MAYO CLINIC HEALTH LETTER
Tools for Healthier Lives
VOLUME 30 NUMBER 1 JANUARY 2012
Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
A dash of good health.
NEWS AND OUR VIEWS . . . . 4
A high-fiber diet reduces risk of
diverticulitis. Tai chi may benefit
people with heart failure.
PNEUMONIA . . . . . . . . . . . . . 4
Reducing your risk.
NIGHT LEG CRAMPS . . . . . . . 6
Self-care can help.
FUNGAL SPORES
IN THE AIR . . . . . . . . . . . . . . . . 7
Inhaling an infection.
SECOND OPINION . . . . . . . . 8
Spinal stenosis
Pain often age related
Just about everyone experiences back
pain at some point in life. Often, this
pain is felt in the lower back. For
many, the pain can be relieved by
simple measures or can improve on
its own. But when back pain is persistent, or becomes slowly worse, it’s
time to look for other causes. One
possible cause, especially as you get
older, is spinal stenosis — a narrowing in one or more areas of your spine.
Spinal stenosis most often results
from narrowing of the spinal canal
that occurs over time. In fact, by age
50, most people’s spines show at least
some signs of age-related wear and
tear of the disks and of facet joints,
which can grow to be enlarged and
arthritic. In some cases, these changes
can put pressure on your spinal cord
and nerves. This can lead to pain,
numbness or weakness in your arms
or legs as well as other problems that
can affect your quality of life.
In severe cases of spinal stenosis,
doctors may recommend surgery.
However, conservative, nonsurgical
treatments typically are used first to
help relieve signs and symptoms.
The effects of time
In addition to supporting the
weight of your upper body, your
spine protects your spinal cord and
nerves, which carry signals that control your body’s movements and
convey its sensations. ➧
Coming in February
BLOOD VESSEL STENTS
Improving blood flow.
MEDITERRANEAN DIET
To your good health.
FOOT ORTHOTICS
Inexpensive is often best.
MOLECULAR
BREAST IMAGING
Seeing past dense breast tissue.
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The bones that make up your
spine are called vertebrae. These
bones are stacked on top of one
another, and each contains a passage through which your spinal
cord and nerves pass from your
brain down to your toes. Other
parts of your spine include muscles
and ligaments that support and stabilize your spine, facet joints that
help your spine move, and disks
that sit between the vertebrae and
cushion the bones of your spine.
Different types of problems can
reduce the amount of space within
your spine. The most common are
age related:
■ Osteoarthritis — This form
of arthritis is sometimes called degenerative joint disease. That’s because it results from wearing away
of the cartilage that cushions the
ends of bones in your joints. When
osteoarthritis occurs in the spine,
the spaces between the vertebrae
narrow and bony growths or disk
bulges may form. When bone surfaces rub together, facet joints and
areas around the cartilage become
inflamed and painful.
■ Disk degeneration — With
age, the cushions between your
vertebrae can flatten and bulge.
Eventually, the tough, outer covering of the disk may develop tiny
tears, causing the dense, jelly-like
substance in the disk’s center to
protrude and press on your spinal cord and nerve roots. When
pressure is put on the nerve root
leading to the leg and foot, it often
results in sciatica pain that starts
in the buttock area and radiates
down to your leg.
■ Thickened ligaments — The
tough cords that help hold the
bones of your spine together can
become stiff and thick. This can
decrease the space within the spinal canal and irritate spinal nerves.
Many people can have evidence of spinal stenosis on X-rays,
but have no signs or symptoms.
2
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When symptoms do occur, they often start gradually and worsen over
time. The neck and lower back
are the most common parts of the
spine affected by spinal stenosis.
When spinal stenosis occurs
in the neck, it’s known as cervical
spinal stenosis. This can cause pain
or stiffness in the neck or shoulder
pain as well as numbness, weakness or tingling in your arm or
hand. In severe cases, nerves in
the spinal cord may be affected
and cause problems with balance
and coordination.
