mattke is joined by Dr. Wirrell for a discussion on epilepsy in children. Related articles: Consumer Health: Treating children with epilepsy.Mayo Clinic Q&A podcast: Epilepsy Awareness Month.


Advances in bone marrow transplant and cellular therapy

Mayo Clinic performed its first bone marrow transplant in 1963 and today hundreds of people receive blood and marrow transplants every year at Mayo Clinic in Arizona, Florida and Minnesota. Recently, Mayo Clinic in Rochester, Minnesota celebrated its 10,000th blood and marrow transplant. Bone marrow transplant is used to treat blood cancers and related disorders by infusing healthy blood-forming stem cells into your body to replace unhealthy bone marrow. A bone marrow transplant is also called a stem cell transplant. Bone marrow transplants may use cells from your own body, called autologous transplant, or from a donor, known as allogeneic transplant. Autologous stem cell transplants are typically used in people who are producing enough bone marrow but need to undergo high doses of chemotherapy and radiation to cure their disease. These treatments are likely to damage the bone marrow. Prior to treatment, healthy bone marrow cells are collected, frozen and stored for later use. After treatment, the stem cells are infused back into the patient to repopulate the bone marrow. Allogeneic bone marrow transplant is used when there is underlying bone marrow failure syndrome or for certain types of bone cancers and blood cancers. In those cases, donor bone marrow is needed to replace the diseased bone marrow. One common complication of allogenic transplant is developing graft versus host disease. This condition occurs when the donor stem cells see the body's tissues and organs as something foreign and attack them. Researchers have now discovered metabolic markers that can predict a person's risk for developing severe graft versus host disease, allowing for a more personalized treatment approach. "Graft versus host disease occurs in patients that have had an allogeneic transplant from a donor," explains Dr. William Hogan, director of the Mayo Clinic Blood and Bone Marrow Transplant Program in Minnesota. "And this is where the donor immune system doesn't just recognize the leukemia that we're trying to treat — which is what we want — but it also attacks the patient's normal tissues. This can be anything from a relatively mild to a very devastating problem that can occur after transplant. And one of the challenges was that, by the time that has been fully developed, then it's harder to treat. So one of the goals of research in the last few years has been to develop markers that will tell us which patients are at risk of having the most severe graft versus host disease, and allowing us to target more effective treatment toward those patients." Other recent advances in blood and bone marrow transplant include the use of mismatched donors and the ability to use bone marrow transplant in older, more frail patients thanks to improvements in antibiotics, antifungal drugs and other medications. Another cellular therapy that is helping treat blood disorders and cancers is chimeric antigen receptor-T cell (CAR-T) therapy. CAR-T involves taking the T cells from a person and reengineering them to recognize and destroy cancer cells. "CAR-T therapy is a very interesting therapy," says Dr. Hogan. "It's really come to fruition in the last five to 10 years. This is similar to bone marrow transplant, but not quite the same. It's a cellular-based therapy, so not a drug, but using cells that are modified in order to try and treat leukemias and other cancers. And basically, what it does is it takes our native immune system — and then the T cells specifically — and modifies them so that they are much more effective at recognizing targets that are on leukemia cells or other malignant cells. And that really kind of allows us to use the native immune system in a much more effective way of trying to kill leukemias." Dr. Hogan says CAR-T therapy also is being developed for noncancerous conditions, like aplastic anemia, and research is looking at CAR-T as a treatment for a particular form of inflammatory multiple sclerosis. "Things have really been...


Mayo Clinic Q&A podcast: World Stroke Day — know the warning signs, take action

When someone has a stroke, every second is crucial. The longer it takes to receive treatment, the more likely it is that damage to the brain will occur. "The mantra is 'time is brain,'" explains Dr. James Meschia, a Mayo Clinic neurologist and stroke expert. "The sooner they get treatment, the better patients do." World Stroke Day is recognized each year on Oct. 29. The aim is to teach the public about stroke risk factors and stroke prevention, and to raise awareness about the warning signs of stroke so people recognize when a loved one may be having a stroke and can take action. To recognize the warning signs of stroke, Dr. Meschia says remember the acronym, BE FAST: There are two main types of strokes: ischemic and hemorrhagic. An ischemic stroke happens when there is a loss of blood supply to an area of the brain. A hemorrhagic stroke happens when there is bleeding into the brain when a blood vessel ruptures. Eighty-five percent of all strokes are ischemic. Globally, 1 in 4 adults over 25 will have a stroke in their lifetime, according to the World Stroke Organization. More than 110 million people in the world have experienced stroke, but thanks to the development of clot-busting drugs and procedures to remove clots using a catheter, outcomes for people who have a stroke are improving. "The first big treatment revolution happened in the 1990s. And in 1995 we finally closed in on a dose and a time window to give a clot-busting drug known as tissue plasminogen activator or, tPA," says Dr. Meschia. "Then in 2015, the added benefits of mechanical thrombectomy were clearly established. That is where a catheter is inserted, and, under guidance by an X-ray camera, the tip of the catheter is positioned in or near the clot and the clot pulled out. So used in combination or by themselves, thrombolysis and thrombectomy have been major advances in the therapy." After emergency treatment, most stroke survivors go through a rehabilitation program. Stroke care focuses on helping people recover as much function as possible, with the goal of returning to independent living. The impact of the stroke depends on the area of the brain involved and the amount of tissue damaged. If the stroke affected the right side of the brain, movement and sensation on the left side of the body may be affected. If the stroke affected the left side of the brain, movement and sensation on the right side of the body may be affected. Brain damage to the left side of the brain may also cause speech and language disorders. Dr. Meschia encourages stroke victims to realize that the effects of a stroke are worse at the beginning, and that there is hope for rehabilitation. "One of the important points with stroke is that it is sudden in onset, and often maximally severe at onset," says Dr. Meschia. "There are some exceptions, but I would say about 9 out of 10 are maximally severe at onset. And then, over the course of one to three months with appropriate rehabilitation — be it speech, physical or occupational therapy, or a combination thereof — patients do rally and improve significantly. And it is one of the things to be aware of because sometimes patients and families can feel like giving up. I think that would be tragic because, at least in the short term, the prognosis is favorable for some level of recovery." Many strokes can be prevented in the first place by minimizing risk factors. Maintaining a healthy body weight, staying physically active and controlling blood pressure reduce the risk of stroke. Other stroke prevention steps include stopping smoking, eating a healthy diet and managing blood sugar levels. On the Q&A podcast, Dr. Meschia discusses stroke prevention, the warning signs of stroke and the latest in stroke treatments.


Proton beam therapy offers benefits to patients with breast cancer

The type of breast cancer a person has and how far it has spread determine the appropriate treatment. Previously, a patient with breast cancer might have received five to six weeks of radiation therapy. But the approach is changing. "For many years, we had the understanding that giving a little bit of radiation each day and spreading that treatment out over multiple weeks was the gentlest on the normal tissues, and that would lead to the least side effects," says Dr. Robert Mutter, a Mayo Clinic radiation oncologist. "But over the last decade or two, there's been a lot of research. We found we might be better off giving bigger doses each day and finishing in a shorter period of time. And that might be better at destroying the cancer cells, while limiting side effects of the normal tissue." The use of proton beam radiation therapy is one way the treatment of breast cancer is advancing. Unlike traditional X-ray radiation, proton beam therapy can more precisely target tumors, sparing more normal tissue. The Mayo Clinic Proton Beam Therapy Program uses pencil beam scanning, which Mayo investigators have shown reduces radiation exposure to healthy tissue. This highly targeted therapy is ideal for people with tumors close to or in vital organs, and for young people, whose organs are still developing. Mayo Clinic offers proton beam therapy in Arizona and Minnesota. Recently, Mayo Clinic announced a $100 million gift from the Fred C. and Katherine B. Andersen Foundation to expand Mayo Clinic’s proton beam therapy services in Minnesota. “Protons have this ability to stop on a dime. And that's because they're charged, and they have a mass,” explains Dr. Mutter. “And so we can actually give them just enough energy to travel to the tissue and have them stop. And so all that tissue behind the tumor or the target is spared of radiation exposure. But we're very excited to be able to study proton therapy and to be able to offer proton therapy for patients that we think may benefit, including breast cancer.” In this Mayo Clinic Q&A podcast, Dr. Mutter expands on Mayo Clinic's research and the development of new therapies to minimize patient side effects from radiation, including the increased use of proton therapy. Dr. Mutter also talks about the patient concerns about relapses and how Mayo is using medicines in combination with radiation to reduce relapse risks.


Imaging plays key role in improving endometriosis treatment

Endometriosis is often a painful disorder in which tissue similar to the tissue that normally lines the inside of the uterus — the endometrium — grows outside the uterus. "Endometriosis is a very common condition," explains Dr. Tatnai Burnett, a gynecologic surgeon at Mayo Clinic. "Most of our studies, which are looking at women who have symptoms, would suggest that about 1 in 10 women, so 10% or so have endometriosis. Now, the difficulty here is that some women do not have significant symptoms and wouldn't go to a doctor, or they minimize their symptoms or think what they are experiencing is normal. So, if anything, that estimate is probably on the low side of what actual reality is." With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit the body, it becomes trapped. Endometriosis can cause pain, which is sometimes severe, especially during menstrual periods. Fortunately, effective treatments are available. Imaging, including ultrasound and MRI, is an important step in evaluating patients with endometriosis and can impact treatment options and surgical planning. "Ultrasound is a great way to start the evaluation of the female pelvis because it's easily accessible," says Dr. Wendaline VanBuren, a Mayo Clinic radiologist who specializes in gynecologic imaging. "And it gives us a lot of information about the ovaries and the uterus. The problem with endometriosis is that, while it can involve the ovaries, it can involve all these sites on the surface of the uterus, the bowel, the ureters and all the structures around it. So, MRI gives us a little bit more of a global perspective of the pelvis. So that's the advantage of using MRI." To better coordinate care for patients with endometriosis, Drs. Burnett and VanBuren instituted an MRI-based interdisciplinary conference at Mayo Clinic that brings together radiology and gynecology. "For endometriosis, we realized that a multidisciplinary approach where we review things together was just in the best interest of the patient because it gives us the best coordination of care between the radiologist and the gynecologist," says Dr. Burnett. "It gives us a nuanced interpretation of what the imaging means for the patient. And then it allows us to apply what we see in the imaging to our surgical plan and to the surgical team. We use all the information that we gather to really make the best plan for the patient in regard to the patient's goals and what they need." The team at Mayo Clinic has been sharing the success of this collaborative model and educating other experts through the publication of their research findings and participation in a disease-focused endometriosis panel through the Society for Abdominal Radiology. "We all have our own expertise," says Dr. VanBuren. "And when we're able to collaborate and share, hearing the clinical stories, looking at the imaging, putting it together, the considerations for management, whether that be medical or surgical planning, we're really able to make a huge impact. It's exciting to see now collaborations between societies, from gynecology and radiology together." On the Mayo Clinic Q&A podcast, Drs. Burnett and VanBuren discuss the multidisciplinary approach to diagnosing and treating endometriosis.


Hot chemotherapy for late-stage cancers

Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers chemotherapy directly into the abdominal cavity. It is used in conjunction with cancer surgery for people with advanced cancer that has spread inside the abdomen. “Hyperthermic” means warm or hot. “Intraperitoneal” means inside the abdominal cavity, which is encased in a sac called the peritoneum. HIPEC uses high-dose chemotherapy to kill microscopic cancer cells inside the abdominal cavity. The HIPEC procedure is performed immediately after a surgeon has removed all visible cancer in the abdomen. HIPEC is well studied in several types of cancer and being explored as a potential treatment in others. "So really any cancer that's just localized in the abdomen on the surface of the peritoneum could be a candidate," explains Dr. Travis Grotz, a Mayo Clinic surgical oncologist. "We know for sure, based on studies and data that HIPEC works well for cancers of the colon, cancers of the appendix, cancer to the ovaries, cancer of the stomach, and there's even a cancer of the lining of the peritoneum, called mesothelioma. So those would be the cancers I think that are well studied and well accepted. Then, there are more rare tumors that we have less data for, such as cancer to the pancreas or gallbladder or small intestine, that we don't know yet if that's the right treatment." The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated. The abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells that might still be present. Heating the chemotherapy enhances its effectiveness because, when it’s hot, chemotherapy penetrates the tissue more deeply, increasing the number of cancer cells it can reach. On this Mayo Clinic Q&A podcast, Dr. Grotz explains what HIPEC is, how it is performed, and the risks and benefits of the treatment. Related Articles: New therapies bring hope for ovarian cancer.Alternative chemotherapy offers hope for late-stage cancers.Aggressive treatment turns tide in fighting colon cancer.