Zeitschrift für Kinder- und Jugendmedienforschung 2/14 4. Jahrgang ISSN 2235-1248, www.kids-media.uzh.ch Männlichkeiten – Indianer in der Pampa: Wann ist ein Mann ein Mann? – „Die Zukunft besteht nur aus Alter, Krankheiten und Schmerzen." Der deformierte, männliche Körper im realistischen Jugendroman – Der grosse Leser: Männlichkeit, Macht und Leseschwäche in fantastischen Kinder- und Jugendmedien der Gegenwart – Abschied vom Macho: TKKG-Tim im Wandel –
MAYO CLINIC HEALTH LETTER VOLUME 27 NUMBER 3
is only one of the many situations thatmay increase your risk of DVT. Inside this issue
People who develop DVT are often predisposed to quicker clotting.
HEALTH TIPS . . . . . . . 3
That's often coupled with some cir- Luggage without pain.
Preventing blood clots
cumstance — more likely hospital-ization or surgery than a long airline NEWS AND OUR VIEWS . . . 4
in the legs
flight — that triggers clot formation. Pneumococcal vaccine may re-
If you have an elevated risk of duce heart attack risk. Forget about You know the drill: Anytime you fly blood clot development, taking pre- ginkgo supplements to aid mem-
on an airplane for more than a cou- cautions to prevent DVT is important.
ple of hours, you're supposed to stay Once a clot develops, it may take hydrated, avoid alcohol and period- months to go away, even with treat- TREATING ANXIETY . . . . 4
ically move your legs to prevent ment. However, treatment greatly Take back your life.
blood clots forming in your veins reduces the risk that the clot will SMALL INTESTINAL BACTERIAL
(deep vein thrombosis, or DVT).
become bigger, or that some or all of OVERGROWTH . . . . . . 6
This is generally good advice. But it will break away and block a lung Cause of digestive trouble.
while public perception closely links artery. This commonly fatal condition cramped airline seats with DVT, this is called a pulmonary embolism. ➧ KNEE LIGAMENT
SURGERY . . . . . . . . 7
Age limits are changing.
SECOND OPINION . . . . 8
Coming in April
Making the impossible possible.
THE B VITAMINS
Simplifying the complex.
Getting your gait back.
Recognizing what connects you.
If fragments of a deep vein thrombosis break loose, they can be carried to the lungs, block-
ing blood flow. This is called a pulmonary embolism, and it can be fatal.
Visit us on the Internet at the address listed to the left, where you'll find more
health information, great offers and more! ■ A past incident of DVT or pul- Deep vein thrombosis is much If you're found to have a DVT, more common than most people ■ Use of hormone replacement the immediate focus of treatment is realize. It's estimated that each year therapy or birth control pills preventing the clot from getting big- around 350,000 Americans are ■ Pregnancy and especially re- ger and reducing the risk of pul- affected by DVT or pulmonary em- monary embolism. The mainstays of bolism, its primary complication.
■ A family history of blood therapy are drugs to prevent blood DVT develops in the larger clots, which may indicate an inher- clotting (anticoagulants). These won't "deep" veins that are the final con- ited blood-clotting disorder dissolve the blood clot, but they duits funneling blood back to the ■ Lifestyle factors such as obe- help prevent blood clots from break- heart. It mostly occurs in the largest ing off of your DVT, and prevent fur- veins of the legs and pelvis, although In addition, any one of several ther blood clot growth. DVT may occasionally develop in situations may be a triggering event Initial anticoagulant therapy the arms. Many factors can make leading to DVT. Even after the trig- involves injections of a fast-acting you more prone to DVT, including: gering event is over, risk of DVT may drug such as heparin. The oral anti- ■ Certain cancers, especially be heightened for up to three months.
coagulant warfarin (Coumadin) may pancreatic, brain, lymph node and Triggering events include: be started along with heparin. War- lung cancers, or chemotherapy ■ Hospitalization for a sudden farin takes a few days before it's fully ■ Advanced age or medical cir- medical problem — Trauma to the effective. As the warfarin takes effect, cumstances that require you to be leg area or pelvis or a fracture of a you will likely be instructed to stop in a nursing home leg or pelvis bone puts you at espe- taking heparin.
cially high risk.
