Mitchell Humphreys, M.D., a urologist at Mayo Clinic, answers the important questions you may have about prostate cancer.
Video timeline: 0:00 Introduction 0:16 How do you know how fast my cancer is growing? 0:49 Is prostate cancer sexually transmitted? 1:04 Is prostate cancer hereditary? 1:36 What can I do to prevent or slow prostate cancer? 2:03 Is there a risk of cancer spreading if I have a biopsy of my prostate? 2:20: When should I stop screening for prostate cancer? 2:46 How can I be the best partner to my medical team? 3:12 Ending
Learning about hypertension can be intimidating. Leslie Thomas M.D., a nephrologist at Mayo Clinic, walks you through the facts, the questions, and the answers to help you better understand this condition.
Video timeline: 0:00 Introduction 0:39 What is hypertension? 1:13 Who gets hypertension? / Risk factors 2:18 Symptoms of hypertension 2:36 How is hypertension diagnosed? 3:14 Treatment options 3:51 Coping methods/ What now? 4:05 Ending
Hypertension is an elevation of the blood pressure in the arteries. It is measured conventionally by blood pressure cuffs, although a catheter in the artery is more accurate. I’ve had my blood pressure taken countless numbers of times by nurses and doctors who sometimes put the cuff on my arm through a piece of clothing, making it less accurate. Sometimes it is taken by an automatic blood pressure cuff even in the doctors office. The automated cuff can be purchased for $20 or less for you to use it at home, but it’s accuracy is questionable when you have an irregular heartbeat with atrial fibrillation such as I do.
The blood pressure reading which is considered to be normal Is dropping. In the present video, following 2017 guidelines , they state that a systolic reading of more than 120 mmHg is elevated, and anything more than 130 is hypertension. It may be true that studies have been done to show that these slight elevations cause problems, but so can the drugs that are used to lower blood pressure; a cough can be caused by ACE inhibitors. Fatigue and fainting can be caused by an excessive dosage of any blood pressure medication.
Healthy diet, especially avoiding extra salt, Regular exercise and good sleep will go a long way towards keeping your blood pressure at 120 or below on the high reading (systolic), and 80 on the low reading (diastolic).
My systolic blood pressure varies between 120 and 140 systolic, and is usually around 60 diastolic. For a long time I thought the relatively low (diastolic) blood pressure was more important, since diastole is of greater duration than systole, but it has now been determined that the systolic blood pressure reading is the one to worry about. Calcification and lack of elasticities in the arteries as you get older can lead to higher systolic blood pressure.
It used to be thought that the normal systolic blood pressure was 100+ your age in years. Those days are gone, however, and greater life expectancy and health Is one result of carefully monitoring your blood pressure, and working hard to keep it down.
Please refer to the Mayo Clinic article to give you (much) more information.
Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure.
The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery or, in severe cases, a heart transplant — depends on the type of cardiomyopathy and how serious it is.
Subarachnoid hemorrhages account for approximately 1.2 million cases of stroke each year, and nearly 40% of those cases are fatal. Dr. Rabih Tawk, a Mayo Clinic neurosurgeon explains the early signs of a subarachnoid hemorrhage and how it’s treated.
Bleeding in the space between the brain and the tissue covering the brain.
Subarachnoid hemorrhage, a medical emergency, is usually from a bulging blood vessel that bursts in the brain (aneurysm). It may lead to permanent brain damage or death if not treated promptly.
The main symptom is a sudden, severe headache.
Hospital care is needed for supportive care and to stop bleeding and limit brain damage. Treatment may include surgery or catheter-based therapy.
Using artificial intelligence in health care seems like a futuristic concept, but it’s something that’s being used now to complement the knowledge of doctors. Radiology was one of the first areas that saw a lot of AI applications.
Dr. Bradley Erickson, director of Mayo Clinic’s AI Lab, says in the case of radiology, machine learning is used to complete some of the more time-consuming work. Beyond that, the diagnostic capabilities of AI are what attracts a lot of the appeal. While imaging-related AI has seen a lot of advancements, Dr. Bhavik Patel, director of AI at Mayo Clinic Arizona, says the next step is looking at AI applications for preventive health and shifting the mindset from pipeline to platform thinking.
There are a broad area of applications (for AI), starting in radiology, but really spreading into the rest of the clinic, including cardiology and even pathology.
Sepsis occurs when the body’s response to an infection damages its own tissues. When these infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.
As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues. If sepsis progresses to septic shock, blood pressure drops dramatically, which can lead to death.
To be diagnosed with sepsis, you must have a probable or confirmed infection, and all of these signs:
Change in mental status.
Systolic blood pressure — the top number in a blood pressure reading — less than or equal to 100 millimeters of mercury, or mm Hg.
Respiratory rate higher than or equal to 22 breaths per minute.
Signs of progression to septic shock include:
The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
High levels of lactic acid in your blood, which means that your cells aren’t using oxygen properly.
Early, aggressive treatment increases the likelihood of recovery.
A number of medications are used to treat sepsis and septic shock, including antibiotics, corticosteroids, painkillers and sedatives. Supportive care, including oxygen and dialysis, and surgery to remove the source of the infection, also may be needed.
People who have sepsis require close monitoring and treatment in a hospital ICU. Lifesaving measures may be needed to stabilize breathing and heart function.
The hospital is a dangerous places to be, and the most common cause of death there is sepsis. Sepsis is an underappreciated killer, and it’s getting more common because people are aging, devices are more commonly implanted into the body, immunosuppressive treatment is being used more commonly, and hospital acquired infections are increasingly resistant to treatment.
Sepsis can be caused by an overwhelming infection with bacteria, but can also be caused by viruses, fungi, and severe trauma. Low blood pressure is a common problem, and is associated with change in mental status, and increased breathing rate in raising a red flag for sepsis. Endotoxins play an important, if confusing, role. Endotoxins derive from Gram negative bacteria, but the most common bacterium causing sepsis is the gram positive staphylococcus aureus. With sepsis, though,the gastrointestinal tract may become more leaky, and Gram negative organisms may thereby gain access to the blood stream.
A ccmmon test to detect sepsis is the serum lactate, which becomes elevated if oxygen utilization is diminished, such as in sepsis. There is also a direct test for endotoxin in the bloodstream, performed by using LAL, or Limulus amebocyte lysate. This substance, derived from the cells of the blood of the horseshoe crab, is very sensitive to endotoxins, and coagulates in its presence. This test is also used to detect endotoxins in Biological products and devices, making horseshoe crab is quite valuable.
Maintaining general health, keeping up on your immunizations, wishing your hands, keeping cuts and burns free from infection, ovoid smoking, controlling diabetes and avoiding hospitals whenever possible are useful preventative techniques.
Flat feet will exempt you from the draft, but that is where are their benefit stops. This condition can be inherited, but the arch can also fail to develop during puberty.
The entire bottom of the foot will contact the ground when walking if you have flat feet.
Overpronation happens when the way you walk causes the arches of the feet to flatten even more, putting a strain on the muscles, tendons, and ligaments that support your arches. Overweight and running a lot on hard surfaces accentuates this problem, and pain in the ligaments in the arch of the foot is the result.
Overpronation may be indicated by excessive wear on the inside of the heels and soles of your shoes, and can cause all kinds of problems such as Achilles tendinitis, iliotibial band syndrome, plantar fasciitis, shin splints, and even knee, hip, or back pain. these things may develop in compensation to overpronation while walking.
As an older person, I have pretty much given up tennis and running, and walk rapidly for long (for me) distances in order to get sufficient exercise. Without noticeably increasing my walking, I have recently developed tenderness in the arch of my left foot that made walking painful. Curling my toes, and walking on the outside of my feet seemed to alleviate the pain. This is an exercise that I remember from my childhood, and may have been shown me because of my moderately flat feet.