Spinal stenosis in the lower
spine is called lumbar spinal stenosis. In addition to lower back
pain, you may feel pain or cramping in your legs, especially when
you walk or stand for long periods
of time. Numbness or tingling in
the legs or buttocks also may occur. Later on, weakness can develop in one or both legs. Some
people may experience foot drop,
a problem in which the foot slaps
the ground while walking. Severe cases of lumbar spinal stenosis also can cause problems with
bowel and bladder functions.
Treatment options
Nonsurgical treatment is almost
always the first line of treatment
for spinal stenosis. Doctors may
recommend one or more options,
including:
■Medications — Acetaminophen (Tylenol, others) or nonster
oidal anti-inflammatory drugs, such
as ibuprofen (Advil, Motrin, others)
or naproxen (Aleve, others) can help
relieve pain. Some studies have
shown that certain antidepressants,
such as amitriptyline, and antiseizure drugs, such as gabapentin
(Neurontin) and pregabalin (Lyrica),
also may reduce pain associated
with spinal stenosis. If pain is persistent or severe, drugs that contain
narcotics — such as the combination drug acetaminophen-hydroco-
January 2012
done (Vicodin) or acetaminophenoxycodone (Percocet) — may be
prescribed. However, these drugs
can be habit-forming, so it’s recommended that they be used for
only a short time under your doctor’s supervision.
■ Exercise and physical therapy — Exercises can be used to
strengthen your abdominal and
back muscles, build strength and
endurance, and maintain the flexibility and stability of your spine.
Some physical therapy treatments,
including heat and ice, also may
help ease pain and allow you to
stay or become more active.
■Steroid injections — This
therapy typically involves injecting cortisone — a steroid medication — into the space around your
spinal cord to help decrease inflammation and swelling in nerve
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.
Medical Illustration
Michael King
Customer Service
Manager
Ann Allen
Editorial Research
Deirdre Herman
Proofreading
Miranda Attlesey
Donna Hanson
Julie Maas
Administrative Assistant
Jane Sultze
EDITORIAL BOARD
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 Hobday,
M.D., Oncology; Lois Krahn, M.D., Psychiatry;
Suzanne Norby, M.D., Nephrology; 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
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Tests and diagnosis
If you have signs and symptoms of spinal stenosis, your doctor will
take your medical history and conduct a physical exam. However,
other tests are often needed to confirm a diagnosis and rule out
other conditions. These tests may include:
■ Spinal X-rays — This type of imaging allows doctors to view
your bones and other bony structures in your body. As a result, Xrays can spot bone spurs or other age-related changes in your vertebrae. X-rays also can spot other problems, such as bone fractures.
■ Magnetic resonance imaging (MRI) — An MRI is often the
imaging test of choice for diagnosing spinal stenosis. By using a
powerful magnet and radio waves to produce cross-sectional images of your spine, it can picture soft tissues. This can help reveal
damage to your disks and ligaments and show pressure on your
spinal cord or nerves.
■ CT myelogram — Computerized tomography (CT) combines
X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. With a CT myelogram,
a CT scan is conducted after a contrast dye is injected into your
spinal column. This outlines your spinal cord and nerves, and can
show whether you have herniated disks, bone spurs or tumors.
A DXA test
■ Dual energy X-ray absorptiometry (DXA) scan —
uses special X-ray devices to measure how many grams of calcium
and other bone minerals are packed into a segment of bone.
roots that are under pressure. Pain
relief usually lasts a few months.
However, the number of steroid
injections you can have in a year
is limited because this type of
medication can weaken nearby
bones and tissue.
■ Alternative therapies — Acupuncture and chiropractic manipulation can sometimes be helpful
for pain caused by lumbar spinal
stenosis. Both are generally considered safe when performed by
an experienced practitioner. However, be sure to first discuss any
alternative treatments with your
primary doctor.
■ Weight loss and nutrition —
Eating a healthy diet and losing
weight if you’re overweight can
reduce the stress of arthritic joints,
helping them to function better
and reducing the signs and symptoms you my be experiencing.
If conservative measures fail to
relieve pain that’s severe or unre-
mitting, surgery may be considered. Surgery is also considered
when complications, such as severe weakness or loss of bladder
or bowel control, have developed.
The purpose of surgery is to
relieve pressure on your spinal
cord or nerves. The most common
procedure, called a laminectomy,
removes the back portion (lamina)
of one or more vertebrae to create more space within your spine.
In some cases, vertebrae also may
need to be fused together to maintain the spine’s strength.
In most cases, surgery helps reduce pain and improve function.
However, if nerves were badly
damaged before surgery, there
may be some remaining pain or
numbness or no improvement. The most common complications of spinal stenosis surgery are
tears in the membranes that cover the spinal cord, infection and
blood clots. ❒
January 2012
Health tips
A dash of good health
Herbs and spices can improve
the taste of your foods, help
reduce your sodium intake
and benefit your health by:
■ Providing antioxidants
— Allspice, cloves, cinnamon, ginger, oregano, sage,
thyme and turmeric powder
are high in antioxidant content. These plant chemicals
may play a role in helping to
prevent cardiovascular disease and Alzheimer’s disease.
■ Having cancer-fighting
properties — There’s research
to suggest that antioxidants
and other phytochemical substances found in turmeric,
garlic, rosemary and saffron
may have anti-cancer effects.
■ Mildly lowering blood
sugar — Limited evidence
indicates that cinnamon and
fenugreek may mildly affect
glucose levels in people with
diabetes. Still, don’t set aside
proven diabetes medications
for these herbs and spices.
Studies also suggest that
eating garlic may improve risk
factors for cardiovascular disease by helping to lower blood
pressure and reducing blood
clot formation. Just don’t consume too much garlic if you’re
taking anti-clotting drugs because it can increase the risk
of bleeding.
The beneficial effects of
many spices were found in
studies where the amount
used was far greater than the
amount typically used in cooking. However, regular use of
these spices may still add up to
a beneficial effect. ❒
www.HealthLetter.MayoClinic.com
3
News and our views
A high-fiber diet reduces risk of diverticulitis
Following a vegetarian diet is a great way to reduce your risk of
developing diverticular disease. But whether you’re a vegetarian or
a meat eater, the most important factor is consuming an adequate
amount of fiber, a recent study shows.
Diverticular disease is the formation of pouches (diverticula) that
bulge outward through weak spots in the lower part of the large intestine (colon). Diverticula can become inflamed, causing an oftenpainful abdominal condition (diverticulitis) that can lead to colonic
bleeding, infection, perforation or obstruction.
The study, published in the British medical journal BMJ, followed
more than 47,000 health-conscious people for an average of about
11 years. Those who were vegetarians had a 31 percent reduced risk
of being hospitalized or dying of diverticulitis-related complications
when compared with people who ate meat.
Even better, those who ate more than 25 grams of fiber a day —
whether vegetarians or meat eaters — had a 41 percent reduced risk
of being hospitalized or dying of diverticulitis complications when
compared with people who ate less than 14 grams of fiber a day.
Mayo Clinic doctors agree that fiber intake is probably the most
important influence on risk of diverticular disease or diverticulitis. ❒
Tai chi may benefit people with heart failure
Results of a recent study that evaluated tai chi’s influence in the lives
of people with chronic heart failure is drawing renewed attention to
the role mind-body medicine might play in improving quality
of life. The study — published in the April 25, 2011, issue of
Archives of Internal Medicine — is the first large-scale clinical trial to find tai chi to be a safe alternative to the low- to
moderate-intensity conventional exercise that’s generally recommended for people with chronic heart failure.
Chronic heart failure is typically managed with medications and
possibly implantable devices, such as defibrillators. Exercise also
is considered an important element. However, it’s recognized that
older adults who have heart failure may find it difficult to begin or
even sustain regular physical activity.
The study involved 100 people with comparable levels of chronic heart failure. For 12 weeks, half the participants attended twiceweekly heart-health education sessions. The other half took part in a
twice-weekly tai chi exercise program. By study’s end, there were no
significant differences in exercise capacity between the two groups.
But the participants in the tai chi group had greater improvements in
quality of life, mood and confidence in their exercise abilities.
Mayo Clinic doctors say the study shows the need to look to the
value of mind-body medicine for people with heart failure. Combining state-of-the-art therapy through a heart failure disease management
program with strategies such as tai chi to help people cope with the
stress of chronic disease may be a way to enhance quality of life. ❒
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www.HealthLetter.MayoClinic.com January 2012
Pneumonia
Reducing your risk
For the last few days you’ve had
what seem to be classic signs and
symptoms of the flu — including a
cough, fever, chills, achy muscles
and fatigue. Yet, despite staying
home to rest and drinking plenty
of liquids, you’re coughing even
more and feeling short of breath.
The problem? You may have
pneumonia, an infection that can
strike one or both of your lungs.
Although pneumonia is a possible
complication of the influenza (flu)
virus, it can occur spontaneously
and many germs can cause it.
If you are age 65 or older or
have a weakened immune system,
you’re at greater risk of developing
pneumonia. Having a chronic illness — such as heart disease, asthma, emphysema or other lung diseases — also can make you more
vulnerable to the infection.
Although some forms of pneumonia can be quite mild, others
can rapidly turn serious and even
be life-threatening. Treatments are
available. However, the best approach is to try to prevent infection.
All about germs
The germs that can cause pneumonia can be found just about
anywhere — including people you
come in contact with and even the
air you breathe. Most of the time,
your body keeps you free from infection. However, certain germs
can invade your lungs, causing
them to become inflamed and fill
up with fluid.
When you get pneumonia from
germs you encounter in everyday
life, it’s called community-acquired
pneumonia. Many types of bacteria
can cause this form of pneumonia. In adults, the most common is
Streptococcus pneumoniae.
Certain germs can invade your lungs, causing them to become inflamed and fill up with
fluid. The illustration at left shows what pneumonia looks like in your lungs. At right is
pneumonia as seen on a chest X-ray.
Viruses are another common
cause of community-acquired pneumonia. Most cases of viral pneumonia are mild and short-lived. Yet
some can become severe, especially when caused by flu viruses. Viral pneumonia can also make your
lungs more vulnerable to bacteria
that can cause a second infection.
Mycoplasma pneumoniae is yet
another pneumonia-causing germ.
Although this tiny organism can
cause widespread sickness or outbreaks, it generally produces mild
signs and symptoms of pneumonia. Other, less common causes
of community-acquired pneumonia include Legionnaires’ bacillus,
fungi, tuberculosis and tuberculosis-related bacteria.
Some of the most severe cases
of pneumonia occur after exposure to germs in health care settings — such as in hospitals, outpatient centers and nursing homes.
Mostly, this risk is for people on
ventilators in intensive care units.
In these settings, it’s possible to be
exposed to a much longer list of
germs. Drug-resistant germs also
are much more common, which
can make health care-acquired
pneumonia more difficult to treat.
The road to recovery
The best treatment for pneumonia depends on a number of
Calling your doctor
Pneumonia can be a serious,
even life-threatening illness,
so let your doctor know if
you suddenly feel worse after
a cold or the flu.
Having a persistent
cough, shortness of breath,
chest pain and fever is of
special concern — especially
if you are older, have a heart
or lung disease, or a weakened immune system.
factors. These include your age
and overall health as well as what
caused your illness and where you
acquired it.
If you have bacterial pneumonia, your doctor will prescribe antibiotics. Although you may start to
feel better after just a few days, take
the full course of this medication.
If you stop antibiotics too soon,
your lungs may continue to harbor
bacteria that can cause a relapse of
your pneumonia. Bacteria also can
begin to develop drug resistance if
they aren’t adequately treated.