Most people with DVT can ■ Major surgery — This espe- expect to take an anticoagulant drug Beware of pulmonary
cially includes hip or knee replace- for a minimum of three months.
ment or surgery in the pelvic area.
■ Long periods of sitting — MAYO CLINIC HEALTH LETTER From the deep veins of the Airplane flights that are around six legs and pelvis it's a straight or more hours are the main culprits, Robert Sheeler, M.D.
shot to the heart, and only a but long car or train rides can be, too.
Associate Medical Editor
Amindra Arora, M.D.
short distance farther to the lungs. If a fragment — or, Hard to detect
more commonly, several Many DVTs can develop and fragments — of a deep vein grow quite large before causing any thrombosis break loose, they symptoms. Still, almost all cause can be carried to the lungs, signs and symptoms eventually.
blocking blood flow. This is These may include: called a pulmonary embo- ■ Swelling in the ankle area of Shreyasee Amin, M.D., Rheumatology; Amindra lism, and it can be fatal.
the affected leg. Typically, only one Arora, M.D., Gastroenterology and Hepatology; BrentBauer, M.D., Internal Medicine; Tracy Berg, R.Ph., Signs and symptoms of leg is affected.
Pharmacy; Julie Bjoraker, M.D., Internal Medicine; pulmonary embolism vary.
Bart Clarke, M.D., Endocrinology and Metabolism; ■ Leg pain that often starts in William Cliby, M.D., Gynecologic Surgery; Diane Sometimes, no symptoms the calf and can feel like a cramp.
Dahm, M.D., Orthopedics; Mark Davis, M.D.,Dermatology; Timothy Hobday, M.D., Oncology; Lois are evident. However, seek ■ Redness or warmth over the Krahn, M.D., Psychiatry; Michael Mahr, M.D., emergency medical care if affected area and fever.
Ophthalmology; Lance Mynderse, M.D., Urology;Suzanne Norby, M.D., Nephrology; Robert Sheeler, If your doctor suspects DVT, M.D., Family Medicine; Phillip Sheridan, D.D.S.,Periodontics; Peter Southorn, M.D., Anesthesiology; ■ Unexplained shortness ultrasound imaging is typically the Ronald Swee, M.D., Radiology; Farris Timimi, M.D., of breath, which can come first test used because it's safe, wide- Cardiology; Aleta Capelle, Health Information. Ex-officio: Carol Gunderson, Joey Keillor.
on gradually or suddenly ly available and quite accurate.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
■ Sharp chest pain when Additional testing, such as more monthly by Mayo Foundation for Medical Education you inhale or cough advanced imaging scans or addi- and Research, a subsidiary of Mayo Foundation, 200First St. SW, Rochester, MN 55905. Subscription price ■ Feeling lightheaded or tional blood testing, may be done is $29.55 a year, which includes a cumulative index dizzy or even fainting published in December. Periodicals postage paid at to aid in diagnosis, identify the root Rochester, Minn., and at additional mailing offices.
■ Coughing up blood cause of the problem or to help POSTMASTER: Send address changes to Mayo ClinicHealth Letter, Subscription Services, P.O. Box 9302, establish effective therapy.
Big Sandy, TX 75755-9302.
2 www.HealthLetter.MayoClinic.com March 2009
That's often about how long it takes impair blood flow. Blood that should for the body to dissolve the blood be getting pumped up to your heart Health tips
clot. However, depending on the can instead pool in your legs when causes of your DVT and your risk of you're upright. The result is leg developing another, you may need swelling due to fluid accumulation Luggage without pain
to continue anticoagulants for as (edema). Without treatment, addi- long as your risk remains increased.
