Mayo Clinic Health Matters

Shoulder replacement surgery is done to relieve pain and other symptoms that result from damage to the shoulder joint. Common conditions that can damage the shoulder joint include osteoarthritis, rotator cuff injuriesand fractures, among others. Thanks to improved surgical techniques and an aging population, the number of shoulder replacement surgeries is increasing."The rate of usage of shoulder replacement in the United States has increased dramatically," explains Dr. Joaquin Sanchez-Sotelo, a Mayo Clinic orthopedic surgeon. "And I think there are two reasons. One is that implants are better. And also, that patients now are more active with their upper extremities later in life. So, they need the procedure because they want to have a life where they can enjoy activities pain-free."Traditionally, shoulder replacement removes damaged areas of bone and replaces them with standard parts made of metal and plastic. Joint replacement surgery could be a challenge if some of the bone is missing, the bone quality is poor, or if a bone graft is not accurate. Now, thanks to new technology, there is another option. Using CT scans and 3D-printed models, some patients can receive joint replacements that are created to be custom fit to their anatomy. "The benefit is you are guaranteeing the patient that the implant is going to fit his or her shoulder, No. 1," says Dr. Sanchez-Sotelo. "No 2., it decreases surgical time tremendously. Because in the past, you had to get exposure and then prepare the bone until it fits one of the off-the-shelf implants. Now you know that the implant is going to fit the patient right out of the box. So surgery time is less." There are some limitations to use of the new implants. People with severe deformities may not be candidates, and people who require surgery quickly may not have time to wait for a custom implant to be built. Despite these limitations, Dr. Sanchez-Sotelo says, like artificial intelligence and mixed reality, custom-fitted joints could be another game-changer in orthopedics and another tool for surgeons to help patients."I think this is going to transform our practice," says Dr. Sanchez-Sotelo. "Technology is advancing so fast in medicine and orthopedic surgery. I'm just excited to see how we can change the operation, make it faster, make it easier, and lead to a much better outcome."On the Mayo Clinic Q&A podcast, Dr. Joaquin Sanchez-Sotelo, discusses advances in shoulder replacement surgery, including custom-fitted implants.The custom-fitted shoulder implant discussed in this podcast is produced by Strkyer. Dr. Sanchez-Sotelo and Mayo Clinic receive consulting fees and royalty payments from Stryker for shoulder arthroplasty products; however, Dr. Sanchez-Sotelo and Mayo Clinic do not have any relevant financial conflicts with this specific device. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath."The most recognized, the most common symptom of heart failure is breathlessness," says Dr. Gosia Wamil, a cardiologist at Mayo Clinic Healthcare in London. "And the type of breathlessness that patients would describe most often is the inability to lie flat, waking up in the middle of the night or gasping for air."Heart failure is often thought to be a disease of advanced age, but it can actually develop at any time in life. In many cases, heart failure can be prevented or treated if people are aware of the risk factors and warning signs. Coronary artery disease is the main cause of heart failure. Stiffening of the heart muscle is mostly a result of poorly controlled hypertensionor diabetes. Proper treatment can improve the signs and symptoms of heart failure and may help some people live longer. Lifestyle changes — such as losing weight, exercising, reducing salt (sodium) in your diet and managing stress — can improve your quality of life. "All the risks of developing heart attack, if we reduce those risks, we improve their lifestyle," explains Dr. Wamil. "If we reduce the risk of diabetes, hypertension, stop smoking, this will reduce the risk of heart attacks, but at the same time, will reduce the risk of heart failure."Dr. Wamil's research efforts include studies aimed at understanding the connection between diabetes and heart disease and using novel medical imaging techniques to identify heart failure early on. Other research underway at Mayo Clinic includes the use of artificial intelligence and machine learning tools to detect heart failure early."An area of research interest at Mayo Clinic is the use of large databases, such as randomized controlled trials, electronic health care records, and applying not only statistical methods but also AI, machine learning models and algorithms to try to identify how we can detect early signs of heart failure risks," explains Dr. Wamil. On the Mayo Clinic Q&A podcast, Dr. Wamil, discusses warning signs of heart failure and advances in early detection of heart disease.Related posts: "Mayo Clinic London Healthcare expert shares heart failure signs, symptoms people may not be aware of." "Mayo Clinic Q&A podcast: Understanding the connection between diabetes and heart disease." "AI-guided screening uses ECG data to detect a hidden risk factor for stroke." "Mayo researchers use AI to detect weak heart pump via patients’ Apple Watch ECGs." Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Most people diagnosed with breast cancer undergo surgery to remove their cancer from the breast as well as have lymph nodes removed as part of their treatment. "Surgical resection of the tumor from the breast and also evaluation of the lymph nodes are used for the vast majority of patients with breast cancer, in particular, those patients where the disease is limited to the breast," says Dr. Judy C. Boughey, a surgical oncologist at Mayo Clinic. "One of the areas where often breast surgery does not have a role is if the breast cancer has spread or metastasized to other areas of the body. So for patients with stage 4 breast cancer, surgery has a much more questionable role."Surgery is used to treat most stages of breast cancer, but it is rarely used to treat metastatic breast cancer — breast cancer that has spread to other parts of the body. Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy and radiation therapy. Breast cancer surgery includes different procedures, such as: Surgery to remove the entire breast (mastectomy) Surgery to remove a portion of the breast tissue (lumpectomy) Surgery to remove nearby lymph nodes Surgery to reconstruct a breast after mastectomy Which breast cancer operation is best for an individual depends on the size and stage of the cancer, other treatment options available, and the goals and preferences of each patient.For people with a very high risk of breast cancer, a preventive (prophylactic) mastectomy may be an option to reduce the risk of future breast cancer. With so many options and decisions to be made, preparing for breast cancer surgery can be a challenge. It's important to be comfortable with your surgeon and to have the support of family and loved ones."Starting on the breast cancer journey is always a very challenging time," says Dr. Boughey. "Lean on your closest loved ones that you let into your inner circle and talk to them about your diagnosis, your treatment and your journey."Dr. Boughey also encourages people to remember that everyone's journey is unique and to rely on your care team for trusted information."I think one thing to be very aware of with breast cancer is it is a very common disease, and every one of us knows someone or someone's relative that has been affected by this disease," explains Dr. Boughey. "Truthfully, breast cancer really is not one disease. And so I would just caution against hearing about your friends and their experience because it may have been a different size tumor and may have been treated a different way. And most importantly, it was likely a different tumor biology. And so you don't necessarily always have to listen to everybody's story and experience because that doesn't mean that yours will be the same. Share with your doctors some of the concerns that you've heard from your friends, from your colleagues, what you may have read on the internet, so that if they're not true, your team can dispel those myths for you and make you feel more comfortable."On this Mayo Clinic Q&A podcast, Dr. Boughey discusses how surgery is used in the treatment of breast cancer. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The Somos Latinos Mayo Employee Resource Group (MERG) was created in 2016 to promote, educate and celebrate the cultural heritage of Hispanic and Latino staff members and improve the patient experience. While the Somos Latinos MERG is based at Mayo Clinic in Rochester, Minnesota, Hispanic and Latino MERGs also are active elsewhere across Mayo."Resource groups are the response to promoting inclusivity as well as championing a team-based approach for all staff," explains Carlos Rodriguez Jr., a senior strategist at Mayo Clinic and chair of the Somos Latinos MERG. "Essentially, our task is simple: to create a community that people feel a part of. And that's what we work to achieve every day."The work of MERGs supports several initiatives underway at Mayo Clinic to improve the experience for Hispanic and Latino patients. For example, Mayo is using in-person interpreters when possible, as well as video and phone interpretation, and making patient education materials available in Spanish. Another support option for patients is the Spanish-speaking patient coordinator program. "The patient coordinator programs are meant to have an individual whose job it is to help the patient navigate the health care system," says Dr. Enid Rivera-Chiauzzi, a Mayo Clinic OB-GYN and physician chair of the Somos Latinos MERG. "It's really complicated to figure out where you're supposed to be for an appointment, where you're supposed to park, who you were supposed to call, and really understanding what happened during your visit. And even if you are proficient in English and Spanish, it's just the culture. Maybe where you grew up is different than here. So the person who is matched with you is a bilingual individual who can help you navigate the health care world." Mayo Clinic also offers support to patients from Latin America who seek care. Representative offices in several countries — Colombia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama and Peru — are staffed by people who speak the local language, and can answer questions, help request appointments and make travel arrangements. "If you think about a patient representative on the ground in a given country, it really affords the patient the opportunity to connect with Mayo Clinic and start the process before they get to us," explains Rodriguez. "One of the differentiating propositions of Mayo Clinic is the integrated approach. The overall health care system is difficult to navigate, particularly when you're not familiar with the environment. So starting that conversation and engagement early is key to making the long-term relationship with Mayo Clinic a positive one."Closer to home, work is underway at Mayo Clinic to build a Latino