Antiviral antibiotics aren’t effective for treating viral pneumonia. However, your doctor may
prescribe an antiviral medication
to reduce your symptoms and the
amount of time you are sick. Other
January 2012
medications that can ease a fever,
cough or other symptoms also may
be recommended for viral as well
as bacterial pneumonia.
Uncomplicated cases of community-acquired pneumonia usually can be treated at home. In fact,
following a few basic self-care
strategies — such as getting plenty
of rest, staying home and drinking lots of liquids — can help you
recover and decrease your risk of
complications. Still, it’s important
to have your doctor monitor your
progress and for you to report any
new or worsening symptoms.
Protecting yourself
Although pneumonia can have
many causes, you can protect
yourself from infection with:
■ Seasonal flu vaccine — Many
people get pneumonia after having
the flu. Getting protection from the
flu also lowers your risk of pneumonia. The Centers for Disease Control
and Prevention (CDC) recommends
that everyone 6 months and older
get a flu vaccination each year.
■ Pneumonia vaccine — This
vaccine protects against Streptococcus pneumoniae, which is also
called pneumococcus, a common
cause of bacterial pneumonia. The
CDC recommends this vaccination
for anyone 65 or older as well as for
those at high risk of complications
from bacterial pneumonia. This includes adults who smoke and adults
who have heart or lung disease, diabetes or a weakened immune system due to a chronic illness or the
use of immunosuppressant drugs,
including corticosteroids and medications to prevent transplant rejection. If you get the vaccine after age
65, it’s usually needed just once. If
it is given before age 65, in some
circumstances a booster vaccine at
65 may be recommended.
Taking care of your overall
health also can limit your risk of
getting pneumonia. ❒
www.HealthLetter.MayoClinic.com
5
Night leg
cramps
Self-care can help
If you’ve ever woken up with a leg
cramp, you know how painful it can
be when one of your muscles suddenly contracts. Night leg cramps
typically involve your calf muscles.
Yet, it’s possible to get these cramps
in your feet or thighs as well.
In most cases, night leg cramps
are harmless and can be relieved or
even prevented with some simple
stretching or other self-care measures. However, if they occur regularly and cause severe discomfort,
see your doctor. This is particularly
true if leg cramps are interfering with
your sleep or you’re having muscle
weakness, numbness or pain that
lingers or continues to come back.
What’s to blame?
Although the risk of getting night
leg cramps increases with age, it’s
often difficult to pinpoint the cause.
In fact, these cramps often occur for
no known reason.
Dehydration, prolonged sitting,
or not getting enough potassium,
calcium or magnesium in your diet
can be associated with leg cramps.
So can certain medications — including diuretics, beta blockers
and other blood pressure drugs.
Sometimes, these cramps also
may be related to an underlying
metabolic condition, such as an
underactive thyroid (hypothyroidism) or a parathyroid condition.
Diabetes or other conditions that
can disrupt your metabolism can
also cause muscle cramps. Night
leg cramps can also be associated
with cancer, for example, a malignancy that has spread (metastasized) to the spine.
Night leg cramps are sometimes
confused with restless legs syndrome
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For a calf cramp, put your weight on the leg in question and then slightly bend your knee.
If you’re in too much pain to stand up, straighten your leg and flex the top of your foot
toward your head.
(RLS). With RLS, you feel throbbing,
pulling or other unpleasant sensations in your legs and have an uncontrollable urge to move your lower limbs. These symptoms primarily
occur at night or when at rest. However, muscle pain is less common
with restless legs syndrome than it is
with night leg cramps.
Pain from swelling caused by
excess fluid (edema) may feel like
leg cramps.
Easing the pain
The pain caused by leg cramps
can vary in intensity and last from
just a few seconds to 15 minutes or
more. To get relief:
■ Massage and stretch the muscle — Gently rubbing a cramped
muscle can help it relax. Stretching also can ease a sudden spasm.
For a calf cramp, try putting your
weight on the leg in question and
then slightly bending your knee. If
you’re in too much pain to stand
up, straighten your leg and flex the
top of your foot toward your head.
■ Apply cold or heat — To
relax tense muscles, apply ice or
a cold pack directly to the area
where you feel cramping. Applying heat with a warm towel or
heating pad, or by taking a hot
bath or shower, also can make
January 2012
you feel better by reducing muscle
pain or tenderness.
Prevention methods
Although night leg cramps can
take you by surprise, prevention is
possible. These steps can help:
■ Staying hydrated — Drinking
water and other liquids throughout
the day can keep you from becoming dehydrated. It can also help
your muscles contract and relax
more easily. It’s especially important to replenish your fluids when
engaging in physical activity and to
continue drinking water and other
liquids after being active.
■ Stretching before bed — If
you have night leg cramps, it’s a
good idea to stretch before turning
in for the night.
■ Doing light exercise — Riding
a stationary bike for a few minutes
before bedtime may help prevent
cramps while you’re sleeping.
■ Choosing the right shoes —
Wearing shoes that have proper support may help prevent leg cramps.
■ Untucking the covers — Loosen or untuck the bedsheets and other covers at the foot of your bed.
If self-care strategies aren’t keeping cramps at bay, pain relievers
such as acetaminophen (Tylenol,
others) may be of help. ❒
Fungal spores
in the air
Inhaling an infection
A recent winter golf vacation to
the sunny Southwest helped drive
away your winter blues. But the
flu-like sickness you went through
after returning was bad enough to
prompt a visit to the doctor. To
your surprise, a return to winter
wasn’t the cause of your illness.
It was a fungal infection that you
likely picked up on your travels.
Various types of fungi are
all around us. Fighting off fungal
spores is all in a day’s work for a
healthy immune system. However,
certain fungal infections of the respiratory tract can sometimes take
root. A weakened immune system
can heighten your susceptibility or
make it harder to recover from the
infection. This can occur in older
adults, especially those who have
diabetes or are being treated with
chemotherapy, corticosteroid drugs
or anti-rejection drugs used after organ transplants.
Knowing the symptoms of a
respiratory fungal infection — and
the geographical regions in which
certain types of fungi are more
likely to show up — can help tip
you and your doctor off to knowing whether you’re dealing with an
ordinary viral illness or something
that’s different.
Fungus among us
Some of the more common fungal respiratory tract infections are:
■ Blastomycosis — This is
caused by the fungus Blastomyces dermatitidis. This organism is
typically found in moist soil with
decomposing organic material. In
the U.S., it’s common in the Great
Lakes area of the upper Midwest,
and in the South Eastern and South
Certain types of fungi are more likely to show up in certain geographical regions.
Central regions. The fungi get into
the air when soil or organic material is disturbed, such as by farming, construction or the wind.
■ Coccidioidomycosis — This
is also known as valley fever and is
caused by the fungi Coccidioides
immitis or Coccidioides posadasii. These fungi thrive in the desert
soils of southern Arizona, Nevada,
northern Mexico, New Mexico,
parts of Texas and California’s San
Joaquin Valley. As with Blastomyces dermatitidis, these fungi can be
stirred into the air by anything that
disrupts the soil.
■ Histoplasmosis — Caused
by the fungus Histoplasma capsulatum, this is found in the Midwestern states along the river valleys of
the Mississippi, Missouri and Ohio
rivers. Spores of this fungus may
also be found in bird and bat droppings. Sites commonly associated
with the disease include chicken
coops, farms, bird roosts, abandoned buildings and caves.
Flu or fungi?
With any fungal infection, you
may experience only mild, flu-like
symptoms — or no symptoms at
all. That’s because your immune
system can usually handle a fungal
infection of this sort.
When more-noticeable signs
and symptoms occur, they tend to
resemble those of more-common
viral or bacterial infections such as
the flu or pneumonia. Symptoms
may include fever, cough, chills,
night sweats, headache, fatigue,
shortness of breath and joint aches.
A few signs and symptoms that
may help differentiate a fungal
lung infection from more ordinary
viral or bacterial infections include
chest pain, rash and symptoms that
last much longer than a typical viral or bacterial infection.
If the initial fungal infection
doesn’t completely go away, it
may progress to a chronic form of
pneumonia in which you experience low-grade fever, weight loss,
cough, chest pain and blood-tinged
sputum — with periods of improvement alternating with worsening.
Help your doctor
Symptoms of a fungal lung infection are easily mistaken for other, more-common infections or diseases. Mention to your doctor any
travels to areas that are known to
be sources of fungal infections —
especially if you’re engaged in outdoor activities. ❒
January 2012
www.HealthLetter.MayoClinic.com
7
Second opinion
Q: How can I find out if I need a
memory pill?
A: First of all, it’s important to un
derstand that there are no memory
pills for people who don’t have de
mentia due to Alzheimer’s disease.
Drugs that may help improve
memory and thinking in people
who have mild to moderate Alz
heimer’s disease include cholines
terase inhibitors such as donepezil
(Aricept), galantamine (Razadyne)
and rivastigmine (Exelon). Done
pezil may also help people with
severe Alzheimer’s disease. The
drug memantine (Namenda) may
be considered for moderate to se
vere Alzheimer’s disease.
If you have concerns about
memory lapses or loss, talk to your
doctor. Your doctor may recom
mend taking a short mental status
exam. These brief tests involve per
forming basic memory recall, arith
metic, drawing and associations.
To a certain degree, increased
forgetfulness or absent-mindedness
is normal in older adults. A mental
status exam can help reassure you
that the memory lapses you’re expe
riencing aren’t a reason for concern.
Alternately, it may prompt more
thorough testing for an underlying
cause of your memory and think
ing problems. These may include
reversible causes — such as drug
interactions, vitamin deficiencies,
depression or thyroid problems —
or a diagnosis of mild cognitive
impairment, Alzheimer’s or some
other form of dementia. Mild cog
nitive impairment is often an early
transition stage between normal
memory and thinking (cognition)
and Alzheimer’s. With it, you ex
perience thinking problems that
are beyond what’s considered nor
mal, but not so much that day-today life is impaired.
Q: In your August 2011 article on
generic versus brand name drugs,
I was disappointed to read your
opinion that buying a brand drug
when a generic is available is likely a waste of money. If that’s true,
why does the brand-name drug I
take cause fewer side effects than
the generic version I tried?
A: Mayo Clinic experts don’t spe
cifically know why brand drugs
sometimes work better or cause
fewer side effects than do their ge
neric equivalents, but they say this
is occasionally seen.
However, they say that the
majority of people experience the
same effects from a brand or a ge
neric drug — and that occasionally
people report they respond better
to a generic drug or have fewer
side effects when compared with
the brand equivalent.
The intent of the article wasn’t
to be critical of the legitimate use of
a brand drug. If a brand-name drug
causes fewer side effects or works
better for you, Mayo experts say
they would support the decision to
continue taking the brand drug.
But, as the article pointed out,
brand and generic versions of a giv
en drug have the same active ingre
dients in the exact same amounts.
Some people don’t know this or
find it confusing — and thus may
be spending more money than nec
essary on a brand-name drug when
a generic version is available.
Mayo pharmacists routinely
work with people who wouldn’t
be able to afford a prescribed drug
if a generic option wasn’t avail
able. For them, knowing they may
be able to take a less costly generic
drug could be the difference be
tween sickness and health.
Not all generic preparations of
the same drug are exactly the same.
While the active ingredient is the
same, the inactive ingredients —
the fillers, preservatives and color
ings — may be different. Because of
this, it’s possible to have a better or
worse experience with different ver
sions of the same drug if you’re sen
sitive to an inactive ingredient. ❒
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]
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Scottsdale, Ariz., 480-301-8000 or visit
www.MayoClinic.org
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website, at www.MayoClinic.com
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