tional skin problems and large, dif- More than 50,000 people With anticoagulant use, there's in- ficult-to-heal sores may occur. sought treatment in 2007 due creased risk of bleeding, so it's When swelling occurs as a result to injuries related to lugging important to work closely with your of DVT, it's called post-thrombotic luggage. These travel safety tips doctor to monitor your risk. syndrome. About 30 to 50 percent are from the American Aca- If you can't take anticoagulants, of those who have DVT will devel- demy of Orthopaedic Surgeons: a clot-trapping filter may be placed op post-thrombotic syndrome. The ■ Pack lightly — Most in the large vein in your abdomen chances of developing it are high- people bring much more than that leads from your legs to your est within the first one to two years.
needed. Cut back. Avoid mus- heart. The filters may be able to But anyone who has had DVT is at cle strains, pulls and tears by block a clot from reaching your risk of developing post-thrombotic packing items in a few small- lungs. However, they're not risk-free syndrome at some point later in life.
er bags instead of one large and may actually increase the risk Well-fitted compression stock- piece of heavy luggage.
of developing clots in the legs. In ings that are put on the affected leg ■ If possible, use wheeled addition, evidence showing they the moment you get out of bed and luggage — Doing so reduces can save lives is lacking.
worn all day are the main treatment the time you're carrying the full In rare cases, clot-dissolving of post-thrombotic syndrome. How weight of your luggage. If drugs (thrombolytics) may be used they're worn varies. Some doctors you're purchasing new lug- to dissolve DVT. For most, the risk recommend that everyone with DVT gage, choose sturdy, light of potentially deadly bleeding out- wear them for one to two years.
pieces with four wheels or two weighs the clot-dissolving benefit.
Others feel they're only needed if wheels and an extendable significant swelling is present. handle. When pulling wheeled Once post-thrombotic syndrome baggage or carrying bags, A deep vein blood clot is like- develops, you'll probably need to avoid fully straightening (ex- ly to cause vein damage or result in wear a compression stocking on the tending) your arm. Instead, residual vein blockage. This may affected leg for life. ❒ keep that arm bent and closerin to your body. If you mustuse stairs, carry your rolling luggage as you climb or de- For most healthy adults, DVT is extremely rare and not worth scend the stairs.
worrying about. If you're at elevated risk of DVT or are working to ■ Use smart lifting and prevent a second episode, help keep your legs clot-free by: carrying techniques — Lift lug- ■ Taking precautions when traveling — Stay hydrated, avoid gage with your leg muscles, alcohol and take hourly breaks from sitting to walk around. The not your back and waist. Stand extra legroom of an aisle or business-class seat may help. For those alongside your suitcase, bend at especially high risk, a below-the-knee compression stocking or at your knees, then grasp the an injection of heparin prior to travel may be needed. handle and straighten up.
■ Making lifestyle changes — Losing weight if you're obese may Avoid twisting or rotating your help reduce your risk of DVT. spine, and don't rush. Carry ■ Following instructions from your doctor or surgeon — There luggage as close to your body are well-established guidelines for preventing DVT in many med- as possible. If using a shoulder ical situations, particularly with surgery. Anticoagulants feature bag, be sure the strap is pad- prominently in almost every DVT prevention plan. It's important to ded and switch sides often.
take anticoagulants for the length of time recommended by your ■ Don't overdo — Check doctor or surgeon — which may be for several weeks or longer — heavier items when traveling.
and to carefully follow any additional instructions.
If you need help, ask for it. ❒
News and our views
Pneumococcal vaccine may reduce heart attack risk
For adults 65 and older, the pneumococcal vaccine offers protec-
Take back your life
tion from a common and sometimes deadly strain of bacteria that cancause serious infections of the lungs (pneumonia), the lining of the It would be great to wake up and brain (meningitis) or blood (bacteremia). But that may not be the only look forward to the day. But it's been way the vaccine prevents illness and death.
months since that happened. In- A study published in the Oct. 7, 2008, issue of the Canadian stead, your first thoughts are shroud- Medical Association Journal showed that among recipients of the pneu- ed by inescapable worries: "I hope mococcal vaccine, the risk of a heart attack in hospitalized patients I don't feel sick again today. What if who were at risk of heart attack was halved. I get another migraine? I can't face Researchers studied about 5,000 Canadians with an average age meeting with my book club tonight.
of about 60 and at least one risk factor for heart attack. A fifth of these I feel so trapped, and I can't focus.
had been admitted to the hospital for heart attack. Pneumococcal vac- I wish I didn't have to leave the cination rates in this group were compared with those of the remain- house and deal with anyone." ing 4,000 participants who hadn't had a heart attack. You weren't always like this. And Among those who had received a pneumococcal vaccine at least chances are pretty good that you two years prior, heart attack rates were about 50 percent lower than don't have to stay like this if you get in those who received the vaccine within the past year or who had- n't received it at all. Anxiety disorders affect about Mayo Clinic specialists agree with study authors that more research 40 million American adults. The is needed to confirm results. There are a number of potential biases good news is that there are effective that the study didn't take into account. For example, participants in treatments for anxiety disorders that the group that had more heart attacks also had more of the diseases can help you take back your life. that increase heart attack risk. In addition, it may be that people Recognizing the problem
who get the pneumococcal vaccine had better health care overall. ❒ Generalized anxiety disorder Forget about ginkgo supplements to aid memory
(GAD) is one of the most common Does the popular medicinal herb ginkgo (Ginkgo biloba) prevent anxiety disorders. Often, it has its dementia? Apparently not, according to results from the Ginkgo beginnings somewhere between Evaluation of Memory (GEM) study published in the Nov. 19, 2008, childhood and middle age, although issue of the Journal of the American Medical Association. it can become evident at any age.
Participants were randomly assigned to two groups. One group Among older adults, GAD can coin- took 120 milligrams (mg) of ginkgo extract twice daily, and the other cide with depression. Close to 7 mil- group took identical-looking tablets with no active ingredients.
lion adult Americans have GAD, Although ginkgo supplements are commonly promoted as use- with about twice as many women ful for enhancing and preserving memory, the GEM findings indi- as men having the disorder.
cated otherwise. The rates of dementia or Alzheimer's disease were Signs and symptoms of GAD the same in both groups. And, there was no evidence that taking gink- may appear gradually over time. In go supplements reduced progression of dementia among those who fact, those who have the disorder had mild cognitive impairment at the start of the study. may not recall the last time that they Mayo Clinic doctors say that the GEM study findings are quite felt at ease. If you have GAD, you clear-cut. Although smaller studies in the past have suggested mem- typically can't seem to shed your ory benefits from ginkgo use, the GEM study along with other recent worries, even though you probably studies delivers a hard blow to the concept of ginkgo supplements realize they're out of proportion to preventing dementia. Instead of spending your money on supple- any given situation. In addition to ments, it might make more sense to spend it on a good book and a excessive worrying, you may startle good pair of athletic shoes, since being mentally active and physi- easily, have trouble falling or stay- cally fit has known benefits for the brain. ❒ ing asleep, and find it difficult toconcentrate when you're awake.
4 www.HealthLetter.MayoClinic.com March 2009
Other signs and symptoms of GADmay include fatigue, muscle tension A thoughtful course of action to cope with anxiety
or aches, restlessness, feeling out ofbreath, nausea, diarrhea, headaches, Cognitive behavioral therapy (CBT) can be a powerful treatment and excessive irritability.
tool for anxiety disorders. This therapy addresses the thought General anxiety disorder is just patterns that support your fear or anxiety and helps you change the one of several types of anxiety dis- way you behave or react in situations that trigger anxiety.
orders. Others include phobia, panic CBT is typically done with the help of a therapist who meets disorder, obsessive-compulsive dis- with you regularly, generally at least an hour each week over the order, post-traumatic stress disorder course of several months. The therapy is directed at your specific and social anxiety disorder.
form of anxiety and is tailored to your needs. For instance, if youdeal with panic disorder, you'll learn about the physical mecha- Deciding on treatment
nisms that produce the uncomfortable symptoms experiencedduring a panic attack — and, despite how it may feel, that you're If anxiety interferes with your not dying. If you're gripped with anxiety at the thought of being in daily activities, it's time to see your a large gathering of people, you'll learn to overcome the belief that doctor. Anxiety disorders can occur you're being judged and watched by others. on their own, independent of any The second prong of CBT therapy occurs when you and your other health concerns. However, a therapist decide you're ready to confront your fear. Exposure-based whole host of disorders that may be behavior therapy — where you encounter the object or situation encountered with age — such as that triggers your anxiety — may be gradually introduced, some- heart disease, lung disease, thyroid times using pictures or sound recordings. When you are ready to problems and even dietary problems face the feared situation, it's not uncommon for your therapist to — can have anxiety as a symptom.
accompany you to provide support and guidance.
If there's an underlying condition, Research shows that CBT is among the most powerful treat- treating and managing it can help ments for anxiety disorders. It may not cure your anxiety, but it can reduce or eliminate anxiety.
give you the power to cope with your situation in a more healthy When the primary concern is way and to feel better about yourself and your life.
anxiety on its own, the main treat-ments include: ■ Psychotherapy — This involves ■ Medications — Generally, two For treatment of acute anxiety working with a therapist to under- types of drugs — antidepressants and over the short term, your doc- stand how feelings and behaviors and anti-anxiety drugs — are used tor might recommend a benzodi- can result from how you think about to treat anxiety disorders. Among azepine, which generally eases anx- yourself and your experiences. This antidepressants that have anti-anx- iety within 30 to 90 minutes. These may be done through cognitive iety properties, the first choice often include alprazolam (Xanax), chlor- behavioral therapy, which involves is a selective serotonin reuptake diazepoxide (Librium), clonazepam learning to identify unhealthy, neg- inhibitor (SSRI), such as fluoxetine (Klonopin), diazepam (Valium) and ative beliefs and behaviors that con- (Prozac), paroxetine (Paxil), sertra- lorazepam (Ativan). There are con- tribute to anxiety and how to replace line (Zoloft) and citalopram (Celexa).
cerns over long-term use of benzo- them with healthy, positive beliefs. Other antidepressants that may be diazepines, because they are habit- These types of therapies can be considered include duloxetine (Cym- forming. In addition, they may cause particularly helpful at improving balta) and venlafaxine (Effexor). unsteadiness, drowsiness, reduced anxiety symptoms. With the help of These drugs can be highly effec- muscle coordination and balance your therapist, you can learn to bet- tive, but it may take several weeks problems. Memory problems are ter understand your anxiety triggers, to months before the full effects are possible and the risk increases with develop coping skills and learn noticed. In addition, it may be nec- higher doses and long-term use. relaxation skills. These treatments, essary to try several before you find Buspirone (BuSpar) is another although generally short-term, can one that works best for you. drug used for anxiety. It's not in the help you acquire the "tools" you'll How long medication may be benzodiazepine class and doesn't need to identify, manage and turn needed varies and is best decided pose a risk of dependence. It takes around the otherwise faulty think- with the help of your doctor, who several weeks to relieve anxiety and ing patterns that can contribute to can help tailor treatment to your must be taken regularly, rather than anxiety disorder.
individual needs. on an as-needed basis. ❒
your small intestine. There, fluid isextracted to be tested for bacteria bacterial
count. Tissue samples (biopsy) of thewall of the intestine also may be taken to look for evidence of abnor-mal tissues or inflammation.
That's a fairly involved process Cause of digestive trouble
that may not be appropriate for justanyone with digestive issues. How- Persistent bloating, gut discomfort, ever, additional clues may suggest gas and diarrhea are signs and bacterial overgrowth and can help symptoms common to many types you and your doctor determine how of digestive problems. One that's far you want to go in pursuing a Small intestinal bacterial overgrowth means
been getting more attention recent- diagnosis. These include: there is either too much bacteria or the
ly is small intestinal bacterial over- ■ Evidence of poor nutrient wrong type in the small intestine.
growth. This simply means that you absorption — Weight loss, foul- have either too much bacteria or the in a section of small intestine with- smelling, greasy stools — or a pos- wrong type in your small intestine.
out normal intestinal movement itive stool-fat test — anemia and Interest has grown because anti- (blind loop). These create a hide- deficiencies of vitamin B-12 may all biotics are sometimes effective at away for bacteria to thrive. suggest poor absorption or malnu- eliminating symptoms, although ■ Scleroderma and Crohn's dis- trition. In addition, since bacteria they may be needed on an ongoing ease, which can cause hardening produce folate, and to a lesser extent basis. This can be a ray of hope for and scarring of intestinal tissues, vitamin K, excesses of either nutri- those with digestive troubles, be- compromising movement within the ent also may be a clue. cause many struggle to find relief.
small intestine. ■ Hydrogen breath test — The However, bacterial overgrowth A number of disorders may con- digestion of certain sugars by bac- probably isn't that common. Among tribute to bacterial overgrowth. Chief teria in the colon produces hydro- those with intestinal digestive prob- among them is diabetes, which can gen, which is absorbed into the lems, such as irritable bowel syn- lead to diminished immune and bloodstream and exhaled through drome (IBS), the ability to relieve small intestine mechanical function.
the lungs, where it can be measured.
symptoms with an antibiotic remains Excessive bacteria in the small As these sugars — such as lactulose the exception rather than the rule.
intestine, or bacteria in the small — pass through your small intestine, Still, bacterial overgrowth may intestine that is normally found in they should remain undigested. If be a reasonable avenue to explore the colon, can result in excessive you have bacterial overgrowth, a if you have persistent digestive prob- gas production in the small intes- hydrogen spike may appear in your lems — especially if there's evidence tine. This can cause bloating, grum- breath as the sugar passes through of malnutrition or poor nutrient bling gut, abdominal discomfort, the small intestine. Unfortunately, absorption, such as weight loss.
excess flatulence and diarrhea.
this test may be accurate only about Bacterial overgrowth may lead 60 percent of the time.
to malnutrition and weight loss. It Bacteria in the small intestine can cause inflammation and dam- Keeping it in check
are naturally kept under control pri- age the lining of your small intes- The underlying cause of most marily through your immune sys- tine, limiting your body's ability to bacterial overgrowth is usually an tem and the coordinated actions of absorb nutrients. Bacteria also com- anatomical problem involving the the intestinal muscles that propel pete with your body for nutrients, small bowel. Therefore, antibiotics food and bacteria toward the colon.
particularly vitamin B-12.
are the main way to manage it. When one or more aspects of Unfortunately, the root cause this system become compromised, Adding it up
remains and overgrowth often re- bacterial overgrowth may occur. The gold standard test — though turns within a year. For many, an on- Potential causes may include: not perfect — for diagnosing bac- and-off cycle of antibiotic use, or ■ Outpouchings (diverticula) in terial overgrowth involves inserting continuous intermittent use of rotat- the wall of the small intestine or cer- a thin, flexible tube (endoscope) into ing antibiotic types, is necessary to tain surgical procedures that result your mouth and to the upper part of keep the bacteria under control. ❒ 6 www.HealthLetter.MayoClinic.com March 2009
■ Nonsurgical rehabilitation — A treatment path of physical thera- py and modified activity is depen-dent upon several factors. Theseinclude whether the knee is stable Age limits are changing
during typical daily activity, theextent of associated damage to your It was a sickening sound — the loud knee and whether you plan to forgo "pop" emitted from your knee as participation in high-risk activities you attempted to return a well- — such as jumping, pivoting, sud- placed tennis volley. The severe pain den stops or starts — that challenge that followed put an end to your the knee joint.
weekly tennis match in favor of an Rehabilitation often focuses on ice pack and a call to your doctor.
strengthening muscles that support It turns out you tore your knee's the thigh, hip and ankle and on anterior cruciate ligament (ACL), one regaining balance and your sense of the key ligaments that stabilize of position. Physical therapy can be and support the knee joint. And now time-consuming in the first few it's time to decide how to treat it.