mentorship program for clinical staff that will ultimately benefit patients."We want to create a community of physicians and health care professionals who have been supported along their journey by other Latino and Latina health care professionals, therefore increasing our numbers," explains Dr. Rivera-Chiauzzi. "Our aim is to have more of us in these positions, which will help our patients see more people who look like them, or at least be as equally represented as they are in the community in general. That doesn't mean, 'Oh, I can only see a doctor that looks exactly like me and is exactly like me.' But we want to be in an environment where we can see all kinds of people and then whatever excellent person takes care of me, I feel like 'Oh, this person welcomes me.' That's important." To celebrate Hispanic Heritage Month, which takes place Sept. 15-Oct. 15, Dr. Rivera-Chiauzzi and Rodriguez join the Mayo Clinic Q&A podcast to discuss Mayo Clinic's efforts to support Hispanic and Latino patients and staff. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Through research, clinical trials and biomanufacturing, Mayo Clinic’s Center for Regenerative Biotherapeutics is working to develop new types of medicines derived from the human body to treat chronic and age-related diseases. Biologics are therapies that come from human sources — cells, blood, enzymes, tissues, genes or genetically engineered cells — for use in medicines. Biomanufacturing is focused on manufacturing commercial grade biologically based medicines for treatment. Some examples include the use of stem cells, gene therapy and cell therapy, and 3D printing of tissues and organs."The important thing is that there's an opportunity to use these type of therapies to cure rather than just treat patients as we move forward looking at different ways of being able to use these products," says Dr. Julie Allickson, the Michael S. and Mary Sue Shannon Family Director of Mayo Clinic's Center for Regenerative Biotherapeutics. "It's definitely a bright future." Dr. Allickson also is the Otto Bremer Trust Director of Biomanufacturing and Product Development in the Center for Regenerative Biotherapeutics.Mayo Clinic is working to move cellular discoveries from the lab to clinical trial and into commercially available therapies. To move technologies forward, partnerships are key.  Mayo Clinic has formed a strategic collaboration with National Resilience Inc. to establish Rochester, Minnesota as a center for biomanufacturing regenerative technologies. Mayo also has manufacturing facilities in Jacksonville, Florida and Phoenix.Recently, Mayo Clinic, Hibiscus BioVentures, and Innoforce announced the launch of Mayflower BioVentures, a cell and gene therapy accelerator dedicated to identifying and forming companies around technologies that address unmet patient needs. All three organizations have a financial interest in the Mayflower collaboration. Mayo Clinic will use any revenue it receives to support its nonprofit mission in patient care, education and research."There is a lot of investment in the field," says Dr. Allickson. "And Mayo Clinic is certainly prioritizing this across the enterprise, to allow the patients here to have treatments focused on rare and complex diseases. Here at Mayo Clinic, we want to make sure that that happens."On the Mayo Clinic Q&A podcast, Dr. Allickson discusses the near- and long-term future of biomanufacturing and biotherapeutics. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Children learn about racial differences and racial bias from an early age, and parents and caregivers are their first teachers. It's important for parents and other adults to be role models for inclusive behaviors early in the lives of children life to decrease racial bias and improve cultural understanding.Experts encourage parents and caregivers to get comfortable with having difficult conversations about race and bias. "It's important for all children to have these discussions, and as an adult in any child's life, everything that you're doing is modeling for them what's okay and isn't okay," says Dr. Emily McTate, a Mayo Clinic pediatric psychologist. Parents may be surprised to find out that a baby's brain can notice race-based differences as early as 6 months, according to the American Academy of Pediatrics. By age 12, many children become set in their beliefs. When children have questions about racial differences, it's important to keep a child's developmental stage in mind and tailor age-appropriate messages. The American Academy of Pediatrics offers these strategies for helping children understand and deal with racial bias: Talk to your children and acknowledge that racial differences and bias exist. Confront your own bias and model how you want your children to respond to others who may be different than them.  Encourage your children to challenge racial stereotypes and racial bias by being kind and compassionate when interacting with people of all racial, ethnic, and cultural groups. Another important step is teaching kids to be critical consumers of media. "I always think about all the moments, whether you're reading books together or watching animated movies together, whatever it is, and hit the pause button and talk about what's going on," says Dr. Daniel Hilliker, a Mayo Clinic pediatric psychologist. "Why is this person being represented in this fashion? And that can kind of open up the conversation about exploring some different perspectives." On this Ask the Mayo Mom edition of the Mayo Clinic Q&A podcast, host Dr. Angela Mattke is joined by Dr. McTate and Dr. Hilliker for a discussion on talking to kids about racism.Additional resources: "Talking to Young Children About Race and Racism." "Coming Together: Celebrating Every Child's Race, Ethnicity, Culture!"  "Talking About Race: Who am I?" Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The number of people who die from uterine cancer is increasing, particularly among Black women.Also called endometrial cancer, uterine cancer begins in the layer of cells that form the lining, or endometrium, of the uterus. The American Cancer Society estimates that about 65,950 new cases of uterine cancer will be diagnosed in the U.S.this year, and about 12,550 people will die from the disease.Researchers recently reported the results of a study of 208,587 women ages 40 and older with uterine cancer. The study showed death rates for all types of uterine cancer increased significantly by 1.8% per year from 2010 to 2017. Death rates remained stable for the most common form of uterine cancer — Type 1 endometrial cancer — but increased by 2.7% per year for a rarer, more aggressive form called Type 2 endometrial cancer."We do see a rise in diagnosis of uterine cancer," says Dr. Kristina Butler, a Mayo Clinic gynecologic oncologist. "And we feel like that is because there's also a rise of some other illnesses such as diabetes, hypertension and obesity, which are risk factors for uterine cancer. And because we're seeing more people experience those types of illnesses, uterine cancer rates are rising." The study also revealed racial disparities in uterine cancer death rates. Death rates from uterine cancer increased 6.7% annually among Hispanic women, 3.5% among Black women, 3.4% among Asian women and 1.5% among White women. Despite representing less than 10% of cases, nearly 18% of all deaths from uterine cancer occurred in Black women."Addressing health disparities is a huge priority of our national organization, the Society of Gynecologic Oncology," explains Dr. Butler. "I think it's very clear that there are disparities as it relates to patient access to care. Also, opportunities to train providers in cultural competency, so that patients feel very comfortable coming and having that patient-doctor relationship. And we need to improve health care access for women in rural communities and take education to those communities so that those women feel comfortable reaching out to us when they need care." On this Mayo Clinic Q&A podcast, Dr. Butler discusses uterine cancer, disparities related to the disease, and what people can do to reduce their risk of developing this type of cancer. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

While childhood cancer is rare, 1 in every 266 children and adolescents will be diagnosed with cancer by age 20, according to the American Cancer Society. Each September, advocacy groups, health care institutions, patients and families recognize Childhood Cancer Awareness Month to help families who receive a cancer diagnosis.“A lot of people still don't know what to do if a child is diagnosed with cancer or where to go,” explains Dr. Wendy Allen-Rhoades, a Mayo Clinic pediatric hematologist and oncologist. “We want people to know that we know that a cancer diagnosis is scary. We know that it’s life-altering. But we also want you to know that there's hope, that we are doing really good things here at Mayo Clinic and elsewhere. And there is hope for a cure, and there is life after childhood cancer.”Dr. Allen-Rhoades says funding is needed for more pediatric cancer research to continue to improve treatments. One area of focus for her has been sarcomas. Sarcoma — the term for a group of cancers that begin in the bones and in the soft or connective tissues — is one of the more common types of childhood cancer. Fortunately, recent treatment advances have increased survival rates. Of children diagnosed with cancer, 84% now survive five years or more. One of the advances in treatment has been improvement in radiation therapy techniques and the use of proton beam therapy to treat pediatric cancers."Radiation therapy works very well for sarcomas," says Dr. Wendy Allen-Rhoades, a Mayo Clinic pediatric hematologist and oncologist. "And the difference between conventional radiation and proton therapy radiation is that our radiation oncologists are able to contour a little bit tighter with proton therapy. Therefore, the surrounding tissue that is normal is spared from some of the side effects. This is really important in children who are growing because we want them to be able to grow normally."In addition to sparing healthy tissue from the effects of radiation, people who must undergo radiation therapy early in life are less likely to have long-term side effects and complications, such as secondary cancers, with proton beam therapy than with conventional radiation therapy.While treatments and cure rates for sarcomas have improved, Dr. Allen-Rhoades hopes for even better results in the future.“Sarcomas have been a tough nut to crack for sure in terms of research and novel innovative therapies,” says Dr. Allen-Rhoades. “We still have a ways to go, but we're doing much, much better than we were 20—30 years ago. But until we can cure everyone, it will never be enough.”On the Mayo Clinic Q&A podcast, Dr. Allen-Rhoades discusses pediatric sarcomas and the importance of funding for research and support of families dealing with pediatric cancer. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Peripheral artery disease, or PAD, affects almost 10 million people in the U.S. Approximately one-third of patients will die within five years of a peripheral artery disease diagnosis, and 20% will experience a heart attack or stroke. Peripheral artery disease usually involves pain in the lower limbs caused by reduced blood flow due to narrowing of the arteries. Its symptoms, like reduced ability to walk due to leg pain, often are brushed off as signs of aging. While age is a factor, younger people with diabetes or who smoke also should be checked for the disease. "If you have risk factors for lower-extremity PAD — diabetes, tobacco use, high cholesterol, high blood pressure, as well as age — it's really important to have those conversations with your provider about your ability to exercise or walk if you are having any limitation," explains  Dr. Amy Pollak, a Mayo Clinic cardiologist. Peripheral artery disease is detectable and treatable, but it's often not diagnosed early enough. This means patients are often not treated with the most aggressive therapies. Health disparities play a big role, with the highest rates of peripheral artery disease occurring in Black men and women."There is an amputation epidemic," says Dr. Pollak. "And I don't use that word epidemic lightly. In today's climate, I use it intentionally. Depending upon where you live in our country, you may be at a higher risk of having an amputation for lower-extremity PAD, and not always be offered a revascularization procedure. So there is a lot of work that needs to be done to raise awareness of PAD, both for patients and health care providers."A new PAD Action Plan spearheaded by the American Heart Association is hoping to do just that. The plan serves as a roadmap for reducing the burden of peripheral artery disease by improving the awareness, diagnosis and treatment of PAD. The plan also highlights the many gaps and opportunities in PAD research to further reduce preventable complications and deaths for future generations."The incidence of PAD is set to triple in the United States in the coming years," says Dr. Pollak, who is a co-chair of the PAD Action Plan. "So we have an important opportunity to not only prevent that from happening, but to prevent heart attacks and strokes to help people live longer lives with a greater degree of functional ability by diagnosing and treating PAD. When it comes to the health disparities, we need to be doing even more outreach to populations that have been historically not focused on with that important information about what PAD is, how it can present, and what treatment options there are."On the Mayo Clinic Q&A podcast, Dr. Pollak discusses the importance of early diagnosis of PAD to reduce the risk of amputation, heart attack and stroke.Related posts: "Mayo Clinic Minute: How is peripheral artery disease diagnosed?" "Peripheral artery disease can signal cardiovascular trouble for heart, brain and legs."  Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Treatment for brain tumors in children can differ from treatment for brain tumors in adults, so it is important to seek care from specialists in pediatric cancer and neurology.Pediatric brain tumors are masses or growths of abnormal cells that occur in a child's brain, or the tissue and structures near the brain. Of the many types of pediatric brain tumors, some are noncancerous, or benign, and some are cancerous, or malignant.Common brain tumors in infants, children and teenagers include: Gliomas These tumors begin in the brain or spinal cord. Types of gliomas include pilocytic astrocytomas, ependymomas and oligodendrogliomas. Medulloblastoma A medulloblastoma is the most common cancerous brain tumor in children. It starts in the lower back part of the brain, called the posterior fossa, and tends to spread through spinal fluid. Treatment and chance of recovery depend on many factors: the type of tumor, its location within the brain, whether it has spread, and the child's age and general health. "The good news is that the really bad tumors are fairly rare," says Dr. David Daniels, a Mayo Clinic pediatric neurosurgeon. "When we look at tumors, we look at their type or classification, and then a grading that goes along with that."Often, a biopsy of the tumor is performed to determine its type and grade. This information helps guide the course of treatment, which can include surgery, radiation therapy and chemotherapy."The biggest thing is that grading," explains Dr. Daniels. "Is this a grade one tumor, which is very benign, or is this a grade four tumor, which is really aggressive? And so our treatment has to match the aggressiveness of that tumor, so to speak." Because new treatments and technologies are continually being developed, several options may be available at different points in treatment. As part of the Mayo Clinic Children's Center, pediatric specialists in Mayo's Pediatric Brain Tumor Clinic work together as a team to develop an individual treatment plan for each child. Typically, a pediatric neuro-oncologist specializing in brain tumors is the child's primary doctor. This doctor coordinates access to other specialists from the pediatric brain tumor treatment team, including pediatric neurology, pediatric neurosurgery, neuroradiology, pediatric endocrinology, neuropathology, pediatric radiation oncology, pediatric oncology, child psychology and pediatric rehabilitation.On this Mayo Clinic Q&A podcast, pediatrician and Ask the Mayo Mom host, Dr. Angela Mattke, is joined by Dr. Daniels to discuss common pediatric brain tumors. Dr. Daniels covers treatment, including when surgery may be an option, and highlights the latest in brain tumor research. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy