MAYO CLINIC HEALTH LETTER Tools for Healthier Lives VOLUME 30 NUMBER 4 APRIL 2012
Inside this issue HEALTH TIPS . . . . . . . . . . . . . 3 Gout and diet choices. NEWS AND OUR VIEWS . . . . 4 Erectile dysfunction drug approved to treat BPH symptoms. Rare brain infection avoided with safe sinus irrigation. CANCER VACCINES . . . . . . . . 4 The quest heats up. CLOSTRIDIUM DIFFICILE . . . . . . . . . . . . . . . . 6 A super serious bug.
Adult scoliosis Dealing with spinal imbalance Scoliosis is the development of asymmetrical curvature and twisting of the spine. It’s commonly thought of as a disease that occurs in adolescents, and is sometimes associated with wearing a back brace to keep the curve from worsening. In fact, scoliosis is more common in older adults than in adolescents. Some adults who had scoliosis as adolescents may see gradual worsening of
their scoliosis with age, but the majority of older adults with scoliosis didn’t have it earlier in life. Scoliosis in older adults is a distinctly different problem from that in adolescents. In adults, back braces are used sparingly, if at all. Adults often benefit most from regular exercise. If surgery is needed, breakthroughs have made certain scoliosis procedures far easier on the body and far more effective than in the recent past.
What’s happening?
Scoliosis in older adults is usually caused by the wear and tear (degeneration) of the spine that commonly
INSIDE WHOLE GRAINS . . . . . 7 The gritty details. SECOND OPINION . . . . . . . . 8
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Scoliosis in older adults is usually caused by the wear and tear (degeneration) of the spine that commonly occurs with age.
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occurs with age. This may include back problems such as: ■ Degenerating disks — Disks are the pads between your vertebrae that act as cushions and allow for spine flexibility. Disk degeneration is a natural part of aging, and diminished disks can place more pressure on joints of the spine. When a disk degenerates unevenly, eventually scoliosis can result. ■ Osteoporosis — This weakening and thinning of bone can cause the vertebrae to fracture and compress. Asymmetric compression can contribute to scoliosis. ■ Prior back surgery that removed spine tissues — Procedures such as laminectomy or facetectomy that remove parts of the spine that are pressing on nerves can lead to spine imbalance. ■ Arthritis — Specifically, this is the development of wear-andtear arthritis (osteoarthritis) in the joints of your spine (facet joints). Spine imbalance — whether caused by pre-existing curvature from youth, disk degeneration or osteoporosis-related degeneration — places uneven force on facet joints. This can cause or worsen arthritis in those joints, leading to further imbalance of the spine.
en. The body responds by producing bony outgrowths that can pinch or compress root nerves that branch from the main spinal column. This can lead to pain or numbness that radiates down one leg and may cause leg weakness. The pain may come and go. The body also responds by thickening spine ligaments. These can gradually squeeze or compress your spinal column (spinal stenosis). It may take years, but this may cause pain that’s centered in the buttocks, rather than radiating down the leg. Position changes such as sitting and leaning forward can often provide relief. But as ligament thickening progresses, position changes provide less relief and leg weakness may make it difficult to walk. Stooped posture is another concern with scoliosis. To relieve pain, you may tip your trunk forward while standing or walking. This can strain and fatigue back muscles, or even cause painful muscle spasms. Additional concerns may include having a rib that pinches against the pelvis or compression of abdominal organs, particularly in those who are overweight. Advanced scoliosis may even make it difficult to keep yourself upright.
■ Addressing bone health — Work with your doctor to develop a plan to stop or slow bone thinning that can lead to osteoporosis and increase risk of spine fractures. This includes getting adequate calcium and vitamin D and possibly taking osteoporosis medications. ■ Maintaining a healthy weight — The more weight you carry, the more stress it puts on your back. ■ Stopping smoking — Smoking reduces blood flow to disks and accelerates disk degeneration. ■ Using pain therapies — Acetaminophen (Tylenol, others), ibu profen (Advil, Motrin, others) or naproxen (Aleve, others) can help relieve pain. Certain antidepressants and anti-seizure drugs also may be considered. Your doctor may prescribe narcotic-containing drugs for severe, persistent pain.
Pain progression
Get active
EDITORIAL BOARD
Scoliosis in older adults isn’t necessarily considered a problem until symptoms develop. Most older adults with considerable spinal curves — especially those who are fit and healthy — can be quite active with no symptoms at all. Problems with scoliosis are often preceded by lack of fitness — specifically the loss of strength in the core muscles of the trunk — and being overweight or obese. These factors — in addition to spine degeneration and unbalanced spinal mechanics — may at first cause low back pain. Over time, osteoarthritis of spine joints may develop or wors-
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Usually, treatment of pain from degenerative scoliosis is similar to treatment for other types of chronic back pain. Strategies include: ■ Exercising — Exercise, such as yoga or Pilates, that strengthens core muscles of the trunk is one of the biggest determinants of longterm health. Avoid extremes of rotation and bending, and use good posture. Balance training and overall fitness can help prevent falls. Load-bearing exercise such as walking can help combat bone degeneration. Aquatic exercise may be a good alternative if walking is too difficult or painful.
April 2012
MAYO CLINIC HEALTH LETTER Managing Editor Aleta Capelle
Medical Editor Robert Sheeler, M.D.
Associate Editors Carol Gunderson Joey Keillor
Associate Medical Editor Amindra Arora, M.D.
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Editorial Research Deirdre Herman Proofreading Miranda Attlesey Donna Hanson Julie Maas
Administrative Assistant Beverly Steele
Shreyasee Amin, M.D., Rheumatology; Amindra Arora, M.D., Gastroenterology and Hepatology; Brent Bauer, M.D., Internal Medicine; Julie Bjoraker, M.D., Internal Medicine; Lisa Buss Preszler, Pharm.D., Pharmacy; Bart Clarke, M.D., Endocrinology and Metabolism; William Cliby, M.D., Gynecologic Surgery; Clayton Cowl, M.D., Pulmonary and Critical Care; Mark Davis, M.D., Dermatology; Timothy Moynihan, M.D., Oncology; Suzanne Norby, M.D., Nephrology; Daniel Roberts, M.D., Hospital Internal Medicine; Robert Sheeler, M.D., Family Medicine; Phillip Sheridan, D.D.S., Periodontics; Peter Southorn, M.D., Anesthesiology; Ronald Swee, M.D., Radiology; Farris Timimi, M.D., Cardiology; Matthew Tollefson, M.D., Urology; Debra Zillmer, M.D., Orthopedics; Aleta Capelle, Health Information. Ex officio: Carol Gunderson, Joey Keillor. Mayo Clinic Health Letter (ISSN 0741-6245) is published monthly by Mayo Foundation for Medical Education and Research, a subsidiary of Mayo Foundation, 200 First St. SW, Rochester, MN 55905. Subscription price is $29.55 a year, which includes a cumulative index published in December. Periodicals postage paid at Rochester, Minn., and at additional mailing offices. POSTMASTER: Send address changes to Mayo Clinic Health Letter, Subscription Services, P.O. Box 9302, Big Sandy, TX 75755-9302.
If inflammation and swelling around nerves is a suspected component of your pain, an injection of an inflammation-reducing corticosteroid drug may help provide pain relief that can last for a few months.
Health tips Gout and diet choices
Surgery that helps
Regardless of the severity of scoliosis you have, surgery won’t help you if you still have good balance, manageable pain and are able to function. However, surgery may be indicated when you have: ■ Radiating nerve root compression that’s also causing leg weakness or significant disability ■ Compression of the spinal column that’s causing pain and weakness, especially if the pain doesn’t subside with an injection of an inflammation-reducing corticosteroid or other pain therapies Since nerve compression and pinching are the main indications for surgery, surgery often involves removing tissues — such as bone or disk material — that are pressing on a nerve and causing pain or other symptoms. When this nerve decompression involves removal of facet joint tissue (facetectomy), it may cause or worsen spine instability. Therefore, your surgeon may couple this with additional work to fuse spine segments together or implant metal bracing devices to add stability to the spine. In the past, fusing vertebrae often involved harvesting bone from the pelvis, requiring more incisions, blood loss, pain and hospitalization. Even then, the fusion failed about a third of the time and most people ended up with ongoing pain where bone was harvested. Today, traditional bone fusion is done less frequently in scoliosis surgery. Synthetic fusion options may include the use of bone morphogenetic protein (BMP). This naturally occurring growth factor stimulates bone growth.
When nerve decompression involves removal of tissue, your surgeon may implant metal braces to add stability.
Surgeons soak a small collagen sponge in a BMP-infused liquid. The sponge is then placed within spinal segments, where it stimulates rapid bone growth that spreads from natural bone and permeates the sponge. Within months, the sponge is replaced by bone. Fusion with BMP may eliminate the need to take bone from elsewhere. The rate of successful fusion is consistently greater than 90 percent, often enabling spinal fusion procedures to be done through much smaller incisions. At Mayo Clinic, BMP fusions can reduce blood transfusion needs in large scoliosis procedures by about 80 percent. Hospital stays can be reduced from five to seven days to two to three. However, it’s not an option for people with existing tumors, as the growth factor may accelerate tumor growth. There’s controversy as to whether BMP increases cancer risk in those without tumors, but Mayo Clinic experts believe the risk — if any — is very low. ❒ April 2012
Gout is a painful and potentially disabling form of arthritis characterized by excess levels of uric acid. Dietary and lifestyle factors may play a part in reducing uric acid. For example, losing excess weight is associated with lower uric acid levels. Other factors include: ■ Choosing the right type and amount of proteins — Increased gout risk has been associated with eating large portions of red meat, seafood and fish. Eating poultry isn’t associated with gout risk. Make red meat meals infrequent and eat more meatless meals. If you do eat meat, eat no more than 4 to 6 ounces daily. Instead focus on lowfat dairy products, which may substantially reduce gout risk. Plant proteins, especially nuts and legumes, also are good protein choices that don’t increase risk of gout. ■ Avoiding alcohol — Evidence suggests beer and hard liquors can raise uric acid levels. But there doesn’t appear to be an association between gout and drinking wine in moderation. ■ Limiting sugar — Put the brakes on beverages that contain lots of fructose. Fructose is a carbohydrate, and it’s the only one known to increase uric acid levels. ■ Keeping hydrated — Aim for eight to 16 cups of fluid — mainly water — each day. Fluids help remove uric acid from the body. Coffee may decrease risk of gout. ❒ www.HealthLetter.MayoClinic.com
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News and our views Erectile dysfunction drug approved to treat BPH symptoms For men, two common problems of aging include difficulty achieving or sustaining an erection and urinary problems due to noncancerous enlargement of the prostate gland (benign prostatic hyperplasia, or BPH). Now, a drug that has been used for erectile dysfunction may have beneficial effects on BPH symptoms, as well. The Food and Drug Administration recently approved tadalafil (Cialis) for treating urinary symptoms of BPH. Mayo Clinic doctors say that while tadalafil has some beneficial effects, alone it probably isn’t enough for more-severe symptoms. Still, for men who have erectile dysfunction and urinary symptoms of BPH, tadalafil may be worth trying. The risk of side effects with tadalafil is relatively low, with backache and headache being the most common. Downsides to tadalafil use include cost, as there’s no generic equivalent. In addition, tadalafil can’t be taken by men who take nitrate medications for heart problems. For those not choosing surgical options, traditional drug choices for BPH symptoms — including alpha blocker drugs and 5 alpha reductase inhibitors, or a combination of the two — remain the most effective choice for relieving urinary symptoms. It’s not well studied whether using tadalafil in combination with drugs from one or both of these drug classes would prove beneficial. For now, tadalafil isn’t recommended for use with alpha blockers, as the combination may increase the risk of developing abnormally low blood pressure. ❒
Rare brain infection avoided with safe sinus irrigation Recent news of two deaths caused by rinsing sinuses with contaminated tap water has drawn attention to the steps necessary to avoid potentially introducing a deadly organism to the brain through the nose. Both deaths were caused by the organism Naegleria fowleri, a single-celled ameba commonly found in warm fresh water, such as lakes and rivers. Rarely, it may be present in water heaters with temperatures lower than 117 F or in geothermal drinking water. The ameba causes no problem if swallowed. But if it gains entry through the nose and travels to the brain, it can cause a brain infection called primary amebic meningoencephalitis (PAM). PAM usually results in death within one to 12 days. Although the risk of the infection is very low, there are steps you should take if you rinse your sinuses with water. The Centers for Disease Control and Prevention (CDC) recommends that the water be distilled, sterilized or previously boiled for one minute — three minutes at elevations above 6,500 feet — and then cooled. Filtered water is another option, as long as your water system filter has an absolute pore size of 1 micron or smaller. The CDC recommends that the device used to help irrigate the sinuses — for example, a neti pot — be rinsed with distilled, sterilized, boiled or filtered water and then left open to air-dry before its next use. Plastic neti pots or sinus rinse bottles should be replaced every three months. ❒
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Cancer vaccines The quest heats up Scientists worldwide are working to develop vaccines to help the immune system isolate and destroy cancer cells while sparing healthy cells. The key is understanding how cancer cells disguise themselves from the body’s disease-fighting immune system and tricking them into making their presence known.
Immune system primer
Your immune system protects your body from foreign invaders — primarily infectious germs (microbes) that cause disease. The immune system also helps protect against abnormal, damaged or diseased cells, including cancer cells. Normally, your white blood cells lead the charge. Specialized white blood cells — called lymphocytes — act like arrows directed at certain microbe invaders or abnormal cells. Most standard vaccines help the body recognize foreign substances (antigens). Antigens stimulate a specific immune response. For instance, the vaccine created to prevent measles contains a weakened live measles virus. That virus acts like an antigen, prompting your immune system to fight the virus and create a long-lasting immunity. Your immune system knows not to attack your normal cells because normal cells have their own set of self-antigens that set them apart as nonthreatening. Cancer cells are different — they can carry both self-antigens and cancer-associated self-antigens, which flag the cancer cells as being foreign. Cancer vaccines are either preventive or treatment oriented. Pre-
ventive cancer vaccines are designed to protect against infections that are linked to the risk of developing certain cancers. Cancer preventive vaccines include: ■ Cervical cancer vaccines — Most cases of cervical cancer are caused by various strains of sexually transmitted human papillomavirus (HPV). The two vaccines approved by the Food and Drug Administration (FDA) are Gardasil and Cervarix. Both vaccines are given before age 26 and can prevent precancerous lesions if given prior to exposure to the virus. Both can prevent most vaginal and vulvar cancer in women, and Gardasil can prevent genital warts. ■ Hepatitis B virus (HBV) vaccine — Chronic HBV infection can lead to a type of liver cancer called hepatocellular carcinoma. The FDA approved the vaccine in 1981, making the HBV vaccine (Recombivax HB, Engerix-B) the first cancer preventive vaccine. It’s given to most U.S. children shortly after birth and again after age 1. Both preventive vaccines use antigens from part of the virus known to prompt or contribute to cancer development.
A different approach
Cancer-treatment vaccines work a different way. In simplest terms, they’re structured to harness the power of the immune system. The first cancer-treatment vaccine was in 2010. The vaccine — sipuleucel-T lactated Ringers solution (Provenge) — is individually customized for men with a certain type of advanced prostate cancer. The vaccine uses specific immune system cells from a man’s blood to help increase his body’s immune response to an antigen found on most prostate cancer cells. In trials, the vaccine increased survival by about four months. Another prostate cancer vaccine still
MUC1 is a protein being studied for vaccine development. At left, MUC1 (in red) lines a normal duct in the breast. At right, MUC1 is produced at high levels in a lymph node where cancer is present. Adapted by permission from Macmillan Publishers Ltd. Oncogene 22, 1324-32, 2003.
under study uses a particular virus to stimulate the body’s immune response to prostate cancer cells. It’s also being studied for use by men with advanced prostate cancer.
Cutting edge
Decades of research have gone into understanding what fuels cancer cells and keeps them alive. The National Cancer Institute (NCI) has recognized the importance of several tumor proteins for vaccine development. Among them is MUC1, a protein found in abundance on the surface of tumor cells, such as those in breast, ovarian, pancreatic and colorectal cancers. MUC1 is produced at high levels when cancer occurs and changes normal cell structure. Viewed under a microscope, tumor-associated MUC1 proteins appear to be decorated with distinctive, shorter sets of sugars, distinguishing them from healthy cells. In 2011, researchers at Mayo Clinic and at the University of Georgia published early findings from laboratory studies of a cancer vaccine that’s built around helping the immune system recognize and kill cancer cells that exhibit changes in their surface MUC1 proteins. It’s too soon to know if the vaccine will make it into clinical trials. But early efforts indicate the vaccine produces a strong immune response. Along with others, Mayo Clinic researchers are pursuing a possible April 2012
vaccine treatment for melanoma, an often deadly skin cancer. Several prior melanoma vaccine trials have helped advance and refine the quest. In 2012, Mayo Clinic researchers expect to be involved in the start of two new melanoma vaccine clinical trials. Mayo Clinic also has FDA approval for clinical trials of ovarian and breast cancer vaccines designed to prevent cancer relapse. The vaccines target proteins. One is folate receptor alpha protein, found in abundance in breast and ovarian cancer cells. The other protein is HER-2-neu, found on some of the most aggressive breast cancers. It’s hoped the vaccines will boost the immune system in women who’ve completed conventional treatment for ovarian or breast cancer and have no sign of disease. Early studies found both vaccines worked best when there was less disease.
Reason for hope
The efforts of cancer vaccine researchers worldwide is fueling optimism that eventually the immune system may be prompted to identify and destroy cancer. According to the NCI, active clinical trials of cancer treatment and cancer preventive vaccines are underway for more than a dozen types of cancer. Clinical trials for vaccines under study are conducted in many settings. Some of these include cancer centers, large medical centers, small hospitals and doctors’ offices. If you’re interested in learning more about possible cancer vaccine clinical trial options, talk with your doctor. In addition, the National Cancer Institute keeps a list of all cancer clinical trials. To reach the NCI, call 800-422-6237. National Cancer Institute information is also available on the Internet at www.cancer.gov. ❒ www.HealthLetter.MayoClinic.com
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Clostridium difficile A super serious bug Antibiotic drugs have cured illness and saved countless lives by destroying infection-causing bacteria. But bacteria can be adaptive organisms. Clostridium difficile (klosTRID-e-uhm dif-uh-SEEL) — also called C. difficile or C. diff — is one example. C. difficile is a bacterium that may cause no symptoms, or it can cause problems ranging from diarrhea to life-threatening inflammation of the colon. In recent years, C. difficile infections have become more frequent, severe and difficult to treat. Older adults are at particularly high risk of developing a C. difficile infection, especially if they’re in a hospital or long term care facility. In an ironic twist, taking antibiotics can trigger a C. difficile infection.
High-risk situations
C. difficile bacteria can be found throughout the environment, but are most common in hospitals and other health care facilities where people are especially vulnerable to infection. These bacteria are passed in feces and produce hardy spores that without effective cleaning can persist on surfaces for months. C. difficile spreads through contact from an environmental source or a health care worker’s hands to a patient and then into the mouth and gastrointestinal tract. Touching contaminated objects such as cart handles, bedrails, bedside tables, toilets, telephones, remote controls, sinks and thermometers may allow spread of the organism. Simply coming in contact with the microorganism usually isn’t enough to make you ill. Your body’s defenses usually protect you.
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However, antibiotics may disrupt the protective bacteria in your gut, allowing C. difficile to cause illness. That’s because your intestines contain millions of beneficial bacteria, many of which help keep harmful bacteria like C. difficile in check. When you take an antibiotic to treat an infection, the drug can destroy some of the helpful bacteria and C. difficile can grow out of control. The risk of infection goes up if you take broad-spectrum antibiotics that target a range of bacteria, use multiple antibiotics or take antibiotics for a prolonged period. Additional risk factors include: ■ Having had abdominal surgery or a gastrointestinal procedure ■ Having had a previous C. difficile infection ■ Taking stomach acid-suppres sing medications for problems such as gastroesophageal reflux disease
Serious symptoms
C. difficile infection may be suspected in anyone with diarrhea who is taking or has taken antibiotics within the past three months, or in those who develop diarrhea within a few days of hospitalization. The most common symptoms of mild to moderate infection are: ■ Watery diarrhea three or more times a day for two or more days ■ Mild abdominal cramping and tenderness Many people have loose stools during or shortly after antibiotic therapy. Still, contact your doctor if these milder symptoms last more than three days. Seek emergency care if you have symptoms of severe C. difficile infection such as a new fever, severe pain or cramping, blood in your stool, or very frequent watery bowel movements a day. Many times, people describe their stool as green in color and odorous. C. difficile can cause significant inflammation and potentially April 2012
deadly complications such as severe dehydration, shock or potential rupture of the colon.
Isolation and treatment
For mild illness, the first step may be to stop taking the antibiotic that triggered the infection. This may relieve symptoms. However, many people require additional treatment to eliminate the infection. This includes antibiotics directed at the bug. Treatments may include: ■ Specific antibiotics — Metronidazole (Flagyl), oral vancomycin (Vancocin) or fidaxomicin (Dificid) keep C. difficile from growing. ■ Intravenous fluids, nutrition — These help avoid dehydration. ■ Surgery — Very rarely in lifethreatening cases, removal of the colon may be lifesaving. About a fourth of people with C. difficile develop recurrent symptoms shortly after completing treatment. Treatment for recurrent disease usually includes: ■ A repeat course of a first line antibiotic or a prolonged course of vancomycin ■ Avoidance of the antibiotics that caused the problem A novel approach is to restore healthy intestinal bacteria by placing healthy donor stool in the colon. The treatment works more than 90 percent of the time when everyting else has failed, but few physicians provide the procedure.
Stopping the bug
If you or a loved one has an episode of diarrhea or you’re visiting a health care facility, vigorously wash your hands with soap and warm water for 30 seconds. The friction of rubbing removes the spores. Alcohol-based hand sanitizers don’t effectively destroy spores of C. difficile. At home, clean the bathroom and other high-touch surfaces daily with a 1-to-10 dilution of household bleach. ❒
Inside whole grains The gritty details Have you ever wondered what distinguishes wheat bread, wholewheat bread and 100 percent whole-grain bread from one another? The answer is how much processing — refining — the original grain has undergone since harvest. Americans are good at eating grain-based foods. The problem is that the majority of those foods are highly processed refined grains, not whole grains. Dietary Guidelines for Americans recommends at least half of your daily grain servings be whole. Making the right choices ensures you get adequate whole-grain nutrients and fiber.
True grit
Whole grains include the entire grain, usually called the kernel. The nutrient-dense kernel includes a fibrous outer coating (bran) that protects the kernel’s interior. Most of the interior is endosperm, a starchy substance that provides energy for the kernel’s reproductive seed (germ). The germ is a treasure trove of vitamins, minerals, healthy unsaturated oils and phytochemicals. Whole grains are products made from kernels that are cracked, crushed or flaked, as long as the proportions of bran, endosperm and germ are relatively the same as when the grain was intact. That relative sameness can be recreated by adding back the same amounts of bran, germ and endosperm removed during processing. Although compounds are altered when whole-grain kernels are cracked, crushed or flaked, those
Check the label Ingredients are listed on labels according to weight. For products such as breads or cereals, if whole grains are first or second after water, and are the primary ingredient, that product is considered predominantly whole grain. For foods with multiple whole grains, look for those to be listed at the top of the ingredient list. Among the whole grains you may see listed are wholegrain corn or barely, buckwheat (kasha), millet, oats, oatmeal, popcorn, quinoa, brown or wild rice, and whole rye. Whole wheat may be listed several ways, including wheat berries, cracked wheat and bulgur. You can also check the Percent Daily Value of dietary fiber listed on the Nutrition Facts label — the higher the percentage, the better. Look for foods that have between 2.5 and 5 grams, which constitutes 10 to 19 percent of the Daily Value. Foods high in dietary fiber contain 5 or more grams.
Commit to more grit
changes may not be as significant as when grains are refined. Refined grains have a finer texture. The bran and germ are removed leaving the endosperm, which is pulverized. Refining strips away fiber and vitamins. Most refined products are enriched with added iron and B vitamins — thiamin, riboflavin, niacin and folic acid. Often, the term “enriched” appears on the package. Whole grains are associated with protection from cardiovascular disease. They may also help lower weight and reduce incidence of diabetes, although evidence is limited.
Dietary guidelines generally recommend that most older women get five to six 1-ounce grain servings a day, and most older men get seven to 10 1-ounce servings. Examples of a 1-ounce serving are a slice of bread, a cup of readyto-eat cereal, or one-half cup of cooked cereal, rice or pasta. Some simple ways to eat more whole grains include: ■ Choosing whole-grain cereals — Try steel-cut oats, a home-made porridge of cracked wheat berries or mixtures of whole grains such as oats and brown rice. These are typically cooked with milk or water. ■ Choosing whole-grain breads — Have a hearty toast with your yogurt and fruit. Enrich your sandwich with whole-grain bread. ■ Trying new dishes — Cook brown rice, wild rice, quinoa or barley. Or try groats. These are minimally processed whole-grain kernels of oats or barley with the outer husk or hull removed. Groats are usually soaked and then slowly simmered until soft. ■ Substituting whole grain — Instead of regular pasta, use wholegrain pasta. Substitute brown rice for white rice or potatoes in soups and other dishes. ❒
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Second opinion Q: I have more eye floaters than in the past. Should I be worried? A: Eye floaters are the gray or transparent specks, strings or webs that you may see drift about when you move your eyes. A noticeable increase in eye floaters over time probably warrants a visit with an eye doctor, as an increase in floaters can be a sign of an underlying eye problem. More importantly, if you experience a sudden increase in the number of floaters — especially if accompanied by flashes of light or a loss of peripheral vision — seek immediate eye evaluation. These painless symptoms could be caused by a retinal tear or retinal detachment. Without prompt treatment, a retinal tear or detachment can lead to permanent vision impairment or even blindness in the affected eye. A sudden increase in floaters can also be caused by a hemorrhage or an inflammation in the eye. Any sudden increase in floaters is deserving of an evaluation by an eye specialist. Still, eye floaters are usually harmless and most people have a few floaters drifting around inside their eyes. Eye floaters are often caused by age-related changes that occur as the jelly-like substance (vitreous humor) inside your eyeballs becomes more liquid. In rare instances, eye floaters can become so numerous that they significantly interfere with your vision. If that happens, your doctor may
suggest a surgical procedure (vitrectomy) that uses a hollow needle to withdraw vitreous humor from your eye. The vitreous humor is replaced with a saltwater solution. However, this procedure can cause retinal detachment and cataracts, and it may not remove all floaters. Laser procedures carry the same serious risks and are rarely recommended. ❒
Q:
When my husband drops a piece of food on the floor, he quickly picks it up and eats it, claiming that if it’s not on the floor for more than five seconds, it’s just fine. I think he’s asking for trouble. What do you think?
A: He may be asking for trouble. One study tested how long it took for salmonella bacteria to transfer from tile, wood or carpet to a slice of bologna that was dropped on the surface. The bologna in the different tests was picked up after five, 30 and 60 seconds. It turns out that the transfer of virtually all of the bacteria that would end up on the bologna oc-
curred almost immediately. Leaving the bologna on the floor for five seconds resulted in virtually the same amount of salmonella bacteria contamination as it did when the bologna was left for a minute. The Centers for Disease Control and Prevention estimates that each year, one in six Americans gets sick from foodborne illness — and about 3,000 Americans die of foodborne diseases. Eating dropped food isn’t a common means of acquiring food poisoning, but the risk of contamination does exist. You have no way of knowing what types of bacteria are on your floor, and research has found that bacteria can persist for hours, days or weeks — although the amount does decline over time. Food that’s been dropped on the floor is almost immediately contaminated with any organisms it comes in contact with, so it potentially could cause illness if eaten. ❒ Have a question or comment? We appreciate every letter sent to Second Opinion but cannot publish an answer to each question or respond to requests for consultation on individual medical conditions. Editorial comments can be directed to: Managing Editor, Mayo Clinic Health Letter, 200 First St. SW, Rochester, MN 55905, or send email to
[email protected] For information about Mayo Clinic services, you may telephone any of our three facilities: Rochester, Minn., 507-284-2511; Jacksonville, Fla., 904-953-2000; Scottsdale, Ariz., 480-301-8000 or visit www.MayoClinic.org
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