Swimming for Exercise, and decreasing the amount of walking seems to have corrected the condition at least temporarily, but I have also ordered some orthotic inserts for my shoes as an arch support, in case I need them going forward. I have been told that if this is insufficient I can go to a specialty store and order some special shoes that might help. I have not mentioned painkillers such as NSAIDs, because I try to avoid them
Please check with the accompanying references for more information about flat feet and over pronation.
Our feet are subjected to such abuse that it is amazing we don’t have more problems with them. But problems there are, and I have been having some. I will be exploring the different types and causes of foot pain beginning with this article on plantar fasciitis.
The plantar fascia is a triangular web of connective tissue on the bottom of the foot that begins at the heel and fans out to attach to the toes. With repeated stress, it can become torn or inflamed and caused pain.
The pain of plantar fasciitis is usually centered around the heel, on the bottom of the foot. It is often absent first thing in the morning, produces a stabbing pain on first walking, and goes away with activity; you can “walk it off”. Plantar fasciitis is usually slow to heal and may take several months
The doctor will usually make the diagnosis by your story(history), and the localization of the pain. X-rays, CT scans, and MRIs or necessary only if there’s a suspicion of a stress fracture.
Conservative treatment focuses upon stretching exercises and orthotics, but there are various types of injections, shockwave therapies, ultrasonic tissue repairs, and surgeries that some people need.
A particularly interesting treatment cited was the injection of platelet rich plasma from your own blood to promote healing. I recently read that this technique, in addition to a collagen scaffold is currently used to treat rupture of the anterior cruciate ligament of the knee.
Of course, prevention is the ideal. Maintaining a healthy weight is important. Supportive shoes, with thick soles and good arch support will help. stretching exercises are also helpful as a preventative.
Please check with the Mayo Clinic article for more information.
PSA screening will pick up prostate cancer very efficiently. However, it will also pick up slow growing cancer that might never be require treatment, and responding to the positive test could cause problems ranging from pain and convenience to erectile dysfunction and incontinence.
It takes 1000 men screened to produce one life-saving treatment for prostate cancer.
Risk reward analysis means that the younger you are, the more reasonable is a test, since you have many more years of potential life. The older you are, conversely, the less you have to gain. The problem is that most cancers are slow growing, and might never cause a problem, especially if you have only a few years left to live.
Most experts recommend a test when a man reaches the age of 45, but reserve annual testing for those who are at high risk, such as having a brother or father with aggressive prostate cancer.
When a man reaches the age of 70, most experts would decline to test.
Sometimes, emotional considerations present themselves; worry is very much a disease. For instance, the best man at my wedding stopped getting his PSA test about three years before he was diagnosed with fatal metastatic prostate cancer. I am inclined to continue getting my annual prostate test, and would worry if I didn’t.
A recent study in the journal Cancer reported that more than half of a group of men 75 years and older had PSA tests and biopsies.
As an interesting aside, the PSA test is the only test I have ever had rejected by Medicare, presumably because of this expert opinion factoring in the cost benefit analysis of using the test.
“Colorectal cancer is almost entirely preventable with proper screening,” says senior author Michael B. Wallace, M.D., division chair of Gastroenterology and Hepatology at Sheikh Shakhbout Medical City in Abu Dhabi, United Arab Emirates, and the Fred C. Andersen Professor at Mayo Clinic in Jacksonville, Florida. “The substantial decrease in miss rate using AI reassures health care providers on the decreased risk of perceptual errors.”
The most relevant cause of post-colonoscopy colorectal cancer (CRC) is the miss rate of colorectal neoplasia — the rate at which neoplastic lesions are not detected in a screening or surveillance colonoscopy. Some studies suggest that 52% to 57% of post-colonoscopy CRC cases are due to missed lesions at patients’ colonoscopies. It’s estimated that 25% of neoplastic lesions are missed following screening colonoscopy.
Mayo Clinic Gastroenterology and Hepatology, in collaboration with colleagues from around the world, found that using artificial intelligence (AI) in colorectal cancer screening produced a 50% reduction in the miss rate for colorectal neoplasia. Results of the study were published in the July 2022 edition of Gastroenterology.