months, but normal daily activities Until recently, ACL tears occur- usually can be resumed within a ring after age 50 — and even after month. Typically, lifelong strength age 40 — were typically managed and stability exercises for your legs A torn ACL is reconstructed with a piece
with nonsurgical care in the form of of tendon from your leg (autograft) or with
are recommended for optimal knee modified activity levels and physi- a tendon from a donor cadaver (allograft).
stability. If you opt for nonsurgical cal therapy, which led to recovery treatment, a knee brace often is rec- but not the same level of stability as mal range of motion and is a par- ommended for activities that involve surgical repair. But that's changing.
ticularly important stabilizer of the twisting and pivoting. Use of the More and more people 50 and knee during twisting, pivoting or brace may reduce, but not eliminate older are leading considerably active jumping activities. the risk of your knee giving way. lives, which generally makes them An ACL tear — whether partial Although many do well with good candidates for surgical recon- or complete — is typically the result nonsurgical treatment, any future struction of the ACL. The procedure of a hard twist on the joint, a sud- injuries — in particular recurrent is proving to be an option for older den stop while running, a jump instability, or episodes of the knee adults who want to remain as active landing or a direct blow to the knee giving way — may put the knee at as they were before their ACL injury. — although most are noncontact risk of additional damage. injuries. At the time of an ACL injury, ■ Surgery — This form of treat- Knee props
you may feel or hear a pop in the ment may be considered if the knee Your ACL is one of many liga- knee and sometimes experience is unstable and gives way during ments in your body. These strong severe pain. Knee swelling usually daily activities, if you're unable to bands of tissue attach one bone to occurs within four to 12 hours. In participate in activities important to another. In the case of the ACL, it's addition, the knee may give way and you due to instability or the inabil- one of two ligaments that cross in feel unstable when you try to stand ity to trust your knee, or if joint car- the middle of the knee to help sta- or put weight on it.
tilage or other knee ligaments also bilize the joint. are damaged.
The ACL connects your thigh- Treatment options
Age used to be a concern with bone (femur) to your shinbone (tibia) Initially, treatment for an acute this surgery. But that's changing as and controls movement of your ACL injury is aimed at reducing pain more and more people remain ac- lower leg bone in several ways. It and swelling in the knee, in addi- tive as they get older. limits rotation of your lower leg and tion to regaining normal joint move- A torn ACL can't be sewn back prevents the tibia from moving too ment and strengthening muscles together. The ligament is recon- far forward in relation to the femur.
around the knee. structed with a piece of tendon from Your ACL also helps keep the Consider with your doctor what your leg (autograft) or with a tendon knee from extending beyond its nor- treatment best suits your needs: from a donor cadaver (allograft). ❒ Questions and our answers
February 2009 Special Report, depend on how many teeth are "Lifelong exercise"). This is usually filled or capped, as these will not Q: I'm an 82-year-old man, and in
enough to net noticeable gains in change color appreciably. Also, the the last couple of years I seem to
strength within just a few weeks.
amount of enamel on your teeth is have lost all the muscle in my thighs
Conversely, continued muscle loss a strong indication of how well your and upper arms. I walk a lot for my
may result in falls or frailty that may teeth will lighten in color. For exam- part-time job and at home. None
affect your independence. ❒ ple, teeth that are severely worn or of this seems to help. Is this just the
have root system exposure don't result of getting older?
Q: Is it possible to whiten teeth too
whiten as easily. Finally, if teeth are much? I've seen some people who
relatively white to begin with, it may A: Age-related muscle loss (sarco-
have almost freakishly white teeth.
not be reasonable to expect them to penia) is largely due to reduced whiten several shades. physical activity. Lacking adequate A: There's no documentation that
As for how white is too white, exercise, muscle mass typically whitening of teeth causes a detri- that's a matter of personal choice.
decreases about 1 percent a year mental change in tooth composi- From the standpoint of someone after age 30. However, sarcopenia tion. However, there's evidence to who desires teeth to be whiter than can be significantly slowed with support the fact that whitening of natural, there may not be such a weight training and exercise.
teeth can create sensitivity or pain thing as too white. Without a doubt, In your case, you've had sub- upon eating foods that are cold or teeth can be whitened more than stantial muscle loss in a fairly short hot or even sweet foods. Often, what's found in the natural makeup period, despite the reasonable level these changes are seen within a few of teeth — magazine cover photos of exercise you get by walking. days of starting the whitening pro- demonstrate this on a daily basis. Given these facts, it's probably cess and usually subside after whit- As everyone's case is unique, it best to talk to your doctor about ening is discontinued. Certain whit- may be wise to seek the advice of what may be causing your muscle ening products list specific treatment your dental professional. ❒ loss. Potential causes among many durations, and if carefully control- may include testosterone deficien- led, don't typically lead to these cy, thyroid overactivity, inadequate problems. Still, caution is advised.
Have a question or comment?
function of your adrenal gland, undi- When it comes to cosmetic den- We appreciate every letter sent to Second agnosed diabetes or other under- tistry — which includes procedures Opinion but cannot publish an answer to each lying factors such as a tumor.
to whiten teeth — it's recommend- question or respond to requests for consultation Whether your muscle loss is ed that you first get a clean bill of on individual medical conditions. Editorialcomments can be directed to: caused by aging or some abnor- oral health from your dentist. Managing Editor, Mayo Clinic Health Letter, mality that can be managed, the Your dentist can determine if 200 First St. SW, Rochester, MN 55905, or good news is that it's never too late your mouth is free of cavities and send e-mail to [email protected] to rebuild lost muscle through resis- gum disease — or address any prob- For information about Mayo Clinic services,you may telephone any of our three facilities: tance or strength training. lems that are found — before dis- Rochester, Minn., 507-284-2511; By using a weight machine, sim- cussing whether whitening is appro- Jacksonville, Fla., 904-953-2000; ple free weights or elastic bands, or Scottsdale, Ariz., 480-301-8000 or visitwww.MayoClinic.org your own body weight as resistance, If you're thinking about pur- you can challenge various muscle chasing a nonprescription whiten- groups for at least 20 to 30 minutes ing kit, other considerations in Check out Mayo Clinic Health Solution's
two to three times a week (see our whitening your teeth should also Web site, at www.MayoClinic.com
2009 Mayo Foundation for Medical We make our Mayo Clinic Health For subscription information from loca- To help our subscribers achieve health- Send subscription inquiries to: Education and Research. All rights reserved. Letter mailing list available to care- tions within United States and Canada, ier lives by providing useful, reliable, Mayo Clinic Health Letter fully selected companies and orga- call Customer Services at: 866-516-4974.
easy-to-understand health information MAYO, MAYO CLINIC, MAYO CLINIC Subscription Services nizations. If you do not wish to From other countries call: 903-636-9029.
that's timely and of broad interest.
HEALTH SOLUTIONS, the triple-shield receive such mailings, please write Subscription prices in United States: $29.55; Mayo logo, and TOOLS FOR HEALTHIER Mayo Clinic Health Letter supplements Big Sandy, TX 75755-9302 us at the address shown at right and in Canada: $45; all other countries: $55 LIVES are marks of Mayo Foundation for the advice of your personal physician, enclose your mailing label.
(U.S.). Single copies are available for $4 Medical Education and Research.
whom you should consult for personal plus shipping, handling and taxes. Pro- health problems.
ceeds, after expenses, help strengthen Mayo Clinic programs in medical edu- We do not endorse any company or Printed in the USA
cation and research.
8 www.HealthLetter.MayoClinic.com March 2009
Optimal clinical management of children receiving the ketogenic diet: recommendations of the international ketogenic diet study group
Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group ∗Eric H. Kossoff, †Beth A. Zupec-Kania, ‡Per E. Amark, §Karen R. Ballaban-Gil, ¶A. G. Christina Bergqvist, #Robyn Blackford, ∗∗Jeffrey R. Buchhalter,